Personal Responsibility And Obesity: A Constructive Approach To A Controversial Issue

Rudd Center for Food Policy and Obesity, Departments of Psychology and Epidemiology and Public Health, Yale University, New Haven, Connecticut, USA.
Health Affairs (Impact Factor: 4.64). 03/2010; 29(3):379-87. DOI: 10.1377/hlthaff.2009.0739
Source: PubMed

ABSTRACT The concept of personal responsibility has been central to social, legal, and political approaches to obesity. It evokes language of blame, weakness, and vice and is a leading basis for inadequate government efforts, given the importance of environmental conditions in explaining high rates of obesity. These environmental conditions can override individual physical and psychological regulatory systems that might otherwise stand in the way of weight gain and obesity, hence undermining personal responsibility, narrowing choices, and eroding personal freedoms. Personal responsibility can be embraced as a value by placing priority on legislative and regulatory actions such as improving school nutrition, menu labeling, altering industry marketing practices, and even such controversial measures as the use of food taxes that create healthier defaults, thus supporting responsible behavior and bridging the divide between views based on individualistic versus collective responsibility.

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    • "Sectors including agriculture, marketing, industry, and government influence the food environment , and are set within social and cultural norms and values. Domestic nutrition research in high-income countries uses the ecological approach to diet and health outcomes routinely , and describes the role the food environment plays in food choices and nutrition transitions (Popkin et al. 2005; Larson and Story 2009; Swinburn et al. 2011; Wansink 2010; Drewnowski et al. 2013; Brownell et al. 2010). In international nutrition research and advocacy, the food environment has been considered to a lesser extent. "
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    ABSTRACT: The food environment in markets constrains and signals consumers what to purchase. It encompasses availability , affordability, convenience, and desirability of various foods. The effect of income on dietary consumption is always modified by the food environment. Many agricultural interventions aim to improve incomes, increase food availability and reduce food prices. Their effects on nutrition could be better understood if food environment measures helped to explain how additional income is likely to be spent, and how food availability and prices change as a result of large-scale interventions. Additionally, measurement of the food environment could elucidate food access gaps and inform the design of nutrition-sensitive interventions. This paper reviews existing measures of the food environment, and then draws from these tools to suggest ways the food environment could be measured in future studies and monitoring.
    Food Security 05/2015; 7(3):505-520. DOI:10.1007/s12571-015-0455-8 · 1.64 Impact Factor
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    • "Numerous surveys have examined perceptions about responsibility for obesity and health, and interventions that citizens, health advocates, industry and policymakers will support to address unhealthy food environments (Branson et al., 2012; Brown, 2013; Brownell et al., 2010; Lusk and Ellison, 2013; Minkler, 1999; Porter, 2013). There is limited research exploring how diverse stakeholders perceive accountability expectations to guide interventions to address unhealthy food environments. "
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    ABSTRACT: In March 2011, the United Kingdom’s (UK’s) Government launched five Public Health Responsibility Deal Networks to address public health priorities. The Networks used voluntary partnerships to influence peoples’ choice architecture to move them toward healthier behaviors. The purpose of this research was to conduct an exploratory study of diverse stakeholders’ perspectives about perceived responsibility and accountability expectations to improve food environments in England through the Food Network partnerships. A purposive sample of policy elites (n = 31) from government, academia, food industry and non-government organizations sorted 48 statements related to improving food environments in England. Statements were grounded in three theoretical perspectives (i.e., legitimacy, nudge and public health law). PQMethod 2.33 statistical software program used factor analysis to identify viewpoints based on intra-individual differences for how participants sorted statements. The results revealed three distinct viewpoints, which explained 64% of the variance for 31 participants, and emphasized different expectations about responsibility. The food environment protectors (n = 17) underscored government responsibility to address unhealthy food environments if voluntary partnerships are ineffective; the partnership pioneers (n = 12) recognized government–industry partnerships as legitimate and necessary to address unhealthy food environments; and the commercial market defenders (n = 1) emphasized individual responsibility for food choices and rejected government intervention to improve food environments. Consensus issues included: protecting children’s right to health; food industry practices that can and should be changed; government working with industry on product reformulation; and building consumer support for economically viable healthy products. Contentious issues were: inadequacy of accountability structures and government inaction to regulate food marketing practices targeting children. We conclude that understanding different viewpoints is a step toward building mutual trust to strengthen accountability structures that may help stakeholders navigate ideologically contentious issues to promote healthy food environments in England.
    Food Policy 12/2014; 49:207–218. DOI:10.1016/j.foodpol.2014.07.006 · 2.33 Impact Factor
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    • "Calls for personal responsibility for health have intensified since then (Brownell et al., 2010). We inhabit an increasingly moralized discourse about lifestyle and personal responsibility (Metzl and Kirkland, 2010). "
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    ABSTRACT: Coronary artery disease (CAD) has dominated mortality for most of the past century, not just in Europe and North America but worldwide. Treatments for CAD, both pharmaceutical and surgical, have become leading sectors of the healthcare economy. This paper focuses on the therapeutic landscape for CAD in the United States. We hope to add texture to the broader conversation of pharmaceuticalization explored in this issue by situating pharmaceutical therapies as just one element in the broader therapeutic terrain, alongside cardiac surgery and interventional cardiology. Patients with CAD must navigate a therapeutic landscape with three intersecting paths: lifestyle change, pharmaceuticals, and surgery. While pharmaceuticals are often seen as a quick fix, a way of avoiding more difficult lifestyle changes, it is surgery and angioplasty that promise patients the quickest fix of all. There also is another option, often overlooked by analysts but popular among physicians and patients: inaction. The U.S. context is often critiqued as a site of excessive treatment with respect to both drugs and procedures, and yet there is deep stratification within it - over-treatment in many populations and under-treatment in others. People who experience the serious risks of CAD do so in a racialized terrain of durable preoccupations with difference and unequal access to care. While the pharmaceuticalization literature disproportionately attends to lifestyle drugs, which some observers consider to be medically inappropriate or unnecessary, CAD does remain the leading cause of death. Thus, the stakes are high. Examination of the pharmaceuticalization of CAD in light of surgical treatments and racial disparities offers a window into the pervasiveness and persuasiveness of pharmaceuticals in an increasingly consumer-driven medicine, as well as the limits of their appeal and their reach.
    Social Science & Medicine 06/2014; 44. DOI:10.1016/j.socscimed.2014.06.035 · 2.56 Impact Factor
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