Sweets from the USA

Ethical aspects of fat: who’s to blame if a child is overweight?

Jemima Hodkinson asks: should parents be held accountable for overweight children?

Childhood obesity is a rapidly increasing problem: the Food Ethics Council has described it as “one of the most serious public health challenges of the 21st century”. If current trends continue, there will be 70 million overweight or obese children aged up to five by 2025. The problem is not just confined to the West: most of the overweight or obese children in the world today live in low- and middle-income countries, and the rate of increase in these countries has been 30 per cent higher than in rich countries.

Obesity early in life can lead to a host of health- and lifestyle-related problems, in both childhood and adulthood. Children who are obese from an early age are likely to continue to be obese as they grow up. They have an increased risk of early-onset diabetes and heart disease, as well as musculoskeletal disorders and some cancers. They have to live with the stigma related to being overweight, and might suffer from bullying and discrimination.

However, unpicking the factors that can contribute to an individual child becoming obese – and therefore the steps that can be taken to prevent this happening – is a complex task. The World Health Organization goes as far as to say that “every aspect of the environment in which children are conceived, born and raised can contribute to their risk of becoming overweight or obese”.

For example, if a mother gets diabetes in pregnancy, then there’s a greater risk that the baby will have a higher birth weight and eventually become obese. And breastfeeding – starting an hour after birth and continuing until the baby is six months old – is widely understood to promote a healthy level of weight gain in early life and protect against obesity.

Later in life, ‘obesogenic’ environments, including having access to fast food and living in areas that encourage sedentary habits, can contribute towards excess calorie intake and insufficient physical activity. Once a child is obese, the psychological distress caused by bullying can create a vicious cycle and make it harder for them lose weight. However, childhood obesity is understood to be largely preventable. So where does the responsibility lie – and should parents be held accountable if their children are overweight?

Position 1: Parents should be held accountable

If you saw a chronically malnourished child, you would probably place responsibility firmly with the parents. We are, sadly, accustomed to seeing stories in the media of undernourished, neglected children who have been taken away from their parents and placed in state care on the grounds that they are at risk of significant harm. In more recent years, examples of severe childhood obesity have led to debates over whether it too constitutes parental neglect.

Many of the steps we can take to prevent obesity in children are simple and widely understood. Although a person’s genetic composition can make them more susceptible to excess fat accumulation, in the vast majority of cases, obesity is the result of calorie intake exceeding calorie expenditure (through physical activity). These are both factors over which parents have much control and, arguably, much responsibility. At least until a child goes to school, parents are responsible for making all food choices on the child’s behalf. In some communities, parents may even overfeed their children on purpose in line with a widespread belief that fat babies are healthier.

If we do hold parents accountable, what course of action should be taken when parents fail to control their children’s weight? Education about diet and healthy lifestyles could provide initial support to help the parents change their children’s food intake and increase their physical activity. However, in severe, chronic cases of child obesity, some would say that the parents are guilty of neglect. If the risk to a child’s health is significant, it could warrant taking the child into care.

Position 2: Parents shouldn’t be held accountable

Placing the blame solely with the parents overlooks the complexity of the food environment surrounding children, and the extent to which this influences the food choices they, and their parents, make.

The Food Ethics Council points out that trends in childhood obesity are “seen as a consequence of a global food economy in which children are, without precedent, exposed to heavily marketed, processed energy-dense foods”. Particularly for older children, aggressive marketing and the wide availability of cheap, calorie-rich, nutrient-poor foods can routinely affect the food choices that they make away from the home. For example, you might get used to buying a snack on the way to or from school.

The marketing of food and drink to children is also a hotly contested issue, with debate about its role in influencing the foods that children and their parents buy. In the UK, Ofcom banned companies from advertising unhealthy food during children’s TV programmes; when the ban was reviewed in 2010 Ofcom estimated that children had watched 27 per cent less junk food advertising than before it was introduced. However, children now spend more time using the internet than watching TV, which has exposed them to a fresh wave of online advertising for unhealthy foods. There is certainly a correlation between exposure to such advertising and problems like obesity, although there hasn’t yet been any definitive evidence that this is a causal relationship or that advertising is more important than other factors.

It is also widely understood that childhood obesity is an issue of inequality. In high-income countries, poorer people are more likely to be obese than richer people as a result of nutrient-poor foods being affordable and widely available, as well as a lack of education and time needed to prepare more nutritious meals.

Recent research into rare genetic and hormonal causes of obesity have revealed many cases of severe childhood obesity that were entirely caused by genetics, and so could be reversed without the need for diet interventions. As studies like this continue, we may find that the causes of obesity are more complex than we thought. If so, this will force us to rethink who is responsible for childhood obesity.

Lead image:

Kevin Krejci/Flickr CC BY

References

Questions for discussion

  • Which of the two positions in the article above do you agree with most? Why?
  • How much responsibility do schools have to prevent children becoming overweight or obese?
  • How can hormonal disorders cause obesity?

Further reading

Downloadable resources

About this resource

This resource was first published in ‘Fat’ in December 2015.

Topics:
Psychology, Medicine, Health, infection and disease
Issues:
Fat, How We Look
Education levels:
16–19, Continuing professional development