改变谈话关于肥胖:没有非此即彼的解决方案

改变谈话关于肥胖:没有非此即彼的解决方案

在哲学课,在逻辑上的第一课,学生学习的一个就是谬误,以及如何避免它们。 我最喜欢的是 错误的二分法,主要是因为其水晶般清晰的例子:你要么我们还是反对我们; 这是我的方式或高速公路。 当然,二分法是假的,因为每个场景已经不仅仅是提供的两个可能的选择更多。 政治言论充满了虚假的二分法,它提供了充足的饲料约思维方式可以去错了轻松愉快的课堂讨论。

它是那么有趣了,但是,对肥胖公众讨论可以在描绘中体重,饮食,活动和疾病风险的关系错综复杂堕入虚假的二分法。 运用假两分法的逻辑,肥胖或者个人造成的 吃太多环境 促进体重增加。 它的 无论是疾病暴食的结果。 为了解决这个问题我们自己,我们应该关注要么 减少热量的摄入 or 多运动.

在此期间,在全球范围内 我们越来越胖.

Reframing The Conversation About Obesity

We need to move beyond these dichotomies when we talk about obesity. These either or statements don’t help us develop good policy solutions, or help us understand the myriad causes that can contribute to obesity. If the conversation needs to change, where do we start?

“柳叶刀”, a leading medical journal, recently published a special series on obesity, addressing the lack of progress in combating the global obesity trend. These six research articles, as well as perspectives, commentaries and reviews, were written by a group of experts in the science, policy, treatment and ethics of obesity. Their goal? To take on the weighty task of identifying, defusing and moving beyond simplistic dichotomies in order to reframe the obesity debate and offer useful directions for reducing obesity and its effects on people, communities and governments.

Does reframing the debate help fight obesity? Yes – in fact it’s necessary, says series lead author Christina Roberto in “Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking.” They suggest a variety of new or retooled strategies ranging from educating health care providers about the dangers of weight stigmatization to mobilizing citizens to demand policy changes to address obesity. Their key insights are locating problems of obesity in the interactions between individuals and their environments, and breaking the vicious cycle of unhealthy food environments that reinforce preferences for those foods.

But reframing is just the first step in the process of reversing the trend of obesity. Researchers also have to ask the questions that health policy makers want to hear and act on, says food and health policy expert Kelly Brownell in a commentary, co-authored with Roberto.

Historian of science 纳奥米Oreskes says that scientists tend to follow a supply-side model of information, assuming their results will somehow naturally reach those who need it. Brownell and Roberto underscore this error, and strongly advise obesity researchers to frame questions and convey results in ways that understandable and relevant to policy makers' and the public. Otherwise their work will remain unheard and unused.

Talking To Policy Makers

Okay, now that the debate has been reframed, and the policy makers are listening, what should we tell them? The Lancet authors offer the many approaches below – some new, some retooled, and all designed to address obesity on multiple fronts.

  • Make the public angry. Mobilize citizens' groups to demand changes in the types of food they can buy and the ways that food is produced, packaged and marketed.
  • Improve people’s diets. Use social science and public health interventions to create avenues for people to develop palates for healthier food and sustain those healthier eating patterns.
  • Drop the regulatory hammer on Big Food. Empower governments to pass regulation and legislation to reduce junk food and soda marketing targeted at children.
  • Treat obese patients better. Shift our health care models to treat obesity with greater sensitivity to its social, political and economic determinants, and teach health professionals to avoid stigmatizing patients about their weight.
  • Hold all accountable, all the time. Mobilize and hold all obesity stakeholders accountable – government, community groups, industry, advocacy groups and so on – through an array of strategies, while monitoring progress.

We Need To Understand How These Messages Come Across

All of these approaches come with challenges. Mobilizing the public requires making them aware, making them care, and finding a single message they can agree on – easier said than done. Public health interventions to improve people’s eating habits are well underway, but with limited long-term success so far。 “ 医学研究所Robert Wood Johnson Foundation have noted the need for increased regulation of food marketing to children, but political will on the part of legislatures or federal agencies to implement their recommendations is still lacking.

Improving health-care systems for better treatment and prevention of obesity is key to any successful approach. One suggestion to further reduce the corrosive effects of weight stigmatization that is not mentioned by the authors: de-emphasize BMI in interactions with patients who are overweight and obese. There is ample evidence that it is overly simplistic and can be clinically misleading for individuals, in addition to a trigger for stigmatizing behaviors by health-care providers. Finally, while accountability recommendations for programs are clearly called for, the devil is in the details – they need funding, strong leadership, oversight, more funding, sustained commitment and then even more funding.

In the spirit of reframing and flipping the obesity debate, let me close with a modest proposal. In addition to talking to scientists and doctors and policy makers, let’s do more research to ask the public how they want to eat – what does healthy eating look like to them in the contexts of their lives? Also, keeping in mind that food means taste, pleasure and community for us, researcher Annemarie Mol urges a shift from asking “Am I being good?” to “Is this food good for me?”

In focusing on people’s lives, tastes and needs, we may find the low-hanging fruit, as it were – some easier and lower-cost avenues to moderately healthier eating that could create a series of positive effects and lead to greater engagement of the public in food and health policy.

谈话本文最初发表于 谈话.
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作者简介

Catherine Womack is a  Professor of PhilosophyCatherine Womack is a Professor of Philosophy, specializing in Public Health Ethics and Food Studies at Bridgewater State University near Boston, Massachusetts. She does research in public health ethics and health policy. Her primary areas of research are obesity and eating practices, health behavior and personal agency.

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