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Obesity—personal choice or public health issue?

Nature Clinical Practice Endocrinology & Metabolism volume 4, pages 2–3 (2008)Cite this article

Obesity is described as an 'epidemic' by 85% of the US population.1 Although the public looks to government for protection against disease epidemics, obesity strikes a very different political chord. A wide range of legal and health-policy tools could potentially be used to address this issue. Such measures include strict standards for nutrition and physical education in schools, and extensive regulation of food labeling and marketing. Nevertheless, many Americans question whether it is appropriate for the government to target a chronic, noncommunicable disease that most individuals could avoid by making healthy lifestyle choices. Such government intervention, it is charged, might lead to creation of a 'nanny state'. In my view, however, a role for public policy in the obesity epidemic can be defended on several grounds.

Making this case is somewhat challenging given the ideological roots and historical health policy preferences of the US. The prevailing political ideology rejects paternalistic intervention by the state and emphasizes individual autonomy, which provides freedom to make 'wrong' choices, so long as they do not harm others. The economic expression of this philosophy is market individualism—defined as confidence in the free market as a regulatory mechanism and belief in the importance of allowing individuals to make choices within the market and accept responsibility for consequences that arise from them. US health policy choices have historically reflected a preference for markets over government provision of health services, for treatment over prevention, and for expenditures to reduce uncontrollable risks over controllable risks. When is it appropriate to break with these presumptions and to classify a health condition as worthy of government attention, especially when such intervention involves public expenditure and coercive policies? Put another way, when does your weight become the government's business?

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  1. Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA mmello@hsph.harvard.ed

Authors and Affiliations

  1. MM Mello is the C Boyden Gray Associate Professor of Health Policy and Law in the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA.,

    Michelle M Mello

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Mello, M. Obesity—personal choice or public health issue?. Nat Rev Endocrinol 4, 2–3 (2008). https://doi.org/10.1038/ncpendmet0695

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