Ethical Agreement and Disagreement about Obesity Prevention Policy in the United States

Document Type : Perspective


1 Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA

2 Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada


An active area of public health policy in the United States is policy meant to promote healthy eating, reduce overconsumption of food, and prevent overweight/obesity. Public discussion of such obesity prevention policies includes intense ethical disagreement. We suggest that some ethical disagreements about obesity prevention policies can be seen as rooted in a common concern with equality or with autonomy, but there are disagreements about which dimensions of equality or autonomy have priority, and about whether it is justifiable for policies to diminish equality or autonomy along one dimension in order to increase it along another dimension. We illustrate this point by discussing ethical disagreements about two obesity prevention policies.


"Listen to PodCast Summary"

1. Mello MM, Studdert DM, Brennan TA. Obesity—the new frontier of public health law. N Engl J Med 2006; 354: 2601–10. doi: 10.1056/nejmhpr060227
2. Silver L, Bassett MT. Food safety for the 21st century. JAMA 2008; 300: 957–9. doi: 10.1001/jama.300.8.957  
3. Dietz WH, Hunter AS. Legal preparedness for obesity prevention and control: the public health framework for action. J Law Med Ethics 2009; 37: 9–14. doi: 10.1111/j.1748-720x.2009.00386.x
4. Center for Science in Public Interest. Trans Fat Bans in Restaurants. Available from:
5. Bernstein S. San Francisco bans Happy Meals. Los Angeles Times [serial on the Internet]. [updated 2010 Nov 2; cited 2013 Aug 1]; Available from:
6. Severson K. Los Angeles Stages a Fast Food Intervention. New York Times [serial on the Internet]. [updated 2008 Aug 13; cited 2013 Aug 1]. Available from:
7. Barnhill A. Impact and Ethics of Excluding Sweetened Beverages from the SNAP Program. Am J Public Health 2011; 101: 2037–43. doi: 10.2105/ajph.2011.300225
8. Brownell KD, Frieden TR. Ounces of Prevention—The Public Policy Case for Taxes on Sugared Beverages. N Engl J Med 2009; 360: 1805–8. doi: 10.1056/nejmp0902392
9. Grynbaum MM. Bloomberg Plans a Ban on Large Sugared Drinks. New York [serial on the Internet]. [updated 2012 May 30; cited 2013 Aug 1]; Available from:
10. Holm S. Obesity interventions and ethics. Obes Rev 2007; 8: 207–10. doi: 10.1111/j.1467-789x.2007.00343.x   
11. Purcell M. Raising healthy children: Moral and political responsibility for childhood obesity. J Public Health Policy 2010; 31: 433–46. doi: 10.1057/jphp.2010.28  
12. Have MT, van der Heide A, Mackenbach JP, de Beaufort ID. An ethical framework for the prevention of overweight and obesity: a tool for thinking through a programme’s ethical aspects. Eur J Public Health 2012; 23: 299–305. doi: 10.1093/eurpub/cks052
13. Barnhill A, King KF. Evaluating equity critiques in food policy: the case of sugar-sweetened beverages. J Law Med Ethics 41: 301–9.
14. Kirkland A. The environmental account of obesity: a case for feminist skepticism. Signs 2011; 36: 463–85. doi: 10.1086/655916  
15. The Checkup. Is a Soda Tax Fair? Washingtonpost. [cited 2013 Aug2]; Available from:
16. Cheh M. 10 Myths About the Soda Tax. [cited 2013 Aug 2]; Available from:
17. Chamberlain A, Prante G. Who pays taxes and who receives government spending? An analysis of federal, sate and local tax and spending distributions, 1991-2004. Tax Foundation; 2007 Mar. Report No.: 1. doi: 10.2139/ssrn.976507
18. Center on Budget and Policy Priorities. Which States Tax the Sale of Food for Home Consumption in 2009? 2009 Nov. [cited 2013 Aug 2]; Available from:
19. Some states like the sweet taste of soda and candy taxes. Stateline [serial on the Internet]. 2010. [cited 2013 Aug 12]; Available from:
20. Nys TRV. Paternalism in Public Health Care. Public Health Ethics 2008;1: 64–72. doi: 10.1093/phe/phn002
21. Arpaly N. Varieties of Autonomy. Unprincipled Virtue. New York: Oxford University Press; 2003. p. 117–48. doi: 10.1093/0195152042.003.0004  
22. Colby SE, Johnson L, Scheett A, Hoverson B. Nutrition marketing on food labels. J Nutr Educ Behav 2010; 42: 92–8. doi: 10.1016/j.jneb.2008.11.002  
23. Nestle M, Ludwig DS. Front-of-package food labels. JAMA 2010; 303: 771–2. doi: 10.1001/jama.2010.179
24. Cowburn G, Stockley L. Consumer understanding and use of nutrition labelling: a systematic review. Public Health Nutr 2005; 8: 21–8. doi: 10.1079/phn2005666
25. Cohen D, Farley TA. Peer Reviewed: Eating as an Automatic Behavior. Prev Chronic Dis 2008; 5: A23.
26. Lang T, Rayner G. Overcoming policy cacophony on obesity: an ecological public health framework for policymakers. Obes Rev 2007; 8: 165–81. doi: 10.1111/j.1467-789x.2007.00338.x
27. Van Baaren RB, Wigboldus DH. The unconscious consumer: Effects of environment on consumer behavior. J Consum Psychol 2005; 15: 193–202. doi: 10.1207/s15327663jcp1503_3  
28. Brownell KD, Kersh R, Ludwig DS, Post RC, Puhl RM, Schwartz MB, et al. Personal Responsibility and Obesity: A Constructive Approach To A Controversial Issue. Health Aff (Millwood) 2010; 29: 379–87. doi: 10.1377/hlthaff.2009.0739
29. Dworkin G. Paternalism. Monist 1972; 64–84 . doi: 10.5840/monist197256119
30. Reuters. Bloomberg’s Ban on Big Sodas Is Unconstitutional: Appeals Court. New York [serial on the Internet]. [updated 2013 Jul 30; cited 2013 Aug 1]; Available from:
31. Yee V. Your Guide to New York’s Soda Ban. New York [serial on the Internet]. [updated 2013 Mar 11; cited 2013 Aug 1]; Available from:
32. A Soda Ban Too Far. New York Times [serial on the Internet]. [updated 2012 May 31; cited 2013 Aug 1]; Available from:
33. Groups: NYC soda ban unfair to small, minority-owned businesses. CNN [serial on the Internet]. [cited 2013 Aug 1]; Available from:
34. NYC Big Soda Ban Could End Up in Court. [serial on the Internet]. [cited 2013 Aug 1]; Available from:
35. Hunter L, Busum and KV. Soda “Ban” May Actually Increase Freedom of Choice. Huffington Post [serial on the Internet]. [cited 2013 Aug 2]; Available from:
36. Conly S. Against autonomy: justifying coercive paternalism. Cambridge: Cambridge University Press; 2013. p.179–80. doi: 10.1017/s0031819113000715