1. Case study: obesity Lord Krebs Kt FRS FMedSci Chair of the Working Party on Public health: ethical issues Principal, Jesus College, University of Oxford

2. Background Obese = BMI ≥ 30 Risk factor for range of chronic diseases 30,000 deaths a year in England are attributable to obesity 23% of men and women were obese in 2004 – trebled since 1980s Childhood obesity increased from 10% in 1995 to 14% in 2003

3. Causes of obesity Highly complex causes: Food high in fat and sugar is cheaper and more available Eating out more Food is lower in protein Bigger portions Advertising Changes to transport patterns More lifts, escalators Reduction in manual jobs Labour-saving devices Need ethical framework to determine intervention

4. Protecting children Obesity in children is a particular concern Schools are part of the bigger picture Conclusions: –Schools should encourage a more positive culture towards food, cooking and physical activity –Weighing young children is crucial but reduce risk of stigmatisation –Develop criteria for intervening in the home

5. Role of industry Consumer choices are influenced by availability and marketing The food industry has an ethical duty to help individuals to make healthier choices Conclusions: –Food industry should adopt the most effective labelling scheme, and if it does not, there is justification for legislation

6. Role of Government Energy expenditure levels have decreased Measures to increase expenditure: –segregating walking and cycling routes from heavy traffic –car-free zones in city centre –maintaining playgrounds Conclusion: –town planners and architects should be trained to encourage people to be active through design of buildings and spaces

7. Costs to the NHS Obesity costs the state billions each year: should obese people be denied NHS treatment? Obesity has complex causes Unfair ‘victim blaming’ and risk of stigmatisation Conclusion: –Not appropriate for obese people to be denied treatment –Appeals to change behaviour could be justified if help offered