Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short- and long-term medical and neurodevelopment advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice.In a letter sent out to 2600 hospitals across the country they [Public Citizen] demand that healthcare facilities “immediately discontinue the distribution of commercial infant formula manufacturer discharge bags,” claiming it undermines women’s success at breastfeeding. What they failed to explain is (...) why a woman’s decision regarding her own tits is anyone’s fucking business but her own.Clearly, policies to promote breast-feeding.. (shrink)

Governments can try to counter obesity through preventive regulations such as sugar taxes, which appear to raise costs or reduce options for consumers. Would the regulations improve the welfare of adult consumers? The regulations might improve choice sets through a mechanism such as reformulation, but the scope for such improvement is limited. Otherwise, a paternalistic argument must be made that preventive regulations would improve welfare despite reducing choice. This paper connects arguments about obesity, health, and choice to a philosophically plausible (...) view of welfare. On the negative side, two errors to avoid are failing to see the limited value of health and thinking that findings of irrationality would alone settle arguments about welfare. On the positive side, preventive regulations could make people better-off if welfare is the satisfaction of preferences and if preventive regulations could better satisfy preferences by overcoming certain forms of irrationality. The leading evidence is from widespread attempts to lose weight. However, at least for the United States, most adults are not trying to lose weight, and that casts doubt on whether they would benefit from preventive regulations. If they would not, that seems a strong albeit not decisive reason against these regulations. (shrink)

The title of the article in the initial online publication was mixed up with copy editing information. The original article has been corrected.

ABSTRACTThe responsibility of the food and beverage industry for noncommunicable diseases is a controversial topic. Public health scholars identify the food and beverage industry as one of the main contributors to the rise of these diseases. We argue that aside from moral duties like not doing harm and respecting consumer autonomy, the food industry also has a responsibility for addressing the structural injustices involved in food-related health problems. Drawing on the work of Iris Marion Young, this article first shows how (...) food-related public health problems can be understood as structural injustices. Second, it makes clear how the industry is sustaining these health injustices, and that due to this connection, corporate actors share responsibility for addressing food-related health problems. Finally, three criteria are discussed as grounds for attributing responsibility, allowing for further specification on what taking responsibility for food-related health problems can entail in corporate practice. (shrink)

Food and beverage firms are frequently criticised for their impact on the spread of non-communicable diseases like obesity and diabetes type 2. In this article we explore under what conditions the sales and marketing of unhealthy food and beverage products is irresponsible. Starting from the notion of ordinary morality we argue that firms have a duty to respect people’s autonomy and adhere to the principle of non-maleficence in both market and non-market environments. We show how these considerations are relevant when (...) thinking about immoral behaviour in the food and beverage industry, and identify under what conditions sales and marketing of unhealthy foods and beverages to adults and children is wrong. Based on this analysis we argue that firms should take into account: whether consumers are able to identify manipulative marketing, the degree of manipulation, as well as the negative impact a product has on health. We hold that for the food industry to act responsible it should re-evaluate the marketing of unhealthy products to adults and refrain from marketing to children. We conclude this study by making several recommendations on how the food industry should interact with consumers and highlight what changes need to be made in corporate practice. (shrink)

ZusammenfassungAdipositas ist eine weltweite Herausforderung für die Gesundheitssysteme. In Zeiten des demografischen Wandels sind auch immer mehr ältere Menschen davon betroffen, was sowohl die Akut- als auch die Langzeitpflege vor erhebliche Herausforderungen stellt. Bislang fehlt eine detaillierte Analyse der vielfältigen Gruppe der über 65-Jährigen in diesem Bereich. Weder die Bedürfnisse der Pflegebedürftigen noch der Pflegekräfte und Einrichtungen werden beobachtet, analysiert oder systematisch bewertet. Darüber hinaus sind die ethischen Implikationen der professionellen Pflege von älteren Menschen mit Adipositas in Forschung und Politik (...) noch nicht diskutiert worden. Wir argumentieren, dass ein bedürfnisorientierter Ansatz angemessen ist, um diese ethische Komplexität anzugehen. Dafür sollte eine breite und umfassende Analyse der ethischen Aspekte aus einer interdisziplinären Perspektive erfolgen. Daher führen wir ein systematische Literaturrecherche (Scoping Review) und eine thematische Fallanalyse durch, um den aktuellen Stand der Forschung aus professionellen Pflegeeinrichtungen in europäischen und nordamerikanischen Institutionen zusammenzufassen. So gewinnen wir Einblicke in die direkten Erfahrungen von Leistungserbringern und adipösen Patient*innen im Pflegebereich. Wir kommen zu dem Schluss, dass auch in Deutschland ein erheblicher Forschungsbedarf an der Schnittstelle ethischer Herausforderungen von Langzeitpflege, Alter und Adipositas besteht. Aus der begrenzten Anzahl von (Fall‑)Studien, die sich finden lassen, geht eine Reihe von ethischen Bedenken hervor, die direkte Auswirkungen auf den Zugang, die Inanspruchnahme und die Qualität der Versorgung haben. Ein empirisch-ethischer Ansatz kann die künftige Forschung und Pflegepraxis im Bereich der Adipositas und der Altenpflege leiten. Schwerpunkte der zukünftigen Mixed-methods-Forschung sollten sein: die Bedürfnisse adipöser älterer Menschen und ihrer Pfleger*innen, Kriterien für die Abwägung von Bedürfnissen und Ressourcenallokation sowie praktische Lösungen für mehrfach stigmatisierte Menschen. (shrink)

Definition of the problem Obesity is a burgeoning challenge for healthcare systems worldwide. In times of demographic change, it also affects an increasing number of older persons, presenting substantial challenges to delivering health and nursing care in both acute and long-term care (LTC) settings. So far, a detailed analysis of the diverse group of 65+ in this field is missing, particularly in the area of LTC. The needs of neither care recipients, nor those of nurses and institutions are monitored, analyzed, (...) or systematically evaluated. Moreover, ethical implications of professional care for older persons with obesity have not yet been discussed in research and policy. Arguments We argue that a needs-based approach is appropriate to address these ethical complexities. We further argue that a comprehensive mapping of the ethical terrain is best from an interdisciplinary and mixed methods perspective. For this, we conduct a scoping review to synthesize the state-of-the-art in both the healthcare and LTC settings; and we focus on challenges reported in case studies from professional care settings in European and North American institutions. Conclusion Our findings point to a lack of research on ethical issues related to the LTC needs of older persons living with obesity and the challenges faced by their professional carers. From the limited number of (case) studies that can be found, however, a series of ethical concerns emerge that have direct import for access, utilization, and quality of care. Accordingly, a new research agenda is needed to inform an ethical approach for policy and practice. It must be rooted in a concern for both care recipients and caregivers in mixed methods studies. Future research should provide criteria for balancing needs, allocating resources and developing practical solutions for people who are confronted with multiple stigma. (shrink)

The covert administration of medication occurs with incapacitated patients without their knowledge, involving some form of deliberate deception in disguising or hiding the medication. Covert medication in food is a relatively common practice globally, including in institutional and homecare contexts. Until recently, it has received little attention in the bioethics literature, and there are few laws or rules governing the practice. In this paper, we discuss significant, but often overlooked, ethical issues related to covert medication in food. We emphasise the (...) variety of ways in which eating has ethical importance, highlighting what is at risk if covert administration of medication in food is discovered. For example, losing trust in feeders and food due to covert medication may risk important opportunities for identity maintenance in contexts where identity is already unstable. Since therapeutic relationships may be jeopardised by a patient’s discovery that caregivers had secretly put medications in their food, this practice can result in an ongoing deception loop. While there may be circumstances in which covert medication is ethically justified, given a lack of suitable alternatives, we argue that in any particular case this practice should be continually re-evaluated in light of the building moral costs to the relational agent over time. (shrink)

Despite the important role of physical activity in population health and well-being, it has received less focus in public health ethics as compared to other modifiable lifestyle factors such as smoking and diet. However, when considering the current and potential role of physical activity within public health—including interventions and policies to encourage physical activity in schools and workplaces, changes to the built environment and the equity issues associated with access to physical activity—it is a ripe territory for ethical analysis. This (...) paper makes a case for a more sustained focus on physical activity within public health ethics by reviewing two ethical issues within physical activity and public health: physical activity inequity as a structural injustice issue, and stigma in physical activity promotion. While the benefits of physical activity for every age group and demographic are numerous, ethics oversight is encouraged to ensure that these efforts do not impose unnecessary risks or stigmatize marginalized populations. (shrink)

We use Marya Schechtman’s Narrative Self-Constitution View to support the widespread idea that food can contribute to the construction and expression of our identities and be used to understand others. What foods we consume can be one such way to construct our identities as food itself can have different values: ethically sourced, healthy, culturally significant, etc. However, the ability to constitute one’s own identity in this way depends on the ability to autonomously choose what we consume. We argue that most (...) consumers have much less control over their own consumption habits than is typically assumed (indeed, much of the literature on food and identity relies on the assumption) and thus consumers have diminished autonomy with respect to identity-constitution. We focus on the effects of three such autonomy compromising practices: food impositions, which are social pressures on food choice; manipulative marketing; and impediments to access. Together these practices diminish second-order endorsement of food-related values, generate false beliefs about what one is eating, and create social, economic, or physical barriers which limit access to desired foods. There are, however, spaces where consumers are fighting back against cultural norms and agribusiness and changing their own relationship(s) with consumption, thereby exercising increased autonomy over their food and their identity. (shrink)

Behavioral weight loss interventions that promote healthy eating as a way to achieve and maintain healthy weights do not work for most people. Most participants encounter significant challenges to behavior change and do not lose weight or maintain meaningful weight loss. For some, there may be negative consequences of participating in a BWLI, including social, psychological and economic costs. The literature is largely silent on these negative unintended consequences, but they are important for both practical and ethical reasons. If efforts (...) to eat healthier have too many negative consequences for individuals and groups, then these efforts are unlikely to be effective, and promoting them may not always be ethical; this would boost the case for moving away from individual-focused efforts as part of healthy eating efforts. Alternatively, if we can make BWLI interventions more effective and more ethical by mitigating these unintended consequences, then it may be too soon to give up on individual-focused efforts. We make a case for systematic assessment and reporting of the unintended consequences of BWLI. This could contribute to more effective and ethical BWLI and inform obesity interventions and policies more broadly. (shrink)

Although “you are what you eat” is a well-worn cliché, personal identity does not figure prominently in many debates about the ethics of eating interventions. This paper contributes to a growing philosophical literature theorizing the connection between eating and identity and exploring its implications for eating interventions. I explore how “identity-policing,” a key mechanism for the social constitution and maintenance of identity, applies to eating and trace its ethical implications for eating interventions. I argue that identity policing can be harmful (...) and that eating interventions can subject people to these harms by invoking identity policing qua intervention strategy or by encouraging people to eat in ways that subject them to policing from others. While these harms may be outweighed by the benefits of the intervention being promoted, they should nonetheless be acknowledged and accounted for. To aid in these evaluations, I consider factors that modulate the presence and severity of identity-policing and discuss strategies for developing less harmful eating interventions. I conclude by considering the relationship between identity-policing and identity loss caused by long-term diet change. This paper contributes to the centering of identity in food ethics and to a more comprehensive picture of identity’s ethical importance for eating interventions. (shrink)

This paper offers a defense of the practice of mindless eating. Popular accounts of the practice suggest that it is non-autonomous and to blame for many of society’s food related problems, including the so-called obesity epidemic and the prevalence of diet related illnesses like diabetes. I use Maureen Sie’s “traffic participation” account of agency to argue that some mindless eating is autonomous, or more specifically, agential. Insofar as we value autonomous eating, then, it should be valued. I also argue that (...) mindless eating can be substantively good: it can help us achieve valuable ends, like creating and maintaining community. Acknowledging the agency and value in mindless eating has both practical and ethical benefits. I contend that it can help us preserve the value in mindless eating while suggesting more effective ways to change it, and, by offering a new narrative about mindless eaters, may be less damaging to agency than popular narratives. (shrink)

This paper argues that common social narratives about unhealthy eaters can cause significant damage to agency. I identify and analyze a narrative that combines a “control model” of eating agency with the healthist assumption that health is the ultimate end of eating. I argue that this narrative produces and enables four types of damage to the agency of those identified as unhealthy eaters. Due to uncertainty about what counts as healthy eating and various forms of prejudice, the unhealthy eater label (...) and its harms to agency are more likely to stick to some people than others and may reinforce patterns of oppression. I argue that fat people are especially vulnerable to this identification and the damage it can do. I then consider possible “counterstories” about unhealthy eaters, alternative narratives that might be less damaging to agency than the control narrative. I identify one promising counterstory but suggest that it may be limited when it comes to repairing damage to the agency of fat people. Overall, this paper illustrates some of the complex ways that healthism about eating affects agency, and emphasizes the ethical importance of the ways we think about and discuss eating and eaters. (shrink)

Eating local food has become a mainstream proxy for virtue and a reliable model of sustainable dieting. It suffers, nonetheless, from genuine criticisms and limitations. In this paper, we suggest theoretical amendments to reorient the local food movement and turn eating local into a robust concept—comprehensive, coherent, and inclusive, affording a firm grip over structural aspects of the food chain. We develop our argument in three parts. The first contends that ‘local’ can be said of lots of entities (e.g. whole (...) or multi-ingredient foods, recipes, menus) and that its meaning varies depending on which entities are under consideration. The second examines three dimensions of being local: the distance from the place of production; the geographical origins; the social links to consumers and producers. The third presents our robust conception of eating local, grounded on a more realistic model that accommodates for heterogeneous and complex actors. (shrink)

Our aim in this paper is to employ conceptual negotiation to inform a method of rethinking defective food concepts, that is concepts that fail to suitably represent a certain food-related domain or that offer representations that run counter to the interests of their users. We begin by sorting out four dimensions of a food concept: the data upon which it rests and the methodology by which those data are gathered; the ontology that sustains it; the social acts that serve to (...) negotiate and establish the concept; and the aims and values that it fosters. We then discuss the conditions that make a food concept defective, pointing out four types of defects—fragility, polarization, incoherence, and schizophrenia—which we illustrate by means of two specific examples: local food and healthy food. (shrink)

In this paper, we establish gastrospaces as a subject of philosophical inquiry and an item for policy agendas. We first explain their political value, as key sites where members of liberal democratic societies can develop the capacity for a sense of justice and the capacity to form, revise, and pursue a conception of the good. Integrating political philosophy with analytic ontology, we then unfold a theoretical framework for gastrospaces: first, we show the limits of the concept of “third place;” second, (...) we lay out the foundations for an ontological model of gastrospaces; third, we introduce five features of gastrospaces that connect their ontology with their political value and with the realization of justice goals. We conclude by briefly illustrating three potential levels of intervention concerning the design, use, and modification of gastrospaces: institutions, keepers, and users. (shrink)

This article surveys recent work on some issues in the ethics of food consumption. It is a companion to our piece on food justice and the ethics of food production.

Food-related non-communicable diseases such as obesity, type 2 diabetes and cardiovascular diseases are key threats to public health. Yet, the responsibility for food-related health harms is contested. While traditionally viewed as mainly an individual responsibility or a governmental responsibility, fingers are nowadays also pointed at the food and beverage industry, as many firms are producing and marketing unhealthy products that contribute to the rise of obesity and other food-related NCDs. Yet, does the behaviour of the industry and the impact its (...) products have on public health also give reason for moral concern? Are these firms doing anything wrong? Are there normative considerations on the basis of which it can be argued that food and beverage firms have a responsibility for public health? This thesis explores the moral grounds for firms in the food and beverage industry to address food-related public health problems, and simultaneously reflects upon what taking responsibility for these problems could entail in practice. Drawing on debates in business ethics, political philosophy, and public health ethics, it is argued that food and beverage firms have distinct responsibilities for food-related health problems, and that these responsibilities spring from considerations of _non-maleficence_, _respect for autonomy _and _justice_. The thesis makes clear how responsibility for public health can be understood as an essentially shared responsibility, and outlines what taking responsibility could entail for various firms in the food and beverage industry and makes recommendations on what kind of behaviour firms should no longer engage in. (shrink)