Ethics and Obesity Prevention: Ethical Considerations in 3 Approaches to Reducing Consumption of Sugar-Sweetened Beverages

Abstract

Obesity and overweight prevalence soared to unprecedented levels in the United States, with 1 in 3 adults and 1 in 6 children currently categorized as obese. Although many approaches have been taken to encourage individual behavior change, policies increasingly attempt to modify environments to have a more positive influence on individuals' food and drink choices. Several policy proposals target sugar-sweetened beverages (SSBs), consumption of which has become the largest contributor to Americans' caloric intake. Yet proposals have been criticized for unduly inhibiting choice, being overly paternalistic, and stigmatizing low-income populations. We explored the ethical acceptability of 3 approaches to reduce SSB consumption: restricting sale of SSBs in public schools, levying significant taxes on SSBs, and prohibiting the use of Supplemental Nutrition and Assistance Program (formerly food stamps) benefits for SSB purchases.

Are Medicaid Closed Formularies Unethical?

“…15 Proposed limits-for instance, on sugar-sweetened beverages in food assistance programs-have been criticized. 16 But the charge of singling out poor patients does not apply particularly well to the use of closed formularies in Medicaid programs because other public payers as well as private payers use closed formularies. 3 Although the use of closed formularies is not distinctive to programs serving poor patients, specific formulary designs could be.…”

Doce veneno: uma análise do consumo de bebidas açucaradas por adolescentes

“…Nos Estados Unidos, 1 a cada 6 crianças é obesa. A obesidade está relacionada com a falta de equilíbrio nutricional, a falta de acesso e disponibilidade de alimentos saudáveis que são fatores relacionados ao ambiente em que o adolescente está inserido 21,22 . Nesse sentido, estudos apresentaram que os maiores consumidores de bebidas açucaradas são do sexo masculino, obesos e costumam fazer várias refeições fora de casa, evidenciando que a rotina alimentar dos adolescentes interfere na frequência de consumo de bebidas açucaradas 23,24 .…”

Moving Beyond the Debate Over Restricting Sugary Drinks in the Supplemental Nutrition Assistance Program

“…Barnhill 18 further illustrates this point by saying, "With its right hand, the federal government funds nutrition education and wellness programs to encourage healthy eating; but with its left hand, the federal government funds SNAP participants' purchase and consumption of sweetened beverages. " Kass and colleagues 19 present an alternative, more nuanced perspective in their analysis of three sugary drink policies (i.e., restricting sales in schools, sugary drink taxes, and restricting purchases with SNAP). They use six ethical considerations: achieve public health benefit; minimize meaningful burdens and harms; reduce morally relevant inequalities and promote justice; ensure fair procedures and accountability; align government policies and programs with evidence-based agency guidelines; and recognize symbolic relevance.…”

“…16 In subsequent years, the debate has continued in the literature as researchers and advocates have outlined many specific arguments to either support or oppose the idea that SNAP should restrict the purchase of sugary drinks. [17][18][19][20] The Institute of Medicine referenced the topic of restrictions within SNAP and stated that these policies "raise both practical and economic concerns," "ethical and social concerns," and "may be viewed as patronizing and discriminatory to low-income consumers." 21 Clearly, there are several layers of arguments to address, but the debate is compounded by growing distrust among the parties involved.…”