In an attempt to address the significant problem of childhood obesity in the United States territory, Puerto Rican officials have proposed a $500 -- $800 fine for parents whose children have obesity and have not improved after parent-focused education. The legislators supporting the bill under debate say it is intended to improve children's health by encouraging parents to make healthier choices for their families. While some public and pediatric health organizations have called the bill "unfair," The Obesity Society (TOS) and The Obesity Action Coalition (OAC) go further to call it a misguided policy that ignores the core scientific understanding of obesity as a disease.
"Obesity is a disease, not a choice made by parents or their children," said Nikhil Dhurandhar, PhD, FTOS, TOS President and professor and chair of the department of nutritional sciences at Texas Tech University. "A complex combination of biological and environmental factors contributes to determining the body weight of an individual. Further, many known and unknown biological factors, in addition to personal nutrition and physical activity decisions, may interfere with weight loss, reinforcing the fact that we can't treat obesity solely by placing the blame on parents, or individuals. The development of obesity and resistance to weight loss is multifactorial, stemming from a variety of issues, including those that are biological, genetic, environmental and societal. A simplistic view of obesity and its treatment shows gross disregard for currently available scientific information."
TOS and OAC are joined by many other leading science-based organizations in recognizing obesity as a disease, including the National Institutes of Health (1998), the Social Security Administration (1999), the Centers for Medicare and Medicaid Services (2004) and the American Association for Clinical Endocrinology (2012). Research shows that obesity is a far more complex disease and its treatment requires much more than willpower or eating less and exercising more. In most cases, obesity is chronic and challenging to treat.
The societies ask Puerto Rican legislators to consider whether they would impose fines against parents whose children had other diseases such as diabetes, asthma or cancer.
"We appeal to policymakers to treat parents of children with obesity with the same respect they would afford parents of children with other diseases -- with compassion, support and incentives for improvement, rather than penalties," said Jose Fernandez, PhD, FTOS, TOS Fellow from Puerto Rico and professor of nutrition science at the University of Alabama at Birmingham. "The political efforts in Puerto Rico should consider a focus on incentives, such as those to buy healthier foods, and improved education and access to professional support services that can help parents better understand obesity and take steps to improve their children's nutritional health and weight."
Research shows that there can be a number of unintended consequences associated with obesity-targeted health policies and suggests that blaming individuals has the potential to downplay other policy initiatives that could truly impact the obesity crisis worldwide. TOS and OAC say the solution lies in better understanding obesity prevention and treatment, which includes more research, and better access to and development of effective treatment options.
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