Editorial

Are We Providing Ethical Care for the Severely Obese?

Authors: L. Raymond Reynolds, MD, FACP, FACE, M. Sara Rosenthal, PhD

Abstract

The prevalence of obesity has increased dramatically worldwide in the past 25 years, but the United States is in the forefront with an estimated 72 million obese persons and over 65% of the population overweight or obese.1 Unfortunately, the proportion of those considered to be severely obese (BMI > 40 kg/m2) with the greatest health risks, increased by 50% between 1986 and 2005.2 Even more alarming is that the number of obese children has increased threefold over the past 30 years.1 The costs of this epidemic to the individual and society are staggering, including an increased disease burden, loss of work productivity, early disability, and premature death. Among the severely obese, healthcare expenditures are double those of normal weight individuals.3 This presents a range of ethical issues that challenge core ethical principles such as the patient's right to self-determination (autonomy-based obligations); weighing therapeutic options in an effort to maximize benefits to the patient and minimize harms (beneficence-based obligations); and assuring distributive justice in access to care and resources (justice-based obligations).4

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1.Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295:1549–1555.
 
2.Sturm R. Increases in morbid obesity in the USA: 2000–2005. Public Health 2007;121:492–496.
 
3.Arterburn DE, Maciejewski ML, Tsevat J. Impact of morbid obesity on medical expenditures in adults. Int J Obes (Lond) 2005;29:334–339.
 
4.Holm S. Not just autonomy—the principles of American biomedical ethics. J Med Ethics 1995;21:332–338.
 
5.Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res 2001;9:788–805.
 
6.Andreyeva T, Puhl RM, Brownell KD. Changes in perceived weight discrimination among Americans, 1995–1996 through 2004–2006. Obesity (Silver Spring) 2008;16:1129–1134.
 
7.Foster GD, Wadden TA, Makris AP, et al. Primary care physicians' attitudes about obesity and its treatment. Obes Res 2003;11:1168–1177.
 
8.Puhl RM, Brownell KD. Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity (Silver Spring) 2006;14:1802–1815.
 
9.Schwartz MB, Chambliss HO, Brownell KD, et al. Weight bias among health professionals specializing in obesity. Obes Res 2003;11:1033–1039.
 
10.Loewy EH. In defense of paternalism. Theor Med Bioeth 2005;26:445–468.
 
11.Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity (Silver Spring) 2009;17:941–964.
 
12.Wicclair MR. Patient decision-making capacity and risk. Bioethics 1991;5:91–104.
 
13.Jones JW, McCullough LB, Richman BW. Informed consent: it's not just signing a form. Thorac Surg Clin 2005;15:451–460, v.
 
14.Bowne WB, Julliard K, Castro AE, et al. Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: a prospective, comparative analysis. Arch Surg 2006;141:683–689.