The Context for Government Regulation of Obesity Around the Globe: Implications for Global Policy Action

• Author: Amy T. Campbell
• Published date: 01 July 2012
• Date: 01 July 2012
• DOI: http://doi.org/10.1515/1948-4682.1238

Volume 4, Issue 2 • 2012 • Article 4

The Context for Government Regulation of Obesity Around

the Globe: Implications for Global Policy Action

Amy T. Campbell, SUNY Upstate Medical University

Campbell, Amy T. (2012) "The Context for Government Regulation of Obesity Around the Globe:

Implications for Global Policy Action," World Medical & Health Policy: Vol. 4: Iss. 2, Article 4.

DOI: 10.1515/1948-4682.4

©2012 Policy Studies Organization

The Context for Government Regulation of

Obesity Around the Globe: Implications for

Global Policy Action

Amy T. Campbell, SUNY Upstate Medical University

Abstract

Introduction: Governments have many “whys” and “hows” to address obesity. While there

are similarities, the “why,” “how,” “what,” and “who” behind action are strongly influenced by

context, the importance of which is critical for international policy understanding of governmental

obesity regulation.

Context for Government to Address Obesity & Regulating through Law: Context, e.g.,

health system and political structure, affects government authority and motivation to address

obesity. This snapshot highlights key contextual features to ground law’s role in addressing obesity.

Comparison of Common Government Approaches to Obesity: Two leading approaches –

information and economic incentives – are featured, and major developments shared. Trends and

themes emerge, notably the prominence of economic incentives (but divergent uses and targets),

and the necessity of incremental strategies.

Conclusion and Policy Implications: Contextual complexity cautions against drawing the

wrong conclusions: what works in one place may not simply transfer and work in another. And yet,

comparative analysis can strengthen the search for transnational measures of policy effectiveness

(e.g., equity) and inform discussion of next steps to confront obesity in a diverse but interconnected

global society.

KEYWORDS: obesity, obesity policy, global health policy, comparative health policy

Author Notes: The author thanks the colleagues at the Fall 2011 symposium, Healthcare Reform in

the United States, held at the University of Connecticut School of Law in Hartford, CT (November

2011), and in particular participants at the “Comparative Health Law Panel,” for feedback on a

presentation from which this manuscript was developed. She also thanks attendees of the annual

meeting of the American Society for Bioethics and Humanities in Minneapolis, MN USA (October

2011) where a US-focused version of this work was presented for helpful feedback. She also thanks

the anonymous peer reviewers for their helpful feedback. Finally, the author thanks Gregory Hall

(L’13) of Syracuse University College of Law Class of 2013 and Melissa Freeman for assistance

with research and references. Conflicts of interest: None declared. Corresponding author: Amy T.

Campbell. Email: campbela@upstate.edu.

Introduction

In our economically fraught and turbulent times, national leaders are inclined to

say, “At least we’re not like them.” And yet, many of our governmental responses

have similarities in form, function, and intent. Too, we see issues that transcend

boundaries, issues such as obesity,1 where we see government responses that

build on what others have done, e.g., taxing unhealthy products or behaviors. It is

these latter commonalities that this article addresses, namely: what does a

comparative snapshot tell us about why and how governments regulate obesity,

and about how context may shape or influence seemingly similar approaches.

How has obesity come to dominate so much of the international dialogue?

First, there are the numbers: “OECD [Organisation for Economic Co-operation

and Development] projections suggest that more than two out of three people will

be overweight or obese in some OECD countries by 2020” (OECD 2012a). Costs

to insurers and employers for obesity-related conditions extend well into the

billions, per country (Federal Ministry 2007; Finkelstein et al. 2009; Finkelstein et

al. 2010; Harvard School of Public Health 2012; CDC 2012c). This does not even

address the less quantifiable costs for individuals and families. Numbers gain

importance due to the negative health impacts of overweight and obesity on

children and adults, with obesity-related conditions causing significant morbidity

and mortality (CDC 2012b). So too have emotional costs been noted (Puhl and

Heuer 2010).

As such costs increase, governments across the globe—even if not

typically inclined to address what may be seen as individual or market factors—

have responded in a myriad of ways. Approaches may focus on individuals,

populations, or industry, and may lean heavier on use of “carrots” or “sticks” with

financial or non-economic incentives. Taxes (explicit or implicit, e.g., “subsidy”

for “good” behavior) are a frequent strategy—but may be more human-oriented

(e.g., tax on individual for “choices” made) or product-oriented (e.g., tax on

saturated fat or sugar content). Related to this is more or less emphasis on private

actor action, and the extent of government (dis)-incentive on such action. Private

or public focus, the government role (however limited) may, in turn, concentrate

its efforts at the macro (e.g., federal policy), meso (e.g., school district policy), or

micro (e.g., individual fitness) level.

Some common trends have emerged in these approaches, such as the role

of political pressure in adapting or rejecting certain regulatory approaches, the

greater ease in “protecting children” than targeting adults, and the trumpeting of

1 It has been noted that metabolic dysfunction is the better target than obesity in a nd of itself

(Lustig, Schmidt, and Brindis 2012); however, as obesity is the focus in much of the liter ature and

policies, it is used herein.

1

Campbell: Global Government Regulation of Obesity

Published by De Gruyter, 2012