Ethical Issues Raised by Interventions to Prevent or Treat Childhood Obesity: A Systematic Qualitative Review.

BACKGROUND: Efforts to control the global obesity epidemic are increasingly focusing on preventing childhood obesity. A wide range of interventions has been implemented; however, such interventions raise important ethical issues. AIM: This study aims to determine systematically the spectrum of ethical issues that are raised by interventions to prevent or treat childhood obesity. METHODS: A systematic review in PubMed was conducted for publications describing and/or assessing ethical issues raised by childhood obesity interventions. Data were analyzed and synthesized using qualitative content analysis. RESULTS: Our literature search retrieved 4637 publications of which 62 were included in the final analysis. When the ethical issues presented by the 11 different types of childhood obesity interventions were identified, it is clear that the discussion of ethical issues regarding interventions to prevent or treat childhood obesity has important gaps. However, two key overarching themes emerged across the different interventions: a lack of evidence of effectiveness and risk of harmful side effects. CONCLUSION: The obesity epidemic is a growing, yet largely neglected, global public health crisis. Despite there being an ethical obligation to address this crisis, it is ethically problematic that efforts to reduce childhood obesity rates have primarily focused on individual behavior. Evidence demonstrates that these lifestyle interventions are not only largely ineffective but also cause harm. A fundamental shift towards more system-level actions is needed.