The IDEFICS intervention:what can we learn for public policy?

Introduction: As considered in the rest of this volume, the effects of the IDEFICS intervention on obesity rates were not encouraging. This paper considers how far findings from the IDEFICS study and similar intervention studies are relevant to the policy process and political decision-making. Methods: The paper offers theoretical and policy-level arguments concerning the evaluation of evidence and its implications for policymaking. The paper is divided into three parts. The first considers problems in the nature and applicability of evidence gained from school- and community-level obesity interventions. The second part considers whether such interventions present a model that policy-makers could implement. The third part considers how we should think about policy measures given the limited evidence we can obtain and the many different goals that public policy must take account of. Results: The paper argues that (1) there are clear reasons why we are not obtaining good evidence for effective school- and community-level interventions; (2) public policy is not in a good position to mandate larger-scale, long-term versions of these interventions; and (3) there are serious problems in obtaining ‘evidence’ for most public policy options, but this should not deter us from pursuing options that tackle systemic problems and have a good likelihood of delivering benefits on several dimensions. Conclusions: Research on school- and community-level obesity interventions has not produced much evidence that is directly relevant to policymaking. Instead, it shows how difficult it is to affect obesity rates without changing wider social and economic factors. Public policy should focus on these

Parents‘ evaluation of the IDEFICS intervention:an analysis focussing on socio-economic factors, child’s weight status and intervention exposure

Introduction: From April 2008 to August 2010 the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) intervention aimed to encourage healthier diets, higher physical activity levels and lower stress levels among European children and their families. While the intervention was intended to improve children’s health, we also wished to assess whether there were unwelcome aspects or negative side-effects. Therefore all parents of children who participated in the IDEFICS intervention were asked for their views on different aspects of the intervention. Methods: A total of 10,016 parents of children who participated in the IDEFICS survey and who were involved in the intervention were invited to complete a questionnaire on positive and negative impacts of the intervention. Responses to each of the statements were coded on a four point Likert-type scale. Demographic data were collected as part of the baseline (T0) and first follow-up (T1) surveys; intervention exposure data was also collected in the T1 follow-up survey. Anthropometric data was collected in the same surveys, and child’s weight status was assessed according to Cole and Lobstein. After initial review of the univariate statistics multi-level logistic regression was conducted to analyse the influence of socio-economic factors, child’s weight status and intervention exposure on parental responses. Results: In total 4,997 responses were received. Approval rates were high, and few parents reported negative effects. Parents who reported higher levels of exposure to the intervention were more likely to approve of it and were also no more likely to notice negative aspects. Less-educated and lower income parents were more likely to report that the intervention would make a lasting positive difference, but also more likely to report that the intervention had had negative effects. Parents of overweight and obese children were more likely to report negative effects – above all, that ‘the intervention had made their child feel as if he/she was “fat” or “overweight.”’ Conclusion: While the results represent a broad endorsement of the IDEFICS intervention, they also suggest the importance of vigilance concerning the psychological effects of obesity interventions on overweight and obese children

Consent and confidentiality in the light of recent demands for data sharing

Many attempts have been made to formalize ethical requirements for research. Among the most prominent mechanisms are informed consent requirements and data protection regimes. These mechanisms, however, sometimes appear as obstacles to research. In this opinion paper, we critically discuss conventional approaches to research ethics that emphasize consent and data protection. Several recent debates have highlighted other important ethical issues and underlined the need for greater openness in order to uphold the integrity of health-related research. Some of these measures, such as the sharing of individual-level data, pose problems for standard understandings of consent and privacy. Here, we argue that these interpretations tend to be overdemanding: They do not really protect research subjects and they hinder the research process. Accordingly, we suggest another way of framing these requirements. Individual consent must be situated alongside the wider distribution of knowledge created when the actions, commitments, and procedures of researchers and their institutions are opened to scrutiny. And instead of simply emphasizing privacy or data protection, we should understand confidentiality as a principle that facilitates the sharing of information while upholding important safeguards. Consent and confidentiality belong to a broader set of safeguards and procedures to uphold the integrity of the research process

Differential outcome of the IDEFICS intervention in overweight versus non-overweight children:did we achieve ‘primary’ or ‘secondary’ prevention?

Background: The aim of this study was to explore whether the IDEFICS intervention had a differential effect on 11,041 children’s weight trajectories depending on their baseline body mass index status. Methods: Two subgroups of children are considered in the present analysis: those who were overweight or obese prior to the intervention and those who were neither overweight nor obese. Results: Among children in all eight countries who did not have prevalent overweight or obesity (OWOB) at baseline, 2 years later, there was no significant difference between intervention and control groups in risk of having developed OWOB. However, we observed a strong regional heterogeneity, which could be attributed to the presence of one distinctly outlying country, Belgium, where the intervention group had increased risk for becoming overweight. In contrast, among the sample of children with prevalent OWOB at baseline, we observed a significantly greater probability of normalized weight status after 2 years. In other words, a protective effect against persistent OWOB was observed in children in intervention regions compared with controls, which corresponded to an adjusted odds ratio of 0.76 (95% confidence interval: 0.58, 0.98). Discussion: This analysis thus provided evidence of a differential effect of the IDEFICS intervention, in which children with overweight may have benefited without having been specifically targeted. However, no overall primary preventive effect could be observed in children without initial overweight or obesity

The Social Creation of Morality and Complicity in Collective Harms:A Kantian Account

This article considers the charge that citizens of developed societies are complicit in large‐scale harms, using climate destabilisation as its central example. It contends that we have yet to create a lived morality – a fabric of practices and institutions – that is adequate to our situation. As a result, we participate in systematic injustice, despite all good efforts and intentions. To make this case, the article draws on recent discussions of Kant's ethics and politics. Section 2 considers Tamar Schapiro's account of how otherwise decent actions can be corrupted by others’ betrayals, and hence fall into complicity. Section 3 turns to discussions by Christine Korsgaard and Lucy Allais, which highlight how people can be left without innocent choices if shared frameworks of interaction do not instantiate core ideals. Section 4 brings these ideas together in order to make sense of the charge of complicity in grave collective harms, and addresses some worries that the idea of unavoidable complicity may raise

Regulation Enables:Corporate Agency and Practices of Responsibility

Both advocates of corporate regulation and its opponents tend to depict regulation as restrictive—a policy option that limits freedom in the name of welfare or other social goods. Against this framing, I suggest we can understand regulation in enabling terms. If well designed and properly enforced, regulation enables companies to operate in ways that are acceptable to society as a whole. This paper argues for this enabling character by considering some wider questions about responsibility and the sharing of responsibility. Agents who are less able or willing to act well are obviously more likely to face criticism, mistrust, and adverse responses. It will be more difficult to hold those agents responsible, especially so when there are many who fail in their responsibilities or where there are wide-reaching disagreements about those responsibilities. Regulatory standards, like other norms and ways of defining responsibilities, address these problems: by restricting, they also enable social cooperation. Like other forms of holding responsible, ways of enforcing those standards against recalcitrant agents, or encouraging conformity to them, may also seem restrictive. Again, however, these practices play an important role in enabling responsible agency. This is partly because they can bolster readiness to act well in agents who experience or witness such responses. It is also because they free other agents to exercise initiative and commitment in defining their individual responsibilities in line with higher standards

Verantwortung, Rationalität und Urteil

This chapter examines the philosophical grounds for linking responsibility with capacities to reason and to judge in the light of moral considerations. It discusses five different accounts that connect responsibility and rationality, the work of: Susan Wolf, R Jay Wallace, the jointly authored work of John Martin Fischer and Mark Ravizza, Angela M Smith, and Pamela Hieronymi. Through these authors’ contributions, the chapter argues that the notion of rational ability is central to understanding and justifying practices of responsibility. Although there has been clear progress in debates about this connection, however, understanding the notion of rational or moral ability still poses profound challenges. One reason for this is suggested: such abilities may have constitutive connections with practices of holding responsible and of taking responsibility – connections that have yet to be fully explored in the literature

Peer Effects on Weight Status, Dietary Behaviour and Physical Activity among Adolescents in Europe: Findings from the I.Family Study

This study uses survey data from the I.Family Study to investigate the association between adolescent and peer overweight in a sample of adolescents aged 12–16 from six European countries. We find clear evidence of peer effects on body mass index, waist circumference, and body fat, which are stronger among adolescents at the upper end of overweight distribution. We also provide evidence that both consumption of less healthy foods and time spent in leisure time physical activity and audio-visual media are positively associated with similar behaviours among friends. These observations may suggest that peer effects on adolescent overweight operate by influencing friends’ behaviour patterns, especially unhealthy food consumption and physical (in)activity

Discrimination and Obesity

In this chapter I argue that even if – as popular prejudice suggests – it were possible to make inferences about character traits or personal abilities from the amount of body fat a person carries, this would do nothing to justify discrimination. In the first section, I briefly indicate the evidence for widespread discrimination against obese people in modern developed societies, and note some debates about appropriate language. In the second section, I highlight some distinctive features of obesity as a ground of discrimination. Most importantly, weight bias is still widely acceptable, and its justifications find institutional support insofar as medicine stresses that obesity is bad and, perhaps, remediable. This brings us to some facts about health and obesity, which are too often simplified in public discussions. I then turn to the wrong of obesity-based discrimination. I argue that the standard rationalisations are untenable, and not only because their factual premises are so dubious. Philosophically, they rest on illiberal confusions about the appropriate place for personal judgments. In our private lives, we may well respond to others on the basis of their body shape or our personal estimates of their virtues or abilities. (Just as they may respond to us in their turn!) When we engage in different forms of civil association, however, anti-discrimination provisions remind us what is, and what is not, ‘our business.’ They thereby help to uphold norms of equality, freedom and respect