International Journal of Public Health

, Volume 62, Issue 9, pp 981–988 | Cite as

Ethical issues in obesity prevention for school children: a systematic qualitative review




Planning and conducting preventive measures against obesity for school children is beset with ethical issues which should be known to make well-informed decisions. The goal of this study was to provide a comprehensive spectrum of these ethical issues by means of a systematic review. In this context, the study also assesses the value of different search strategies for ethical literature in public health.


Literature was searched in Medline, EBSCO and others. Three different search strategies with varied scopes were applied and their output was compared. Qualitative content analysis was used for extracting and categorizing ethical issues.


109 publications (published from 1995 to 2015) were finally included. The qualitative analysis resulted in 60 potentially relevant ethical issues. The three search strategies showed substantial differences regarding their search results.


The presented spectrum provides an initial evidence base for dealing with ethical issues adequately. The findings of the study further suggest that a broader scope is more fruitful for systematic reviews on ethical issues in the field of public health.


Ethics Ethical issues Obesity prevention School children Systematic review 



We would like to thank Nadine Komainder for her assistance in the search, selection and analysis procedures.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


We had no additional funding for this study.

Supplementary material

38_2017_1027_MOESM1_ESM.pdf (147 kb)
Supplementary material 1 (PDF 147 kb)
38_2017_1027_MOESM2_ESM.pdf (290 kb)
Supplementary material 2 (PDF 289 kb)


  1. ABIM Foundation MPP (2002) Medical professionalism in the new millennium: a physicians’ charter. Lancet 359:520–522CrossRefGoogle Scholar
  2. Ahrens W, Pigeot I, Pohlabeln H, De Henauw S, Lissner L, Molnar D, Moreno LA, Tornaritis M, Veidebaum T, Siani A (2014) Prevalence of overweight and obesity in European children below the age of 10. Int J Obes (Lond) 38(Suppl 2):S99–S107CrossRefGoogle Scholar
  3. Beauchamp TL, Childress JF (2009) Principles of biomedical ethics. Oxford University Press, New YorkGoogle Scholar
  4. Caprio S, Genel M (2005) Confronting the epidemic of childhood obesity. Pediatrics 115:494–495CrossRefPubMedGoogle Scholar
  5. Chaloupka FJ (2011) Public policy versus individual rights and responsibility: an economist’s perspective. Prev Chronic Dis 8:A100PubMedPubMedCentralGoogle Scholar
  6. Cuttler L, Whittaker JL, Kodish ED (2005) The overweight adolescent: clinical and ethical issues in intensive treatments for pediatric obesity. J Pediatr 146:559–564. doi: 10.1016/j.jpeds.2004.12.013 CrossRefPubMedGoogle Scholar
  7. Daniels N (2000) Accountability for reasonableness: establishing a fair process for priority setting is easier than agreeing on principles. Br Med J 321:1300–1301CrossRefGoogle Scholar
  8. Diedrichs PC, Barlow FK (2011) How to lose weight bias fast! Evaluating a brief anti-weight bias intervention. Br J Health Psychol 16:846–861CrossRefPubMedGoogle Scholar
  9. Droste S (2008) Systematische Gewinnung von Informationen zu ethischen Aspekten in HTA-Berichten zu medizinischen Technologien bzw. Interventionen. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 102:329–341CrossRefPubMedGoogle Scholar
  10. Ebbeling CB, Pawlak DB, Ludwig DS (2002) Childhood obesity: public-health crisis, common sense cure. Lancet 360:473–482CrossRefPubMedGoogle Scholar
  11. Egan KB, Ettinger AS, Bracken MB (2013) Childhood body mass index and subsequent physician-diagnosed asthma: a systematic review and meta-analysis of prospective cohort studies. BMC Pediatr 13:121CrossRefPubMedPubMedCentralGoogle Scholar
  12. Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303:235–241CrossRefPubMedGoogle Scholar
  13. Fry CL (2012) Ethical issues in obesity interventions for populations. N S W Public Health Bull 23:116–119. doi: 10.1071/nb12062 CrossRefPubMedGoogle Scholar
  14. Hinds HL (2005) Pediatric obesity: ethical dilemmas in treatment and prevention. J Law Med Ethics 33:599–602CrossRefPubMedGoogle Scholar
  15. Kahrass H, Strech D, Mertz M (2016) The full spectrum of clinical ethical issues in kidney failure. Findings of a systematic qualitative review. PLoS One 11:e0149357CrossRefPubMedPubMedCentralGoogle Scholar
  16. Kelishadi R, Ardalan G, Gheiratmand R, Majdzadeh R, Hosseini M, Gouya MM, Razaghi EM, Delavari A, Motaghian M, Barekati H, Mahmoud-Arabi MS, Lock K (2008) Thinness, overweight and obesity in a national sample of Iranian children and adolescents: CASPIAN Study. Child Care Health Dev 34:44–54PubMedGoogle Scholar
  17. Knuppel H, Mertz M, Schmidhuber M, Neitzke G, Strech D (2013) Inclusion of ethical issues in dementia guidelines: a thematic text analysis. PLoS Med 10:e1001498. doi: 10.1371/journal.pmed.1001498 CrossRefPubMedPubMedCentralGoogle Scholar
  18. Marckmann G, Schmidt H, Sofaer N, Strech D (2015) Putting public health ethics into practice: a systematic framework. Front Public Health 3:1–8CrossRefGoogle Scholar
  19. Masse LC, de Niet JE (2013) School nutritional capacity, resources and practices are associated with availability of food/beverage items in schools. Int J Behav Nutr Phys Act 10:26CrossRefPubMedPubMedCentralGoogle Scholar
  20. Mertz M, Strech D (2014) Systematic and transparent inclusion of ethical issues and recommendations in clinical practice guidelines: a six-step approach. Implement Sci 9:184CrossRefPubMedPubMedCentralGoogle Scholar
  21. Mertz M, Kahrass H, Strech D (2016) Current state of ethics literature synthesis: a systematic review of reviews. BMC Med 14:152CrossRefPubMedPubMedCentralGoogle Scholar
  22. Misra A, Vikram NK, Sharma R, Basit A (2006) High prevalence of obesity and associated risk factors in urban children in India and Pakistan highlights immediate need to initiate primary prevention program for diabetes and coronary heart disease in schools. Diabetes Res Clin Pract 71:101–102CrossRefPubMedGoogle Scholar
  23. Narang I, Mathew JL (2012) Childhood obesity and obstructive sleep apnea. J Nutr Metab 2012:134202CrossRefPubMedPubMedCentralGoogle Scholar
  24. Ogden CL, Carroll MD, Fryar CD, Flegal KM (2015) Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief 219:1–8Google Scholar
  25. Orgel E, Genkinger JM, Aggarwal D, Sung L, Nieder M, Ladas EJ (2016) Association of body mass index and survival in pediatric leukemia: a meta-analysis. Am J Clin Nutr 103:808–817CrossRefPubMedGoogle Scholar
  26. Panzer BM, Dhuper S (2014) Designing a group therapy program for coping with childhood weight bias. Soc Work 59:141–147CrossRefPubMedGoogle Scholar
  27. Park MH, Falconer C, Viner RM, Kinra S (2012) The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev 13:985–1000CrossRefPubMedGoogle Scholar
  28. Paulis WD, Silva S, Koes BW, van Middelkoop M (2014) Overweight and obesity are associated with musculoskeletal complaints as early as childhood: a systematic review. Obes Rev 15:52–67CrossRefPubMedGoogle Scholar
  29. Poustchi Y, Saks NS, Piasecki AK, Hahn KA, Ferrante JM (2013) Brief intervention effective in reducing weight bias in medical students. Fam Med 45:345–348PubMedPubMedCentralGoogle Scholar
  30. Ramos Salas X (2015) The ineffectiveness and unintended consequences of the public health war on obesity. Can J Public Health 106:e79–e81. doi: 10.17269/cjph.106.4757 CrossRefPubMedGoogle Scholar
  31. Seitzer F, Kahrass H, Neitzke G, Strech D (2016) The full spectrum of ethical issues in the care of patients with ALS: a systematic qualitative review. J Neurol 263:201–209CrossRefPubMedGoogle Scholar
  32. Strech D, Mertz M, Knüppel H, Neitzke G, Schmidhuber M (2013) The full spectrum of ethical issues in dementia care: systematic qualitative review. Br J Psychiatry 202:400–406CrossRefPubMedGoogle Scholar
  33. Ten Have M (2014) Ethical aspects of obesity prevention. Best Pract Res Clin Gastroenterol 28:303–314CrossRefPubMedGoogle Scholar
  34. ten Have M, de Beaufort ID, Teixeira PJ, Mackenbach JP, van der Heide A (2011) Ethics and prevention of overweight and obesity: an inventory. Obes Rev 12:669–679PubMedGoogle Scholar
  35. Ten Have M, van der Heide A, Mackenbach JP, de Beaufort ID (2013) An ethical framework for the prevention of overweight and obesity: a tool for thinking through a programme’s ethical aspects. Eur J Public Health 23:299–305. doi: 10.1093/eurpub/cks052 CrossRefPubMedGoogle Scholar
  36. van Emmerik NM, Renders CM, van de Veer M, van Buuren S, van der Baan-Slootweg OH, Kist-van Holthe JE, Hirasing RA (2012) High cardiovascular risk in severely obese young children and adolescents. Arch Dis Child 97:818–821CrossRefPubMedGoogle Scholar
  37. Williams GM, Bredow M, Barton J, Pryce R, Shield JP (2014) Can foster care ever be justified for weight management? Arch Dis Child 99:297–299. doi: 10.1136/archdischild-2013-304654 CrossRefPubMedGoogle Scholar
  38. Wu H, Li H, Zong X (2016) The prevalence of overweight, obesity and stunting in school children aged 6–19 years in Beijing, China. Ann Hum Biol 43:505–509CrossRefPubMedGoogle Scholar
  39. Zhang YX, Wang ZX, Zhao JS, Chu ZH (2017) The current prevalence and regional disparities in general and central obesity among children and adolescents in Shandong, China. Int J Cardiol 227:89–93CrossRefPubMedGoogle Scholar

Copyright information

© Swiss School of Public Health (SSPH+) 2017

Authors and Affiliations

  1. 1.Hannover Medical SchoolInstitute for History, Ethics and Philosophy of MedicineHannoverGermany

Personalised recommendations