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Federal, state, and local governments are now highly involved in policies meant to reduce obesity. Legislative and administrative regulation consumes less political capital when designed to work hand-in-glove with norms of personal responsibility, so as government actions expand, it will be important to acknowledge and build upon personal responsibility beliefs. We present here several promising public policy approaches and discuss in each case how personal and collective responsibility can act together.
Legislative and regulatory actions become more probable if there are identifiable victims who are unavoidably harmed without their consent. Children have traditionally been seen as just such victims. Some of the first policy victories have been in schools. Regulations that promote the disclosure of information promote personal choice and responsibility by ameliorating information asymmetries in the marketplace.
If consumers are to make better food choices, they must be armed with accurate, truthful information about what they purchase. This philosophy was the basis for the Nutrition Labeling and Education Act of , which requires nutrition labels on packaged food. Menu labeling legislation is the more recent variant designed so that consumers see, at the very least, calorie information on restaurant menus and posted food options at fast-food outlets. New York City was the first to propose labeling regulations.
The restaurant industry mounted a major effort to fight this action, twice suing the city. Eventually the city prevailed in the courts, and regulations are now in place. But when a number of other states and cities began introducing labeling legislation, the restaurant industry faced the specter of inconsistent and demanding regulations and asked for federal legislation that would set a weak national requirement and preempt states and cities from setting their own standards.
In a sign of the changing climate in Washington, this bill did not succeed; instead, a more comprehensive bill was introduced into both House and Senate versions of health care reform. Consumers must also be protected from inaccurate, misleading, or deceptive information, thus making enforcement of federal and state consumer protection laws a public health priority.
For example, a report on the marketing of breakfast cereals found almost perfect overlap between the cereals with the worst nutrition ratings and those marketed most aggressively to children. Congress has the authority to set tighter standards for what can be marketed; states, particularly through the attorneys general, may be in a position to take action. Two industry actions must be anticipated if government acts to curtail food marketing. Any change is virtually certain to be challenged in the courts using First Amendment protection of commercial speech as the basis.
Second, as public scrutiny of industry intensifies, companies will continue issuing self-regulatory promises to act in the public good. The tobacco industry voluntarily withdrew its television advertising in the s in exchange for the right to market in all other media. What seemed at the time to be a public health victory turned out otherwise, as industry used other more cost-effective means of marketing.
In another move to exercise collective responsibility in ways that enhance personal awareness and hence informed choice, government can set specific standards for food products and announce these standards through legislation or administrative regulation. These standards often seek to avert consumer harm.
Although not particularly relevant to obesity fats that replace trans fats have equivalent calories , the precedent could be very important.
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Salt is the next most likely ingredient to be the target of regulatory authority, but fat and sugar might be possibilities at some point. Encouraging healthier ingredients in food prompts promising dietary defaults. Consider that no restaurant patron in New York City will be eating trans fat. The ban carried little cost to restaurants and government and no cost to consumers. Attempting to accomplish this through education would be expensive and, in all likelihood, ineffective. Perhaps the most controversial public policy proposal, and the one to evoke greatest outcry from industry about government intrusion, is to tax food, particularly sugar-sweetened beverages as a starting point.
The proposal considered most frequently would introduce a tax of a penny per ounce on beverages with added sugar or other caloric sweeteners, with all or part of the revenue designated for obesity prevention programs or subsidies for healthy food such as fruit or vegetables. Changing food prices is a means of creating better defaults. Arguments that the tax is regressive are countered by knowledge that obesity and diabetes are regressive diseases that affect the poor in greater numbers.
Moreover, revenues from the tax could be used for programs that would specifically help the poor. Creating conditions that foster and support personal responsibility is central to public health. Default conditions now contribute to obesity, a reality that no amount of education or imploring of individuals can reverse. Government has a wide variety of options at its command to address the obesity problem.
The authors received external financial support for work that contributed to this paper from the Rudd Foundation, the Robert Wood Johnson Foundation, and the National Institutes of Health. Kelly D. Although his primary focus today is prevention of obesity, he started his academic career more focused on obesity treatment. As a graduate student in clinical psychology at Rutgers University, he studied under G. Terence Wilson, a specialist in the treatment of weight and eating disorders and psychological mechanisms of behavioral change.
He continued to pursue treatment studies at the University of Pennsylvania, where Albert Stunkard, a leader in obesity research, hired him in But the ongoing disappointing results of treatment, and one particular case he encountered, eventually led Brownell to change his focus. She insisted she had stuck to the diet.
When repeated gains and losses actually prompted the rats to lose weight more slowly, Brownell and his colleagues turned to humans stuck in the same cycle. From there, Brownell wanted to examine the health effects of chronic dieting and sought another collaboration, this time with investigators in the renowned Framingham Heart Study. The collaboration allowed scientists to examine weight fluctuation in a large group of people over time.
It found significant relationships between weight variability and risk for both coronary heart disease and all-cause mortality. He also supports menu calorie labeling and is an outspoken critic of advertising by Big Food. Brownell brushes off the criticism and says that his side is simply outgunned by industry spending to protect its interests.
Published online 1 March Research Article Health Affairs Vol. Brownell , Rogan Kersh , David S. Ludwig , Robert C. Post , Rebecca M. Puhl , Marlene B. Schwartz , and Walter C. Affiliations Kelly D. Brownell kelly. David S. Robert C. Rebecca M. Puhl is director of research and weight stigma initiatives at the Rudd Center for Food Policy and Obesity. Marlene B. Walter C. Willett is chair and professor in the department of nutrition at the Harvard School of Public Health in Boston, Massachusetts.
Abstract The concept of personal responsibility has been central to social, legal, and political approaches to obesity. Medicine: do defaults save lives? Brownell Kelly D. Cited By Epidemiology of childhood overweight, obesity and their related factors in a sample of preschool children from Central Iran. Framing terrorist attacks: A multi-proximity model. Obesity, political responsibility, and the politics of needs. Mountain biker attitudes and perceptions of eMTBs electric-mountain bikes.
Nanny or canny? Community perceptions of government intervention for preventive health. Obesity, equity and choice. The obesity transition: stages of the global epidemic. Digital health information seeking in an omni-channel environment: A shared decision-making and service-dominant logic perspective. Allicin induces beige-like adipocytes via KLF15 signal cascade. Associations between causal attributions for obesity and long-term weight loss. Tomorrow is the start of the rest of their life — so who cares about health? Exploring constructions of weight-loss motivations and health using story completion.
Going too far? How the public health anti-obesity drives could cause harm by promoting eating disorders. Acceptability of financial incentives for maintenance of weight loss in mid-older adults: a mixed methods study. Size acceptance: A discursive analysis of online blogs. Healthy Weight and Obesity Prevention.
Theorizing failure: explanations regarding weight regain among people with fat bodies. Determinants of support for government involvement in obesity control among American adults.
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Responsibility, prudence and health promotion. Public health and obesity prevention campaigns — a case study and critical discussion. Government continues to have an important role in promoting cardiovascular health. Freedom and responsibility go together: Personality, experimental, and cultural demonstrations. The science against sugar, alone, is insufficient in tackling the obesity and type 2 diabetes crises — We must also overcome opposition from vested interests. Characteristics of healthy weight advertisements in three countries.
Trends in the perceived body size of adolescent males and females in Scotland, — changing associations with mental well-being. Obesity and Stigmatization at Work. Applying a food processing-based classification system to a food guide: a qualitative analysis of the Brazilian experience.
Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review. Responsibilisation at the margins of welfare services. The emotional eating and negative food relationship experiences of obese and overweight adults. Steven H. The application of defaults to optimize parents' health-based choices for children. Putting nudges in perspective. Advocacy coalitions involved in California's menu labeling policy debate: Exploring coalition structure, policy beliefs, resources, and strategies.
Role for Government: In Principle. Community Organizing for Healthier Communities. The role of line managers in creating and maintaining healthy work environments on project construction sites. What cognitive sciences have to say about the impacts of nutritional labelling formats. A year Follow-up. Social inclusion and the Fatosphere: the role of an online weblogging community in fostering social inclusion.
Gambling advocacy: lessons from tobacco, alcohol and junk food. Increasing public support for food-industry related, obesity prevention policies: The role of a taste-engineering frame and contextualized values. Lifestyle and treatment adherence among overweight adolescents. The Obesities. Challenges to an integrated population health research agenda: Targets, scale, tradeoffs and timing. The pathogenesis of insulin resistance: integrating signaling pathways and substrate flux.
The effect of weight controllability beliefs on prejudice and self-efficacy. What Should We Eat? Biopolitics, Ethics, and Nutritional Scientism. Corporate Social Responsibility programs of Big Food in Australia: a content analysis of industry documents. Dong D. Wang , Yanping Li , Stephanie E. Chiuve , Frank B. Hu , and Walter C. Global prevention and control of NCDs: Limitations of the standard approach. Epidemiology, aetiology and pathogenesis of type 2 diabetes.
Japanese and American public health approaches to preventing population weight gain: A role for paternalism? Exploring consumer responsibility for sustainable consumption. Informed choice and the nanny state: learning from the tobacco industry. Of nannies and nudges: the current state of U. One study with a sample of Asian American college women found a significant positive association between eating disorder cognition e.
Of these studies, Moore et al. To date, no study has examined the link between eating disorder cognition and eating disorder behavior separately by each ethnic group e. Mindfulness, although varying in definition across investigators Hayes and Wilson, , is an emotion and behavior regulation process that is conceptually relevant to eating disorder concerns, as eating disturbances and mindfulness may be inversely correlated Kristeller and Wolever, One popular view of mindfulness conceptualizes it as an adaptive regulation process of becoming aware of the present moment as measured by the Mindful Attention Awareness Scale MAAS; Brown and Ryan, ; Brown et al.
In the mindfulness literature, this aspect of mindfulness is often called acting with awareness Baer, ; Baer et al. The significance of mindfulness found in the behavioral health literature parallels contemporary cognitive behavioral models of eating disorders and eating disorder treatment Fairburn, ; Haynos et al. These cognitive behavioral models postulate that a set of emotion regulation processes, in addition to eating disorder cognition, is relevant to psychopathology specific to eating disorders.
In these conceptual models, mindfulness e. A growing body of cross-sectional investigations show that greater mindfulness is associated with fewer eating disorder symptoms in a sample of college women and men Lavender et al. Furthermore, particularly relevant to the present study, mindfulness was found to moderate the positive association between eating disorder cognition and eating disorder behavior in a sample of college women and men Masuda et al. With higher levels of mindfulness, the positive association between eating disorder cognition and eating disorder behavior was significantly smaller than the association of the two eating disorder-related variables under lower levels of mindfulness.
Extant evidence shows that mindfulness moderates the positive association between eating disorder cognition and eating disorder behavior Masuda et al. However, no studies have investigated mindfulness as a potential moderator of the association between eating disorder cognition and eating disorder behavior directly in Asian American, Black American, and White American women. Given the findings on the salutary effects of mindfulness Brown et al.
However, proponents of diversity psychology have cautioned us not to assume that any given model, including the modulating effect of mindfulness, is universal; a model should be directly examined with the target sample Cheng and Sue, As discussed extensively elsewhere, universality assumptions have often been found to be incorrect Sue, ; Hall et al.
As such, the logical next step was to directly investigate whether mindfulness moderates the association between eating disorder cognition and eating disorder behavior in samples of Asian American, Black American, and White American female college students. We did not examine Latina American college students because we expected that we were not able to recruit enough Latina American college students for the present study.
Undergraduate women were recruited from a southeastern public university in the United States through an online research recruitment tool managed by the Department of Psychology. The inclusion criteria for study participants were a age between and year-old, b self-identified ethnic background of Asian American, Black American, and White American, c self-reported height and weight for computing body mass index BMI. Exclusion criteria were set on a age i.
Participants who enrolled in the study were asked to complete an anonymous web-based survey. Prior to the survey, information explaining the purpose of the present study and instructions regarding how to complete the survey were presented on a computer screen.
Then participants anonymously filled out demographic information and completed the survey measures. The following measures were used to assess eating disorder cognition, eating disorder behavior, and mindfulness.
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These cognitions are the fear of weight gain e. Each item is scored on a five-point Likert scale, ranging from 1 strongly disagree to 5 strongly agree , with a total score derived from the sum of all responses. Total scores range from 24 to with higher scores indicating greater disordered eating-related dysfunctional cognitions.
Based on previous findings Masuda et al. These items clearly capture the behavioral symptoms of disordered eating e. More specifically, seven items reflect restricting and AN e. All items are scored on a six-point Likert scale: never 0 , rarely 0 , sometimes 0 , often 1 , very often 2 , or always 3. The total score of the behavioral scale EAT B ranges from 0 to The MAAS Brown and Ryan, is a item self-report measure, which is designed to assess the frequency of mindlessness, the opposite of the construct of mindfulness, over time e.
Participants rate the degree to which they function mindlessly in daily life, using a six-point Likert scale ranging from 1 almost always to 6 almost never. Total scores range from 15 to 90, with higher scores denoting greater mindfulness. The MAAS has good internal consistency i. In the present set of analyses, we first examined zero-order correlations among study variables that were collected as interval variables for each ethnic group. We then ran a hierarchical multiple regression for each ethnic group to investigate whether eating disorder cognition and mindfulness accounted for unique variances in eating disorder behavior and whether mindfulness moderated the association between disordered eating cognition and disordered eating behavior.
The first step included age, sexual orientation, and BMI as covariates. The second step included eating disorder cognition and mindfulness. Six-hundred forty-six undergraduate women were recruited and completed the present web-based survey. An additional 29 individuals were removed from the study because they failed to self-report their weight and height for computing their BMI. Finally, 42 participants were removed because they were either year-old or younger or older than year-old. This ethnic distribution was representative of the university from which the present study participants were recruited.
Sexual minorities were represented in each ethnic group, with seven Asian American, 14 White American, and 25 Black American students reporting sexual minority status i. Descriptive statistics and correlations among the study variables are shown in Tables 1 , 2. Eating disorder cognition was positively associated with eating disorder behavior and BMI, and BMI was positively associated with eating disorder behavior. TABLE 1. Means and standard deviations of study variables by sexual orientation in each ethnic group. In the White American group, mindfulness was negatively associated with eating disorder cognition and with eating disorder behavior.
Eating disorder cognition was positively associated with BMI. BMI was not significantly related to eating disorder behavior or mindfulness. In the Black American group, mindfulness was inversely associated with eating disorder cognition, but not with eating disorder behavior. Eating disorder cognition was positively associated with eating disorder behavior and BMI. BMI was not associated with eating disorder behavior. Significant effects for ethnic group, sexual orientation, and their interaction were followed by pairwise comparisons with a Bonferroni correction to maintain the overall alpha at 0.
No other ethnic group difference was found in eating disorder behavior. There was no difference in mindfulness between the Asian American and Black American groups. No other ethnic group differences were found in age. Being a sexual minority was related to lower BMI than being heterosexual in the White American group.
Table 3 presents the final step of a hierarchical linear regression that examined the associations of eating disorder cognition and mindfulness with eating disorder behavior by ethnic group. TABLE 3. Final step of a hierarchical linear regression examining the role of eating disorder cognition and mindfulness on eating disorder behavior. The present study examined mindfulness as a potential moderator of the association between eating disorder cognition and eating disorder behavior. An ethnically diverse, non-clinical sample included groups of Asian American, White American, and Black American women.
In all three groups, bivariate correlations showed that eating disorder cognition was significantly correlated with eating disorder behavior. Among White Americans and Asian Americans, both cognition and behavior were also associated with mindfulness, consistent with past results Moore et al. However, among Black Americans, mindfulness was associated with only eating disorder cognition, but not with eating disorder behavior. These novel results suggest that the association between eating disordered behavior and mindfulness found previously in other samples Masuda et al.
These findings emphasize the importance of examining associations independently in different ethnic groups, rather than assuming generalizability or universality across cultures Sue, ; Hall et al. Hierarchical regression also examined the unique association of eating disorder cognition, mindfulness, and their interaction with eating disorder behavior, after adjusting for BMI, age, and sexual orientation. As with the bivariate analyses, different results emerged across ethnic groups. Among White American women, mindfulness moderated the association between eating disorder cognition and eating disorder behavior.
Consistent with past research Masuda et al. However, among Asian Americans, only a trend toward the interaction emerged. Importantly, the interaction was not significant among Black Americans. Again, this pattern of results highlights the importance of investigating theories within distinct cultural groups, as the associations between putative maintenance variables can differ, with potentially different treatment implications.
It is possible that the slightly lower levels of eating disorder cognition and behavior among Black American women might have been related to the absence of their interaction in this group. It is also possible that the higher BMI among the Black American group suggests that the behavioral eating disturbances in this group might have taken a slightly different form than those in the other two groups, and perhaps were more focused on concerns about overeating or loss-of-control eating rather than dietary restraint Wildes et al.
These findings have important theoretical implications. In all three groups, eating disorder cognition was associated with eating disorder behavior, consistent with cognitive behavioral theories of the maintenance of eating disorders Vitousek and Hollon, ; Fairburn, In addition, the associations between mindfulness and both eating disorder cognition across all groups and eating disorder behavior among Asian and White Americans support more recent theoretical models of psychopathology emphasizing the importance of mindfulness as an adaptive emotional and behavioral process that may regulate and mitigate the development of eating disorder symptomatology Keng et al.
Both mindfulness-based treatments and cognitive behavioral treatments aim to improve self-awareness and self-regulation surrounding eating behavior in order to regain control over eating, food choices, and responses to both emotional e. The treatments might use different methods to achieve this goal e. The present study further emphasizes an important role for mindfulness in the treatment and prevention of disordered eating problems. Acceptance- and mindfulness-based treatments have shown preliminary efficacy in reducing disordered eating problems Kristeller and Wolever, ; Masuda and Hill, However, most participants in these studies have been individuals from non-minority groups.
The present investigation has several limitations. The current data were collected from students attending an urban university in the southeastern United States. As such, generalizability to other ethnic groups and other geographic areas is unknown. Further research is also needed to investigate the associations examined here among women from other ethnic groups e. The scales used in the present study have not been fully psychometrically tested and validated across diverse ethnic groups, although they have been used in prior research with similar populations Masuda et al.
The coefficient alphas of the measures used here were all in the adequate range, except those of EAT B. The somewhat lower coefficient alphas of EAT B in across the three ethnic groups suggest that the construct of eating disorder behavior that was used in a previous study with a sample of ethnically diverse college women Moore et al.
As such, future studies should examine the association of eating disorder cognition and mindfulness to specific types of eating disorder behaviors systematically. As with all correlational research, the present study does not allow for causal conclusions to be drawn, and longitudinal and experimental studies are warranted.
Finally, the construct of mindfulness examined in the present study focused on the awareness of present moment experience, and did not include other domains of mindfulness highlighted by other studies, such as acceptance and non-judgment Kabat-Zinn, ; Bishop et al. Thus, it is possible that different patterns of results would emerge if other measures of mindfulness were used. Despite these limitations, the present study extends our understanding of the associations between eating disorder cognition, eating disorder behavior, and mindfulness, and the attenuating role of mindfulness in the association between disordered cognition and behavior.
Importantly, this study examined these associations in samples of previously understudied populations, Asian Americans and Black Americans, as well as White Americans. The present results serve as a reminder of the importance of investigating hypothesized associations across different populations and avoiding assumptions of generalizability. The results also underscore the importance of further research devoted to better understanding the maintenance factors of eating-related psychopathology across cultures, especially among Black American and Asian American women Rogers-Wood and Petrie, ; Cheng et al.
It is possible that additional variables not yet examined in the context of eating disorders but identified as important in other domains e. The protocol was approved by the institutional research committee. All subjects gave written informed consent in accordance with the Declaration of Helsinki. AM designed and executed the study, assisted with data analysis, and wrote the paper.
RM collaborated in the writing and editing of the final manuscript. JL collaborated on the design and wrote the paper. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Adams, C. Mindfulness ameliorates the relationship between weight concerns and smoking behavior in female smokers: a cross-sectional investigation. Mindfulness 5, — Baer, R. Google Scholar. Using self-report assessment methods to explore facets of mindfulness. Assessment 13, 27— Bishop, S.
Mindfulness: a proposed operational definition. Brown, K. The benefits of being present: mindfulness and its role in psychological well-being. Mindfulness: theoretical foundations and evidence for its salutary effects.
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Chambers, R. Mindful emotion regulation: an integrative review. Cheng, H. Disordered eating among Asian American college women: a racially expanded model of objectification theory.