Project Details

Research project: Health equity and high body weight: The importance of empirically-informed ethics for health policy analyses

Duration: Since 01.10.2023
Research Team:

PD Solveig Lena Hansen, Dr. phil. (Projektleitung);


Imogen Weidinger M.Sc.;


Leonie Renelt B.A.;

Project Partner: Dr. Lorraine Frisina Doetter (Bremen University), PD Dr. Deborah Janowitz (Helios Clinic Stralsund), Dr. Regina Müller (Bremen University), Benedikt Preuss M.Sc. (Bremen University), Prof. Dr. James Wilson (University College London)
Project Type: Third-party funded project
Funding: Zentrale Forschungsförderung der Universität Bremen


High body weight has a variety of causes. These include genetic, psychological/psychiatric and medical reasons; environmental and socio-cultural factors. Depending on culture, ethnicity, socioeconomic status, and education, some social groups have a significantly higher prevalence of high body weight and are therefore even more affected by stigmatisation and discrimination (e.g., in the workplace or by healthcare staff).

Discussions in recent years have shown that the deep causes of the distribution of disease and access to health care lie in social inequality and not just in individual behaviour. While high body weight is currently associated with lifestyle-related conditions and individual responsibility in both public and professional discourse, from an ethical perspective, the multifactorial causes of obesity raise questions about whether it is justified to exclusively hold individuals accountable.

Public health ethics deals with such areas of tension from a normative perspective. An interdisciplinary approach can also include the incorporation of empirical results. Public health ethics thus contributes to justifying and reflecting on practical decisions that affect the health of populations and the healthcare system based on scientific findings and in relation to moral theories. While the field of public health ethics is highly differentiated internationally, in Germany it does not yet have any systematic networking in practice, established theoretical frameworks, or established structures for policy advice. Although the importance of social justice is recognized in research and practice, there is as yet neither a uniform understanding of justice nor concrete criteria.

In our project, we, therefore, use obesity as a paradigm of public health to investigate which theories of justice are suitable for ethically reflecting on current structures of health care and health promotion for obese people. The focus is firstly on the normative level, the examination of current approaches to justice and the development of a concept of needs-based justice in particular; secondly, the empirical-ethical evaluation of interviews with patients and experts; and thirdly, the ethical implications of current concepts in health and nursing care. Fields of practice are health communication, digital health applications and older people with obesity as a previously neglected group. Fourthly, we want to make suggestions on how ethical reflections can be translated into concrete recommendations for action. To this end, international policies in the area of high body weight will be systematically analysed and compared from an ethical perspective. This should not only help to understand the role that theories of health justice already play in this context, but also to develop an ethically reflected model for policy development in Germany.