hospitalCross-posted at WLF’s contributor page at

The federal Affordable Care Act, better known as “ObamaCare,” may provide activists and government a little-known wedge to advance their obesity agendas through regulated health-care providers — specifically America’s nearly 3,000 non-profit hospitals. One organization, The STOP Obesity Alliance, recently identified this wedge as a way to have such hospitals embrace its core convictions, including one principle which questions the role of personal responsibility as a cause and a solution to obesity.

Community Health Needs Assessments. Section 9007 of the Act requires non-profit hospitals, as a condition of maintaining their tax-exempt status, to conduct Community Health Needs Assessments (CHNAs). These documents, which must be filed with the IRS, will demonstrate the health needs of the hospitals’ local communities and explain how hospitals are meeting those needs. One assessment of CHNAs likened them to banks’ responsibilities under the Community Reinvestment Act, in the sense that the documents might be used as tools by activists to prompt agreements or actions. It’s likely the STOP alliance understood this when it made its “recommendations.”

STOP’s Recommendations. The STOP Obesity Alliance “strongly encourages nonprofit hospitals to overcome and prevent obesity on the following core principles.” On balance, the coalition’s principles are laudable (encourage physical activity, encourage best practices, address and reduce stigma). One recommendation — that CHNAs use a “sustained loss of five to ten percent of current weight” as a barometer to successful weight reduction — may be troublesome for hospitals. If hospitals incorporate such a specific goal into their CHNAs, and their patients don’t achieve such consistent weight loss, that could provide STOP and other advocates with the clear data they need to oppose continued non-profit status at the IRS or with a potent stick to prod hospitals to certain actions.

The wording of another recommendation also gives us pause. It calls for “interventions that provide support for sustained weight loss and go beyond recognizing the role of personal responsibility.” The minimization of personal responsibility is a consistent theme throughout STOP’s policy statements and communications strategies. In their general policy recommendations, for instance, they profess to be “dedicated to negating the myth that overcoming obesity is solely a matter of personal responsibility,” and see roles for multiple actors, including government, for “creating an environment that will help overcome and prevent overweight.”

“Myth” of Personal Responsibility. STOP sets up and knocks down a straw man with its statement. Obesity and overweight result from many factors. But its efforts to discount personal responsibility and elevate “environmental” causes draw upon a theme that is troublingly prevalent in the public health activist community. For instance, a media strategies group which works with public health activists is managing an ongoing project to analyze “personal responsibility rhetoric” in tobacco- and obesity-related litigation, legislation, and news coverage. As the description reflects, personal responsibility rhetoric is looked upon as a way to deflect focus on who is really causing weight gain: Big Food and Soda, of course.

Legal activists’ scholarly writings reflect this effort to write personal responsibility out of the obesity equation. For litigation to succeed as a public health tool, activists and lawyers must convince judges, as one journal article put it, to focus not on “illusory individual choices,” but on the amorphous, holistic “environment” which impose such choices. That way, inconvenient hurdles to seven-figure damage awards, like individualized causation, fall by the wayside. Another article views personal responsibility as a shield conceived by Corporate America: “By reinforcing a view of individual personal responsibility, corporations maintain a focus away from the institutions that manipulate and define the situation.”

Defeatist Approach? As we’ve argued previously in the context of claims of “food addiction,” efforts to blame weight gain on an unsupportive environment could do more harm than good. Many of us don’t want to give up the food and beverages we love, and being told repeatedly that it’s not our fault, it’s the environment, could lead many to numbly surrender to inevitable weight gain. Let’s hope that non-profit hospitals take a pass on adopting the STOP Obesity Alliance’s “it’s not your fault” principle, even if they feel it’s necessary to embrace the others.