Genomics Research and Childhood Obesity through the Lenses of Equity: Reassessing Responsibilities and Costs between Families and Society

This paper explores the ELSI of genomics research around childhood obesity, by focusing on equity in relation to accessibility and the reshaped dimensions of responsibility. The increasing rates of obesity in the global population – disproportionately high in contexts of socioeconomic deprivation - is among the most serious public health emergencies of our time. Genomics research offers an important opportunity to prevent and treat obesity, especially in children, by timely identifying and targeting its molecular causal mechanisms, but it also raises important ELSI. We focus on those related to equity. Specifically: (1) By building on our previous research on patterns of exclusion in genomics research and medicine, we explore the unequal barriers for children to access genetic testing and targeted therapies, and the related risk of exacerbating inequity in the obesity epidemic. (2) Grounding ourselves on the literature on personal and social responsibility in health, we explore how genetics of obesity, against the molecular-socioenvironmental interplay, redistributes responsibilities between individual families and institutions, and the effects in terms of costs, stigma, calls for action. We argue that the costs and responsibilities (in terms of healthcare, screening, and lifestyle changes) redistributed by genetics of obesity, contrasted with the socioeconomic constraints to the “control” condition of responsibility, pose novel challenges to equity. We conclude that addressing specific socioeconomic and psychosocial barriers is vital for the equitable efficacy of genetic approaches to obesity, and that genetics of obesity shapes new dimensions of responsibility for families that need to be corresponded by specific institutional support.

Authors: Ilaria Galasso, Technical University of Munich; Stuart McLennan, Technical University of Munich