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“Choice”: what we mean by it and what that means for obesity prevention

Much public debate about obesity prevention policy, particularly in relation to food, centers on notions of “choice.” This research surfaces values underlying some of this discourse and discusses implications in the context of larger ethical and philosophical debates in public health. Through coding and discourse analysis of 105 stakeholder interviews conducted in the Northeast of the US, it identifies three main “choice” frames: choice as freedom, choice as moral responsibility, and the influence of context on choice. The corresponding dominant values for the first and second frame, respectively, are autonomy and personal accountability. Most people using the third frame also held these values, but focused on conditions required to enable people to be accountable for their choices and to make truly free choices. A small subset thought outside the frame of individual choice, valuing, as one person put it, a “social contract.” This paper discusses these results in relation to public health debates about autonomy/paternalism, agency/structure, and individual/group and concludes with implications for obesity prevention strategies that respect the values underlying these three “choice” frames. Support for transcriptions: Hatch and Smith‐Lever funds.