Social justice for adults with high body weight: a systematic review

Health inequalities that arise form structural and social factors beyond an individual's control (e.g., socioeconomic status (SES), education access, or neighbourhood and built environment) are widely regarded as unjust in public health ethics. However, to be translated into practice, meaningful calls for greater social justice in health must be grounded in a clear and robust conception of justice. Against this backdrop, this systematic review examines how notions of social justice are conceptualized and operationalized in responses to public health challenges, using obesity as paradigmatic example.

Following a PRISMA guideline for systematic reviews on ethics literature we searched PubMed, Web of Science, and BeLit in March 2024 and identified 1,377 titles. Screening, data extraction, and analysis were conducted independently by two authors. A total of 33 texts were included in this study. The analysis followed the Qualitative Analysis Guide of Leuven (QUAGOL) framework, providing a structured and theory-oriented interpretation. The qualitative software ATLAS.ti supported the analysis throughout. This systematic review was not registered.

While global inequalities are extensively studied, ethical debates focus mainly on the Global North. The included literature discusses obesity primarily in terms of responsibility, autonomy, disease concepts, stigma, healthcare and food access, as well as prevention. Social justice theories helped to identify injustices and guide policy, although a unified understanding remains emergent.

This paper examines how ethical theories can guide efforts to advance social justice for adults with high body weight (AHBW) and identifies practical steps forward, thereby providing a robust starting point for interdisciplinary research and translational work.