A/HRC/32/33 social functioning and reduced stress, are reported more frequently among sports participants,12 as is improved life satisfaction.13 Additionally, although any form of daily physical activity is associated with a lowered risk of psychological distress, the strongest effect is seen in sport (as opposed to other activities such as walking or domestic work).14 11. However, overtraining, doping and the performing of unnecessary medical procedures can have negative health impacts on individuals, and may represent rights violations in some instances. Moreover, certain types of sport or physical activity may produce positive effects in some subpopulations and negative effects in others. 15 For instance, participation in sporting activities where physical appearance is an important factor may increase the risk of developing female athlete triad, a syndrome suffered by female athletes which may involve eating disorders, delayed or interrupted menstruation, and osteoporosis (low bone mass). This syndrome is usually caused by self-imposed or externally driven pressure to maintain an unrealistically low body weight. For these reasons, a nuanced approach is required when considering sport and physical activity as a tool for realizing the right to health. III. Obligations of States regarding sport and healthy lifestyles and the right to health 12. In its general comment No. 14 (2000) on substantive issues arising in the implementation of the International Covenant on Economic, Social and Cultural Rights, the Committee on Economic, Social and Cultural Rights confirmed that certain aspects of human health cannot be addressed solely within the relationship between States and individuals, and noted that various factors may play an important role in relation to human health, such as genetic factors or the adoption of unhealthy or risky lifestyles. However, this does not absolve States of any obligations in this regard. Just as a State may implement a genetic diseases screening project to improve the health of the population despite being unable to modify genetic risk, an obligation also arises for States to attempt to reduce the extent to which individuals adopt unhealthy or risky lifestyles, even if they cannot directly influence individual behaviour. 13. There has been a troubling tendency to view engagement in physical activity as an individual or moral obligation, and to characterize a sedentary lifestyle as a personal failing, to be overcome with willpower. This ignores the powerful role that social or structural determinants of health play in dictating supposed lifestyle “choices”, and the vital role of the State in mitigating the effect of such negative determinants by promoting, facilitating and encouraging the adoption of healthy lifestyles through education, social policy and public investments.16 Illustrating this principle, the Committee on Economic, Social and Cultural Rights has expressly stated that the obligation to “fulfil” requires States to disseminate appropriate information relating to healthy lifestyles and nutrition and to 12 13 14 15 16 Rochelle Eime and others, “A systematic review of the psychological and social benefits of participation in sport for adults: informing development of a conceptual model of health through sport”, International Journal of Behavioral Nutrition and Physical Activity, vol. 10 (December 2013). Runar Vilhjalmsson and Thorolfur Thorlindsson, “The integrative and physiological effects of sport participation: a study of adolescents”, Sociological Quarterly, vol. 33, No. 4. Mark Hamer, Emmanual Stamatakis and Andrew Steptoe, “Dose-response relationship between physical activity and mental health: the Scottish Health Survey”, British Journal of Sports Medicine, vol. 43, No. 14. Melinda Asztalos and others, “Specific associations between types of physical activity and components of mental health”, Journal of Science and Medicine in Sport, vol. 12, No. 4. WHO, Report of the Commission on Ending Childhood Obesity (2016). 5