It’s almost quaint that government hasn’t tried to do more to deter weight gain. Perhaps it’s because the politics of fat are not easily digestible: Unlike traditional illness, obesity is largely the result of individual choices about diet and exercise. Still, maybe taxpayers really should care, given that they’re footing most of the medical bills.
The singular feature of American obesity is its steep, out-of-nowhere rise. For most of the 20th century, U.S. obesity rates were stable, with a slight upward trend through the late 1970s. Suddenly, they spiked across all demographic groups and have continued to rise unabated. In sheer body mass, the entire population is heavier than it used to be, and the heaviest are much heavier. Just between 1998 and 2006, obesity rates increased by 37%, according to the CDC.
The costs are nearly as startling. In a study published this week in the journal Health Affairs, CDC researchers estimate that obesity now accounts for 9.1% of all medical spending—$147 billion in 2008. The Milken Institute estimates that chronic disease costs more than $1.2 trillion every year. On top of the medical resources devoted to preventable illness, a fatter and sicker work force is a drag on economic growth. In effect, we’re eating money.
Why are Americans getting so fat, so fast? Harvard economists David Cutler, Ed Glaeser and Jesse Shapiro examined changes in U.S. food consumption and exercise between the 1970s and 1990s and came up with an empirical answer: Americans are eating too much. The growth in per capita calories in the food supply (rather than less exercise) is enough to explain the obesity explosion. We are eating larger portions and more snacks.
Enter the McLawsuit. Class-action litigation against fast food, Coke, General Mills and the rest a la Marlboro used to be a joke, but the Hamburglar will soon meet the same bill of indictment as Joe Camel. This may succeed in transferring wealth to the trial bar and creating a cartel of food conglomerates, a la Big Tobacco, but it has nothing to do with the public interest.
Namely, the food market reflects what people want. A business that disregards consumer preferences is unlikely to survive for long in today’s ultracompetitive food industry. The obesity paradox is that people are much better informed about nutrition as a result of label laws, education campaigns and so forth. They’re paying more attention to food than they have for decades. We spend more than $50 billion a year dieting, and anyone mainlining mayonnaise knows the risks.
Modifying such unhealthy habits is the only solution. But the policy quiver is not well-stocked, and the arrows are dull. Restricting access to unhealthy options, such as the use of transfats or prohibiting soda and candy machines in schools, is being tried across the country. Obama CDC director Thomas Frieden and the public health bureaucracy cite the smoking precedent, but the limitations are obvious. If we followed that example, we’d ban eating in restaurants.
Dr. Frieden thinks the tax code should target sugar-sweetened drinks, no doubt before moving on to fat, salt or calories. Yet sin taxes are unpopular, especially when imposed on dinner. In any case, the real problem is excess, so one option would be a tax on the overconsumption of food—that is, a tax on obese people. Fat chance of that.
The depressing thought is that even if a new government intervention—such as chronic disease management in Medicare, which is trivial in both the House and Senate health bills—somehow changed behavior, it would take years for the health benefits to materialize, and even longer to reduce overall health-care costs. More preventive care is very expensive and almost never produces cost containment.
But Congress could give up its own bad habits right now. Start by reforming agricultural “policy,” meaning subsidies that help make unhealthy food artificially cheap. Most of the new calories in the American diet come from processed foods, and taxpayers have underwritten them since the New Deal with huge price supports for commodity crops like corn and soy.
These are processed into low-quality calories that make their way to consumers as refined starches, high-fructose corn syrup, hydrogenated oils and feed for livestock. Most farmers receiving ag subsidies are actually prohibited by law from growing “specialty crops”—i.e., fruits and vegetables—as protectionism for California and Florida produce growers. Call the 19% of kids who are obese the children of the corn.
***Government could also free up the private market to change the economic incentives to have better health. If people have skin in the game, preventable costs fall. Safeway and other companies have saved a lot of money with wellness programs, and increasing cost-sharing also has a huge effect. Yet Democrats are moving in the opposite direction, prohibiting insurers and employers from designing policies based on health status and limiting the financial involvement of patients in their own care.
This is all part of their effort to pass “universal” coverage and gradually transition everyone into a single government program like Medicare, thus insulating people even more from the costs of their lifestyle decisions. Don’t expect to win the war on obesity by making the government fatter.