What Can Government Do About the Obesity Epidemic?
Obesity is an increasingly common problem around the world, and especially in the United States. According to the U.S. Department of Agriculture (USDA), two-thirds of the U.S. population is overweight, and nearly half of those are heavy enough to be considered obese.
The proportion of obese children in the United States will almost double over the next four years, according to projections. By 2010, nearly half of all children in North and South America will be obese, according to a recent report in the International Journal of Pediatric Obesity.
Medicaid and Medicare bear significant costs for treating health conditions associated with obesity, including diabetes and cardiovascular problems. A 2001 Surgeon General's report put the social cost of obesity at about $117 billion per year.
Because of all this, public health advocates are increasingly calling for government intervention to slow the increasing incidence of obesity. They are trying to remove from schools foods and drinks they consider unhealthy. Trial lawyers have explored suing fast food restaurant chains. One of the more extreme proposals is a so-called "fat tax" to offset government medical expenditures and raise the cost of unhealthy foods.
Government Taking Lead
Current government efforts to control obesity largely take the form of consumer education and food industry requirements for transparency in nutritional information. The federal government has required food producers to disclose nutritional information for years. The Fair Packaging and Labeling Act (1966) required all consumer products involved in interstate commerce to have labels that are both accurate and informative. The Nutrition Labeling and Education Act of 1990 further enhanced labeling requirements.
Many of the larger restaurant chains and fast food establishments make the nutritional information of their menus available on Web sites or on printed menus or posters.
Could government do even more? Economists generally agree government should intervene when the costs of one person's actions are borne by others. However, most also say government should not interfere when the cost is borne primarily by the individual. The reason economists give is that individuals are better than government at making choices that best fit their preferences.
For example, even though we might prefer to be slender, we value the taste of food in the present more than we dislike the added weight that will accumulate in the future. Hence, we are only as fat as we want to be.
But USDA researchers Fred Kuchler and Nicole Ballenger argue not all of the bad consequences ("negative externalities") of obesity are borne solely by the individual. Some, they note, are absorbed by society in the form of higher health care expenditures.
Proper Role Is Limited
That problem could be remedied by charging higher health insurance premiums to obese people. The fact insurers have not done so is probably because it is not worth the effort to underwrite populations in this way.
Economist Arnold Kling, author of the forthcoming book Crisis of Abundance, suggests there is an additional role for government, but it is limited. In an interview for this story, he said, "The impression I have is that we do not have knowledge in these areas that is sufficiently definitive to provide a basis for a major policy initiative." He continued, "I believe that the main contribution of the government at this point would be to continue to support research concerning the causes, consequences, and treatments for obesity."
More than Calorie Counting
As Kling points out, to fight obesity we must first understand what causes it. Obesity is a complex medical condition and likely related to a number of different factors. People often blame overeating, too much fast food, and sedentary lifestyles. Other theories include increased automobile use and living in suburban neighborhoods where people walk less than in other areas. Carbonated beverages and sweeteners made from corn syrup are often mentioned as contributing factors.
But not everyone agrees preventing obesity is simply a case of counting calories consumed and subtracting those that are burned.
Sandy Szwarc, a registered nurse who has worked with international obesity researchers and eating disorder clinicians for years, says the evidence for obesity being directly caused by diet and exercise is less clear than people often believe. Szwarc says, "It's easy to accept the popular beliefs that inactivity, gluttony, and eating the wrong foods are the cause of fatness, and to believe that exercising and eating 'right' will keep us slim. But researchers, using a variety of methodologies, have shown time and again for more than 50 years that it isn't consumption of fat, sugars, or any 'bad' food; 'overeating'; or even exercise that predicts and precedes the onset of obesity. It is primarily our genes and restrictive eating," Szwarc concludes, with the latter term referring to caloric restriction diets.
Szwarc points to work by the prominent researcher Jeffrey M. Friedman, head of the Laboratory of Molecular Genetics at Rockefeller University, who finds obesity has a hereditary basis similar to a person's height.
Changing Tech Adds Pounds
Interestingly, research points to technology as another primary cause of weight gain. A study by professor Tomas J. Philipson and senior lecturer Richard A. Posner, both of the University of Chicago Law School, found technology affected caloric intake in several ways. Technological change, they observe, has increased labor productivity but also reduced the calories expended, by making work easier. In addition, as time has become more valuable, the opportunity cost of home-prepared meals and exercise also has risen. The main effect technology has had on obesity, the authors find, has been in reducing the cost and effort required to mass-produce foods, including processed foods that are ready to eat when purchased.
Researchers Shin-Yi Chou, Henry Saffer, and Michael Grossman say the increase in fast food restaurants likely represents higher demand from time-strapped families for a quick meal. Why are families so short on time? Expanded work opportunities for women have resulted in fewer women preparing food at home. The researchers also contend the decrease in smoking over the past few decades has further boosted obesity rates.
Kling has an additional explanation for the rise in obesity. In an August 2004 essay, he compared weight gain to saving for the future. The less a family spends compared to its take-home pay, Kling observes, the bigger the nest egg they accumulate over time. Likewise, the more a person consumes compared to his or her daily caloric needs, the more weight he or she will accumulate in the future.
Even small amounts of food can make a difference, Kling notes. For instance, consuming 99 percent, rather than 102 percent, of daily caloric needs would result in a substantial difference in weight over the course of several years.
Feds Changed Definition
Another important observation is that obesity has increased largely due to the stroke of a bureaucratic pen. Dr. Eric Oliver, an associate professor of political science at the University of Chicago and author of Fat Politics: The Real Story Behind America's Obesity Epidemic, argues the obesity epidemic is largely a creation of the diet industry. Over the past 30 years, the weight of the average adult American has risen by only 8 to 12 pounds. At the same time, however, the definition of what is overweight was lowered by the National Institutes of Health.
As Oliver told Health Care News, "The only reason that over 60 percent of Americans are 'overweight' and roughly 25 percent are 'obese' is because these definitions are set at unreasonably low levels. In fact, the official definitions of overweight and obese are based on dated and inaccurate data linking body weight to mortality and were written by a handful of doctors with extensive financial ties to the weight loss industry. The most recent scientific evidence suggests that the optimal weight for mortality is what we consider 'overweight' (i.e., a BMI between 25 and 29)."
It's easy to see there is no simple fix for the obesity "epidemic." Many of the factors behind obesity are desirable to society: lower rates of smoking, higher standards of living, less expensive foods, and technology that makes food cheap and work easy. These are indicators of economic development, and most Americans see them as worth carrying a few extra pounds for. To achieve the goal of making Americans reach an unreasonably low body mass standard, anti-obesity advocates will increasingly have to confront this reality.