TCS Daily


The Doctor's Out

By Duane D. Freese - June 13, 2003 12:00 AM

The so-called obesity epidemic is a big medical problem. So, where are the doctors in fighting it?

Well, in Australia and Britain this week, they appear to be thumping the money tin.

The Australian Medical Association has come out in favor of a "fat tax" for foods with high fat or sugar content, such as ice cream, hamburgers, soft drinks and chips. And some of Great Britain's doctors, despite a defeat at their public health conference, continue to push for a VAT fat tax - extending the nation's 17.5 percent value added tax now applied to take out and restaurant meals to previously exempted groceries that contain fat as well.

The taxes, the doctors claim, would encourage purveyors of fat foods to lower their fat content, discourage shoppers from buying them and, no doubt, provide another source of money for government programs to encourage healthy eating habits.

Ain't it always the case? The minute you socialize something in a country, especially involving health care, the next thing is that "society" as a whole has a problem if some people - by their own activities or peculiarities - have one.

That was the road on smoking and health, leading to the wondrous tobacco settlement, and it appears now to be the tack that will be taken on obesity and health as well.

Obese people have a lot of health problems, as was made clear by some speakers at a day-long forum, "Obesity, Individual Responsibility and Public Policy", at the American Enterprise Institute in Washington, D.C., moderated by TCS host James Glassman on June 10.

Dr. David Hu of Harvard pointed out the association of obesity with a host of respiratory, heart and cancerous diseases. The rise in Type 2 Diabetes among children as young as 8 years old has left health professionals aghast. Some studies suggest obesity has nearly doubled in the last couple decades to about 20 percent of the population (with the overweight population now accounting for 60 percent of people here, in Britain and Australia).

Kelly D. Brownell, a psychology professor and director of Yale's center on eating disorders and obesity argued that society has to do something to keep people from getting fat and help them lose weight when they do.

"The question is not why individuals are overweight, it's why the nation is overweight," he said. And he declared that it is not so much a matter of personal responsibility - people are no less responsible today than they were a couple decades ago before obesity become epidemic - as it is a "toxic food environment."

"Food is available everywhere all the time, like never before in history. Fast food is in most schools. Almost every gas station has a food mart." In short, "unhealthy food is cheap, convenient and tastes good, while just the opposite is true of healthy foods." So, one way to handle that problem is to raise its price - through taxes. Got it?

Well maybe not. Surgeon General Richard H. Carmona clearly buys into the idea that obesity is a national problem. He cited statistics showing that obesity costs the nation $117 billion a year in additional health care costs and 300,000 lives, a number disputed by many experts who claim it includes such deaths as obese people in auto accidents.

Nevertheless, Carmona said: "I refuse to accept the spread of obesity." And, he declared, "it will take all of us working together" to solve the problem.

But how should we work together? Not by suing each other. Carmona took a dim view of that "blame game," which is probably why he isn't on the agenda for the trial lawyers' obesity summit June 20-21 at Northeastern University in Boston. Nor does he see mandated labeling at restaurants as the key. "The average person eats out four times a week. That leaves 17 meals at home at which they are making bad choices." And when people eat out, he noted, they still choose what and how much they'll eat.

So what to do? Educate consumers, especially young people, about exercising and eating right. Create "health literacy." Everyone can be involved because "good health habits don't have an expiration date."

Amen. As Greg Critser, author of Fat Land noted, the French have essentially accomplished that education. Their Dr. Spock, Augusta Moll-Weiss, pushed a strict diet regimen for kids to combat obesity epidemic of the 1930s. "It is unimportant how much freedom is left in this choice," she wrote, "the essential thing is that the quality and quantity of the diet correspond to the exertion of the young human being."

But how much is that? Good health habits may differ from person to person, notwithstanding the societal nature of the "obesity epidemic."

As Ruth Kava of the American Center for Science and Health noted, obesity involves the first law of thermodynamics - energy can be neither created nor destroyed, merely converted in form. Thus energy we take in in the form of calories doesn't disappear, we either expend it or store it as fat. But that is not a simple or easy process as people have different rates of natural metabolism based on hormones, thyroid condition, and other variables. In short, genetics is a key ingredient in our caloric expenditure. It also can affect our input as different people have different desires for food.

And modern agriculture in this country provides us plenty of food to eat and modern technology means that we lead more sedentary lives than ever, even though our genetics for taking in energy and putting it out hasn't changed.

Those factors have more to do with obesity than fast food advertising and food "addiction," the causes pushed by trial lawyers such as George Washington University law school professor John Banzhaf. As AEI scholar John E. Calfee noted, "It's very hard to persuade people to buy what they don't want to buy." Even Popeye didn't make spinach all that popular with kids. And as psychiatrist and addiction specialist Sally Satel said, pretending that some foods are addictive stretches the definition of addiction to an unrecognizable extreme.

Tomas J. Philipson of the University of Chicago and currently working with the Food and Drug Administration pointed out that obesity has increased in recent decades even as calorie consumption has remained stable. What's gone down over time is calories used on the job as we've gone from manual to automated jobs, not merely in offices but also on factory floors.

"We used to get paid to exercise," he said. "Now we pay to exercise. We used to sweat 10 hours a day at the job versus three hours a week at the gym." That makes weight reduction costly as it takes time away from other leisure activities.

Philipson says that studies of the health costs to society of obesity, meanwhile, don't look at the whole picture. Obese people die younger, so they may not actually cost society any more.

The bottom line, though, on obesity is to deal with the fact that it is better for a society generally to be "fat and rich" than "poor and skinny." Higher food prices (through taxation, for example) and more physical labor in making goods and services (lower productivity) are not good things.

So, lawsuits against fast food places and higher taxes upon them offer no solution to the obesity epidemic, while exercise certainly may, even if people don't lose a lot of weight. Glenn Gaesser, author of Big Fat Lie, countered Hu's arguments about the dangers of obesity, noting that the fat can be fit, even if that doesn't mean it's OK to be fat. Fat people who exercise can be almost as healthy as lean people who do. And people can stick to exercise regimens better than they can to diets, he claimed.

But how do you get people them to start? By discriminating against them?

Rick Berman of the Employment Policies Institute, which represents the interests of restaurants, mockingly suggested that food outlets might deny food to people who look overweight or obese or out of shape, much as bartenders deny drinks to people who appear drunk.

At a more serious level, University of Chicago law professor Richard Epstein suggested that eliminating the cross subsidies in health insurance and health care would lead people to lead more healthy lifestyles.

That reversal of longstanding policies, though, will be long in coming. So what about in the interim?

Well, how about some more discrimination by doctors? How about more of them getting on their patients' cases and telling them to lighten up by working out?

One of the key findings in this "epidemic" is that doctors have been remiss in telling their overweight patients what they need to do. According to a Centers for Disease Control survey of obese patients who were trying to lose weight and had a checkup in the last year, only 43 percent were told by their doctors to lose weight, while 55 percent got no advice at all. For patients who were overweight, less than 16 percent were advised to lose weight, while 81 percent got no advice.

If obesity is a health problem, rather than getting restaurants to act as doctors, it seems that getting doctors to act as doctors would be a good place to begin the battle against the bulge. And in the meantime, if we really are going to socialize obesity, well, if you exercise for me this week, I promise to diet for you next week. Really.
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1 Comment

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