The War on Fat

Is the size of your butt the government's business?

Jacob Sullum from the August/September 2004 issue

(Page 4 of 4)

"The greatest danger, I believe, does not come from individual lawsuits," Schwartz says. If a case gets as far as discovery, however, it may produce industry documents that support the image of devious companies tricking people at a young age into unhealthy habits they later have trouble breaking. And once the public has begun to fault Big Food for hooking kids on cheeseburgers and fries, Schwartz suggests, "a state attorney general or two could...bring a tobacco-like lawsuit against the food industry because of the cost obesity places on Medicaid....Then a lot of these legal barriers could crumble, just the way they did with tobacco." And as with tobacco, much of the anti-fat agenda, including higher food prices and marketing restrictions, could be achieved through lawsuit settlements, making it unnecessary to lobby legislators.

The rationale for such lawsuits is also the main rationale for the war on obesity. As Banzhaf put it in a May 2003 press release, "obese patients are contributing to skyrocketing Medicare and Medicaid outlays and costing thin taxpayers tens of billions of dollars a year." A study published last year in the journal Health Affairs estimated that the health care costs associated with excessive weight amount to something like $93 billion a year, half of it covered by Medicare and Medicaid. On average, medical treatment cost $732 more per year for the obese and $247 more for the merely overweight. (The increases in Medicare and Medicaid costs were statistically significant only for the obese.) "If people want to be 200 pounds," said the study's lead author, economist Eric Finkelstein, "then that's their choice. But ultimately, if the taxpayer is paying for those choices...that is where the justification for government involvement comes from."

As Finkelstein and his co-authors acknowledged, however, it's not clear that taxpayer costs are higher, on balance, than they would be if everyone were thin. In the case of smokers, economic analyses indicate that taxpayer savings from less health care in old age and fewer Social Security payments (because of shorter life expectancies) outweigh the costs of treating tobacco-related diseases. Finkelstein argues that the calculation is likely to come out differently in the case of obesity, partly because "the elderly obese have only a marginally shorter life expectancy." Yet the data from the Framingham Heart Study suggest that obesity and smoking have a similar impact on life expectancy. University of Chicago economist Tomas Philipson, whose work on weight trends is widely cited, says "it's not clear whether obese people are costing us more or costing us less."

More important, the argument based on taxpayer-funded health insurance proves too much. It gives the government an open-ended license to tax, regulate, or ban any behavior that might lead to disease or injury. In Food Politics, Marion Nestle declares that "obesity contributes to increased health care costs, thereby becoming an issue for everyone, overweight or not." When I ask her how far she would take this principle, she says that depends largely on how social norms evolve. "The government deals with all kinds of risky behavior: smoking, seat belts, alcohol -- all of those," she says. "I think it's a case-by-case situation." But if, as Nestle insists, "diet is a political issue," what isn't? The same logic suggests the government should take an interest in how much sleep you get, what kind of sex you have, and whether you floss regularly.

Disease Control

Both Nestle and Brownell dismiss defenses of individual choice and responsibility as the self-serving rationalizations of profit-hungry corporations. But while anti-fat activists treat "freedom" as an empty corporate slogan, they seem to think the mantra of "public health" can justify any policy proposal. The phrase allows them to smuggle in the assumption that government action is appropriate without having to offer an argument. Like the habit of calling rising BMI trends an "epidemic," this rhetorical trick obscures the fact that obesity is not a contagious disease; it does not spread from person to person in a way that justifies state action.

Brownell does not acknowledge a distinction between voluntarily assumed risks and risks imposed on others. He wants us to think of efforts to "clean up" the "toxic food environment" as equivalent to restrictions on air and water pollution. "Prudent public health practice structures the environment so citizens have lowered exposure to hazards," Brownell and Horgen explain. They seem oblivious to the totalitarian implications of such a broadly understood "public health" agenda, which makes even the most personal choices subject to group control. "Before progress can be made on changing the American diet," they write, "there must be collective agreement that the population should be eating more of some foods and less of others." They call their goal a "Braver New World," apparently without recognizing the chilling connotations of that phrase. And although Brownell has said "a militant attitude is warranted" when it comes to food, he describes his policy proposals as "centrist."

In some respects, Brownell does not seem to have the courage of his collectivist convictions. When I facetiously suggested at the AEI conference that, rather than tax certain foods (which might be eaten by the thin as well as the fat), the government should tax people for each pound over their ideal weight, he objected. Brownell's complaint was not that such a system would be tyrannical because how much you weigh is your business, not the government's. Plainly, he doesn't believe that. Instead, he worried that a weight tax puts too much emphasis on individual responsibility rather than the environment. But if the prices people pay for food are part of the environment that encourages obesity, so is the price they pay for being fat.

Speaking of which, Brownell condemns "anti-fat media messages" and the social stigma attached to obesity, saying people should not be blamed for their failure to resist the forces that make it is so difficult to stay thin. But from a "public health" standpoint, fairness is not the issue. The only question is whether making fat people miserable encourages them to lose weight. Brownell suggests it doesn't, but why would such pervasive social pressures be less effective than a tax on Doritos?

Similarly, last year John Banzhaf told the Obesity Policy Report, "I don't think the government can order [people] to exercise." Why not? Which is more likely to make Ameri-cans thinner: suing McDonald's, or mandatory calisthenics in the public square every morning? If you assume that slimming us down is a proper goal of government, it's hard to see the objection to policies that show promise of actually working, as opposed to enriching lawyers or making a statement.

While the idea of legally compelled jumping jacks may seem utterly fanciful (as the Twinkie tax did until recently), it is by no means the most extreme scenario suggested by a government-waged war on fat. As economist Tomas Philipson notes, Americans have been getting fatter for at least a century, primarily because of developments that have been tremendously positive on balance. Technological improvements in agriculture and processing have made food so cheap that even the poorest people in developed countries can afford to eat more than they need to survive. (Indeed, the poorest Americans are the fattest -- an astonishing reversal of the relationship between wealth and weight that prevailed for most of human history.) Work is much less arduous than it used to be, Philipson notes, so "the price of spending calories has gone up....Exercise has been pushed from labor to leisure." Rather than getting paid to expend calories, we now pay to do so, whether in leisure time or in money spent on health clubs, exercise equipment, and outdoor recreation. Labor-saving devices from the car and the washing machine to the remote control and the networked computer mean that we expend fewer calories away from work as well as on the job. We can choose from an amazing variety of entertainment options, many of them sedentary.

All these developments have contributed to our expanding waistlines, but as Philipson puts it, "We are better off being fatter and richer. I would not want to go back." Given this reality, it's rather disconcerting to see Brownell and Horgen proclaim, "Fundamental changes are necessary, because fundamental economic factors are central to the obesity epidemic."

Those who insist upon such "fundamental changes" cannot understand why others find the prospect alarming. Brownell thinks his critics are not being constructive if they fault his plan for remaking the world without offering a plan of their own. The same sort of incomprehension was apparent at the AEI conference on obesity, where University of Chicago law professor Richard Epstein argued that fat people can impose costs on others only if the government forces taxpayers to pick up the tab for their health care or prevents insurers and employers from discriminating based on weight. Eliminate these distortions, he said, and weight control would be purely a private matter. In that case, a hostile audience member asked him, what are you doing to prevent obesity? Epstein's answer: "I play basketball."

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