New Weight Loss Plan: Drop Your Health Insurance?

Peter Suderman | July 29, 2009

On Monday, Jacob Sullum noted an article about new Health Affairs study that found that "the annual medical burden of obesity has risen to almost 10 percent of all medical spending and could amount to $147 billion per year in 2008."

Combating obesity, and the mounting expenses associated with it, has risen to prominence as a chief goal of health-care reformers looking to bring down spending on medical care. At the same time, those same reformers also tend to see universal health insurance as an important goal.

But those aims may not exactly work in hand in hand. A new study shows a positive correlation between having health insurance and being overweight. The Wall Street Journal reports:

Americans who have health insurance, either private or public, are more likely to gain weight or become obese, wrote authors Jay Bhattacharyaand Kate Bundorf from Stanford University, Noemi Pace from University College Londonand Neeraj Sood from the RAND Corporation. According to the paper, which estimates weight gain in terms of body mass index, a measure of weight related to height, “private insurance increases BMI by 1.3 points and public insurance increases BMI by 2.1 points.”

...Though the study found weak evidence that more generous insurance encourages greater weight gain, or that risk-adjusted premiums discourage it, there was “strong” statistical evidence that being insured increases body mass index and obesity.

Read Reason's past coverage of the politics of obesity.

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|7.29.09 @ 4:08PM|#

Megan McCardle who normally snapped out of her normal dumb white girl routine and actually did a great post on national healthcare yesterday. She had this to say about weight loss

"The other major reason that I am against national health care is the increasing license it gives elites to wrap their claws around every aspect of everyone's life. Look at the uptick in stories on obesity in the context of health care reform. Fat people are a problem! They're killing themselves, and our budget! We must stop them! And what if people won't do it voluntarily? Because let's face it, so far, they won't. Making information, or fresh vegetables, available, hasn't worked--every intervention you can imagine on the voluntary front, and several involuntary ones, has already been tried either in supermarkets or public schools. Americans are getting fat because they're eating fattening foods, and not exercising. How far are we willing to go beyond calorie labelling on menus to get people to slim down?

These aren't just a way to save on health care; they're a way to extend and expand the cultural hegemony of wealthy white elites. No, seriously. Living a fit, active life is correlated with being healthier. But then, as an economist recently pointed out to me, so is being religious, being married, and living in a small town; how come we don't have any programs to promote these "healthy lifestyles"? When you listen to obesity experts, or health wonks, talk, their assertions boil down to the idea that overweight people are either too stupid to understand why they get fat, or have not yet been made sufficiently aware of society's disgust for their condition. Yet this does not describe any of the overweight people I have ever known, including the construction workers and office clerks at Ground Zero. All were very well aware that the burgers and fries they ate made them fat, and hitting the salad bar instead would probably help them lose weight. They either didn't care, or felt powerless to control their hunger. They were also very well aware that society thought they were disgusting, and many of them had internalized this message to the point of open despair. What does another public campaign about overeating have to offer them, other than oozing condescension?"
http://meganmcardle.theatlantic.com/archives/2009/07/a_long_long_post_about_my_reas.php

She absolutely nails it.

|7.29.09 @ 4:12PM|#

Private or public plans increasing BMI? I think not. There is a difference between causation and association.

Peter Suderman|7.29.09 @ 4:15PM|#

Thanks for pointing that out John, though I'd already read the post. In fact, I read McArdle every day -- not only because I think she's really smart, and almost always insightful about important issues, but because she is, in fact, my fiancée.

Rich|7.29.09 @ 4:15PM|#

> "They were also very well aware that society thought they were disgusting, and many of them had internalized this message to the point of open despair. What does another public campaign about overeating have to offer them, other than oozing condescension?"

Well, when people start offing themselves as a result of the campaign, money.

Juan|7.29.09 @ 4:18PM|#

The other major reason that I am against national health care is the increasing license it gives elites to wrap their claws around every aspect of everyone's life.

This is a problem? Whatever it takes to get us all slim and trim and non-smoking is inherently a good thing, I'm all for it if it is going to save us money on health care.

|7.29.09 @ 4:20PM|#

but because she is, in fact, my fiancée

Your heterosexism sickens me.

|7.29.09 @ 4:21PM|#

I read McArdle every day -- not only because I think she's really smart, and almost always insightful about important issues...

Someone's looking to get laid tonight.

|7.29.09 @ 4:22PM|#

Peter,

I generally like Megan. She just drives me crazy on some issues. She put up like three posts in a week on how it is irresponsible to live in the suburbs because it is a "unsustainable lifestyle". I just don't understand how someone who can be so smart on some things can write stuff like. I wouldn't be so snarky and hard on her if I didn't really like a lot of the stuff she writes.

Congratulations on marrying her. I hope you can get her to at least brave the wilds of the suburbs seeing how she once admitted she couldn't spend the night alone in a suburb house in Washington. She needs to get out more.

|7.29.09 @ 4:25PM|#

Props, Pete. I keep up with her blog; I don't always agree with her (she's a little too East Coast elite comfy with state intervention), but because I generally learn things.

Anybody who can turn blogging into a paid gig gets my respect.

|7.29.09 @ 4:26PM|#

In every picture of Peter I google up, he looks a bit drunk.

I do not mention this as a criticism.

|7.29.09 @ 4:30PM|#

"I don't always agree with her (she's a little too East Coast elite comfy with state intervention)"

Exactly and she should know better which makes it even more grating.

Peter Suderman|7.29.09 @ 4:42PM|#

Well, I don't have much desire to live in the 'burbs myself, but I grew up in a cute, small town setting in the South (a town literally called Niceville) -- pretty much the opposite of East Coast Elite -- so I'm sympathetic. Hopefully, between us we'll find a happy medium.

Peter Suderman|7.29.09 @ 4:44PM|#

I took down all the sober photos before I started with Reason. I was worried they wouldn't hire me if they saw me sans-booze.

|7.29.09 @ 4:45PM|#

John and Peter Suderman-

LOL! Priceless.

|7.29.09 @ 4:46PM|#

Peter,

Take her back to Niceville. DC sucks these days anyway. It is priced like New York but it is not New York. I loved the place when I was in grad school. Then I moved back here 10 years later and my city was gone. When they want 500K for a townhouse in Rockville, something has gone seriously wrong.

|7.29.09 @ 5:07PM|#

Americans who have health insurance, either private or public, are more likely to gain weight or become obese. . .

So they've proven having money for insurance premiums means you have money for food. Wonder what that study cost?

More affluence = more fatties.

Mike Laursen|7.29.09 @ 5:23PM|#

Correlation does not imply causality, even when the conclusion reached agrees with our libertarian prejudices.

Matt Welch|7.29.09 @ 5:36PM|#

When they want 500K for a townhouse in Rockville, something has gone seriously wrong.

Don't go back to Rockville!

|7.29.09 @ 5:37PM|#

"there was "strong" statistical evidence that being insured increases body mass index and obesity."

So, on the one hand, medical insurance, and especially a government-run program, is supposed to save us all, but it's also upping our chances of gaining weight and hiking up the cost of health care? Brilliant. I love the irony of this.

|7.29.09 @ 5:48PM|#

Matt,

The Rockville in the REM song is really Rockvile Maryland. And yes I wouldn't advice going back there either.

|7.29.09 @ 5:49PM|#

More affluence = more fatties.

Only at a societal level. In an affluent society, the less money you have, the less likely you are to be fat.

MattXIV|7.29.09 @ 6:23PM|#

Tbone,

The problem with that conclusion is that if you look at income in general, there's a negative correlation with obesity and people on public insurance are likely to have lower incomes than people with private insurance.

I wonder what specific things they controlled for in the regression.

One explaination that may fit is that people who are above the income level where they qualify for gov't benefits and below the income level where they can afford private insurance are likely to have jobs that involve more manual labor than average - people who have low enough incomes to qualify for benefits are more likely to be underemployed or unemployed and people who get employer provided health insurance are less likely to have jobs that involve manual labor.

Another alternative explaination is that people who are wealthy enough that they don't mind risking out of pocket expenses for unexpected treatment compose a significant enough chunk of the uninsured that the old more wealth/better health correlation is showing up.

Of course, if they controlled for income, the above points are moot.

|7.29.09 @ 6:36PM|#

Congrats Peter. Every time Megan is holding a John Howard Kuntsler, you raise her a Virginia Postrel. Soon your bride to be will be looking at the suburbs in a more REASONable light.

Weight Loss|7.29.09 @ 7:04PM|#

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|7.29.09 @ 7:39PM|#

Reason Magazine: Where smart people waste their time writing about shitty studies.

Seems like they should exclude Medicare recipients, to control for weight gain in older people with reduced mobility and fixed dietary habits.

construction magazine|7.30.09 @ 7:30AM|#

|7.30.09 @ 8:10AM|#

It shouldn't be surprising if there is, in fact, some moral hazard to having health insurance.

TallDave|7.30.09 @ 11:56PM|#

All else being equal, under our system we should expect healthier people to be less likely to buy insurance, since they are being asked to subsidize less healthy people.

construction journals|8.7.09 @ 4:52AM|#

This Spring edition of the US Developers Journal features several builders taking big strides in the green building initiative. Cover spotlight on PN Hoffman revamping the DC waterfront with elegance and style.

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