Again, With Feeling: Thinner Is Not Cheaper

Jacob Sullum | September 10, 2009

In a long New York Times op-ed piece, food journalist Michael Pollan argues that "our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform...the food industry." He says Big Food encourages people to eat too much of the wrong stuff, which raises health care costs by promoting diet-related disease. (Although Pollan says "there's lots of money to be made selling fast food," he never considers whether consumer choices, as opposed to corporate mind control techniques, might help explain why this is so.) Pollan concludes that controlling medical spending will require a soda tax, "a federal campaign to discourage the consumption of sweetened soft drinks," "school lunch reform," restrictions on food marketing, an overhaul of farm subsidies, and "the development of regional food systems."

I'm all for eliminating agricultural subsidies (as opposed to shifting them toward nutritionally and ideologically correct producers, which seems to be more like what Pollan has in mind), and I have no problem, in principle, with trying to improve school lunches. The rest of Pollan's ideas offend my libertarian sensibilities, but I'd like to focus on his fiscal claim: Is tackling obesity a good way to control health care costs?

First it should be noted that Pollan does a lot of double counting when he totes up the medical expenses attributable to overeating. He claims "we're spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet." That first number is based on the difference between the annual health care costs of obese people and the annual health care costs of thin people. The vast majority of that money goes to treat diseases associated with obesity, not obesity itself. Hence the $147 billion already includes much of the $116 billion spent on diabetes and the "hundreds of billions more" spent on cardiovascular disease and cancer. In fact, to the extent that the latter three conditions are associated with obesity, the first number already accounts for them. Pollan uses the additional numbers to reinforce his claim that "the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained...by our being fatter." But in this context they are big fat red herrings.

According to the study that generated the $147 billion estimate, obesity accounts for about 10 percent of health care spending, which hardly makes it "the elephant in the room" of health care reform, as Pollan claims. But even this figure is misleading, because it is based on a comparison of annual costs. As I have pointed out before, obesity is associated with higher annual health care costs but lower lifetime costs, because obese people tend to die earlier than thin people (or those who are merely "overweight"). The upshot is that reducing obesity will, over the long term, raise health care costs, exactly the opposite of what Pollan is claiming. You can, of course, argue that reducing obesity is nevertheless a good thing, that extra years of life should be welcomed, instead of being seen as an added burden on the public treasury. But that is not the argument Pollan is making.

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|9.10.09 @ 12:33PM|#

When you have an organic hammer, everything looks like a fast food nail.

@|9.10.09 @ 12:35PM|#

Pollan concludes that controlling medical spending will require a soda tax, "a federal campaign to discourage the consumption of sweetened soft drinks," "school lunch reform," restrictions on food marketing, an overhaul of farm subsidies, and "the development of regional food systems."

Statements like this one help to explain why Washington is overrun by lobbyists. Food producers and restaurants must fight on two fronts: their competitors and their own government.

Vines & Cattle|9.10.09 @ 12:40PM|#

Here's what drives me nuts about Pollan....

His argument is rightfully "legislation, bureaucracy, and their unintended consequences are what got us in this mess!"

Thus his solutions are always "more legislation, bureaucracy will get us out of this mess! What unintended consequences?"

ARGH

Xeones|9.10.09 @ 12:42PM|#

I liked The Omnivore's Dilemma. It pretty unequivocally blamed subsidies and other government interference for the horrifying state of the American food industry. It's a shame Pollan has decided that government intrusion is the only cure for earlier federal misdeeds.

PR|9.10.09 @ 12:42PM|#

"school lunch reform,"

yo, fuck soyburgers!

Xeones|9.10.09 @ 12:43PM|#

ARGH Vines & Cattle beat me to it. But, yeah, it's kind of maddening.

|9.10.09 @ 12:48PM|#

|9.10.09 @ 12:50PM|#

Yeah sugar taxes are no doubt going to join ciggie and booze taxes to form an unholy triumvirate of sin taxes.

Normally, the only groups of people in society who deliberately take advantage of people with addiction problems are members of the mafia.

But I guess since the government's involved here that must mean it's for our own good... since the government never would be so callous as to take advantage of people who are addicted to sugar, booze or nicotine by taxing them through regressive taxation.

Right? Right??

Joe M|9.10.09 @ 12:51PM|#

Isn't that pretty much what's happening in every aspect of our lives these days? Healthcare, bank crises, mortgages, etc....

creech|9.10.09 @ 12:51PM|#

How nice that the health conscious Mr. Pollan will get to drop dead at 95 of a massive heart attack - with no previous medical care of any kind needed, thus saving taxpayers a ton of money. And if he can do it, why can't you?
He'll just rustle up an armed government agent or two to make sure you comply.

|9.10.09 @ 1:00PM|#

I bet this same turd is opposed to risk based pricing of health insurance, which would actually charge obese people more in proportion to their expected expenditure. It's the same as a sin tax in result but not unfair and not mandatory.

I, Kahn O\'Clast|9.10.09 @ 1:01PM|#

The focus should be on quality of life not quantity of it. It's why I actually liked the idea of death panels when I first heard the term: A kind of "Logan's Run" kind of thing through which people could be done in just as they start to really decline, say, at 60 or so. Alas that was not what they had in mind. Oh well.

It would be great for everyone to be slim and beautiful and in great health and then turned into lean soylent green burgers at just the right moment.

*Sigh* Another utopian opportunity missed.

|9.10.09 @ 1:11PM|#

Thinner may not be cheaper, but it's much sexier. Instead of the government dictating what everyone can or cannot eat, maybe they should just have public service announcements that make clear what a bunch of ugly cows all these fat people are.

Instead of "this is your brain on drugs", the new ads could state "this is your body on Big Macs", and feature a grossly obese naked person chowing down on grub, as thinner members of the opposite sex runn away with screams of terror & disgust. Or perhaps they could just borrow the infamous bucket scene from Monty Python's "Meaning of Life".

|9.10.09 @ 1:12PM|#

These people don't care one whit about the health of the country or reforming healthcare. They just want to control other people's lives.

In a long New York Times op-ed piece, food journalist Michael Pollan argues that "our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform...the food industry."

How about if we take on and reform bloviating fucks who insist that we give up even more freedom so that we can advance their special personal agenda.

I'll leave it to the reader to fill in the blanks as to what "take on" and "reform" should mean in this scenario. I only insist that they have a fighting chance of escape.

|9.10.09 @ 1:14PM|#

This increased obesity trend has really brought down the quality of my life and therefore I fully support Pollan's forced diet plan. I just want people to get thin again so I can go to the club/bar and actually see some good looking girls again instead of (quickly becoming the average)the heffers with seven pounds of flesh busting out their jeans on each side. I remember back in the day you'd get a group of skinny chicks with one fat friend, now it seems the trend has gone totally the other way, a bunch of fat bitches with a skinny girl lost somewhere in the masses of flesh. Oh and by the way, "NO, FATTY, you shouldn't wear that mini dress, or those super tight jeans, or that midriff shirt..." I suspect we will shortly see a trend that closely correlates average weight and binge drinking, as more and more guys are forced to don thicker and thicker beer goggles.

|9.10.09 @ 1:22PM|#

How about we get this man to focus on the obesity of our government?

Maybe?

Maybe?

No...?

**Bitter b*stard**|9.10.09 @ 1:24PM|#

I remember back in the day you'd get a group of skinny chicks with one fat friend...

The problem my friend is that you have gotten older, as are the women you are looking at. Young women, who wouldn't have a thing to do with your (or my) old ass, are still for the most part skinny(-ish) until they get married.

|9.10.09 @ 1:25PM|#

charge obese people...

Define obese

They should just come out and what they really want to do. Tax fat people.

|9.10.09 @ 1:27PM|#

"""Define obese"""

Sure, we'll start with 300+ pounds. When that doesn't provide enough revenue, we will lower the bar. Knowing greedy government assholes, obese will eventually be defined as anything over 100 pounds.

But it's for the money, er, the kids!! Yeah that's the ticket

|9.10.09 @ 1:28PM|#

You know what the real problem is? Good TV. 20, 30 years ago, TV for the most part sucked. There were no DVRs, no original HBO series, etc. So people got out of the house and were more active. I say, we need to ban good TV! Go back to the golden age of The Love Boat and Manimal! This is the solution, I'm telling you.

|9.10.09 @ 1:40PM|#

No Epi,

It is people not smoking. Everyone I know who quit smoking gained weight. Smoking was great for the healthcare and retirement systems. It kept people thin and killed off 1/3rd of them in the 50s and 60s with a quick relatively untreatable disease.

kc|9.10.09 @ 1:41PM|#

Skinny people live longer so they are on the receiving end of Social Security many more years.
Whether it's eating too much or smoking, both "bad" behaviors end up saving the taxpayers and the private pension industry in the long run. I worked for a company in the mid-80's, who was considering a "stop smoking" workplace program, and had the actuaries run the numbers just for ha-ha's. Add'l costs to fund the company pension liability far outweighed the projected health care cost savings. Did the "stop smoking" campaign anyway.
Let the actuary jokes begin.........

|9.10.09 @ 1:42PM|#

The problem my friend is that you have gotten older, as are the women you are looking at. Young women, who wouldn't have a thing to do with your (or my) old ass, are still for the most part skinny(-ish) until they get married.

You know I'd have thought that as well. But in my area, keeping in mind that I do live in the fatest city around here, its the younger ones that are getting chunky. Maybe the ladies that got older did get a bit heavier on average, I just don't think its been as drastic as it has been with the generation that is just coming of drinking age. I'm not sure however, whether they really did get fatter, or if they simply come out in greater numbers now, and in clothing that used to be reserved for the finest of bodies. No doubt encouraged by the devil's tool that is this whole 'positive body image' movement. Positive body IMAGE? How about some positive body REALITY.

|9.10.09 @ 1:43PM|#

At least Mao had the guts to control what food his subjects were allowed to produce! We need our own Great Leap Forward!

|9.10.09 @ 1:44PM|#

Everyone I know who quit smoking gained weight.

Exactly. I always think of this with systemic horripilation when I see a very large person smoking. What happens if they stop? Would it be piano crate coffin time?

$|9.10.09 @ 1:45PM|#

Go back to the golden age of The Love Boat and Manimal!

Let's put fat people on a boat with a panther.

We televise it and everyone will be glued to their sets and get fat.

Then they go on the boat.

Problem solved.

|9.10.09 @ 1:58PM|#

If we're going to look at obesity and healthcare costs on a strictly financial level, then I think Sullum's anlysis is missing a potentially major component.

If obese people die too young, when they're still working, then they fail to pay into healthcare for the last 10 years or so (when premiums are high)... does this effect destroy the obesity is cheap thing?

|9.10.09 @ 1:59PM|#

"obesity is associated with higher annual health care costs but lower lifetime costs, because obese people tend to die earlier than thin people (or those who are merely 'overweight')."

On the other hand, people who live longer will pay more in lifetime taxes and contribute more to the economy. I'm starting to think on a cost/tax ratio, skinnier, non-smoking, moderate-drinking people do save money. I don't like pretty much everything Pollan says, but I think healthier people might be lower in costs on net.

|9.10.09 @ 2:06PM|#

Define obese

I don't have to, since I don't work for a health insurance carrier. I will let them each define it as they see fit and charge whatever the market will bear. We might end up with one carrier who charges more for smokers and another who charges more for obesity and another who charges more for alcoholism and another who gives discounts for people with high self esteem or a vasectomy or no history of breast cancer in the family or whatever.

|9.10.09 @ 2:08PM|#

I'm not sure however, whether they really did get fatter, or if they simply come out in greater numbers now, and in clothing that used to be reserved for the finest of bodies. No doubt encouraged by the devil's tool that is this whole 'positive body image' movement.

I concur. The fatter people get on average, the less shame they feel, emboldening fatties to the point where they feel confident to hit the bars in halter tops, waving those flabby arms in the air like they just don't care.

I think if we brought shame and smoking back (Justin Timberlake style!), we could keep good TV.

|9.10.09 @ 2:11PM|#

I should have discounts for knowing I'll never see a shrink, I'm not overweight, I don't smoke, and I don't drink much. I should get charged more because my daughter has congenital scoliosis and my wife has fertility issues that require drugs that are covered by my insurance. However that could be tempered by the fact we don't expect any oops babies. The actuary and underwriting to determine my rate would be very interesting to me as a consumer.

|9.10.09 @ 2:16PM|#

...in clothing that used to be reserved for the finest of bodies.

Do you know my ex-GF's older daughter? The stupid bitch thinks she looks good in midrifs (sp?). The thing is, if she would not try to dress like something she is not, then she might be worth a tumble...as long as I wasn't in homeport.

|9.10.09 @ 2:20PM|#

Lots of women, even relatively thin ones wear clothes they shouldn't. They need to find what accents the positives and hides the negatives. These lowrise jeans create love handles on girls that would not have them if they wore something else.

|9.10.09 @ 2:23PM|#

The problem my friend is that you have gotten older, as are the women you are looking at.

Only the first half of your sentence is correct. I've always preferred to look at girls in their late teens & twenties, regardless of my advancing age. But I no longer try to date them, because (a) I'm married and (b) I know I wouldn't stand a chance with them anymore.

|9.10.09 @ 2:24PM|#

Stop believing the bullshit propaganda. Quit eating carbs. Problem solved.

Rich|9.10.09 @ 2:26PM|#

"the development of regional food systems"

Assuming he doesn't mean farmer's markets, not sure I understand how this is supposed to control medical spending.

Tax fat people.

Tax 'em all -- let God sort 'em out. 8-(

Tomcat1066|9.10.09 @ 2:40PM|#

First they want to put their hand in my pocket and their nose in my bedroom. Now, they're keeping the hand in the pocket, but have moved the nose to my fridge.

They can all kiss my liberty loving ass, because when cheeseburgers are outlawed, only outlaws will have cheeseburgers!

|9.10.09 @ 2:42PM|#

I CAN HAZ OUTLAWZ CHEEZBURGER?

Old Mick|9.10.09 @ 2:45PM|#

"The problem my friend is that you have gotten older, as are the women you are looking at. Young women, who wouldn't have a thing to do with your (or my) old ass, are still for the most part skinny(-ish) until they get married."

Not in my neighborhood. Wall-to-wall ghetto fatties.

|9.10.09 @ 2:48PM|#

There was a recent Japanese study that said chubby people live longer than skinny people. And bony chicks are the worst.

|9.10.09 @ 2:50PM|#

Mr Sullum -

I would like to advise you to take another look at the lifetime costs of obesity. The PLoS study you cite, which gained a lot of media attention, uses data from the Netherlands, which may or may not be representative of the United States. They found that obesity's annual costs were offset by reduced survival.

In an article estimating the lifetime costs of obesity, Finkelstein et al (Obesity, 2008) found positive lifetime costs. This study (of which I am a co-author) found that the reduced survival associated with obesity is not enough to offset the annual medical expenditures associated with obesity. Overweight, however, was found to be no different than normal weight.

|9.10.09 @ 3:05PM|#

You can, of course, argue that reducing obesity is nevertheless a good thing, that extra years of life should be welcomed, instead of being seen as an added burden on the public treasury. But that is not the argument Pollan is making.

Yeah, because that argument opens the door to consider whether people value health and longevity more than eating and drinking what they want. And the last thing Pollan and his ilk want is for the false god of individual choice to get its nose under the tent.

Dr. Charles Martin|9.10.09 @ 3:08PM|#

Cost and longevity issues aside, quality of life considerations alone are sufficient to recommend prevention of type 2 diabetes, which is now epidemic with 24 million Americans diagnosed with diabetes and an estimated 57 million with prediabetes.

We write extensively about related issues at http://dentistryfordiabetics.com/blog, especially the links between elevated blood sugar and gum disease that can interfere with diabetes control and significantly increase risk of serious health events such as heart attack, stroke and blindness.

- Charles Martin, DDS
Founder, Dentistry For Diabetics

Tomcat1066|9.10.09 @ 3:16PM|#

|9.10.09 @ 4:28PM|#

"""The actuary and underwriting to determine my rate would be very interesting to me as a consumer."""

Full disclosure of all activities and wanna be activites?

Say swimming becomes defined as a hazardous activity which your insurance would consider to establish your rate. Say you don't swim, but on vacation you decide to jump in the pool. Would you need to get a waiver or a add-on to your policy? Or are you shit out of luck if you hurt yourself in the pool?

I think trying to determine people's level of health risk is a stupid thing would usher in an era of full disclosure about your life, nothing could be private.

|9.10.09 @ 5:13PM|#

On the other hand, people who live longer will pay more in lifetime taxes and contribute more to the economy.

Not really. Most people are net tax consumers later in life, and don't hold jobs, or at least productive jobs.

Ask yourself this: If everyone dropped dead on their 65th birthday, would the deficit be larger, or smaller?

|9.10.09 @ 9:23PM|#

In all of these articles they constantly say "we're spending". Who, exactly, is "we"? If it's me meeting my deductible and the insurance company covering the rest, I don't see where anyone else needs to be involved.

Secondly, all this money is going to somebody. Doctors, drug companies, ambulance services, the folks who make the machine that goes "ping", someone is getting it. Wouldn't reducing health care costs reduce the amount of money all around?

Finally, there's a certain amount of evidence that living in a slight state of starvation increases your lifespan. Anyone here suggesting the government force people to starve so they can live longer?

Michael Ejercito|9.10.09 @ 9:48PM|#

Just slap price controls on health care and the problem will take care of itself.

|9.10.09 @ 11:16PM|#

Vines & Cattle:
His argument is rightfully "legislation, bureaucracy, and their unintended consequences are what got us in this mess!"

Thus his solutions are always "more legislation, bureaucracy will get us out of this mess! What unintended consequences?"
____________________
ARGH:

Isn't that pretty much what's happening in every aspect of our lives these days? Healthcare, bank crises, mortgages, etc....
____________________

By "these days" I take it you mean since before I was born (and I'm old enough I could have a daughter you could date without legal trouble).

Marie|9.11.09 @ 3:55AM|#

The thing few realize is that although obesity in itself does not cost, the fact is that obesity is a side effect, a symptom, of metabolic syndrome, which is responsible for heart disease, cancer, diabetes and possibly even Alzheimer's. So if the government stops promoting the food pyramid and subsidizing foods that are the cause of metabolic syndrome (sugar, corn, wheat) then not only would people be thinner, but the diseases that cause bankrupting medical bills would be largely eliminated.

|9.11.09 @ 1:15PM|#

"""Ask yourself this: If everyone dropped dead on their 65th birthday..."""

Run Logan run.

|9.11.09 @ 2:54PM|#

Finally, someone points out the obvious! I'm so sick of hearing about how smokers, boozers, and fatties are a drain on society. They consume more, they pay more sin taxes, and they die younger. Go yell at an old person.

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