Weight Problem


Last year The New Republic's Hanna Rosin chided "alarmist" commentators who had criticized the notion of using taxes to encourage better eating habits. Aside from Yale obesity expert Kelly Brownell and a couple of other academics, she said, very few people were taking that idea seriously.

One of them, it turned out, was Hanna Rosin. "It's too bad Brownell isn't more popular," she wrote. The rest of her article was devoted to explaining why a "Twinkie tax," as U.S. News & World Report had dubbed the psychology professor's scheme, was not such a crazy idea after all.

If Rosin's aim was to reassure people who worry that a government campaign against snack cakes and cheeseburgers could be around the corner, she missed her mark. After all, endorsements in respected journals of opinion are the sort of thing that can give credibility to policy proposals that might otherwise seem outlandish.

Declaring a crisis also helps. At the American Obesity Association's first annual conference, held this month in Washington, excessive weight was described as "a national emergency," "a worldwide epidemic," and a "ticking time bomb in the health-care system." A Twinkie tax was one of several possible solutions discussed at the meeting.

That does not necessarily mean that everyone at the conference was ready to endorse Brownell's vision of a world in which fried pork rinds are heavily taxed while fruits and vegetables are subsidized. But the attendees did agree that obesity is, as Surgeon General David Satcher put it, "a major public health problem…that deserves much more attention than it receives."

"Attention," of course, is a euphemism for government intervention. The incantation of the phrase "public health" is supposed to stop you from wondering whether that intervention is justified.

Here is how the magic works: If you've got a gut hanging over your belt, that's your business. If a lot of people have guts hanging over their belts, that's the government's business.

The experts say most Americans are overweight (fat) and more than a fifth are obese (really fat). One widely cited estimate puts the death toll from poor diet and physical inactivity at 300,000 a year. A report released at the obesity conference estimated that treating 15 conditions associated with excessive weight, including diabetes, heart disease, and various cancers, costs more than $100 billion a year.

To public health bureaucrats like David Satcher, big numbers naturally imply big government. But it's not clear why simple multiplication should transform something as personal as what you eat or how much you exercise into a political issue.

Nor is it clear how the obesity experts want the government to deal with fat people. On the one hand, obesity is said to be a disease, implying that individuals cannot be expected to control their food intake or activity level.

That view is reflected in the suggestion, heard at the obesity conference, that the government require health insurers to pay for weight loss programs, which would mean forcing skinny policy holders to subsidize chubby ones. It is also reflected in the claim that "much work is needed to combat the social stigma and discrimination overweight Americans face," a position that a Knight Ridder report attributed to "some experts" at the conference.

On the other hand, Brownell's Twinkie tax proposal assumes that fat people respond to price incentives, meaning that they can control their behavior. If so, "social stigma and discrimination" may be just the ticket to discourage their sloth and gluttony.

Indeed, if we're serious about tackling this "major public health problem," perhaps the government should pay for propaganda aimed at further stigmatizing fat people, thereby encouraging them to shape up. This is the strategy public health officials are pursuing with smokers.

Brownell, who looks forward to the day when junk food purveyors such as McDonald's face "the same social climate that has enveloped the tobacco companies," blames obesity on "a toxic food environment," which he proposes to clean up with censorship of irresponsible advertising. Public service announcements that depict fat people as inconsiderate slobs who impose costs on the rest of society presumably would complement that approach.

Another solution discussed at the obesity conference, according to Knight Ridder, was "lengthening the school day to give kids more exercise." Why stop there? Why not mandate phys. ed. for grownups, too?

I await the New Republic article exploring the merits of the idea.