Time For Tubby Bye Bye?

Fat as a public health issue


Your weight is now a public issue. The U.S. Centers for Disease Control has declared, "In the United States, obesity has risen at an epidemic rate the past twenty years." Fat is news, too. Just four years ago, between the months of October and December, there were only 50 articles in magazines and newspapers focusing on obesity as a public health issue. During the same period last year there were more than 1,200. Statistics detailing the "obesity epidemic" are flying out of universities, think tanks, and government agencies. Obesity is allegedly responsible for more than 300,000 deaths a year in the United States.

Depending on your source, either three out of five or two out of three American adults are overweight. Children and adolescents waddle in at 25 percent. Poor diets are said to cause one out of every three cases of cancer, and Surgeon General Richard Carmona has estimated the U.S. economy loses $117 billion annually because people aren't eating right (though he also says that Type II diabetes, which is associated with being overweight, costs $132 billion a year alone).

To address the spreading epidemic of flab, the American Enterprise Institute (AEI) in Washington, D.C. organized a day-long conference yesterday to discuss "Obesity, Individual Responsibility, and Public Policy."

The audience of lobbyists and policy wonks was treated to dueling statistics from Dr. Frank Hu of Harvard, who argued that fat kills, and Dr. Glenn Gaesser, a professor of exercise physiology at the University of Virginia, who said that the real killer was sloth.

Hu cited reams of numbers showing a correlation between fat and both heart disease and cancer. Interestingly, Hu thinks that the famous Body Mass Index (BMI)—weight divided by the square of metric height—is a much less accurate guide to dangerous obesity than is waist circumference. Generally, a BMI over 25 means a person is overweight, and 30 or more indicates obesity. According to Hu, women whose waists are more than 35 inches around and men whose waists bulge to 40 are basically obese. Hu's conclusion: "Public health measures are urgently needed to curb the obesity epidemic."

Gaesser, the rail-thin author of Big Fat Lies: The Truth about Your Weight and Your Health, asserted that the "health risks of being fat have been exaggerated, and the health benefits of weight loss have been overstated." He countered Hu's statistics with data from the Cooper Aerobics Center showing that "obese men who are fit have the same risk of mortality as men with normal weight and less risk than do lean men." The health problem is not fat, it's lack of exercise. Gaesser argued that people can obtain most health benefits from exercising rather than losing fat, and cited data showing that it's easier to stick with an exercise program than a diet. His slogan is, "It's easier move more than to eat less." Bolstering Gaesser's data and pointing the finger of blame away from his industry, National Restaurant Association CEO Steven Anderson notes in the must-read newsletter Obesity Policy Report that "the amount of calories people are eating hasn't changed in the last 20 years."

Setting aside the dueling statistics, what, if anything, should the federal government do about America's expanding waistlines? As Michael Jacobson, executive director of the Center for Science in the Public Interest put it, "We live in a culture that supports sloth and gluttony. If the government is not willing to help them, who will?"

And the public health nannies think that Uncle Sam can do a lot. Some, like Yale University professor Kelly Brownell, are seriously suggesting that a tax be placed on fatty foods in order to raise their prices and provide revenue to offset the obesity-related costs to "society." Anti-flab activists like the CSPI also want, at a minimum, legislation requiring restaurants to put nutritional labels on their meals. Maine has already passed such a law. Longtime anti-smoking activist John Banzhaf, head of Action on Smoking and Health, is now shifting his focus to fat. He correctly notes in the Obesity Policy Report that there are two major reasons why obesity is increasing: "lack of physical activity and the growing proportion of fast food restaurants with super-size portions." Then he adds, "I don't think we can sue people to get more exercise and I don't think the government can order them to exercise. But we can sue fast food restaurants to provide clear and conspicuous disclosure" of nutrition information. In fact, he has already tried suing fast food restaurants on behalf of a couple of morbidly obese kids in New York. The Restaurant Association's Anderson responds that Banzhaf might just as well "sue couch manufacturers or go after remote-control manufacturers."

Fortunately, AEI invited the always reasonable University of Chicago law professor Richard Epstein to sort through the issues. Epstein first noted that, in general, we resort to the public health rationale when the government wants to stop an activity that can cause harm to third persons who cannot reasonably protect themselves. The classic case is forcibly quarantining someone who has a virulent disease. He then pointed out that it is a misnomer to call the increasing number of fat people an "epidemic," since being fat is not a communicable disease. With regard to nutrition labels, Epstein observed, "Most people pretty much know that eating ice cream is fattening."

So what's his solution? Instead of lawsuits, fat taxes, and endless lists of nutrition information, Epstein suggests that we allow employers, schools, insurers and so forth to "viciously discriminate against any person who is obese." He was joking about the "vicious" part, but his point is serious. First, this policy would impose the costs for being overweight on individuals, giving them stronger incentives to slim down. (I know from personal experience that such policies work. For example, I decided to quit smoking shortly after I got turned down for a job because I was a smoker.) Second, since most employers want a healthy workforce, it would give them an incentive to help employees control their weight, perhaps by doing things like restricting what's served in the company cafeteria, or offering exercise facilities.

The good news from the conference is that Surgeon General Richard Carmona, who just recently told Congress that if he could he would ban all tobacco products, seems disinclined to impose a fat tax or require labeling in restaurants. And he doesn't blame fast food for bulking up Americans. "Americans eat out an average of four times per week," he noted. "That means that there are 17 meals at home per week where they are making bad choices. And even with the meals eaten out, it's still our own decision."

What does Carmona recommend? "Every American needs to eat healthy food in healthy portions and get some exercise every day." I'd say that's about as much government meddling as we need on this issue.