Is Mandatory Dieting and Exercise Next?


A new study published in the journal PLoS Medicine finds that changing four preventable risk factors could substantially increase average life expectancy and reduce disparities in life expectancy between ethnic groups in the United States. As ScienceDaily reports:

A new study led by researchers from the Harvard School of Public Health (HSPH) in collaboration with researchers from the Institute for Health Metrics and Evaluation at the University of Washington estimates that smoking, high blood pressure, elevated blood glucose and overweight and obesity currently reduce life expectancy in the U.S. by 4.9 years in men and 4.1 years in women…

Below is the number of years that would be gained in life expectancy in the U.S. if each individual risk factor was reduced to its optimal level:

  • Blood pressure: 1.5 years (men), 1.6 years (women)
  • Obesity (measured by body mass index): 1.3 years (men), 1.3 years (women)
  • Blood glucose: 0.5 years (men), 0.3 years (women)
  • Smoking: 2.5 years (men), 1.8 years (women)

Certainly these findings can be usefully publicized with the goal of influencing people and their physicians into making better lifestyle choices. The researchers, however, have other, potentially more coercive, goals in mind:

"It's important that public health policy makers understand that these behavioral and metabolic risk factors are not just personal choices or the responsibility of doctors," said Goodarz Danaei, a postdoctoral research fellow at HSPH and the lead author of the study. "To improve the nation's overall health and reduce health disparities, both population-based and personal interventions that reduce these preventable risk factors must be identified, implemented, and rigorously evaluated."

nanny state poster

"… not just personal choices…?" Back in a 2006 column looking at the ongoing erosion of the distinction between public and private health, I noted:

If the United States finally succumbs to universal government funded health care, health bureaucrats will no doubt justify their intervening in the exercise, dining, transportation, smoking, drinking, and recreational drug choices of Americans on the grounds that they are saving taxpayers money. We might all live longer, but we will certainly be enjoying it less. "There are lots of good reasons to do this kind of thing, but the questions it raises all have to do with the nanny state: Should the government be collecting this kind of information? Should it be intervening like this?" said Lawrence O. Gostin, who directs the Center for Law and the Public's Health at Georgetown and Johns Hopkins universities in the Washington Post last month. "You can imagine it getting to the point where you have a public health worker showing up at your door and asking, 'Did you remember to exercise, eat right and take your medication today?' "

Coming soon: Mandatory daily calisthenics outside your home so that the authorities can monitor your compliance?

For more on the totalitarian implications of public health see my colleague Jacob Sullum's superb feature article, "An Epidemic of Meddling."

NEXT: Reason Writers Around Town: Shikha Dalmia on Non-Violent Resistance to ObamaCare

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  1. “Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience.”
    ? C. S. Lewis

    1. It’s all bullshit, anyway. I don’t doubt that many of the voters supporting this crap have goodwill for others in their hearts (by any means necessary, of course), but the leaders by and large don’t. This is about consolidating and permanently entrenching a power base, nothing more. If they thought doing it as theocrats would work, they’d do that. There’s no principle or altruism here. At all.

      1. Altruism has nothing to do with trying to force anybody else to do anything to begin with.

        It is only altruism when someone voluntarily chooses to assist someone else in some way.

        1. Altruism is the underlying principle. What makes it evil is that this altruism is forced upon people. That fact alone speaks volumes. If it’s such a great and popular idea, why is compulsion necessary?

    2. “The modern state exists not to protect our rights but to do us good or make us good — anyway, to do something to us or to make us something. Hence the new name ‘leaders’ for those who were once ‘rulers’. We are less their subjects than their wards, pupils, or domestic animals. There is nothing less of which we can say to them, ‘Mind your own business’. Our whole lives are their business.” — C. S. Lewis

  2. Blood glucose: 0.5 years (men)

    6 months? Thousands of needles and gallons of blood drawn for 6 fucking months?

    I’m going to go eat a whole fucking cake.

    1. I once saw a study that claimed that, if you give up all delicious fatty food and eat melba toast for life, you can expect to live something like 3 months longer. Fuck you, health assholes.

    2. SugarFree: I believe the 6 month increase is the result of optimal compliance compared to usual compliance. For a diabetic, no compliance would substantially reduce one’s life expectancy.

      1. Oh. Damn. Now my hands are all sticky. With cake.

        1. Episiarch, you were right. They do want cake.

          1. I’m going to give Steve Steve your address. Expect a hairy, thudding knock in the dead of night.

            Followed by your screams.

        2. Time for a vodka & insulin screwdriver.

        3. should have had pie.;-)

          1. There wasn’t any cake, anyway

            /gratuitous Portal video game reference

    3. Of course, these numbers are meaningless when applied to individual health. My life expectancy doesn’t increase if everyone else quits smoking. How could this be? Maybe these are all purely personal choices which affect only the individual’s health.

      1. Obviously, you have not heard of the dangers of third & fourth hand smoke.

      2. The argument is that, if stopping behavior A results in a .01% lower chance of horrible death B, then forcing everyone in the society to stop A will save lots of people from B. It’s an evil argument.

    4. Smokers have 2.5 years less life expectancy? Geez that’s not much. Makes it a lot harder for me to quit. And that’s 2.5 years off the part of your life that generally sucks anyway. It’s not like you lose 2.5 years from your 20’s or 30’s.

      1. No. These are averages for everyone. Some people smoke, some don’t. If the ones who smoke would all quit, the average for everyone would go up 2.5 years.

        Suppose 1/3 of everyone smoked. Suppose the non-smokers all died at age 80 and the smokers all died at 70. The average age at death for everyone would be about 77, a three- year difference, even though individual smokers in this case cut their lifespans by ten years.

        1. Gotcha. Not enough coffee yet.

        2. Still, I’ll enjoy my pipe and forgo those last 10.

          1. +1. The sad part is that the nanny statists just can’t comprehend that. They can’t grasp that someone would trade off a certain amount of future longevity in return for present enjoyment.

  3. Tony, Chad, and MNG will LOVE this line of thinking.

  4. “To improve the nation’s overall health and reduce health disparities, both population-based and personal interventions that reduce these preventable risk factors must be identified, implemented, and rigorously evaluated.” [italics added]

    Goodarz Danaei, Eric B. Rimm1, Shefali Oza, Sandeep C. Kulkarni, Christopher J. L. Murray and Majid Ezzati1 can all line up to the left and patiently wait their turn to kiss my royal American ass.

    1. “We have our next 6 contestants for The Running Man!”

  5. You left out the best line in the whole paper:

    An essential first step in achieving the aggregate and disparity promises of prevention is to discard a dominant view in the US that behavioral, dietary, and metabolic risk factors are either personal choices and responsibilities or are in the domain of clinical practice and hence only a subject of health education and physician advice for individuals.

    Silly people, thinking that diet and exercise choices — and their consequences –are your own. You need to be re-educated.

  6. Note to self: more guns and ammo.

    1. Note to self:

      More whiskey and cigars.

      1. Note to self:

        More hookers and blow.

        1. Note to self:

          More notes to self.

        2. I’m reasonably certain hookers and blow would reduce my life expectancy dramatically, especially if my wife found out. And I don’t even need an academic study to figure it out.

          1. Especially if you first stocked up the house with the guns and ammo.

        3. Note to self: more dots. More dots. Don’t see enough dots. More dots.

          OK- stop dots.

  7. I’m going over to my good friend Winston Smith’s at exercise time. It’s important, especially now, that we’re all able to grab our ankles.

  8. If you guys don’t take care of yourselves, how the hell are you going to work to pay all those taxes to support free health care and public sector pensions? The state has a right to worry about the health of its beasts of burden.

  9. Awesome “motivational” poster, R. Bailey. Thanks!

  10. Don’t collectivists engage in any unhealthy behavior? Why aren’t they worried that prohibitions will affect them, too?

    1. Because rules are for little people.

    2. Our Masters won’t be participating in the Single Payer system for the Little People, creech. The Master Health Plan won’t have all these niggling rules, which are only for the little people.

      Our Masters work so hard, and are so smart, that they need their little diversions, see?

  11. Silly Government! If these people live past retirement they are going to suck up health care resources. It’s time to enourage Bloomin’ Onions, B.A.S.E. jumping, Russian Roulette, and ‘The Brave Little Toaster bathtub toy’.
    We should also impose a special 80% estate tax on all people who are overweight or ever smoked a cigarette.

  12. It won’t be “mandatory” per se, but you can bet that there will be all sorts of taxes or surcharges or whatever for fat people, smokers, people who can’t show regular attendance at health clubs, people whose metabolic indicators are sub-par, etc., in Single-Payer nirvana.

    And its all good, because the Total State can do any damn thing it wants, as long as the IRS enforces it with a “tax”. Right?

    1. It’s a “contribution,” RC. It isn’t a tax unless there’s a legal challenge. Besides, compliance, like filing your income tax forms, is “voluntary.” The Tax Czar says so.

    2. Just do your patriotic duty and pay more taxes.

  13. Obama should be forced to take daily piss tests for nicotine in the blood stream. For everyone he fails, 1,000 regulations are rescinded.

  14. “You can imagine it getting to the point where you have a public health worker showing up at your door and asking, ‘Did you remember to exercise, eat right and take your medication today?’ “

    ‘Oh, and how’s your thinking? We don’t want any depraved thoughts shortening your life. You do understand, don’t you?’

  15. Well, it’s a good thing our medical records are private and the government would never access our records in order to determine whether or not we were as healthy as we should be, and whether or not we should be paying more taxes based on our physical condition, right?


    Your Medical Records Aren’t Secure

    We are so fucked.

  16. Coming soon: Mandatory daily calisthenics outside your home so that the authorities can monitor your compliance?

    It’s called gym class, Ron.
    The Industrial/Education Complex has required it for years.

    1. My gym teacher in elementary school was a beast. She made us recite definitions and march in unison. Good times 🙂

      1. We played “bombardment” (dodge ball). Got a concussion and blacked out when ball hit head and head hit brick wall. Gym teacher never called a doctor and the parents laughed it off. Should have sued the bunch for malpractice.

  17. Coming soon: Mandatory daily calisthenics outside your home so that the authorities can monitor your compliance?

    I’m actually OK with this as long as I can do mine punching politicians repeatedly in the kidneys, diaphragms, and floating ribs.

    Hey, working the heavy bag is good cardio, right?

    1. Is that a Nancy Pelosi reference?

    2. The calisthenics will be indoors so compliance can be monitored via the telescreens.

  18. The Jezebel ladies respond to exercise recommendations.

    There’s one choice comment that wistfully pines for government mandated exercise time in the workplace (comes with a side of “tee-hee-guess-I’m-a-fascist”).

    1. And I’m sure that furniture movers and warehouse workers would just love some government-mandated exercise time in their workplaces. Idiots.

  19. Actually, the easiest way to reduce “health disparities” would be to encourage white males to eat fatty and high-calorie foods and not exercise, so that we’d get sick and die earlier.

    1. But those white males contribute disproportionately to the tax revenue stream, so they need to be kept healthy until they retire.

      Then the Barcaloungers and cake will become mandatory.

  20. Why would we want people to live longer? Won’t that just cost more? It makes alot more sense to have the majority of people die quickly from a heart attack then to have to pay for bypass surgery, etc.

  21. Is Mandatory Dieting and Exercise Next?

    You tell me, asshole. Mandatory health insurance was YOUR idea.

    1. IF: You’d like my version a whole lot better than the one we’re going to get.

  22. You will jog for the good of the state!

  23. Ron,

    Have you seen the actual analysis? High Blood Pressure and Smoking are real and well known risks with Relative Risks (RR) in the double digits. Obesity RR’s are in the low single digits near or below the level of statistical significance. The greatest RR’s for weight are a t the very low and very high BMI’s. About 25% of men are smoker and about the same number are above a BMI of 30. This study pins about as much life span reduction for both. What are they smoking?

  24. How do you mandate daily exercise?

    Just think Camazotz.

  25. Coming soon: Mandatory daily calisthenics outside your home so that the authorities can monitor your compliance?

    That’s just silly. We have the technology to put a camera right inside everyone’s home.

  26. So how have so many polities for so long socialized medicine without comparably socializing lifestyles?

  27. I wonder why conservatives are all about smaller government, and tout that they want less government involvent in our personal freedoms – yet when it comes to morality issues like gay marriage or online poker, they are all about big government enforcing laws.


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