At a "Harvard Thinks Big" confab earlier this year, evolutionary biologist Daniel Lieberman offered his own bright idea for tackling the nation's obesity epidemic. Merely medicating it won't do, he said, and education is well-meaning but ineffective. His answer? "Coercion. … We should start telling corporations what to do." But not just corporations. He also advocated – "to hearty applause," the Harvard Gazette noted – "requiring people to exercise."
Lieberman's idea sounds radical. For now. But in fact, he is (pardon the term) only slightly ahead of the curve. Yale's Kelly Brownell has long advocated taxes on Twinkies, soda, and other high-sugar snacks. That idea has gained support from New York Mayor Michael Bloomberg, along with the mayors of Philadelphia, Baltimore, and state lawmakers in numerous states. The New York Times' Mark Bittman likens foods with added sugar to tobacco, and asks "How do we regulate the consumption of dangerous foods? … We need the government on our side. It must acknowledge the dangers caused by the most unhealthy aspects of our diet and figure out how to help us cope with them." Bittman's colleague, Frank Bruni, agrees. In a column lamenting America's spreading waistline, he concludes that "we need to rethink and remake our environment much more thoroughly."
Well. Like the cavalry riding to the rescue, the Institute of Medicine has just unleashed a report – 478 pages, corpulent in its own right – addressing the topic. It advances the notion that obesity is not an individual shortcoming requiring voluntary personal reformation, but a societal problem requiring compulsory systemic change. So in addition to exposing what it calls "obesogenic environmental forces," the IOM proposes a wide range of government policies to combat them, from the sensible (provide healthy food in the public schools) to the seriously alarming (let government dictate the recipes for commercial foods).
Conspicuously absent from the recommendations? Any significant redress for those government policies that have contributed to the problem in the first place. Take dietary advice. According to the Harvard Gazette, "Our ancient ancestors' diet was heavy on tubers, fruits, and vegetables, and lean meat from game animals. In fact, Lieberman said, if you look at what our ancient ancestors likely ate, you'd wind up with something like the dietary advice coming out of [the Harvard School for Public Health]." You certainly would not wind up with a recommendation that you carbo-load by eating, oh, six to 11 servings of bread, cereal, rice, and pasta every day. Yet that is precisely what the federal government's food pyramid advised from 1992 to 2005. By remarkable coincidence, that time frame happens to overlap the period of the greatest growth in obesity rates.
The IOM report does mention building more sidewalks and scrutinizing federal agricultural policy. But Dan Glickman – a former agriculture secretary who chaired the panel producing the IOM report – rejects the idea of ending government subsidies for the makers of high-fructose corn syrup. "There is no evidence subsidies contribute to obesity," he says. Yet the IOM evidently thinks more subsidies could help reduce obesity, because it recommends subsidizing fruit and vegetable crops. In the event of a government failure, apply more government directly to the wound.
All this sturm und drang seems odd, or at least oddly timed – because the obesity epidemic has actually leveled off. Rates of obesity in men have remained largely stable for the past eight years. Among white women, obesity has not risen for the past 12 years. And among black and Latino women, obesity has risen only slightly – and "that increase mostly occurred early in that 12-year period," reports The Washington Post.
So if obesity rates have not changed significantly, what has? Government's share of total spending on health care – which was 41 percent in 2007 –is expected to exceed 52 percent by 2019, whether the Supreme Court upholds the Affordable Care Act or not. And the government says obesity costs a lot of money: more than $150 billion a year, by some estimates.
Those estimates are wildly inflated by the inclusion of factors such as "the value of income from decreased productivity" and "the value of future income lost by premature death." Yet there are genuine costs induced by illnesses resulting from obesity, such as diabetes. And the government does spend billions of dollars – principally through Medicaid and Medicare – to treat them. Since Jones is being forced to pay for Smith's medical care, goes the argument, Smith should be forced to stay fit and trim, lest he become a burden on Jones. And since he cannot be expected to do so on his own – owing to "obesogenic" factors and whatnot – he should be made to. Even through compulsory exercise, if that is what it takes.
Of course the coercionaries could leave Smith alone, if they simply left Jones alone too. But this solution never seems to occur to them, does it? And why should it? It would require a certain degree of humility and restraint. Besides, they already know the solution: In the event of any government failure, apply more government directly to the wound.
A. Barton Hinkle is a columnist at the Richmond Times-Dispatch, where this article originally appeared.