Nanny State

U.S. Government Fights Fat With Cash

But does it work?


Look out obese America!

You have assumed from smokers the mantle of Public Health Enemy No. 1, this time in the federal fight against fat and the bottom line.

Of course, federal lawmakers are coming after the nation's overweight to save them — from themselves — and they apparently want to spend a lot of money on this rescue operation.

Just how much isn't yet clear.

This week, a bipartisan group of U.S. representatives, including Wisconsin western district Congressman Ron Kind, introduced the Treat and Reduce Obesity Act,which would give Medicare beneficiaries and their health-care providers "additional tools" to treat and reduce obesity.

"We know how severe the health risks of obesity are, and the actual costs of care for obesity-related illnesses are just as alarming," Kind said in a statement. "This bipartisan legislation will help bring health care costs under control, by providing more tools for those trying to overcome obesity and lead longer, healthier lives."

Among its provisions, the bill would "allow" Medicare to cover additional obesity treatments such as prescription drugs for chronic weight management, which Medicaid already covers in more than 20 states. Weight-loss surgery is the only obesity treatment tool currently covered by Medicare.

The legislation also would require the Centers for Medicare and Medicaid Services to highlight Medicare coverage of intensive behavioral counseling for obesity for seniors and their doctors, and give CMS authority to "enhance Medicare beneficiary access to benefits for intensive behavioral counseling by allowing additional types of providers to offer this service."

THE BOTTOM LINE: A bipartisan bill making its way through the House would pump more money into America's growing obesity problem.

There's no doubt about it: Obesity is a huge health issue in America, with related health-care costs pegged at nearly $200 million.

A 2009 report titled, "The Future Cost of Obesity: National and State Estimates of the Impact of Obesity on Direct Health Care Expenses," estimates that "if current trends continue, 43 percent of U.S. adults will be obese and obesity spending would quadruple to $344 billion by 2018. The report was based on research by Emory University health-care economist Ken Thorpe, Ph.D., executive director of the Partnership to Fight Chronic Disease.

Thorpe this week teamed up with former Wisconsin Gov. Tommy Thompson, who served as Health and Human Services secretary under President George W. Bush, to urge policymakers to act expeditiously in fighting what they and many others define as an obesity epidemic.

Thompson, in the op-ed piece headlined, "Targeting Obesity with Health Care Reform,"warned, "We cannot afford to wait until patients are on Medicare to fight obesity. Rather, we need to encourage weight control over the course of patients' lives."

In other words, the government needs to save the increasingly average American from himself.

Thompson had some kind things to say about Obamacare and the potential for its applications, some things he may not have gone on the record to say when he stood by repeal of the contentious health-care act during his unsuccessful bid for U.S. Senate in 2012.

"Fortunately, we now have an ideal opportunity to implement reforms. The new health insurance exchanges created under the Affordable Care Act  can establish effective care coordination strategies to identify and treat chronic conditions earlier, addressing not just the immediate conditions but the underlying ones as well," the op-ed piece asserts.

Thompson and Thorpe argue Medicare can adopt the strategies, and the "benefits for both patients and taxpayers will be substantial."

Proponents of government intervention into a chronic condition now classified as a disease by the American Medical Association, say federal investments – whatever they may be – will pay off multi-fold over time.

Perhaps these prevention crusaders would be well served to dust off a 2009Congressional Budget Office report which shows preventative medicine – at least the kind the federal government likes to doctor – is rarely cost-effective.

Pound of prevention

How much would the Treat and Reduce Obesity Act, or TROA, cost taxpayers? Nobody seems to know. Kind's office did not have cost projections. An official from the Congressional Budget Office on Thursday told Wisconsin Reporter there won't be a fiscal estimate until the bill is reported out of committee.

In an August 2009 letter to the House's Subcommittee on Health, the Congressional Budget Office broke down its analysis titled, "The Budgetary Effects of Expanding Governmental Support for Preventive Care and Wellness Services."

In short, "expanded governmental support for preventive medical care would probably improve people's health but would not generally reduce total spending on health care."

The problem, according to the CBO report, is that even when the unit cost of a particular preventative service is low, costs can accumulate quickly when a large number of patients are treated preventively. Such is the case in Wisconsin, where 28 percent of the population is obese, in a nation with a 26.2 percent obesity rate.

Thorpe argues institutional changes could save the United States $200 billion in obesity-related health-care costs.

The CBO report, however, notes that researchers who have examined the effects of preventive care "generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illnesses."

A research paper in the New England Journal of Medicine, after reviewing hundreds of previous studies on how preventive care affects costs, concludes that less than 20 percent of the services that were examined save money, while the rest add to costs.

A study by researchers from the American Diabetes Association, the American Heart Association and the American Cancer Society found use of highly recommended preventive measures aimed at cardiovascular disease would substantially reduce the projected number of heart attacks and strokes that occurred but would also increase total spending on medical care because the "ultimate savings would offset only about 10 percent of the costs of the preventive services on average."

Of course, as the CBO analysis points out, just because a preventive service adds to total spending doesn't mean it is a bad investment. Saving a life, improving someone's quality of life, most would agree, are inherently good things. But those who argue they do not come with a cost, or that the cost benefits eventually outweigh the initial taxpayer outlays, are ignoring critical research over time.

The CBO also notes the overlap often associated in services under federally mandated preventive programs.

"Consequently, a new government policy to encourage prevention could end up paying for preventive services that many individuals are already receiving – which would add to federal costs but not reduce total future spending on healthcare," the report states.

Ted Kyle, a pharmacist and chairman of the Obesity Society's Advocacy Committee, has a family history of obesity and has struggled with the disease.

He said the current health care system as it relates to overweight Americans is "insane."

"My health plan would not pay for obesity treatment. I paid for it out-of-pocket, and in doing so I forestalled the need for lipid-lowering medicines," he said. "When my condition (worsened), they happily would pay for those kinds of medicines but they were not happy to pay for the costs that would keep me healthier across the board."

Kyle said he understands the criticism of those who see the ineffective results of spending on wellness, preventive and treatment programs not grounded in evidence-based research. But Kyle believes the Treat and Reduce Obesity Act would be well worth the investment.

Freedom to be obese

Curbing obesity, as laid out in the bill, is about encouraging lifestyle changes. The CBO report underscores the challenge in government-funded programs to induce people to live healthier lives.

"Even successful efforts might take many years to bear fruit and could involve significant costs," the report states.

And, at some level, it does come down to fruit –that is, choosing fruit over fast food, say those in the individual rights camp. It's a question of choice, they say: The individual's or the collective's. Who makes those kinds of health care decisions is a growing matter of debate.

This article originally appeared on

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  1. And right next to the article on my screen is an ad for Papa John’s. Do I file a complaint against Reason or Google for this?

    And Treat And Reduce Obesity Act – TARO Act? They couldn’t come up with a better name like For Your Trimmer Waistline Act or something?

    1. How about TARD. Totalitarian Assholes Restricting Diets.

    2. TARO Act

      Now their evil plan becomes clear. They know that the disgusting slop that is poi is practically a weight loss drug.

      1. “poi can be known as two-finger or three-finger, alluding to how many fingers one would have to use to eat it, depending on its consistency”.


        1. Kind of like the classification system commonly used to allude to your mom.

          1. Not enough fingers

            1. Fisting was one thing, but when we got to Elbowing and Shouldering I knew I was way out of my league.

              1. Damn straight.

      2. Look, you can either get poi or white rice with your laulau. I’ll take the poi. You can eat it with the lomi salmon and the mac salad.

        1. So you are a fat Hawaiian. Got it. Will be over for laulau in a sec.

          1. Fat?!? No laulau for you; all you can have is Kalua pork. I mean, you wouldn’t want the laulau with that big juicy piece of pork fat inside it.

    3. FYTW Act….I like it!

      1. I didn’t catch that. I’d say I’m getting old, but then everyone would respond, “Getting?”

  2. OT: Madonna “Guns don’t kill people, people kill people”. Also, doesn’t think Sandy Hook is an excuse to be retarded. Amen material girl.…..un-rights/

    1. I guess it could be related since she also talks about eating french fries three nights in a row even though she’s fit as you can be. It’s physical activity folks.

    2. Fun Fact: Madonna is now older than Blanche was for the first three seasons of Golden Girls.

      I feel ooooold.

      1. Tell me about it. She looks a hell of a lot better than Blanche ever did at that age though.

        1. Wait, people are discussing Golden Girls on H&R?!

          1. Uh oh. No good can come of summoning such unsavoury elements.

          2. It’s all something about not fucking someone with Bea Arthur’s dick. Jeffrey Ross said it!

      2. Madonna, Prince, and Michael Jackson were born within three months of each other in the summer of 1958.

    3. Madonna? I hardly know what to say to that.

      What a pleasant surprise.

  3. Following the irrepressible law of government activity, after a year of TROA we’ll have spent twice the outlay, obesity rates will tick up another few notches, and the Medicare bureaucracy formed to administer the funds will be begging for upwards of a billion extra dollars from the Feds. And boosters will declare it an unparalleled success.

  4. And, at some level, it does come down to fruit?that is, choosing fruit over fast food,

    A wildly important idea got flown past in that sentence:

    Fruit is somehow seen as the “super-food.” It’s full of sugar. Sugar is the super-villain (pardon the Man O’Steel lingo). Sugar intake from fruit is better than from juices, candies or pastries because it’s bound up in fiber, to be sure. But it still much more closely associated with obesity, heart disease, cancer, diabetes and many other chronic diseases than fat is.

    IOW, there’s no point in spending for programs countering obesity until we are sure about what constitutes a healthy diet. The government already went off half cocked after the McGovern Commission and pushed out a lot of misinformation that got us as fat as we are.

    1. I dont think fighting obesity or good health is the point of this program.

      See Dweebston’s comment just above yours.

      “Fruit? Sugar? Fat? Diets? What the fuck are you talking about? Fork over the dough!” – Congress

    2. Fruit is not “full of sugar.” This table was convenient but I’m not committed to its accuracy. It would seem that the most sugar-dense fruit (grapes) pales in comparison to almost any candy (which admittedly could be cherry-picked) – and the fruit will have, as you said, all the fiber and other plant-related micro-nutrients that candy excludes during the refinement and extraction processes their ingredients undergo.

      Now you could probably get by without fruit for your whole life – our northern-latitude ancestors probably did just that much of the time, or at best they had seasonal access to it. But I wouldn’t point to fruit as a culprit for anyone but the severely metabolically deranged.

      1. I got to nurse my Type 2 diabetic wife through several days of not being able to see straight during a particularly tasty season for nectarines back in the 1990s. My threshold for what’s an acceptable level of sugar might not match up with yours. Still, sugar is the macronutrient that correlates best with (formerly known as “Western”) metabolic diseases.
        The table you provide looks accurate to me, and I like the inclusion of the right-hand column for total metabolic fructose. Unfortunately, the author did not include juices. Most people have no clue that drinking 12 ounces of OJ amounts to eating 3 or 4 oranges, but without the fiber, which is important.

        Frankly, I love fruit. When I say I treat it like dessert, I mean it. Lately I’m on a kick:
        Take a cup of heavy cream, a cup of frozen fruit (just fruit, no extra stuff) and 1/2 teaspoon of vanilla extract and make ice cream in a quart Ziplock bag. It takes about 10 minutes of hand-mashing inside a gallon Ziplock with about a pint of crushed ice and a few tablespoons of salt. The result is unbelievably rich ice cream.

        1. I think a big difference between fruit and candy or juice is that it’s hard for most healthy people to eat enough fruit to get a harmful amount of sugar. There’s a lot of volume and mass that goes along with the sugar, and the time it takes to chew and swallow it all allows the body to analyze the input and send the “full” signal early enough to deter you.

          I think I’ll have to try that recipe. Do you think it would work for fresh fruit, or is the frozen needed for congealment?

          1. Frozen is not necessary. Ripeness is key, for full flavor getting in the ice cream from the juiciness and softness.
            For really tart fruit I have been known to toss in a packet of Equal.

        2. Gotta try that! But it takes a lot longer to eat four oranges than it does to eat a candy bar and they contain about an equal amount of sugar.
          Most fruits have other nutrients which help metablolism, or at least ameliorate the effects of the fructose. Resveratrol in grapes, quercetin in apples, ursolic acid in apple peels, pterostilbene in blueberries, for some outstanding examples.

      2. From that chart, Honey is basically HFCS.

        I wonder how many of the people who freak out over HFCS use honey instead?

        1. Well, there is more to honey and HFCS than their sugar content. There could be significant differences in the margins. (Strictly hypothetically; I’ve not studied them but there are if nothing else subtle flavor and color differences even between different varietals of honey.)

          1. There have been several studies showing the efficacy of local raw honey in relieving allergies. It also thins mucous and has been shown to relieve joint pain.

        2. I think people think of honey as natural, and natural as automatically good.
          Lead is natural.
          Malaria is natural.
          Foxglove is natural.
          Poverty is natural.
          Doesn’t make them good.

  5. Tax excess body weight.

    Let the obese pay their fair share.

    1. Stop paying for others’ healthcare. Allow insurers and providers to charge whatever they want. Problem solved.

      1. Nice idea; but if we can’t stop paying for others’ , say, *education*, not sure it’ll get very far.

    2. Tax excess body weight.

      “Excess” would soon mean anything over 50 pounds!

    3. That just defeats the point, which is to avoid responsibility for lifestyle choices. I mean, sure, if you make everyone pay based on their behavior, you still get a huge government bureaucracy to manage. But government drones themselves can only vote so many times. There’s only so much for politicians in that.

    4. Since overweight people live longer than people with a normal BMI, should we also tax people with a normal BMI?

      Also, there is little or no evidence that if an obese person loses weight, it will extend his or her lifespan. However, getting active at any weight will increase lifespan and quality of life. So if you really want to properly motivate people, you will have to find a way of measuring activity, not weight.…..hink-again…..ur-weight/

  6. Recently there was an article on H&R positing that without the insane amount of government regulation we have endured for some past decades, the average household income today would be 330K/year instead of in the mid fifties. The more I thought about that, the more it reminded me of an interview I saw with an Italian lawyer years ago.

    He was explaining the ways in which organized crime in Italy was strangling the economy. He concluded his explanation by saying that the Mafia only took, it never contributes to production. They are a pure parasites.
    Businesses and productive people have to pay and pay and pay just to operate and do business. The instant the Mafia thinks you are producing enough to pay more, they up the price. If you fall out of favor with them or get caught saying mean things about them, they shut you down.

    I am going to take a wild guess that everyone here knows where I am going with this. If Tony were reading today he would already be speckling his screen with spittle, and pounding out a post exclaiming something about externalities and calling me a wealth apologist.

      1. I realize that was tounge-in-cheek, but I should point out that reasons 1, 9 and 10 are completely false.

        Trading one devil for another is not a good idea.

        1. I realize that was tounge-in-cheek, but I should point out that reasons 1, 9 and 10 are completely false.

          No doubt. Note the video is called “Why the Mafia is Better than the State,” not “Why the Mafia is Desirable.”

          Trading one devil for another is not a good idea.

          Isn’t that pretty much what elections are 90% of the time, though? 😉

          1. I think her point is that Organized Crime and the State are quite similar in important ways.

          2. Your point was well made and well taken.

          3. Funny, but bullshit. There is a reason why the areas dominated by organized crime do poorly relative to their peers — seriously, check out the economic statistics of Sicily and Calabria relative to the rest of Italy, or areas where the Russian mafia operates to above-board areas.

            Organized crime is far more arbitrary than the government, and there’s no reason to expect that they would not be so.

        2. #1 – apparently she’s never seen the Russian mob, or anyone from New Jersey.

        3. Trading one devil for another is not a good idea.


          Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would 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.

          A government that just stole some percent of your income and otherwise left us alone would be a huge improvement over what we have now.

          1. No shit.

            Someone has to Godwin at least one thread today, so here goes.

            My father had a friend who recently died. He was in the wehrmacht when he was young. He swears all he did was carry supplies to the other soldiers. Sure he did.

            A couple of years ago I was visiting and he showed up. Politics came up. He immediately began cursing the progressives.
            “The Nazis would mostly leave you alone if you didnt make trouble. Not these bastards! They are like the plague.”

            In other words, the progressives are worse than Nazis, from a guy who would know.

            1. Just look at the way absolutely everything has to have some political significance in some of their (more extreme, granted) intellectual circles.

            2. “The Nazis would mostly leave you alone if you didnt make trouble. Not these bastards! They are like the plague.”

              Well, assuming you weren’t Jewish, Gypsy, gay, Slavic, etc. or lived in a neighboring country

              1. What’s six million Jews among friends?

                1. What’s six million Jews among friends?

                  Reminds me of the old VW Bug joke.

            3. The progressives ARE Nazis. Well, fascists anyway. Fascism is socialism lite, AKA progressivism.

  7. “Fried Food Paradise II” just concluding on the Travel Channel. Didn’t see much fruit in here, although scallops and corn dogs are close to being fruit. Depending where you’re from.

  8. Why don’t we just eliminate corn subsidies? Then we’ll be spending less money and leaving the market to adjust to life after HFCS. As a bonus, it’ll help make Mexican agriculture more competitive, which could only help the illegal immigration problem.

    1. Damn, somebody else who just wants to wake the baby!

      Actually, I have an otherwise intelligent friend who literally gasps when I suggest killing the Farm Bill. He’s rather anti-corporate and anti-millionaire, but uses up all the air in the room when you talk about cutting off their subsidies.

      1. That’s because farmers are noble – like cops, firemen, and politicians.

        1. “noble – like cops, firemen, and politicians”

          So that’s why he got that prize…

          Maybe I should google what that “noble” thing is supposed to mean.

  9. “There’s no doubt about it: Obesity is a huge health issue in America, with related health-care costs pegged at nearly $200 million.”

    How about we put the burden of all that cost on the people whose foolish eating habits cause it?

    1. You mean like if everybody paid for their own stuff and their actions were only of consequence to their own finances? Crazy!

      1. Next, you’ll be telling me that rich old people should fund their own retirements.

  10. “if current trends continue, 43 percent of U.S. adults will be obese and obesity spending would quadruple to $344 billion by 2018.

    This sentence is missing a closing quotation. Also, I’m pretty sure that about 20% of the $344 billion in obesity spending goes to McDonalds.

  11. It is true that obesity i son the rise in the U S define and is becoming a huge health issue.If not controlled now it might just take the shape of a forest fire.Health care should be taken care by the government as they are the only people who are equipped to tackle such a situation.Therefore a right step is needed by the policymakers to act expeditiously in fighting what they and many others it as an obesity epidemic.So I feel we should all get together and give a thought to this health problem and not think that we are paying someones bill.We all live in a society and want to make it a better and healthy place for our children to live in.

  12. “But you have to admit it’s encouraging that they’re aware enough of the POLITICAL upheaval they’ve created that they’re kicking it down the road.’

    I think that scans mo betta, FoE.
    To be clear, I don’t think they give a shit so long as they suffer no political damage from it.

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