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The War on Fat

Is the size of your butt the government's business?

Kelly Brownell won't talk to me. I can't say I'm surprised. He's miffed that I called attention to his weight at the beginning of a column I wrote last year after attending a conference on obesity at the American Enterprise Institute (AEI). It was an easy shot, I admit. But was it simply a "personal attack," as he complained in an e-mail message after I requested an interview for this article?

Surely it would be legitimate to point out that an anti-tobacco activist was a chain smoker, that an opponent of legalized gambling liked to play the slots, or that an anti-porn crusader was fond of dirty movies. So when a leader of the burgeoning war on fat, a Twinkie tax advocate who never tires of comparing Ronald McDonald to Joe Camel, turns up sporting an extra chin and an ample gut, noting those facts should not be considered out of bounds. And if Brownell does not like it when someone suggests he could stand to lose a few pounds, perhaps he should think twice about enlisting the government in his campaign to slim down millions of his fellow Americans. He would be on much firmer ground in objecting when people note that he's fat if he were consistent in treating weight as a private matter.

Then again, Brownell's portliness -- which he attributes to inactivity and overeating while he was working on his recent book about the "human crisis" created by inactivity and overeating -- could be viewed as Exhibit A in his case against the "toxic food environment." Here we have a professor of psychology at Yale, an expert on weight control frequently consulted by the press and invited to appear on television, who is reduced to using an old photo of his formerly thin self on the jacket of Food Fight: The Inside Story of the Food Industry, America's Obesity Crisis, and What We Can Do About It (McGraw-Hill). Worse, Brownell directs the Yale Center for Eating and Weight Disorders, which offers counseling to people desperate to lose weight. If anyone has an incentive to stay slim, you might think, he does.

In a sense, then, Brownell's paunch reinforces his argument that Americans have little real choice about what we eat, that we are prisoners of an environment in which food is too cheap, too tasty, and too convenient. Combine these ever-present temptations with meager opportunities for exercise, and you get the "epidemic" that Brownell and his allies decry: The federal government's survey data indicate that two-thirds of American adults are overweight, up from a quarter in the late 1970s. The overweight category includes the obese, who represented more than 20 percent of adults in 2001, compared to 12 percent a decade earlier. (These categories are defined by body mass index, which is weight in kilograms divided by the square of height in meters. If your BMI is 25 or more you're "overweight," and once your BMI hits 30 you're "obese.") Medical conditions associated with obesity include arthritis, gout, sleep apnea, diabetes, high blood pressure, heart disease, stroke, and various cancers. A recent analysis by researchers at the U.S. Centers for Disease Control and Prevention (CDC) attributed 400,000 deaths a year in this country to "poor diet and physical inactivity." When the study was published in March, Secretary of Health and Human Services Tommy Thompson emphasized that "poor eating habits and inactivity are on the verge of surpassing tobacco use as the leading cause of preventable death in America." Last year Surgeon General Richard Carmona declared: "I refuse to accept the spread of obesity...I am committed to advancing the prevention agenda...It will take all of us working together to find the solution to this growing problem."

One can argue about the magnitude of the problem that worries Thompson and Carmona. The 400,000 estimate -- which covers all diseases related to diet and inactivity, not just those stemming from excess weight per se -- is based on risk increases inferred from associations found in epidemiological studies. As a 1998 editorial in The New England Journal of Medicine noted regarding an earlier version of this calculation, "that figure is by no means well established. Not only is it derived from weak or incomplete data, but it is also called into question by the methodologic difficulties of determining which of many factors contribute to premature death." In any case, such death tolls obscure the risks faced by someone who is trying to decide whether the benefits of losing weight are worth the costs in terms of effort and forgone pleasure.

Two studies published in January 2003 give a clearer sense of the dangers associated with excess weight. One, reported in The Journal of the American Medical Association, found that white men in their 20s with BMIs of 45 or more (e.g., a man who is five feet, nine inches tall and weighs at least 305 pounds) live, on average, about 13 fewer years than men who are not overweight; the comparable figure for white women was eight years. By contrast, the merely overweight (with BMIs between 25 and 30) "lost" only a year or so. The other study, reported in the Annals of Internal Medicine, looked at life expectancy for 40-year-olds enrolled in the Framingham Heart Study. Among nonsmokers, it found, overweight men and women could expect to live about three fewer years than subjects who were not overweight. For obese 40-year-olds, the "years lost" rose to six for men and seven for women -- similar to the loss of life expectancy associated with cigarette smoking.

The health effects of extra pounds can be difficult to isolate, especially since overweight people tend to be sedentary and to eat poor diets. Although thin people who exercise seem to be the healthiest group, overweight people who are physically active are healthier than thin people who are not. Without plunging into the "fit vs. fat" debate, suffice it to say that what you eat and how much you exercise clearly have implications for your health and longevity. Even if they don't account for as many fatal illnesses as the CDC's estimate suggests, they do make a substantial contribution to disability and mortality.

The more important question is why any of this is the government's business. Granted that obesity is a health issue, why is it a public health issue? The answer from Brownell and like-minded activists is that the government must rescue consumers -- especially children -- from the environmental forces that make them fat, thereby rescuing taxpayers from the burden of obesity-related medical expenses. They propose to accomplish this mission through a combination of taxes, subsidies, censorship, and regulation. In his book Food Fight (co-authored by Katherine Battle Horgen), Brownell says "profound change is necessary." Among other things, the government must "change the basic economics of food," redesign cities so that "times, places, and incentives for people to be physically active [are] engineered into daily life," "prohibit marketing of products to children," "prohibit snack foods and soft drinks from schools," and "prohibit the operation of businesses selling food within a certain distance of schools." If legislatures fail to go along with this agenda, "litigation may be necessary."

The war on fat is the latest manifestation of a collectivist philosophy that says the government has a duty to protect "public health" by discouraging behavior that might lead to disease or injury. It also reflects an anti-capitalist perspective that views people as helpless automatons manipulated into consuming whatever big corporations choose to produce. The anti-fat crusaders want to manipulate us too, but for our own good. They seek to reshape us by reshaping the world.

Dining Fine

Before you dismiss this agenda as the pie-in-the-sky wish list of wannabe social engineers, consider the trajectory of the Twinkie tax, which has gone from reductio ad absurdum to serious policy proposal in just a few years. In a June 1994 newspaper ad that criticized proposals to sharply raise tobacco taxes, R.J. Reynolds said: "Today it's cigarettes. Will high-fat foods be next?" Anti-smoking activists traditionally responded to this sort of slippery-slope argument by insisting that cigarettes were unique, "the only legal product that when used as intended causes death." To suggest that anti-smoking measures might pave the way for attacks on cheeseburgers and ice cream, they said, was just silly.

Yet six months after R.J. Reynolds tried to scare people with the outlandish prospect of a tax on fatty foods, Brownell endorsed the idea on the op-ed page of The New York Times, citing the precedent set by cigarette taxes. He said "taxing foods with little nutritional value" would deter consumption and help raise money for bike paths, running tracks, and nutrition education. "Fatty foods would be judged on their nutritive value per calorie or gram of fat," he explained. "The least healthy would be given the highest tax rate."

Brownell was serious, and pretty soon people started to take him seriously. At the end of 1997, U.S. News & World Report picked what it dubbed the "Twinkie tax" as one of "16 Silver Bullets: Smart Ideas to Fix the World." The following 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 Brownell and a couple of other academics, she said, very few people were voicing support for the idea. One of them, it turned out, was Hanna Rosin. "It's too bad Brownell isn't more popular," she wrote.

By last year, TV commentator Morton Kondracke, the very embodiment of inside-the-Beltway centrism, was opining in his syndicated column that "a hefty tax based on the fat and sugar content of foods would discourage consumption, provide revenue for education programs...and recover some of the billions that obesity-related illnesses cost the government in Medicare and Medicaid outlays." He presented the idea as a sensible, moderate alternative to "allowing trial lawyers to get rich suing McDonald's, Wendy's, and Burger King."

Such endorsements may not constitute a stampede, but U.S. News, The New Republic, and Morton Kondracke are good barometers of what's considered part of mainstream political debate. It seems the Twinkie tax qualifies.

So far legislative proposals to implement the idea, including bills in New York and California, have not gone anywhere. But in his book Brownell plausibly argues that modest junk food taxes aimed more at revenue raising than behavior modification have a good chance of passing. Although Brownell wants the money earmarked for anti-obesity efforts, it's not hard to imagine a legislature welcoming this new source of revenue as a way to avoid spending cuts. "Small taxes with earmarked money...may be the way to begin," Brownell and co-author Horgen write. "This would introduce the concept to the public, and if the earmark programs were successful, higher taxes might be acceptable at a later time."

Ultimately, Brownell wants to combine the taxes with subsidies for fruits, vegetables, and other foods deemed healthy, achieving centrally planned prices designed to minimize weight, maximize nutritional value, and "thereby improve public health." Given that Brownell is undaunted by the complexity of this task, perhaps it's not surprising that he does not bother to make a persuasive case that price is an important barrier to healthier eating. Potato chips are cheap, it's true, but so are most fruits and vegetables. At my local Giant supermarket, green beans, apples, kale, and fresh carrots cost $1.99, $1.49, 99 cents, and 89 cents a pound, respectively. A 20-ounce bag of Utz potato chips goes for $4.19, or $3.35 a pound.

Anti-fat activists do not let such mundane facts obstruct their vision of food prices perfectly geared toward health improvement. In her 2002 book Food Politics, New York University nutritionist Marion Nestle, who agrees with Brownell that the government should be doing much more to fight obesity, notes that "it is not difficult to select a health-promoting diet...at quite low cost." Yet 24 pages later, she suggests that "the prices of fruits and vegetables...could be subsidized to compensate in part for the low economic added value of these foods -- just as is already done through price supports for dairy foods and sugar." Price supports, of course, make prices higher, not lower, but you get the idea.

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