Americans keep getting fatter. Can public policy help make them thinner?
We think it can, but government needs to create positive incentives for wellness, not punitive measures for poor lifestyles.
It’s a sensitive topic. On the one hand, no one disputes that our country’s obesity epidemic has a direct financial cost to society at large. Obesity-related health expenditures in the U.S. reached $75 billion in 2003, and taxpayers finance about half of all medical costs through Medicare and Medicaid. Weight gain, of course, is also driving the costly rise in type 2 diabetes.
But unlike other conditions, being fat is often viewed as the failure of individual will. According to this view, government should not intervene to help people who are responsible for their own condition.
We don’t agree that obesity, or being overweight, is strictly a matter of lifestyle. Experts on the topic emphasize that fatness is caused by a combination of genetic susceptibility and a toxic, obesity-promoting environment.
But that view still leaves open the broader question – what, exactly, should government do?
Lawrence O. Gostin, the Director of the Center for Law & the Public’s Health at Johns Hopkins and Georgetown Universities, addressed that question in a JAMA commentary (Jan. 3, 2007). He describes the pros and cons of eight different laws that could improve lifestyles and prevent obesity. Oddly, he doesn’t promote one over the other but allows readers to make their own judgments.
Most of the suggested laws are what I would call “punitive” – making someone or some entity do something they would rather not do. For example, drawing on the lessons from tobacco litigation, lawyers could use liability lawsuits against food companies to force them to make healthier products. Lawmakers could pass legislation to curb junk-food advertising directed at children; they could also tax unhealthy foods (a.k.a, the “the Twinkie tax”). High schools could remove vending machines. The most conspicuous – and Draconian – punitive measure of late was New York City’s decision to restrict trans-fats in restaurants (which Gostin notes could drive the market toward saturated fat).
My own view is that these anti-obesity measures, while well intended, are short-sighted and that government efforts – at the federal, state, and local level – are better spent on promoting wellness than on penalizing people or companies that contribute to fatness. I’ll use a personal example.
Our 5-year-old son is in kindergarten in the Boston suburbs. Exercise is important for him not because he’s overweight but because he has type 1 diabetes. His grade school, however, only has physical education class once a week, though it had been twice a week when his older sister enrolled three years ago. When I asked the principal why P.E. was only once a week – I believe it should be five days a week – he apologized profusely but said that budget cuts were responsible. We don’t live in the richest suburb in Massachusetts but certainly not the poorest, yet budget cuts are undermining our efforts to raise healthy children. How much does a P.E. class cost?
Now, our son also watches cartoons on TV in the morning, and I’m not thrilled with all the ads for sugar cereals; but I’m not outraged either. He’s exposed to unhealthy foods every time he goes into a restaurant, a supermarket, a movie theater, a bowling alley, or a friend’s house. It’s naïve to believe that censuring “bad-food” ads from TV will protect my child, and as he gets older, the temptations – for food and all else – will be even greater.
My point is that the government’s time and money would be far better spent doing something that I know will help not only my son but most every child in America: increase their daily exercise. That makes far more sense than a costly, protracted Constitutional battle in trying to restrict ads by food companies.
Similarly, high schools across the country have soft-drink and candy vending machines not because they believe these products are good for students but because they need the revenue to buy equipment for the science lab or uniforms for the sports teams. I’m all for public health officials trying to evict the vending machines, but I’d rather see government fund the schools with enough money so they don’t need the machines in the first place.
I fear that the “punitive approach” to anti-obesity legislation – taxes on junk food, censuring ads, prohibiting certain products – will be mired in legal battles, elicit cries of “Big Brother,” and probably fail in actually reducing obesity. These unhealthy foods are simply too ubiquitous – and too much in demand – to stem the tide.
A far better approach, I believe, is creating healthier communities – what Gostin calls the “Built Environment.” Local officials, he writes, “could limit the number of fast food restaurants, build recreational parks and bike paths, expand mass transportation, and provide incentives to stores that sell nutritious and affordable foods.” Other advocates of healthy communities cite the importance of paying for street safety – increased number of street lights and a greater presence of police – so residents feel safe to take walks, ride bikes, or play outside.
Healthy communities, in my mind, would also include more government money for after-school sports programs and, of course, P.E. classes.
Would these communities leave everyone trim and fit? Of course not. But by promoting wellness in a positive way, the government could help far more people than it’s now doing – and not fear the backlash from more heavy-handed measures. At some point, the dual epidemics of obesity and diabetes will break the health care system as we know it. Until then, let’s hope a government leader stands up and says, “Money spent on wellness is money well spent.”
-- James S. Hirsch