April 07, 2005

Stand Up, Slim Down

The other day Jane Galt wrote on how the nation is losing the battle of the bulge. Obesity is widespread, and getting, um, wider, and our public health programs and well-meaning exhortations to diet and slim down aren't working. The solution, Jane says, it to shame these people into slimming down, to create the sort of strong social stigma that now surrounds smoking.

Well, perhaps she was kidding, but even so, it won't work. The good thing about creating a collective public frown towards smokers is that smokers can always get away from it. Smoking, after all, is just something people do, and they can always stop temporarily when in the company of carpers and tsk-tskers. Meanwhile, things like banning smoking in bars are relatively low-cost. (I've never understood smokers who complain about this. Yes, it's a pain in the ass to go outside, especially in the winter. But once you're out there, it's a prime opportunity to meet people you wouldn't otherwise meet inside the bar. Girls even! Provided there are girls who smoke. Which there invariably are.)

Being obese, alas, isn't so easy to hide, and for many people it unfortunately ends up becoming something they are, part of their identity, largely due to the already-strong stigma against fat people. Now you might say, "Eh, who cares? They should take better care of themselves, and if shaming them gets results, then shame away!" Nevertheless, there are real costs to making people feel bad about themselves—undue stress and anxiety, for one, which has its own attendant health problems.

That said, something obviously needs to be done about obesity. Libertarians may think that being fat is mostly (not always, but mostly) a choice, and find it offensive that the government would try to control people's lifestyles. But obesity leads to all sorts of health problems, and ends up taking money out of everyone's pockets—the costs run to from $70 to $100 billion a year, and even without public health care, all our premiums would go up thanks to those who are obese. But Jane's right: the conventional public health programs don't work. Getting the president to jog on TV and letting everyone else know how much fun jogging is doesn't work. We've tried it for years. Vladimir Putin's tried it. Nor will widespread dieting or prescribed exercise work: According to the NIH, people who follow strict low-calorie diets do lower their weight, but then gain it back afterwards.

No, the right thing to do is to restructure the whole weight-gaining environment in America. Use taxes and zoning to create economic incentives away from junk food. Regulate the shit out of food advertising. Ban vending machines from schools. Offer, as Phillip Longman once proposed, subsidies for fruits and vegetables. More PE in school. Programs targeted at the poor, who tend to suffer from higher levels of obesity. Heck, something simple like requiring that all elevators have signs letting people know that taking the stairs is better for the heart. One Philadelphia study found that this tripled the number of stair-users. That's six pounds a year, vanquished! It's quite easy. But the government quite obviously needs to focus on holistic environmental factors that affect everyone, rather than simply targeting obese people and trying to get them to change their lifestyle. We could all use healthier lifestyles, I certainly could. No need to discriminate by weight.

Then there's the drug issue. The New York Times reported the other day that companies were vying to cash in on the next wave of weight-loss drugs. Maybe that will work. But it's not optimal, and perhaps destructive. For one, every penny spent researching the genetic basis for obesity is one less penny researching the environmental bases. And the latter should be emphasized. Drugs will cost a lot, and raise health care premiums. Period. Meanwhile, exercise and proper nutrition offer a whole host of benefits, some of which can't be gained via a weight-loss drug. The reduction in stress, for instance. Indeed, I fear that once safe weight-loss drugs become in vogue, we'll lose all motivation to attack the environmental factors behind obesity and sedentary lifestyles, which is where the real progress ought to be made.
-- Brad Plumer 3:57 AM || ||