Obesity Epidemic Calls for Measures Like Tobacco War

Posted April 13, 2005 at 5:31pm

Since 1964, thanks to taxes, lawsuits, social pressure and prevention programs, the percentage of Americans who smoke has dropped from 65 percent to 25 percent. It’s time to tackle obesity just as aggressively.

[IMGCAP(1)]Libertarians, the fast-food industry and advocates for the obese object to “nanny-statism” and discriminatory incentives to fight the obesity epidemic. But in all likelihood, we’ll need negative as well as positive pressure to slim America back down to a healthy size.

Lawsuits like the one pending against McDonald’s aren’t my preferred solution — they’ll likely benefit trial lawyers more than consumers — but taxes on the fat content of food would be useful, and so would higher insurance premiums for those who are overweight.

The life insurance industry does impose higher premiums for the obese, but not as large as it does for smokers. And the health insurance industry generally provides lower premiums on a limited basis only as a reward for participation in diet-and-exercise programs.

Obviously, we are not going to make people eat their Big Macs and Whoppers outside in the cold, as governments and landlords force smokers out. But charging extra-fat people extra when they can’t stuff themselves into one airline seat, as Southwest tried to do? Why not?

Obesity is not simply a private matter. Every week or so, a new study comes out showing that Americans are getting fatter and that the trend is progressively harmful to public health and the economy.

In 1991, only 12 percent of American adults were considered obese, according to U.S. government data. By 2001, that was up to nearly 21 percent, a 75 percent increase. Other studies indicate that 65 percent of the population is overweight and 30 percent is obese.

If those numbers are right, only 35 percent of adults are at or below a healthy weight. And 15 percent of children are overweight, double the number 30 years ago.

The health and economic effects of all this fat are daunting. Average U.S. life expectancy, which has been rising for more than a century, is poised to decline as a result. The annual death toll from obesity-related illnesses — diabetes, heart disease and certain cancers — is estimated at 300,000, rivaling the 400,000 who die from smoking.

A 2003 study by the Centers for Disease Control and Prevention estimated the annual cost of treating obesity-related illness at $93 billion, or 9 percent of all U.S. health costs. It estimated the cost for smoking-related illness at somewhere between 6.5 percent and 14 percent.

All citizens, regardless of weight, bear part of this cost through higher insurance premiums and extra costs for Medicare and Medicaid, including costs to pay for highly expensive bariatric surgery for the profoundly obese.

The obesity epidemic is a much-publicized phenomenon and the U.S. government is taking various steps to deal with it, most of them pioneered by former Health and Human Services Secretary Tommy Thompson, who popularized wearing a pedometer to promote physical activity.

The Medicare system last year broke decades of precedent in declaring obesity an “illness,” making some treatment and prevention programs eligible for reimbursement.

The Agriculture Department was somewhat less helpful this year in issuing a massive new set of nutrition guidelines that recommended, among other things, 60 to 90 minutes of daily exercise — so much that most people will give up before trying.

The health insurance industry also has been active in promoting incentives to lead healthier lifestyles, such as offering discounted health club memberships and dietary counseling.

Milwaukee-based Fortis Health offers a 15 percent “preferred rating” on individual health insurance policies based on a person’s body-mass index, as well as tobacco use and blood pressure.

But for group plans, the health insurance industry believes it is barred by federal law — and the threat of lawsuits — from discriminating on the basis of weight in setting premiums.

Companies do offer discounts — but only in the 10 percent to 20 percent range — when employees successfully participate in weight-loss programs offered to all those covered by an insurance plan.

The industry is plainly frightened at the rapid increase in demand for gastric bypass surgery, which costs about $25,000 and can lead to serious complications that cost even more.

About 140,000 such operations are performed each year on those who are 100 pounds or more overweight. Some patients have been said to “bulk up” to qualify for the surgery, and others have it more than once. Surely that ought to be limited by law.

In the meantime, life insurance companies do charge an average of 25 percent higher premiums when would-be policyholders are 30 percent or more overweight.

On the other hand, smokers customarily are charged 75 percent to 100 percent higher premiums than nonsmokers, even though obesity presents a risk just as great as smoking.

The American Obesity Association, an advocacy group, considers it unfair to offer financial incentives and disincentives to encourage weight loss. Obesity “is not a matter of economics,” one of its spokesmen says. “It’s a matter of biology.”

Conservatives in Congress, on the other hand, regard obesity as a matter of personal choice and want to protect fast food chains from lawsuits and taxes striking at fat content and calories.

There is a middle ground here: Obesity is sometimes a matter of biology, but mostly it’s a matter of choice. Most people choose whether to eat too much and exercise too little. They ought to be given every incentive, social and financial, to keep themselves healthy.

And the government should help, by adequately funding physical education for children, getting fatty and sugary foods out of school lunchrooms (and healthy foods in), and imposing taxes on fat and sugar.

As conservatives often say, if you tax something, you get less of it. Cigarettes used to cost 25 cents a pack. Now, in New York, they cost $8. We should try that with fat.