Krugman on obesity

Paul Krugman had a couple of op-ed's on obesity in the New York Times recently. From "Girth of a Nation" (via Smirking Chimp)

I've been looking into the issues surrounding obesity because it plays an important role in health care costs. According to a study recently published in the journal Health Affairs, the extra costs associated with caring for the obese rose from 2 percent of total private insurance spending in 1987 to 11.6 percent in 2002. The study didn't cover Medicare and Medicaid, but it's a good bet that obesity-related expenses are an important factor in the rising costs of taxpayer-financed programs, too. Fat is a fiscal issue.

(Yes it is: and it's tied, like so many other seemingly single issues, into a web of a multitude of others, like self-esteem and mental well-being, "free market" values and government oversight, education priorities, etc etc et al ad nauseaum)

There is, understandably, a movement to do something about rising obesity, especially among the young. Bills that would require schools to serve healthier lunches, remove vending machines selling sweets and soda, and so on have been introduced in a number of state legislatures. By the way, Britain - with the second-highest obesity among advanced countries - has introduced stringent new guidelines on school meals.

But even these mild steps have run into fierce opposition from conservatives. Why?

In part, this is yet another red-blue cultural conflict. On average, people living outside metropolitan areas are heavier than urban or suburban residents, and people in the South and Midwest are heavier than those on the coasts. So it's all too easy for worries about America's weight to come off as cultural elitism.

More important, however, is the role of the food industry. The debate over obesity, it turns out, is a lot like the debate over global warming. In both cases, major companies protect their profits not only by lobbying against policies they don't like, but also by financing advocacy groups devoted to debunking research whose conclusions they don't like.

And a week later, this is "Free to Choose Obesity?"

How can medical experts who see obesity as a critical problem deal with an ideological landscape tilted in the direction of doing nothing?

One answer is to focus on the financial costs of obesity, and the fact that many of these costs fall on taxpayers and on the general insurance-buying public, rather than on the obese individuals themselves...

It is more important, however, to emphasize that there are situations in which "free to choose" is all wrong - and that this is one of them.

For one thing, the most rapid rise in obesity isn't taking place among adults, who, we hope, can understand the consequences of their decisions. It's taking place among children and adolescents.

And even if children weren't a big part of the problem, only a blind ideologue or an economist could argue with a straight face that Americans were rationally deciding to become obese. In fact, even many economists know better: the most widely cited recent economic analysis of obesity, a 2003 paper by David Cutler, Edward Glaeser and Jesse Shapiro of Harvard University, declares that "at least some food consumption is almost certainly not rational." It goes on to present evidence that even adults have clear problems with self-control.

Above all, we need to put aside our anti-government prejudices and realize that the history of government interventions on behalf of public health, from the construction of sewer systems to the campaign against smoking, is one of consistent, life-enhancing success. Obesity is America's fastest-growing health problem; let's do something about it.