Reason Magazine - Topics > Obesity

Girlie-Governor

matt.welch@reason.com (Matt Welch) — Fri, 25 Jul 2008 17:48:00 EDT

L.A. Times: "Gov. Schwarzenegger signs law banning trans fats in restaurants."

L.A. Says "No" to Cheap Food for Poor People

rbalko@reason.com (Radley Balko) — Thu, 24 Jul 2008 08:40:00 EDT

The Los Angeles city council says no more fast food joints in South L.A.

Here's what I've always wondered: If the goal is to get low-cost fresh fruits, vegetables, and lean meats to low-income areas, why are these big city politicians so obsessed with keeping Walmart Supercenters out of the inner city?

Okay, I know the answer to that question. But no company has a better track record at getting huge amounts of produce to low income people at discount prices.

What About Famous Original Singas Pizza?

jsullum@reason.com (Jacob Sullum) — Tue, 22 Jul 2008 16:40:00 EDT

New York City's regulation requiring the conspicuous posting of calorie counts on restaurants' menu boards was supposed to apply just to big chains that standardize their dishes and already do (or can easily afford) nutritional analyses. But A.P. reports that the threshold for the rule, 15 or more outlets nationwide, is low enough to include obscure local chains and quasi-chains:

"This has been an absolute nightmare," said Enrique Almela, director of operations at Singas Famous Pizza, which has 17 restaurants, most in the borough of Queens....
Almela spoke with The Associated Press from his car Wednesday as he rushed sample pizzas to a food laboratory. He said the calorie tests for his 35 different pizza combinations will cost $10,000, and he doubts they will produce accurate data.
"I may put 15 pepperoni on a pie. Someone else may put 12. We don't measure the amount of cheese we put on," he said. "If you put up roundabout numbers, how does that help anyone?"
The deadline also looked problematic for a unique class of New York City eateries: loosely affiliated, largely immigrant-owned restaurants that share the same name and sometimes the same suppliers, but operate independently.
Afgan Paper & Food Products, which distributes food and packaging materials to many of the eateries, said it was scrambling to get them calorie info.
"The stores are all calling and asking for information. We don't have it," said Mariam Mashriqi, a receptionist at the company.
In the meantime, Mashriqi said, some owners were paying for the laboratory tests themselves.
"These are small stores. They are barely making a profit," she said.

You can find recent reason coverage of the menu board rule here, here, and here.

[via Scott Stein at When Falls the Coliseum]

Why Does Pixar Hate America?

gillespie@reason.com (Nick Gillespie) — Thu, 10 Jul 2008 12:16:00 EDT

The real Bill Wyman—the journalist, not the Humbert Humbert Rolling Stones bassist—asks:

What if Pixar released a ferocious broadside attacking the American way of life and the movie reviewers didn't notice?...
If Michael Moore, or Oliver Stone, or, God forbid, some effete French director, had crafted a feature film that was a thinly disguised political broadside portraying Americans as recumbent tubbos who moved around on sliding barcaloungers with built-in video screens and soft drinks always at the ready, don't you think there'd be some sort of notice taken?
But Pixar does it and ...
... the reviewers barely mention it. The new Pixar film, Wall-E, does indeed, as you have heard, tell the story of an adorable robot working alone on a depopulated earth. There's an obvious ecological lesson here, and this has been duly noted, along with mentions of unspecified "themes" and "messages."
But what was rarely analyzed in the reviews is that the earth is deserted because a Wal-Mart-like company called "Buy n' Large" has filled it up with trash, and the departed humans, expanded to Big Gulp size, are contentedly gorging themselves amid the comforts of a flying Club Med, where they slide around on those carts, on which they watch TV continuously without even having to sit up completely. While some of the better reviewers mention the beglotted humanoid forms, I found it odd that most mainstream reviewers didn't bother to point out what the film was saying.

More here, at Wyman's interesting Hitsville blog.

As someone who saw Wall-E the day after it opened, I've got a slightly different question: Why didn't reviewers say that the film sucks eggs? The goddamn thing, in my humble and useless opinion, was as bloated, slow-moving, and soft as the fat fucks populating the film like so many twins riding on motor scooters. It even somehow manages to misuse Fred Willard, who is every bit as much a national resource we desperately need to exploit as the ANWR oil reserves.

reason gives thumbs up to Pixar's Toy Story here; fat people here.

What About Fat Kids With Low Cholesterol?

jsullum@reason.com (Jacob Sullum) — Mon, 07 Jul 2008 14:37:00 EDT

Today the American Academy of Pediatrics issued new guidelines that call for cholesterol screening in children as early as age 2 and no later than age 10. According to the guidelines, treatment with cholesterol-lowering statins should be considered for children as young as 8 with certain risk factors. I don't know enough about the risks and benefits of statins in children to say whether this is a good idea or not, and it sounds like research on the question is meager. But I was struck by the way the New York Times story about the guidelines conflates cholesterol levels with weight:

Proponents [of the guidelines] say there is growing evidence that the first signs of heart disease show up in childhood, and with 30 percent of the nation's children overweight or obese, many doctors fear that a rash of early heart attacks and diabetes is on the horizon as these children grow up....
Previously, the academy had said cholesterol drugs should be considered in children older than 10 if they fail to lose weight after a 6- to 12-month effort.

Shouldn't the decision to treat a patient for high cholesterol hinge on how high his cholesterol is, as opposed to how much he weighs? Even if there's a correlation between weight and cholesterol, doesn't it make sense to focus on the risk factor that's the target of the treatment, instead of simply assuming that all fat kids have high cholesterol and that failing to lose weight is the same as failing to reduce cholesterol?

Another, apparently related puzzle: By way of justification for more-aggressive use of statins in children, Jatinder Bhatia, a neonatologist who serves on the committee that revised the guidelines, says, "We are in an epidemic." But between 1988 and 2000, according to the guidelines, "triglyceride concentrations [measured by the National Health and Nutrition Examination Survey] decreased approximately 8.8 mg/dL in adolescents aged 12 to 17 years, and total cholesterol, LDL, and HDL concentrations remained relatively stable." Furthermore, a comparison of NHANES data from 1988-1994 with data from 1966-70 found "a decrease in mean total cholesterol concentration of approximately 7 mg/dL" among 4-to-19-year-olds. Evidently, then, Bhatia is not talking about an "epidemic" of high cholesterol levels. Probably he means an "epidemic" of obesity (although recent data indicate that the upward weight trend in children and teenagers seen in the '80s and '90s has leveled off in the last decade or so).

This slippery switching between cholesterol and weight disguises the paucity of evidence that extra weight per se is unhealthy. NHANES data indicate that people in the "overweight" (but not obese) category actually have lower mortality rates than people in the "healthy"/"normal" category. Even for the BMIs that are correlated with shorter life spans, it's not clear how much people should worry about fatness, as opposed to the poor diet and sedentary lifestyle associated with it. This is especially true in the case of heart disease. "As near as I can tell," Barry Glassner reports in his 2007 book The Gospel of Food, "not a single published study demonstrates that heart disease among the overweight and moderately obese results from their heft rather than from other factors that contribute to both obesity and heart disease." Other critics of the conventional wisdom about weight, including Paul Campos, Eric Oliver, and Gina Kolata, make similar points.

The Difference Between Informing and Nagging

jsullum@reason.com (Jacob Sullum) — Mon, 23 Jun 2008 13:13:00 EDT

On Friday I attended a CDC-sponsored obesity conference where I participated in a panel discussion about laws requiring the conspicuous display of calorie counts in restauraunts, the topic of Steve Chapman's latest column. Chapman notes "there is little research to suggest that calorie alerts will make any difference in obesity rates," which is why a new study of fast food customers in New York City that was discussed at the conference is bound to be widely cited.

The researchers, all of whom work for the New York City Department of Health and Mental Hygiene, surveyed about 7,300 customers at 275 randomly selected locations of 11 fast food chains before the city's new menu board requirement took effect. (The regulation, which requires calorie counts as big as prices, is still being contested in court, but some chains are already complying.) The health department researchers found that 32 percent of Subway customers said they had seen calorie information, compared to 4 percent of customers at other fast food restaurants. Since Subway promotes a subset of its menu as lower in calories and fat than its competitors' offerings, using a pitchman who lost hundreds of pounds while eating at the chain every day, this disparity is not surprising. But even at Subway, calorie information seemed to make a difference for a minority of customers. Of those who reported seeing the calorie information at Subway, 37 percent (i.e., 12 percent of all Subway customers) said it affected their purchases. Subway customers who said they used calorie information bought about 100 fewer calories (based on data from receipts and survey questions) than those who said they didn't see it and those who said they saw it but didn't use it.

Notably, "there was no significant difference in mean calories purchased by patrons reporting seeing but not using calorie information and patrons who reported not seeing calorie information." In other words, simply making people aware of calorie content is not enough to affect their food choices. It may be that the information's influence is limited to people who are predisposed to count calories, in which case the impact of regulations like New York's will depend on the extent to which those people are not already taking advantage of nutritional information available on fast food chains' websites and on posters, counter mats, tray liners, and brochures in restaurants.

Already supporters of New York-style menu rules are using this study, which is scheduled to be published in the August issue of the American Journal of Public Health, to estimate how many lives can be saved by making calorie information more conspicuous. Given the uncertainty about who would lose how much weight and what the health consequences would be, this is a dubious exercise. Even if the health risks (or benefits) of extra pounds were well understood (they aren't), it's not clear that the Subway results can be applied to customers of other restaurants. Given its emphasis on healthier options, Subway probably is more likely than other chains to attract weight-conscious customers, the sort who seek calorie information and act on it.

Even so, only 12 percent of Subway customers in this study (i.e., 37 percent of 32 percent) said they noticed the calorie information and took it into account. This suggests that the vast majority of fast food customers are not very interested in nutritional information, as does the fact that most chains make it available without highlighting it in the way that the New York City health department thinks is appropriate. The restaurant business is highly competitive. If people are clamoring for impossible-to-ignore calorie counts, why don't more restaurants voluntarily provide them as a way of attracting customers? A legal requirement is necessary not because diners want conspicuous nutritional information but because, by and large, they don't want it. The information apparently does not enhance their dining experience and may even detract from it. Perhaps they prefer to enjoy their food without being reminded about what it may be adding to their waistlines.

Pretty soon, I suspect, customers of restaurant chains (the focus of the regulations, since it's hard for mom-and-pop restaurants to standardize dishes) will no longer be able to exercise their right not to know. In addition to New York City, jurisdictions requiring conspicuous nutritional information in restaurants include San Francisco; Santa Clara County, California; and King's County, Washington. California, New York state, Chicago, Philadelphia, and Washington, D.C. are considering similar requirements. As the restaurant industry faces a multiplicity of demands from various jurisdictions (Santa Clara County, for example, requires fat, carbohydrate, and sodium information as well as calorie counts), it may start lobbying for a national law that establishes a uniform standard.

Radley Balko criticized menu regulations in his Fox News column last week.

Force-Fed the Facts

schapman@tribune.com (Steve Chapman) — Mon, 23 Jun 2008 07:00:00 EDT

The 21st century has many problems, but a shortage of information is not one of them. Trying to avoid being endlessly barraged with facts is like trying to stay dry in a hurricane. But no matter. One government body after another has the idea that some people need more information, and it will be supplied or else.

The targets of this campaign are restaurants. New York City has a new law commanding chain outlets to post the calorie count of every item on menus and menu boards. The legislatures in New York and California are considering state laws to require even more extensive disclosures.

The reason, as the New York City Health Department explains, is that "New Yorkers get a third or more of their calories away from home. The lack of readily available calorie information in food service establishments makes it easy to consume too many calories without realizing it."

Imposing this mandate is supposed to help combat obesity. The Los Angeles County Department of Public Health asserts that if just 10 percent of restaurant patrons cut their intake by a mere 100 calories per meal, we would see a 39 percent decline in weight gain.

But the entire effort rests on assumptions that are unexamined and unfounded. The first is that consumers place a high value on the information being mandated. Actually, most of it is already accessible (online, among other ways) to anyone who is interested. In many places, it is available onsite, on tray liners or pamphlets.

Americans may say they would also like to see dietary information on menus. But providing it costs money, in a fiercely competitive industry. If patrons really wanted such disclosures, no law would be needed. Restaurants, eager to attract customers, would already be providing the numbers—just as they strive to offer other things that bring in business.

Among the attributes that most people look for when they dine out, nutritional information is below tasty fare, reasonable prices, courteous service, pleasant surroundings, agreeable lighting, and free parking. It's probably tied with clean restrooms and free mints at the cashier's counter.

The belief that more facts will generate wiser decisions is appealing but, at least in the realm of food, yet to be proved. No one seems to have noticed that as nutritional labeling has expanded, so have American waistlines. The federal government first required packaged foods to carry such information in the mid-1970s, and today, we are collectively fatter than we were then.

What does that suggest? Either people don't notice what's in the food they buy, or they don't let the knowledge affect what goes in their mouths.

"You can certainly say that most people certainly don't understand the food label," former Food and Drug Administration Commissioner Lester Crawford told the 2004 World Obesity Congress. "And it's not because they can't understand it, it's because they don't care to understand it."

If people don't heed the information they already have, they aren't going to waste effort digesting an additional onslaught of facts. The assumption is that people eat badly because they don't acquire the essential knowledge about their food. But it may be they fail to obtain those facts because they prefer to eat whatever they like. Not everyone approaches dinner as a research project.

There is little research to suggest that calorie alerts will make any difference in obesity rates. In 2004, the American Journal of Preventive Medicine reported that when women of normal weight were given this kind of information, it had no effect on what they ate, and that facts furnished in restaurants were also irrelevant in dining decisions.

A study in the Journal of the American Dietetic Association found that people who dine out frequently are less likely to pay attention to nutritional data than people who eat mostly at home. It suggested that "those who have a less nutritious diet are less likely to use food labels and have less interest in doing so."

As anyone who's ever raised a teenager knows, continually bombarding people with information that is useful or even crucial to their well-being is not always productive. Menu laws may not increase our ability to make good food choices. But they will certainly improve our ability to tune out.

COPYRIGHT 2008 CREATORS SYNDICATE, INC.

Accidents, Murders, Preemies, Fat, and U.S. Life Expectancy

rbailey@reason.com (Ronald Bailey) — Tue, 17 Jun 2008 17:00:00 EDT

Last week, the National Center for Health Statistics announced that the average life expectancy for Americans has risen to an all-time high of 78 years. In addition, record high life expectancy was recorded for both white males and black males (76 years and 70 years, respectively) as well as for white females and black females (81 years and 76.9 years). This is obviously good news. But a question nags—why are people in other countries living longer on average than Americans? After all, we are the country that spends the most money per capita on health care.

For example, according to the World Health Organization, average life expectancy in Japan is 83 years; Australia, 82; Switzerland, 82; Canada, 81; Sweden, 81; Spain, 81; Italy, 81; France, 81; Germany, 80; and the United Kingdom, 79. In all, there are 29 countries whose citizens have longer life expectancies than Americans.

So why do Americans die younger than people living in most other developed democracies? Well, there is the Michael Moore answer delivered in his "documentary" Sicko—it's because we lack a benevolent government funded health care system. But life expectancy is not dependent on just medical care. For example, Texas A&M health economist Robert Ohsfeldt and health economics consultant John Schneider point out that deaths from accidents and homicides in America are much higher than in any other of the developed countries. Taking accidental deaths and homicides between 1980 and 1999 into account, they calculate that instead of being at near the bottom of the list of developed countries, U.S. life expectancy would actually rank at the top.

However as Carl Bialik, the invaluable Wall Street Journal "Numbers Guy" columnist, notes Ohsfeldt and Schneider's analysis does not account for the fact a better health care system would have saved more accident victims and thus would have boosted life expectancy. In fact, in 2002, Harvard researchers argued that the U.S. murder rate is much lower than it would otherwise have been because so many assault victims are being saved by improved medical care. Nevertheless, Ohsfeldt and Schneider are likely right that U.S. life expectancy is being depressed by our higher accident and homicide rates.

America's relatively high infant mortality rate also lowers our life expectancy ranking. A 2007 study done by Baruch College economists June and David O"Neill sheds some light on why U.S. infant mortality rates are higher—more low weight births. In their study, U.S. infant mortality was 6.8 per 1,000 live births, and Canada's was 5.3. Low birth weight significantly increases an infant's chance of dying. Teen mothers are much more likely to bear low birth weight babies and teen motherhood is almost three times higher in the U.S. than it is in Canada. The authors calculate that if Canada had the same the distribution of low-weight births as the U.S., its infant mortality rate would rise above the U.S. rate of 6.8 per 1,000 live births to 7.06. On the other hand, if the U.S. had Canada's distribution of low-weight births, its infant mortality rate would fall to 5.4. In other words, the American health care system is much better than Canada's at saving low birth weight babies —we just have more babies who are likely to die before their first birthdays.

Life expectancy rates also depend on personal habits such as smoking, diet, and physical activity. Interestingly, U.S. smoking rates are lower (17 percent of adults) than for many developed countries with higher life expectancies. For instance, 30 percent of Japanese adults smoke daily. In France, 23 percent of adults smoke; Germany, 25 percent; Switzerland, 25 percent; Spain, 28 percent, and the U.K., 25 percent.

The fact that Americans tend to be a lot fatter than the citizens of other rich developed countries increases their risks of heart disease and diabetes. A recent international survey reported that 31 percent of Americans are obese (body mass index over 30), whereas only 23 percent of Britons, 21 percent of Australians and New Zealanders, 14 percent of Canadians, 13 percent of Germans, 9 percent of the French, and 3 percent of Japanese have body mass index measurements over 30.

Taking all these unhealthy proclivities into consideration, the American health care system is most likely not to blame for our lower life expectancies. Instead, American health care is rescuing enough of us from the consequences of our bad health habits to keep our ranking from being even lower.

Ronald Bailey is reason's science correspondent. His book Liberation Biology: The Scientific and Moral Case for the Biotech Revolution is now available from Prometheus Books.

Back Away From That Teriyaki With Your Hands Up!

matt.welch@reason.com (Matt Welch) — Fri, 13 Jun 2008 10:19:00 EDT

Is your waist size a 36? Better not be Japanese:

Under a national law that came into effect two months ago, companies and local governments must now measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups. That represents more than 56 million waistlines, or about 44 percent of the entire population.
Those exceeding government limits - 33.5 inches for men and 35.4 inches for women, which are identical to thresholds established in 2005 for Japan by the International Diabetes Federation as an easy guideline for identifying health risks - and having a weight-related ailment will be given dieting guidance if after three months they do not lose weight. If necessary, those people will be steered toward further re-education after six more months.
To reach its goals of shrinking the overweight population by 10 percent over the next four years and 25 percent over the next seven years, the government will impose financial penalties on companies and local governments that fail to meet specific targets. The country's Ministry of Health argues that the campaign will keep the spread of diseases like diabetes and strokes in check.

Whole thing here; hat tip: Veronique de Rugy. Jacob Sullum wrote about "the totalitarian implications of public health" last May.

As Fat As We're Gonna Be?

jsullum@reason.com (Jacob Sullum) — Wed, 28 May 2008 20:15:00 EDT

Data from the National Health and Nutrition Examination Survey (NHANES), which includes direct measurement of height and weight, indicate that the prevalence of obesity among children and teenagers, after tripling between the '70s and the '90s, has leveled off at around 16 percent since 1999. Looking at body mass indexes among 2-to-19-year-olds in 1999-2000, 2001-2002, 2003-2004, and 2005-2006, CDC researchers found "no statistically significant trend over the 4 time periods." This result, reported in The Journal of the American Medical Association, is similar to the conclusion of an earlier analysis of NHANES data on adults, which suggested that the obesity rate among American women, and possibly among men as well, has reached a plateau in recent years.

I don't know why we've stopped getting fatter (assuming that we have), but there's little reason to believe changes in government policy have had much to do with it. "It is not clear if the lull in childhood weight gain...is the result of public anti-obesity efforts to limit junk food and increase physical activity in schools," concedes New York Times reporter Tara Parker-Pope. "The lull could represent a natural plateau that would have occurred regardless of public health efforts." But she clearly wants to believe (emphasis added):

In Arkansas, a statewide obesity effort has eliminated vending machines in elementary schools, added a half-hour of daily physical activity to the school curriculum and sent home annual childhood health reports alerting parents about obesity risks. As part of the program, school officials in the past four years have tracked the weight and height of 475,000 children, and those numbers show that average body mass index rates in Arkansas have held steady....
One worry is that as obesity rates stabilize, financing for childhood health efforts will wane. In Arkansas, the program was a success but a financial crunch prompted the state legislature recently to cut physical activity programs in seventh through 12th grade.

The only evidence Parker-Pope offers to back up her assertion that the Arkansas program "was a success" is that BMIs among kids in the state "have held steady"—just as they have throughout the country. Isn't that what the article is about?

Back in January, I noted former Arkansas governor and former GOP presidential aspirant Mike Huckabee's concern about your weight.

A Pill a Day Keeps the Doctor Away?

kmw@reason.com (Katherine Mangu-Ward) — Wed, 14 May 2008 10:58:00 EDT

More than half of Americans now take prescription meds to treat chronic health problems, according to a new study out today. The study is being played as bad news, with the wire services quoting doctors proclaiming that "things will get worse instead of getting better" and chalking the problem up to our "couch potato culture."

But digging deeper into the study reveals that much of the increase is the result of good preventive treatment for diseases that were once debilitating or fatal, like the use of allergy medication and steroid treatments to prevent asthma flareups in kids, and higher rates of antidepressant use, especially among young women.

(For more on the latter topic, re-read reason contributor Will Wilkinson's excellent article on whether an epidemic of depressive disorder is sweeping America. Answer: Not really)

There's no doubt Americans have brought many cases of diabetes and hypertension on themselves by being lazy fatties. Chronic medication use is growing fastest among young people, but the real heavywights continue to be the oldsters. Drug use grows steadily because as we live longer the ol' bod just starts to experience wear and tear, as in the case of arthritis.

Plus, we aren't just a nation of unreflective pill poppers: Rates of use for hormone replacements fell by half in 2007 when news broke about potential side effects. People are, at least in many cases, educated consumers of all those meds.

One doctor, at least, saw a "silver lining": "People are receiving treatment which can prevent more serious health problems down the road."

Debating CSPI

rbalko@reason.com (Radley Balko) — Mon, 21 Apr 2008 13:24:00 EDT

This morning, I debated a rep from CSPI for the Retirement Living channel on the topic of public health.

I was hoping she'd bring up trans-fats. And she did, blaming your partially hydrogenated oils for some 50,000 deaths per year. I have no idea where they got that number, but I did point out that if it's true, CSPI's activism is partially to blame. Back in the late 1980s and early 1990s, the organization put public pressure on the fast food industry to adopt "healthier" trans-fats in place of animal fats. In response to one early study citing the dangers of trans-fats, one CSPI rep wrote in a newsletter, "trans-schmans!"

The restaurant industry caved, and now CSPI is demanding they switch back, at least when it comes to foods where other alternatives won't work.

Should have video in about a week.

In Defence of the 3,000 Calorie Breakfast

gillespie@reason.com (Nick Gillespie) — Mon, 21 Apr 2008 09:34:00 EDT

Well, not really. In the Times of London, Giles Cohen attacks the Brits' "national dish": its 3,000 calorie breakfast featuring eggs, various sorts of meat, and all sorts of grease:

We're drunk, we're underslept, we smell, we can't walk straight, it hurts to talk and all we want is something to make the blood rush to our stomach, and away from our brains.

He means this as a bad thing. Read "Why the Great English Breakfast is a Killer."

Hat tip: Alan Vanneman.

Lando Calrissian's Cloud City for Fat People

gillespie@reason.com (Nick Gillespie) — Thu, 17 Apr 2008 15:07:00 EDT

David Small writes in with news that, as an AP headline puts it, "France may make it illegal to promote extreme thinness":

The French parliament's lower house adopted a groundbreaking bill Tuesday that would make it illegal for anyone—including fashion magazines, advertisers and Web sites—to publicly incite extreme thinness.
The National Assembly approved the bill in a series of votes Tuesday, after the legislation won unanimous support from the ruling conservative UMP party. It goes to the Senate in the coming weeks.
Fashion industry experts said that, if passed, the law would be the strongest of its kind anywhere. Leaders in French couture are opposed to the idea of legal boundaries on beauty standards.

More here.

reason on chubsy-ubsyism here.

Lando Calrissian: "Cloud City Entrepaneur (sic) or Everyday Cock-Blocker" here.

The Burden of Healthy Living

jsullum@reason.com (Jacob Sullum) — Tue, 05 Feb 2008 18:14:00 EST

A Dutch study reported yesterday in the online journal PLoS Medicine undermines the fiscal argument for a government-led War on Fat, which says how much you weigh is everyone else's business because other people have to pick up the tab via taxpayer-funded health care programs. The researchers found that eliminating obesity would, over the long term, increase medical spending instead of reducing it:

Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures....
Obesity prevention, just like smoking prevention, will not stem the tide of increasing health-care expenditures. The underlying mechanism is that there is a substitution of inexpensive, lethal diseases toward less lethal, and therefore more costly, diseases.

The researchers compared the medical expenses of three hypothetical cohorts: obese people, smokers, and thin nonsmokers. They found that annual costs were highest among obese people until age 56, after which smokers were the most expensive group. But because both groups had lower life expectancies (80 and 77, respectively) than the "healthy-living" cohort (84), they had lower lifetime health care costs as well. Taking the long view, the thin nonsmokers cost the most, followed by obese people and smokers, in that order:

At discount rates of, respectively, 3% and 4% successful smoking prevention would result in additional health-care costs of €7.1 and €3.4 million (assuming costless intervention). For obesity prevention these figures would amount to €1.8 and €1.0 million. Only for discount rates above 4.7% would costless obesity prevention be cost saving. For smoking prevention to be cost saving, the discount rate for costs should be at least 5.7%.

The authors note that they considered only health care costs, leaving out "other potentially substantial costs and consequences" of obesity, such as reduced productivity and "the reduced well-being of family members due to morbidity and premature death." But the former cost would be borne mainly by obese people themselves through reduced earnings, and the latter should be internalized to the extent that obese people care about their family members. (If the government did not force some people to pay for other people's health care, medical costs would be internalized as well.) Notably, the study also left out taxpayer-funded pensions, which increase the burden that healthy-living people impose on the rest of society.

In my 2004 reason article about the War on Fat, I noted that research might find that obesity, like smoking, saves taxpayers money.

[via The Freedom Files]

Post-Reductio America

rbalko@reason.com (Radley Balko) — Fri, 01 Feb 2008 12:21:00 EST

A Mississippi lawmaker and three co-sponsors have introduced a bill that would....well, let's just quote straight from the bill:

Any food establishment to which this section applies shall not be allowed to serve food to any person who is obese, based on criteria prescribed by the State Department of Health after consultation with the Mississippi Council on Obesity Prevention and Management established under Section 41-101-1 or its successor. The State Department of Health shall prepare written materials that describe and explain the criteria for determining whether a person is obese, and shall provide those materials to all food establishments to which this section applies. A food establishment shall be entitled to rely on the criteria for obesity in those written materials when determining whether or not it is allowed to serve food to any person.

Sandy Szwarc called the bill's sponsor, who confirmed that he isn't kidding. We've finally arrived. Now just wait until the first bill like this actually passes.

First, They Came for the Fat-Fuck Gamers in New Mexico...

gillespie@reason.com (Nick Gillespie) — Fri, 01 Feb 2008 07:28:00 EST

...and because I was a fat fuck non-gamer, I did nothing.

Kerry Howley mentioned this awhile ago, but New Mexico--a.k.a. The Land of Enchantment--is mulling like a zaftig patron the whole left side of a menu at a Wendy's a proposal for a "1 percent tax on TVs, video games, and video game equipment. The fund would help pay for outdoor education throughout the state."

The name of the program: The No Child Left Inside Fund, which really makes it sound like Pol Pot is advising New Mexico Gov. Bill Richardson, who could, you know, afford to step away from the buffet line every other meal.

An AP story today, however, makes it clear that eventually this law, or something like it, will pass. Here's the anti-argument, which makes total sense and will be totally unconvincing once the Coach Kleatses of the world start snapping legislative jockstraps to force Piggy to literally take a hike.

[Dave] Gilligan, [the 24-year-old co-owner of the store Gamers Anonymous], says he learned to read at a young age thanks to video games. He also attributes his interest in art to gaming.

It's a sound argument--and let's not even get into that whole life, liberty, and the pursuit of Halo 3 baddies--and one that will, alas, certainly lose in the long run.

More here.

reason on obesity here.

Interesting National Bureau of Economic Research paper on the net effect of gym classes on kids' body mass indices (you get one guess and it's zero of course) here.

K-12 physical education requirements nationwide here.

Great Chieftain o' the Pudding Race: Banned

kmw@reason.com (Katherine Mangu-Ward) — Wed, 23 Jan 2008 13:24:00 EST

Every year on January 25, Scots celebrate Burns Night, the putative birthday of poet Robert Burns. And how better to celebrate than with the dish the great poet immortalized in his masterwork "To a Haggis," a paeon to the "Great chieftain o' the pudding-race!"?

Sadly, again this Friday, Scottish-Americans will be left without authentic haggis with which to honor the noble poet--imports have been banned since the outbreak of mad cow in Britain. But the Scottish government is gearing up for a fight to re-legalize the heart, liver, and lungs-based treat.

"The Scottish government will consider engaging the U.S. government on its haggis import ban ... It is safe or we wouldn't eat it here," said a spokeswoman. "We think there is a large market for it amongst expatriate Scots there."

Part of the campaign should feature Burns' poem, which describes what haggis could do for you:

But mark the Rustic, haggis-fed,
The trembling earth resounds his tread.

The story chronicling the decision at Yahoo! news asks the question we must all ask ourselves: "Haggis ban an offal burden?"

The Thin Man Goes to Washington

jsullum@reason.com (Jacob Sullum) — Wed, 09 Jan 2008 07:12:00 EST

In his inaugural New York Times column, William Kristol suggests Mike Huckabee may be the right Republican presidential candidate to beat "a liberal Democrat" who will "want to increase the scope of the nanny state." This is like counting on Godzilla to save us from King Kong.

Losing more than 100 pounds in less than a year is the former Arkansas governor's main claim to fame, and for Huckabee the personal is political. "Although my weight-loss battle was a very personal one," he wrote in the journal Health Affairs in 2006, "my position as governor allows me to help others to see the importance of making healthy lifestyle changes."

Huckabee created the Healthy Arkansas program, "a comprehensive effort to clearly define specific areas where behavioral changes can lead to healthier citizens." As chairman of the National Governors Association, he led the Healthy America initiative, aimed at creating "a culture of wellness across the nation."

Both efforts relied primarily on information and persuasion, but the rationales Huckabee offered for them suggest sterner measures could be justified. Because of the burden that bad habits such as overeating, inactivity, and smoking impose on taxpayer-funded medical care, he said, a state's fiscal health is tied to its residents' physical health. In any case, he said, "states have both the authority and the duty to enact laws and regulations to advance the public's health."

So what happens when people fail to "see the importance of making healthy lifestyle changes"? The Arkansas Clean Indoor Air Act, which Huckabee brags about championing, provides a clue.

Huckabee says the law, which prohibits smoking in virtually all enclosed spaces that are not private residences, is about "workplace safety." Yet the main health benefit from smoking bans comes from encouraging smokers to quit, not from reducing exposure to secondhand smoke. And lest you think that federalist scruples would prevent Huckabee from pursuing his vision of a smoke-free America as president, he has promised to support a national ban on smoking in "public places."

In his 2005 book Quit Digging Your Grave With a Knife and Fork, Huckabee implies that he does not favor similarly coercive tactics aimed at getting Americans to eat better and exercise more. "We do not need the government to become the ‘grease police,'" he writes, "dictating what size cheeseburgers the law will allow or taxing obese people at a different rate than thin people because of the likelihood of additional health care costs associated with obesity."

But given his broad view of the government's authority to "advance the public's health," it's hard to see how Huckabee can rule out such measures, especially since he portrays the "huge epidemic of obesity" as a crisis that threatens the treasury, the economy, and even national security. "We keep talking about the war on terror," he said in an August speech to the Southern Governors' Association. "Who's going to fight it if we don't have enough people who are healthy enough to show up and pick up a backpack?"

Like other obesity alarmists, Huckabee warns that poor eating habits and lack of exercise could make American life spans shorter. A lot shorter: "If we continue with this trend," he told CNN in 2006, "within another generation you'll see kids dropping dead at their desks at the high school."

To avoid that prospect, CNN reported, Huckabee called for "a culture of health," citing four examples "in which concerted public campaigns, aided by government, led to cultural shifts": littering, seat belt use, smoking, and drunk driving. Notably, littering, failing to wear a seat belt, and driving while intoxicated are all illegal, while smoking is headed in that direction, thanks to Huckabee and like-minded politicians.

For those of us who worry that a President Huckabee would be inclined to force his culture of health on America, there's one consolation: If he's right, Grease Police recruits will be so fat that we'll be able to outrun them easily.

The Flatness of Fatness

jsullum@reason.com (Jacob Sullum) — Mon, 03 Dec 2007 18:01:00 EST

The prevalence of obesity among American women, and possibly among men as well, seems to have reached a plateau, according to a CDC analysis of the latest data from the National Health and Nutrition Examination Survey (NHANES). Overall, the share of American adults who are considered obese, meaning they have body mass indexes of 30 or more (equivalent to a weight of 203 pounds or more for a man who is five feet, nine inches tall), has more than doubled since the late 1970s, when it was about 15 percent. But the rate for women, which was 35 percent in the 2005-06 NHANES, has not increased significantly since 1999, while the rate for men was 33 percent in 2005-06, the same as in the 2004-05 survey. Fat warrior Kelly Brownell, who has repeatedly predicted that the current generation of children will have shorter life spans than their parents because they're so damned fat (even though there's no evidence to support that prediction), grudgingly concedes that the latest NHANES numbers are sorta good news, telling New York Times science reporter Gina Kolata:

There is slight joy in fact that the number has not increased since 2003. But it is mainly discouraging news that the number has not gone down at all.

Madelyn Fernstrom, director of the weight management program at the University of Pittsburgh Medical Center, has a different perspective:

She said there might be more to it than people finally reaching the limit of how fat they can get.
Instead, Dr. Fernstrom said, many Americans are setting more rational weight goals and discovering that even if they cannot lose much weight, they can try to avoid gaining.
The national goal of no more than 15 percent of Americans being obese is "unrealistic," she said, even counterproductive. And the so-called normal weight defined as a body mass index, or B.M.I., of 18 to 25 is impossible for many people to maintain.
"When the bar is set too high, people do nothing," Dr. Fernstrom said. "Whether it's 7 to 10 fruits and veggies a day when people can't even get to 5, or 75 minutes of physical activity when 20 is hard for most people, or a B.M.I. under 25."

As I noted in a recent column, the scientific basis for setting the preferred BMI range at 18 to 25 is questionable, since people in the "overweight" (but not obese) category have the lowest mortality rates. And as Kolata points out in her book Rethinking Thin, it's not clear that people who lose weight become healthier as a result of shedding pounds, as opposed to the lifestyle changes that go along with it. Look for my review of Kolata's book in the January issue of reason.

Is it only a coincidence that obesity's upward trend has leveled off around the same time as the downward trend in smoking? Maybe, although smoking is associated with lower weight, probably because it curbs appetite, quickens metabolism, and/or serves as an alternative form of oral gratification. Still, the health risks posed by a pack-a-day cigarette habit seem to be quite a bit worse than the health risks associated with being "overweight," although you might not guess that from listening to anti-fat alarmists like Kelly Brownell.

Nutritionist Fed Up With Secondhand Fat

jsullum@reason.com (Jacob Sullum) — Thu, 15 Nov 2007 12:29:00 EST

The BBC reports that John Tickell, a "leading Australian nutritionist," thinks "society should take a more hardline stance against obesity and get tough on fat airline passengers." Specifically, he thinks it's only fair that fat passengers pay more for their seats than thin passengers do, since they contribute disproportionately to fuel costs. "I think we're a bit too nice, we're a bit too precious about minority groups," says Tickell. "I think the majority group must have something to say too."

Scott Stein suggests that Tickell visit a playground, where he could "find plenty of evidence of coddling of fat people—because, as you surely know, fat people are never teased, mocked, and humiliated by their peers." In any case, Stein notes, thin people are no longer "the majority group" in Australia or the United States; two-thirds of adults in both countries are considered "overweight." Then, too, if fuel consumption is the real issue, airlines ought to charge tall people more than short ones. Why focus just on width when height also contributes to weight?

One reason, apparently, is that Tickell wants to "highlight his country's obesity crisis." But the head of the Australasian Society for the Study of Obesity, Tim Gill, objects to Tickell's punitive approach. "It's not fair to single out those people who have a problem, which is already impacting greatly on their life, and make them feel like pariahs," he says.

Why is it that public health types rarely raise similar objections to propaganda that mocks and denigrates smokers, smoking bans that push them into the street, and taxes that punish them for behavior that, according to anti-tobacco activists, they can't really control? Before you say "it's the secondhand smoke," consider Tickell's tirade against fat fellow fliers:

I fly Sydney to Perth—five hours—and being totally disadvantaged by some huge person next to me literally flopping over into my seat. Why should I pay the same as them?

Tickell's proposed solution, of course, does not really address the problem of secondhand fat. It makes more sense to assign obese people two seats, and then the question is whether they should have to pay for the extra seat. Of course they should, Michael Lynch argued on reason online back in 2002, when Southwest Airlines announced that it would start enforcing a longstanding policy to that effect. My own view (Mike's too, I think) is that airlines should neither be forbidden to charge people above a certain size for an extra seat (based on anti-discrimination laws, say) nor required to do so (to satisfy social engneers like Tickell). As with smoking rules in bars and restaurants, each airline should have to weigh the negative and positive reactions from its customers in deciding which policy makes the most sense.

Fat Chances

jsullum@reason.com (Jacob Sullum) — Wed, 14 Nov 2007 06:55:00 EST

At five feet, nine inches tall and 175 pounds, I have a body mass index (BMI) of 25.9, which makes me "overweight." If I lost seven pounds, I'd have a BMI of 24.9, indicating what the government considers a "normal," "healthy" weight.

Yet that weight is not normal, since two-thirds of American adults exceed it. And judging from the latest research, it is not necessarily healthy either. According to a study recently published by The Journal of the American Medical Association (JAMA), people in the government-recommended BMI range of 18.5 to 24.9 are more likely to die from a variety of diseases than people with BMIs of 25 to 30.

The JAMA study updates research by Katherine Flegal of the National Center for Health Statistics and three other government-employed scientists, who two years ago scandalized the public health community by concluding that the annual death toll associated with excessive weight was far lower than the U.S. Centers for Disease Control and Prevention (CDC) had been claiming. The CDC later reduced its estimate from 365,000 deaths blamed on "poor diet and physical inactivity" to 112,000 "obesity-related deaths."

Looking at data from the National Health and Nutrition Examination Survey, Flegal and her colleagues found that people who qualified as "obese" (with BMIs of 30 or more) did indeed have a higher mortality rate than people in the "normal" range, as did those considered "underweight." But people who were merely "overweight" had the lowest mortality rate of all.

In their new study, Flegal et al. examine specific causes of death in each weight range and find that cardiovascular disease is by far the biggest contributor to "excess deaths" among the obese. Deaths from certain cancers and the combined category of "diabetes and kidney disease" also were significantly more common than in the "normal" group.

Although being merely "overweight" was associated with a higher death rate from diabetes and kidney disease, it "was not associated with mortality from cancer or cardiovascular disease." And since overweight people were significantly less likely to die from other causes, "the net result was that overweight was associated with significantly decreased all-cause mortality." Adjusting for smoking and pre-existing illness, both of which can be associated with lower weight, did not change the findings.

Standing alone, these data do not prove that plumpness is healthy or that thinness kills. But they do cast doubt on some of the more alarmist predictions made by "obesity epidemic" doomsayers.

"This could be the first generation of American children to lead shorter lives than their parents," warns Yale obesity expert Kelly Brownell, who urges a panoply of taxes and regulations aimed at averting that disaster. Yet there's no evidence that life spans are getting shorter in the U.S. In fact, as Flegal et al. note, death rates from cardiovascular disease continue to decline, while the association between obesity and cardiovascular disease seems to be getting weaker.

In response to the JAMA study, obesity researcher JoAnn Manson told The New York Times "health extends far beyond mortality rates." In particular, extra weight can make it harder to get around, discourage exercise (lack of which helps explain the association between obesity and cardiovascular disease), and contribute to problems such as sleep apnea and arthritis.

But such day-to-day impairment is much more obvious than the lurking, lethal risk of a few extra pounds that Manson has been warning people about for years. A 1995 New York Times headline inspired by one of Manson's studies warned that "Even Moderate Weight Gains Can Be Deadly." The story quoted Manson's prediction that "it won't be long before obesity surpasses cigarette smoking as a cause of death in this country."

It looks like both of those claims were wrong. That's good news not only for those of us who weigh more than the government says we should but for anyone who worries about the social engineers who have plans for making Americans thinner.

© Copyright 2007 by Creators Syndicate Inc.

Overweight: The New Healthy

jsullum@reason.com (Jacob Sullum) — Wed, 07 Nov 2007 12:35:00 EST

A couple of years ago, a team of researchers led by Katherine Flegal of the U.S. Centers for Disease Control and Prevention looked at data from the the National Health and Nutrition Examination Survey and discovered that the mortality rate for people the government considers "overweight" was lower than the mortality rate for people with weights the government deems "normal," "healthy," or "optimal." The study did find a higher death rate among people fat enough to be considered "obese" (and among the "underweight"), but it implied a much lower annual death toll associated with excess weight than the CDC had been claiming: about 100,000, as opposed to 400,000 or so. (If you take into account the lower mortality rate among the merely "overweight," the net number of "excess deaths" among those who weigh more than the governnment thinks they should is about 26,000.) Just as important, the study cast doubt on the meaning of the "overweight" label, since it showed that the government-preferred range is not only not "normal" (since most people exceed it); it may not even be "optimal" in terms of health. Now (as Ron Bailey notes below) Flegal and several other government-employed scientists are back with a detailed look at causes of death in various weight ranges.

The new study—published, like the earlier one, in The Journal of the American Medical Association—finds that the excess deaths among the obese are overwhelmingly due to cardiovascular disease. The category "diabetes and kidney disease" comes in second. While the overall cancer death rate was not higher than in the "normal" weight group, certain cancers (colon, breast, esophagus, uterus, ovary, kidney, and pancreas) were slightly more common. By contrast, compared to people of "normal" weight, those who were merely "overweight" (but not "obese") had lower rates of death from a variety of causes, including respiratory disease, Alzheimer's, and Parkinson's. Flegal et al. say the differences remained after they controlled for smoking and pre-existing disease, both of which are associated with lower weight.

Standing alone, these data do not prove that plumpness is healthy or that thinness kills. But they do cast doubt on the conventional wisdom that everyone should strive for a government-approved weight. In response to Flegal et al.'s research, JoAnn Manson, chief of preventive medicine at Boston's Brigham and Women's Hospital, tells The New York Times "health extends far beyond mortality rates," which is true enough. In particular, Manson notes that "excess weight makes it more difficult to move about and impairs the quality of life." But that sort of day-to-day impairment is much more obvious than the lurking, lethal risk of a few extra pounds that Manson has been warning people about for years. A 1995 New York Times headline inspired by one of Manson's studies warned that "Even Moderate Weight Gains Can Be Deadly." The story quoted Manson's prediction that "it won't be long before obesity surpasses cigarette smoking as a cause of death in this country." It looks like both of those claims were wrong, which is good news not only for "overweight" people but for anyone worried about the social engineers with plans for making us thinner.

Are You Sure You Want Fries With That?

jsullum@reason.com (Jacob Sullum) — Fri, 26 Oct 2007 17:30:00 EDT

New York City has revived its regulation requiring restaurants to post the calorie counts of menu items, which was overturned on narrow statutory grounds last month. A federal judge ruled that the requirement, which applied only to restaurants that voluntarily offer nutritional information, improperly ventured into an area covered by the federal Nutrition Labeling and Education Act. But since that law specifically regulates the practices of restaurants that supply information on their own, the city can make its regulation pass muster by broadening it. The new version, which is expected to be approved by the New York City Board of Health in January and take effect in March, covers restaurant chains with 15 or more outlets nationwide.

That change eliminates the perverse incentive created by the original regulation, which encouraged chains to refrain from releasing nutritional information and thereby avoid the cost and inconvenience of complying with the menu requirement, which says calorie counts have to be as conspicuous as prices. (Some chains, including Wendy's, Quiznos, and White Castle, stopped offering such information in anticipation of the new rule.) But the regulation still forces restaurants to engage in a form of government-mandated nagging, intended to have the same effect as paying someone to whisper "Are you sure you want fries with that?" in the ear of every customer contemplating his order. New York City Health Commissioner Thomas Frieden justifies the imposition this way:

The big picture is that New Yorkers don't have access to calorie information. They overwhelmingly want it. Not everyone will use it, but many people will, and when they use it, it changes what they order, and that should reduce obesity and, with it, diabetes.

Since many chains do provide calorie information (the very chains that would have been covered by the original regulation), it's simply not true that "New Yorkers don't have access to calorie information." If they really want it, the they can get it from posters, tray liners, and websites produced by chains that have decided enough of their customers are interested to justify the effort. And if the public were clamoring for calorie counts as loudly as Frieden implies, more and more restaurants would voluntarily provide them simply to make their customers happy. A legal requirement is needed only to the extent that people don't want to be reminded of how many calories are in a bacon double cheeseburger.

Fat Fucks in England Their Parents' Fault

gillespie@reason.com (Nick Gillespie) — Mon, 22 Oct 2007 08:39:00 EDT

Via Drudge, in the London Times:

Parents of 5-year-olds are to be sent official warning letters if their child is found to be obese, as part of a national programme to weigh children in schools.
Ministers are bracing themselves for charges that they will stigmatise fat children when they publish proposals next month to tackle rising levels of obesity, The Times has learnt.
Alan Johnson, the Health Secretary, is understood to have been persuaded that it is in children's best interest if their weight is brought formally to the attention of their parents.

More here.

Channel reason's take on chubsy-ubsyism here.