It Came From The Library: On Fat

by in News, August 7th, 2009

Fat, the kind we carry around, is big news of late. A study of the astronomical price of obesity-related chronic illnesses just published in the journal Health Affairs has been focusing attention on the public costs of personal decisions and injecting obesity into the debate over healthcare reform.

The Washington Post’s Ezra Klein frames the urgency of the issue thusly:

“If trends continue, health-care costs will chew up 100 percent of the gross domestic product by the end of the century. And estimates suggest that half to two-thirds of that growth is coming from chronic diseases related to diet. We’re eating our way through the national budget.

In other words, inaction is something we as a nation can no longer afford. But what is to be done? What will it take for us to eat less? That is the subject of another report making rounds. That study, from Urban Institute, suggests that obesity poses a public health crisis of such severity that it’s now time for some tough love:

“America’s state and federal policy makers may need to consider interventions every bit as forceful as those that succeeded in cutting adult tobacco use by more than 50%”

Such ‘interventions’ would include tough labeling laws, tax subsidies to encourage fruit and vegetable consumption, and stiff excise or sales taxes on fattening foods. All of which would generate hundreds of billions of dollars in revenue, enough to pay for a whole lot of healthcare. And all of which, unfortunately, sounds more than a little pie-in-the-sky (if you will), considering the enormous political obstacles to enacting such measures.

Furthermore, if Slate’s Daniel Engber is right, the tough love prescribed by the Urban Institute is crippled by a false premise: that the fat are more of a drain on the public coffers than the rest of us. If anything, Engber argues, they save us money by sparing us the cost of all the expensive illnesses we suffer in our golden years:

“While it’s true that someone who’s grossly overweight might rack up bills for obesity-related ailments like diabetes and hypertension, those added costs would be more than offset by his shorter lifespan.”

Morbid stuff. You can follow this argument a little further here.

Policy aside, one can’t help but wonder how we got here in the first place. How, in a mere 30 years, has the average weight of an American male has grown by 17 lbs and an American female by 19 lbs? What’s changed? A spate of recent books surveyed in a must-read New Yorker article tackle just this question. Explanations range from the economic–fattening foods have become a lot cheaper–to the evolutionary-biological–we’re hard-wired to pursue the maximum calories with the minimum of effort–to the neuroscientific-corporate conspiratorial–companies have reformulated processed foods to exploit this hard-wiring.

Interestingly, as fat is demonized in Washington policy circles, ‘fat acceptance’–bolstered by recent medical studies suggesting that overweight is (contra Engber) actually ‘a protective against mortality’–may be making inroads into popular culture, according to a recent NYTimes article. Who knows, perhaps Lifetime’s plus-size heroine in “Drop Dead Diva” and Fox’s new reality show “More to Love” represent the shape of things to come. If so, it’s unlikely to faze Food Network viewers, who’ve known all along that beauty comes in all sizes.

Jonathan Milder, Research Librarian

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