Does Health Insurance Make You Fat?

According to this new paper (HT McArdle & WSJ), it constitutes a “true economic subsidy for obesity.” As one of the WSJ economics blogs sums the paper up:

According to the paper, which estimates weight gain in terms of body mass index, a measure of weight related to height, “private insurance increases BMI by 1.3 points and public insurance increases BMI by 2.1 points.”

Economists have long been saying that fat people weigh on taxpayers’ finances. A 2005 study estimated that the federal government pays for roughly half the total annual medical costs associated with obesity, resulting in an average annual $175 in per-capita taxpayers’ costs to pay for obesity expenditures among Medicaid and Medicare recipients.

And a study released today revealed that the overall cost of obesity-related health-care treatment doubled in a decade to $147 billion, growing faster than obesity rates, which went up 37% during the same time period.

The new evidence fits well with what Bhattacharya, Bundorf, Pace and Sood argue: Health insurance isn’t simply a transfer of wealth from thin taxpayers to overweight ones, but a “true economic subsidy for obesity.” According to the study, health-care coverage literally encourages obesity, because people tend to become less careful about weight-gain when they know that insurance will cover at least some of the weight-related health costs in which they may incur.

Though the study found weak evidence that more generous insurance encourages greater weight gain, or that risk-adjusted premiums discourage it, there was “strong” statistical evidence that being insured increases body mass index and obesity.

I am both intrigued with and skeptical of papers purporting to find economic-sy rationales underlying cultural and, more exactly, biologically-grounded behaviors (food, eating, hunger, etc.). A quick (granted, very quick) read of the paper suggested that the details and qualifiers make it far more cautious than suggested by statements such as “insurance makes you fat” or that the fact of certain correlations quite so literally “literally encourages obsesity.”

My own personal sense, as someone who always struggles with weight issues, is that the economics obesity accounts (this paper), or the political-ideological-social accounts (Fast Food Nation or David Kessler’s new book) don’t explain much about personal behavior. Well, let’s be more precise. They don’t explain much about my behavior – and, as my md-phd brother once remarked, think of yourself as the most exciting statistical series possible of 1: I’m the one who matters here (!).

At least in my own case, I think the more useful stuff lies at the level of appetite changes, set points, hormonal changes triggered by eating and digestion, research into what makes me eat at the biological level. I struggle every bit as much with weight and obesity as the obese African-American teenager who is apparently programmed to go to McDonald’s every day, or the middle class white teen who spends all possible moments in front of the videogame and then goes to McDonald’s. I suspect, for whatever prognostication on this most difficult of bio-behavioral topics is worth, that the most important work will come from understanding how what we eat now affects our eating at the next meal, along with the basic question of how much physical activity. I don’t think it will come from calorie counts in restaurants – I don’t mind them, but as a candidate for Jenny Craig, my interior calorie consumer tells me that it’s not the fundamental issue.

That said … look, I never thought I’d find myself admitting this in public or, frankly, anyplace else. I ran across the Seth Roberts thing from Freakonomics and thought, well, here’s one that is (a) effortless (b) won’t do any harm (c) worst downside is another 400 calories of monounsaturated fats a day (d) at an additional 400 calories a day, I’ll know in a month or two what the verdict on the technique is, for better or worse …

But I’ll be danged if over the last two years, I haven’t found myself gradually losing weight. Very gradually, and I’ve been working out more, especially in the deadly light-deprived winter – but, anecdotal series of one, I would swear that my appetite is simply less. I just don’t have the same interest in food. Your results might radically differ and, who knows, it might all come back tomorrow or maybe it will cause some weird cancer of the big toe, and also you have no idea how embarrassing it is to be gratuitously plugging a thing called the Shangri-la Diet …

Bottom line is I’ll stick with both my health insurance, Congress and the President willing, thanks, and the Shangri-la Diet. I am also mildly worried that telling you all about how this seems to have kinda worked for me will – I don’t know – jinx it or something. Maybe it only works if you keep it a secret. I’d like to keep those twenty pounds off, if possible. And if it’s not possible for an academic with control over his time, it’s not possible for anyone. It’s not as if this diet has any scientific evidence behind it, as that same md-phd brother has further pointed out; it is based explicitly on the Seth Roberts series of 1.

(Update: Megan McArdle has a nice series of posts on obesity and health policy in America, including an interview with Paul Campos, author of The Obesity Myth.