pageok
pageok
pageok
WATCH IT, FATSO:

As someone who believes your right to overeat ends where my airplane seat begins, I don't think that Medicare's decision last week to begin paying for obesity treatments is such a terrible example of nanny-state meddling. The thin already are forced to subsidize the fat anyway, via taxes and higher private insurance costs. Why not pay a little more in prevention now, if that will cut huge Medicare bills for obesity-related problems later? Plus, fat pride activists are appalled by the Medicare decision, which probably means it's a pretty good idea.

Which isn't to say that we shouldn't emphasize personal responsibility when it comes to obesity. Certainly losing weight is difficult; this doesn't mean it's impossible. My friend Greg Critser, author of "Fatland: How Americans Became the Fattest People In the World," argues that beltless pants and limitless refills are symptoms of modern American culture's general lack of boundaries and self-control. He also doesn't like the way upper-middle-class boomer parents, who lead the public discussion, are loathe to talk about limiting children's diets or making them exercise, lest kids end up anorexic or with damaged self-esteem.

"Feminists and liberals have transformed a legitimate medical issue of the poor into identity politics for the affluent," Greg told me, "which I find the worst kind of narcissistic behavior." But he also lacks patience with right-wing complaints about government intervention: "Those libertarians who have all kinds of problems with government programs about obesity are going to be crying their eyes out 20 years from now," he added, when a fat and aging population brings with it increased taxes and social burdens.

Greg is now fit and trim but used to be chubby. At school, he was called Blimpboy and Skipper, after Gilligan's hefty pal. He only took the weight off a few years ago, when a man yelled "Watch it, Fatso!" at him for opening the car door into traffic.

"On the one hand, he's a dick and I'd like to find that guy now," Greg recalled. "On the other hand, the social shaming worked."

Buzz:
"Those libertarians who have all kinds of problems with government programs about obesity are going to be crying their eyes out 20 years from now," he added, when a fat and aging population brings with it increased taxes and social burdens.

That's assuming the state is to fund health care for these people — an assumption said libertarians would never make to begin with. If you want to get fat, fine, but don't come crying to us to pay for your heart bypass. (Same deal as for smoking.)

Indeed, one thing the government could "do" to solve the problem is tell the fatties that they won't be getting any help from Uncle Sam. Letting them know that they'll have to bear the cost of their own actions, thus breaking the moral-hazard structure created by government-funded health care (= subsidy of risky behavior), might well have a measurable effect.
7.22.2004 3:50pm
Joseph (mail):
"your right to overeat ends where my airplane seat begins"

Self-discipline certainly must play a role in personal health, but I think you are oversimplifying the situation. I have several friends who were healthy and within the normal range of weight. But when they were diagnosed with certain diseases (schizophrenia, lupus), the medications they had to take caused them to balloon up. And they suddenly became victim to these nasty, moralizing, unhelpful comments so often lobbed at overweight people.
7.22.2004 4:17pm
Mike (mail) (www):
I've never understood why some people get so worked up about other peoples' body weight. That makes as little sense as being concerned with other people's style of dress or hobbies.

I know that under our current medical system, we end up subsidizing other peoples' unhealthy lifestyles, but this isn't limited to obesity -- we also subsidize smokers, "extreme" athletes, people who excessively tan, people who never exercise, promiscuous people, and people who are allergic to common things.

In a perfect libertarian world, this wouldn't be so, but that is the way things are.
7.22.2004 4:29pm
Joseph (mail):
Social shaming of "fatties" is about as effective as social shaming of gays and lesbians. Sure, it will be effective to some extent: you'll get some people to curtail the behavior you consider morally suspect, but at the same time you inflict unjustified pain on people who, like it or not, can't help that they are overweight or gay.
7.22.2004 4:32pm
Jason (www):
Perhaps the correct course would be to treat obesity properly. That is, the doctor, before prescribing meds and the like would prescribe ten miles a day plus three healthy meals. It would be responsible to say, before we give you meds you have to get your input/output in balance. Until then, you get nothing else. (obviosuly excusing various obesity causes ie thyroid, meds, you get the point.)
7.22.2004 4:39pm
Gomez:
Government could start start solving the problem by letting health insurers underwrite obese insured's policies. If it's true that the prevantably obese are driving up all of our insurance rates because of their lifestyle, they should pay a little bit more to account for the risk.

As for Medicare: Can someone explain to me again why the government is in the health insurance business?
7.22.2004 4:51pm
sean (mail):
"we also subsidize smokers, "extreme" athletes, people who excessively tan, people who never exercise, promiscuous people, and people who are allergic to common things. In a perfect libertarian world, this wouldn't be so"

How exactly are allergies, which are not at all a matter of individual choice, similar to people who make the choice not to exercise, to tan excessively, or to have lots of dangerous sex? I don't know anybody who woke up and decided they wanted to be allergic to bee stings or peanut butter or grass pollen.
7.22.2004 5:04pm
TMarcell:
All of these "pro" argumens rest on the same assumption—but tell me, why, exactly, is it the government's concern or responsibility to insure that we don't pay a certain level of insurance costs? This is the market's job. And I can't imagine 20 years hence what social "burdens" we will be faced with that can strictly be attributed to obese people, in fact, I, for one, look forward to the gym being a little less crowded. Do we seriously want to see just how slippery the slope of governement intervention into making judgments about our personal weight can be? Should the government be in the business of making "better" people? I say, Keep Your Laws Off My 'Fridge!
7.22.2004 5:22pm
storis38 (mail):
"As someone who believes your right to overeat ends where my airplane seat begins, I don't think that Medicare's decision last week to begin paying for obesity treatments is such a terrible example of nanny-state meddling."

While I agree with your first observation, I couldn’t disagree more with your second. I don’t believe it is the government’s responsibility to cover the medical treatment of those citizens who knowingly engage in voluntary behavior that increases their risk of becoming unhealthy. If you are a smoker, if you are a pilot, if you engage in certain hazardous occupations, insurance companies reflect the additional risk by charging higher premiums. The same should apply to people who are obese because they choose to “super-size” their food intake. If medicare want to start covering obesity treatment, then those that are obese should be required to pay higher medicare taxes.
7.22.2004 5:46pm
Mike (mail) (www):
Sean, the inclusion of allergies in my list of risky behavior was a mistake. Strike "allergies" from that last.
7.22.2004 6:24pm
TJIC (www):
"Those libertarians who have all kinds of problems with government programs about obesity are going to be crying their eyes out 20 years from now," he added, when a fat and aging population brings with it increased taxes and social burdens.

A true libertarian would argue that Medicare should not fund obesity treatments now, *or* obesity-related-disease treatments later.


Wonkish analysis of whether prevention now is cheaper than
cures/amelioration later entirely misses the point: the State has no legitimate legal interest in, nor legitimate legal power to, deal with the health of individuals.

Did someone ammend the constitution to add a 19th bullet point to Article I Section 8?

The Congress shall have Power to...fund gastric bypasses, personal trainers, replacement hips, and walkers for individual citizens?

No?

I didn't think so.
7.23.2004 9:43am
jenny:
TJIC: I think "dealing" with the health of individuals fits rather nicely under that little bit at the beginning of the constitution that says, "promote the general welfare." and again in article 8 where it says congress shall have the power to "lay and collect taxes... to... provide for the... general welfare."
7.23.2004 11:14am
beloml:
Joseph,

If people cannot control what they put into their mouths, what in the world CAN they control?
7.23.2004 11:29am
beloml:
Joseph,

If people cannot control what they put into their mouths, wht in the world CAN they control?
7.23.2004 11:29am
wyoh:
Most people don't know about the links between high fructose corn syrup and obesity. The corn lobby makes the syrup cost less than sugar, so, look at processed food, most of it will have corn syrup in it as a substitute for sugar. Corn syrup doesn't activate the body's sugar response loop (insulin, etc), and so the body stores it as fat, and is still hungry. We'd probably reduce a lot of overweightness if we didn't eat stuff with HFCS in it. But try getting your next load of groceries with zero corn syrup in it.
And this does affect the poor more, as they are more likely to choose cheaper processed food/fast food over organic alternatives. If you're working 2 or 3 jobs who has time to cook properly?
7.23.2004 12:02pm
ray_g:
I have acquaintances who are fitness fanatics that like to complain about overweight people and smokers making health insurance costs rise. The irony is that I know at least 3 who have had operations for their knees and ankles that they have damaged by overdoing their running, and were covered by our health care plan. As long as there is group insurance, we all have to be tolerant of each other's life styles
7.23.2004 12:53pm
Joseph (mail):
Beloml,
I am not saying that people cannot control what they put in their mouths. I am criticizing the simple cause-effect link between undisciplined overconsumption of high-carb/fat foods and an individual's health or superficial body weight. There are many causes of overweight (genetics, medication, mental illness, etc.). So, using social shaming of obesity to try to improve their health (as has been suggested by Cathy and her friend) is an overly broad remedy for the problem. So, yes, lack of self-discipline and overeating cause obesity. But some people have also argued that gay sex caused the spread of AIDS, which is true on one level. However, shaming homosexuality is not the best answer to AIDS because it was really caused by a more discrete problem: ignorance and unprotected sexual promiscuity. And the social stigma attached to homosexuality actually exascerbated the problem because it made politicians weary of addressing the subject and further isolated the gay community.
7.23.2004 3:47pm
ganso (mail):
It is far from established fact that the obese "cost more" when you factor in their lower life expectancies. SS pensions cost less, other terminal illness treatments (eg, cancers) are avoided, etc. The same may be true for smokers. By some analyses, we should 'subsidise' smoking rather than tax it, if all social costs are accounted for.

Jenny, be thoughtful about invoking the "General Welfare" clause. Your interpretation would allow government intrusion into any aspect of life. A perusal of the Federalist Papers would likely help you understand what this meant.
7.23.2004 5:05pm
one:
"If you are a smoker, if you are a pilot, if you engage in certain hazardous occupations, insurance companies reflect the additional risk by charging higher premiums. The same should apply to people who are obese because they choose to “super-size” their food intake."

The problem with this is that there isn't a foolproof measure of "obesity." either you're a pilot, or you're not; either you're a smoker or you're not. with weight, though, it's not a simple yes-or-no checkbox. BMI, which simply a height-weight ratio, is a terrible measure even though it's the one most commonly cited in obesity scare articles since it can't account for muscularity or bone structure at all. As a weightlifter, for example, my BMI puts me on the "obese/overweight" border; my level of body fat, though, is on the low end of the "healthy" range. Should I pay a "fat tax" on insurance simply because I weigh more than than I "should" for my height, even though i have none of the health problems that are often correlated with obesity, and even though I'm in far better physical shape than most people who happen to weigh less but lead sedentary lives?
7.23.2004 5:42pm
Bill B (mail):
wyoh:

1. All forms of carbohydrate are converted into glucose by the liver. Fructose, glucose, and Sucrose are all mono-saccharides and have the same glycemic index (i.e. are equally fast in making your blood sugar and insulin levels rise). The reason that complex carbohydrates (starches in wheat bread for example) have a lower glycemic index is because it takes longer for the body to break it down to the same building blocks (fructose, glucose, and sucrose). 2. Insulin is the hormone that makes the body store food as fat. If a sugar did not "activate the body's sugar loop" it wouldn't make you fat at all, it would not be a useful nutrient at all (like Splenda(tm)).
7.23.2004 5:46pm
Eileen Hawkins (mail):
Since no one here seems to be obese, let me speak of the "links" of obesity to heart disease, etc. If a fat person exercises, they will live as long a thin person who exercises. If they don't, they won't. The solution to "obesity" is not medical treatment at all, especially for the poor. What they need is to have a living wage so they aren't working 2-3 jobs that don't give them a chance to exercise. I have contended that my Medicaid could do more for my health by paying for a YMCA membership than by many other interventions. I have severe osteoarthritis in my knees, and am not a good candidate for a knee replacement. However, my orthopedic surgeon offered to send me for gastric bypass. Both surgeries cost about $32,000 each. I would have less depression and more energy if I could do water walking. However, the "discounted" membership for people on welfare or SSDI is a $50 joining fee, and $26 a month. That is difficult to come up with on my $339 the state gives me for my disability. It is also difficult to "eat right" on the $5/day I have for food on food stamps.
Before you castigate me for wearing out my knees by being obese, it is a genetic problem where the cartilage breaks down before it should. My normal weight father had a knee replacement at age 63, I was diagnosed at 53, and my normal weight brother is already bitching about his knees at age 43. As for my sleep apnea, the other obese disease I have, I have had symptoms of it since I was in my teens. People used to remark on how tired I looked at the beginning of my shift. Recently they have been discovering more cases of sleep apnea in teens and small children. Is it not at least possible that I am obese because I was always exhausted and my knees hurt, rather than that I am a "bad person, and can't control what I put in my mouth?" My greatest fear with Medicare treating obesity as a disease, it will spread to Medicaid, and a lot of poor people will be coerced into gastric bypass surgery. This cuts off the part of the intestine that absorbs nutients, so you are not only deficient in calories, you are deficient in nutrients. What a healthy way to lose weight!
7.23.2004 8:23pm
wyoh:
Bill, sorry to paraphrase above, I was going for brevity:

"For example, consumption of glucose kicks off a cascade of biochemical reactions. It increases production of insulin by the pancreas, which enables sugar in the blood to be transported into cells, where it can be used for energy. It increases production of leptin, a hormone that helps regulate appetite and fat storage, and it suppresses production of another hormone made by the stomach, ghrelin, that helps regulate food intake. It has been theorized that when ghrelin levels drop, as they do after eating carbohydrates composed of glucose, hunger declines.

"Fructose is a different story. It "appears to behave more like fat with respect to the hormones involved in body weight regulation," explains Peter Havel, associate professor of nutrition at the University of California, Davis. "Fructose doesn't stimulate insulin secretion. It doesn't increase leptin production or suppress production of ghrelin. That suggests that consuming a lot of fructose, like consuming too much fat, could contribute to weight gain." Whether it actually does do this is not known "because the studies have not been conducted," said Havel.

"Another concern is the action of fructose in the liver, where it is converted into the chemical backbone of trigylcerides more efficiently than glucose. Like low-density lipoprotein — the most damaging form of cholesterol — elevated levels of trigylcerides are linked to an increased risk of heart disease. A University of Minnesota study published in the American Journal of Clinical Nutrition in 2000 found that in men, but not in women, fructose "produced significantly higher [blood] levels" than did glucose. The researchers, led by J.P Bantle, concluded that "diets high in added fructose may be undesirable, particularly for men."

(this article was posted before some other studies that do make the link, but this has more body chemistry. Google "high fructose corn syrup obesity" for more)
7.23.2004 11:09pm
storis38 (mail):
"If you are a smoker, if you are a pilot, if you engage in certain hazardous occupations, insurance companies reflect the additional risk by charging higher premiums. The same should apply to people who are obese because they choose to “super-size” their food intake."

The problem with this is that there isn't a foolproof measure of "obesity." either you're a pilot, or you're not; either you're a smoker or you're not. with weight, though, it's not a simple yes-or-no checkbox. BMI, which simply a height-weight ratio, is a terrible measure even though it's the one most commonly cited in obesity scare articles since it can't account for muscularity or bone structure at all. As a weightlifter, for example, my BMI puts me on the "obese/overweight" border; my level of body fat, though, is on the low end of the "healthy" range. Should I pay a "fat tax" on insurance simply because I weigh more than than I "should" for my height, even though i have none of the health problems that are often correlated with obesity, and even though I'm in far better physical shape than most people who happen to weigh less but lead sedentary lives?

Yes. Because reliance on ideal weight standards slone would not be the standard for classification as obese. For example, people like you who are "overweight" by the tables would be excused from higher insurance charges if they had a low BMI and could demonstrate a baseline level of acceptable physical fitness.
7.24.2004 7:44pm
storis38 (mail):
"If you are a smoker, if you are a pilot, if you engage in certain hazardous occupations, insurance companies reflect the additional risk by charging higher premiums. The same should apply to people who are obese because they choose to “super-size” their food intake."

The problem with this is that there isn't a foolproof measure of "obesity." either you're a pilot, or you're not; either you're a smoker or you're not. with weight, though, it's not a simple yes-or-no checkbox. BMI, which simply a height-weight ratio, is a terrible measure even though it's the one most commonly cited in obesity scare articles since it can't account for muscularity or bone structure at all. As a weightlifter, for example, my BMI puts me on the "obese/overweight" border; my level of body fat, though, is on the low end of the "healthy" range. Should I pay a "fat tax" on insurance simply because I weigh more than than I "should" for my height, even though i have none of the health problems that are often correlated with obesity, and even though I'm in far better physical shape than most people who happen to weigh less but lead sedentary lives?

Yes. Because reliance on ideal weight standards slone would not be the standard for classification as obese. For example, people like you who are "overweight" by the tables would be excused from higher insurance charges if they had a low BMI and could demonstrate a baseline level of acceptable physical fitness.
7.24.2004 7:44pm
storis38 (mail):
"If you are a smoker, if you are a pilot, if you engage in certain hazardous occupations, insurance companies reflect the additional risk by charging higher premiums. The same should apply to people who are obese because they choose to “super-size” their food intake."

The problem with this is that there isn't a foolproof measure of "obesity." either you're a pilot, or you're not; either you're a smoker or you're not. with weight, though, it's not a simple yes-or-no checkbox. BMI, which simply a height-weight ratio, is a terrible measure even though it's the one most commonly cited in obesity scare articles since it can't account for muscularity or bone structure at all. As a weightlifter, for example, my BMI puts me on the "obese/overweight" border; my level of body fat, though, is on the low end of the "healthy" range. Should I pay a "fat tax" on insurance simply because I weigh more than than I "should" for my height, even though i have none of the health problems that are often correlated with obesity, and even though I'm in far better physical shape than most people who happen to weigh less but lead sedentary lives?

Yes. Because reliance on ideal weight standards slone would not be the standard for classification as obese. For example, people like you who are "overweight" by the tables would be excused from higher insurance charges if they had a low BMI and could demonstrate a baseline level of acceptable physical fitness.
7.24.2004 7:44pm
storis38 (mail):
"If you are a smoker, if you are a pilot, if you engage in certain hazardous occupations, insurance companies reflect the additional risk by charging higher premiums. The same should apply to people who are obese because they choose to “super-size” their food intake."

The problem with this is that there isn't a foolproof measure of "obesity." either you're a pilot, or you're not; either you're a smoker or you're not. with weight, though, it's not a simple yes-or-no checkbox. BMI, which simply a height-weight ratio, is a terrible measure even though it's the one most commonly cited in obesity scare articles since it can't account for muscularity or bone structure at all. As a weightlifter, for example, my BMI puts me on the "obese/overweight" border; my level of body fat, though, is on the low end of the "healthy" range. Should I pay a "fat tax" on insurance simply because I weigh more than than I "should" for my height, even though i have none of the health problems that are often correlated with obesity, and even though I'm in far better physical shape than most people who happen to weigh less but lead sedentary lives?

Yes. Because reliance on ideal weight standards slone would not be the standard for classification as obese. For example, people like you who are "overweight" by the tables would be excused from higher insurance charges if they had a low BMI and could demonstrate a baseline level of acceptable physical fitness.
7.24.2004 7:45pm
one:
storis38,
the whole point of my post was that i *do* have a high BMI (as do many athletes), and that BMI is not a good measure precisely because it is so simplistic. further, the cost of having everyone "demonstrate a baseline level of acceptable physical fitness" (whatever that means) would negate any money saved by tacking a fat-tax onto insurance premiums.
7.27.2004 12:13am
Daniel Newby (mail):
one: Body fat percentage is the definitive measure of obesity. It can be measured in a few seconds with an inexpensive electronic meter. It's what insurance companies would use if they tied premiums to metabolic fitness.
7.27.2004 7:12pm