The war on fat: is the size of your butt the government's business?

Reason, August-Sept, 2004 by Jacob Sullum

"The greatest danger, I believe, does not come from individual lawsuits," Schwartz says. If a case gets as far as discovery, however, it may produce industry documents that support the image of devious companies tricking people at a young age into unhealthy habits they later have trouble breaking. And once the public has begun to fault Big Food for hooking kids on cheeseburgers and fries, Schwartz suggests, "a state attorney general or two could ... bring a tobacco-like lawsuit against the food industry because of the cost obesity places on Medicaid.... Then a lot of these legal barriers could crumble, just the way they did with tobacco." And as with tobacco, much of the anti-fat agenda, including higher food prices and marketing restrictions, could be achieved through lawsuit settlements, making it unnecessary to lobby legislators.

The rationale for such lawsuits is also the main rationale for the war on obesity. As Banzhaf put it in a May 2003 press release, "obese patients are contributing to skyrocketing Medicare and Medicaid outlays and costing thin taxpayers tens of billions of dollars a year." A study published last year in the journal Health Affairs estimated that the health care costs associated with excessive weight amount to something like $93 billion a year, half of it covered by Medicare and Medicaid. On average, medical treatment cost $732 more per year for the obese and $247 more for the merely overweight. (The increases in Medicare and Medicaid costs were statistically significant only for the obese.) "If people want to be 200 pounds," said the study's lead author, economist Eric Finkelstein, "then that's their choice. But ultimately, if the taxpayer is paying for those choices ... that is where the justification for government involvement comes from."

As Finkelstein and his co-authors acknowledged, however, it's not clear that taxpayer costs are higher, on balance, than they would be if everyone were thin. In the case of smokers, economic analyses indicate that taxpayer savings from less health care in old age and fewer Social Security payments (because of shorter life expectancies) outweigh the costs of treating tobacco-related diseases. Finkelstein argues that the calculation is likely to come out differently in the case of obesity, partly because "the elderly obese have only a marginally shorter life expectancy." Yet the data from the Framingham Heart Study suggest that obesity and smoking have a similar impact on life expectancy. University of Chicago economist Tomas Philipson, whose work on weight trends is widely cited, says "it's not clear whether obese people are costing us more or costing us less."

More important, the argument based on taxpayer-funded health insurance proves too much. It gives the government an open-ended license to tax, regulate, or ban any behavior that might lead to disease or injury. In Food Politics, Marion Nestle declares that "obesity contributes to increased health care costs, thereby becoming an issue for everyone, overweight or not." When I ask her how far she would take this principle, she says that depends largely on how social norms evolve. "The government deals with all kinds of risky behavior: smoking, seat belts, alcohol--all of those," she says. "I think it's a case-by-case situation." But if, as Nestle insists, "diet is a political issue," what isn't? The same logic suggests the government should take an interest in how much sleep you get, what kind of sex you have, and whether you floss regularly.