Girth of a Nation - The Cost
of Obesity in the USBy PAUL KRUGMAN -
New York Times Op-Ed Columnist
The Center for Consumer Freedom, an advocacy
group financed by Coca-Cola, Wendy's and Tyson Foods, among others, has a
Fourth of July message for you: worrying about the rapid rise in American
obesity is unpatriotic.
"Far too few Americans," declares the
center's Web site, "remember that the Founding Fathers, authors of modern
liberty, greatly enjoyed their food and drink. ... Now it seems that food
liberty - just one of the many important areas of personal choice fought for by
the original American patriots - is constantly under attack."
It sounds like a parody, but don't laugh.
These people are blocking efforts to help America's children.
I've been looking into the issues
surrounding obesity because it plays an important role in health care costs.
According to a study recently published in the journal Health Affairs, the
extra costs associated with caring for the obese rose from 2 percent of total
private insurance spending in 1987 to 11.6 percent in 2002. The study didn't
cover Medicare and Medicaid, but it's a good bet that obesity-related expenses
are an important factor in the rising costs of taxpayer-financed programs, too.
Fat is a fiscal issue.
But it's also, alas, a partisan issue.
First, let's talk about what isn't in
dispute: around 1980, Americans started getting rapidly fatter.
Some pundits still dismiss American pudge as
a benign "affliction of affluence," a sign that people can afford to eat tasty
foods, drive cars and avoid hard physical labor. But all of that was already
true by 1980, which is roughly when Americans really started losing the battle
of the bulge.
The great majority of us (yes, me too) are
now overweight, and the percentage of adults considered obese has doubled, to
more than 30 percent. Most alarmingly, obesity, once rare among the young, has
become common among adolescents, and even among children.
Is that a bad thing? Well, obesity clearly
increases the risks of heart disease, diabetes, back problems and more. And the
cost of treating these weight-related diseases is an important factor in rising
health care spending.
So there is, understandably, a movement to
do something about rising obesity, especially among the young. Bills that would
require schools to serve healthier lunches, remove vending machines selling
sweets and soda, and so on have been introduced in a number of state
legislatures. By the way, Britain - with the second-highest obesity among
advanced countries - has introduced stringent new guidelines on school
But even these mild steps have run into
fierce opposition from conservatives. Why?
In part, this is yet another red-blue
cultural conflict. On average, people living outside metropolitan areas are
heavier than urban or suburban residents, and people in the South and Midwest
are heavier than those on the coasts. So it's all too easy for worries about
America's weight to come off as cultural elitism.
More important, however, is the role of the
food industry. The debate over obesity, it turns out, is a lot like the debate
over global warming. In both cases, major companies protect their profits not
only by lobbying against policies they don't like, but also by financing
advocacy groups devoted to debunking research whose conclusions they don't
The pro-obesity forces - or, if you prefer,
the anti-anti-obesity forces - make their case in part by claiming that
America's weight gain does no harm. There was much glee on the right when a new
study, using data from the Centers for Disease Control and Prevention, appeared
to reject the conventional view that obesity has a large negative effect on
But as officials from the C.D.C. have
pointed out, mortality isn't the only measure of health. There's no question
that obesity plays an important role in many diseases that diminish the quality
of life and, crucially, require expensive treatment.
The growing availability of such treatment
probably explains why the strong relationship between obesity and mortality
visible in data from the 1970's has weakened. But the cost of treating the
obese is helping to break the back of our health care system.
So what can we do?
The first step is to recognize the
industry-financed campaign against doing anything for the cynical exercise it
is. Remember, nobody is proposing that adult Americans be prevented from eating
whatever they want. The question is whether big companies will have a free hand
in their efforts to get children into the habit of eating food that's bad for