Mark Kleiman lays out a few “simple truths” about obesity, some of which aren’t quite as simple as he makes them out to be, others of which are hardly true on their face. Let’s take them one by one:

The Body Mass Index is a very crude measure of obesity, since it doesn’t distinguish among body types, distinguish fat from muscle, or distinguish abdominal fat from less harmful fat carried elsewhere on the body.

Agreed. The problem is, even though the CDC concedes that BMI is crude and merely one small measure of overall health, government obesity tabulators use BMI and only BMI when making pronouncements about our collective weight. And those pronouncements inevitably lead to policy recommendations.

Carrying a little extra padding around after 40, as compared with currently published health standards (to say nothing of current fashion standards) seems to reduce mortality somewhat, though it may decrease quality-of-life in other ways.

I suppose, though “decrease quality-of-life” is inherently subjective. Perhaps to some people, “quality-of-life” means fitting into a pair of 34s at age 40. But for others, it may mean indulging in a tasty, fulfilling meal several times per week. My point has always been that that ought to be an indvidual decision.

Being obese, as opposed to mildly overweight, is really, really, really bad for you: bad at a level comparable to smoking, though not as bad as heavy drinking.

Agreed, though what the government currently considers “obese” doesn’t qualify. If we go back too Kleiman’s first point, and consider only those people who are truly putting themselves at risk, instead of those who merely meet the arbitrary BMI figure, the number of truly obese shrinks rather dramatically. Also, mortality tables strongly suggest that activity is a far better indicator of good health than body weight. An obese person who is active 3-4 times per week is far less likely (about 2.5 times) to die early than a sedentary person who’s at a weight the government considers ideal.

The country (leading the developed world in this regard, though probably only by a few years) is in the midst of an epidemic of obesity, especially juvenile obesity.

I can’t agree. If we measure obesity as the number of people who are truly putting their health at risk, it’s hard to say we’re in the midst of an epidemic. As I and others have pointed out several times before, life expectancy is at an all-time high in America, across all demographic groups. In fact, the demographic groups most likely to have become obese in the last 20 years have also added the most time to their average life expectancies, respectively. And we’ve seen dramatic declines in cancer and heart disease, two health ailments most closely associated with obesity. Certainly most all of this attributable to advances in medical science and technology. But we’ve been getting fat for about 30 years now. If the health consequences of that trend are as drastic as the public health people make them out to be, we should at least be seeing the first signs of this looming catastrophe. On the contrary, we seem to be getting healthier.

As for children, teens and adolescents remain at least 500 times more likely to have an eating disorder than two have Type II diabetes. Yes, our kids are plumper than they have been in the past. But it isn’t clear just how dangerous that is to their health, nor is it clear that any of the proposed remedies will have much effect, and may in fact cause unintended damage in other areas.

Bad diet and lack of exercise are the two main factors leading to obesity, though individuals obviously vary in their congenital risks of becoming obese.

Agreed.

The causes of bad diet and lack of exercise are diverse and poorly understood. Of course they are individual behaviors, but those behaviors are chosen within complex social contexts.

Sure. But the fundamental question then becomes, is it appropriate to use the force of government to alter those social contexts in attempt to coerce people into making decisions the non-obese consider “proper?” And even if it’s appropriate, would it even work? Kleiman specializes in drug prohibition. Seems to me that he of all people should know that government efforts to influence indulgent behavior inevitably come up short, and usually effect all sorts of peripheral damage along the way.

Walking and bicycling burn more calories than driving. Land use and transportation patterns that discourage walking and bicycling thereby contribute to obesity.Agreed. To the extent that the land is already publicly-owned, I have no problem with governmetn using that land in better ways. Kleiman and I probably differ when it comes to privately-owned land. I don’t think government should restrict how private people use their own land in order to influence choices made by third parties. That means that I’m not okay with, for example, using zoning laws to discourage fast food franchising, or co-opting private land for sidewalks or public parks.

The food industries, and especially the convenience-restaurant and snack-food sectors, relentlessly market bad eating habits to children. It seems unlikely that their multi-billion-dollar efforts have no impact on actual behavior.

It may seem that way. But kids are actually seeing fewer food advertisements than they were a decade ago. And caloric intake among children has increased by only about 1% over the last twenty years (activity levels have dropped 13%). What’s more, the single biggest factor of childhoold diet and nutrition habits is the diet and nutrition habits of the kid’s parents. If parents are being influenced by advertising, then passing bad habits on to their kids, do you ban the advertising and marketing of junkfood altogether? Doesn’t seem like it would take much of a leap for us to get there.

Also, fast food and junk food companies don’t market bad habits. They market products, which some people consume too frequently and in amounts too excessive. But that’s true of just about anything. And even if you agree with Kleiman’s statement, what’s the solution? Ban marketing to children? It’s been tried, and has failed, in places like Sweden, Norway, and Quebec. Ban the advertising and marketing of any product that can be abused? Wouldn’t that include just about anything? What’s more, banning ads directed at kids would cripple children’s programing. Furthermore, children get most of their information from adult programing, anyway. Banning ads for “bad” food during programs solely aimed at kids wouldn’t do much good. I think we’d slowly begin to see calls for bans on ads on shows where a certain percentage of the audience is under a given age, just as the public health folks attacking alcohol advertising are doing. And you’d see those percentages gradually decrease over time.

It’s likely, though not certain, that we could design and implement a combination of policy changes — regulations, taxes, and services — that would reduce obesity at acceptable costs in money and intrusion into private choice.

Really? When has such a policy worked in the past? Perhaps (though arguably) with smoking (economists have also made a pretty good argument that the public health efforts aimed at reducing smoking were a significant contributor to the obestiy problem in the first place). I can’t think of another example. Of course, everyone eats. Not everyone smoked.

The drug war strikes me as the most ambitious attempt at influencing behavior in the manner Kleiman desires. Alcohol prohibition, too. Few would argue either were/have been successful. I could break down each specific proposal publci health advocates have suggested, but I’ve already done so more than a few times over the last year.

Kleiman also neglects the most important point in this debate: What we eat is just about the most intimate, private decision we make. If that becomes cause for government meddling, it’s difficult to conceive of what’s left that wouldn’t be. I’d also guess that most people know by now that a greasy cheeseburger or gooey donut is bad for them. Yet they still eat them. Perhaps they’ve concluded that the enjoyment they get from good-tasting food is worth the added risk to their health, or a few extra months in the nursing home. I guess the fundamental question, then, is does a free society let peopole make that decision on their own, or does it implement tax, regulatory, and other punitive measures aimed at making that decision for them?

This entry was posted on Thursday, April 28th, 2005 at 10:02 am by Radley Balko and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.