The Unbroken Window

If we are to be generous to the ideas of those who are concerned about obesity in America, you would argue that there are two reasons for the worry. First, people might reasonably be concerned about the impacts of your obesity on them. In other words, there are external costs of obesity that the obese themselves are not taking into account when making health choices for themselves. You might be tempted to argue that these costs include psychological ones – that the larger the share of the population is obese, the more acceptable obesity is, which increases the chances that I myself may fall into the obesity trap. Your mileage may vary with that story, but there it is.

A second approach would be more standard economics fare – that being obese imposes true costs on people that they do not account for when they make health decisions for themselves. So, when a potentially obese person is thinking about downing an extra bucket of fried chicken, they do not consider the fact that when they walk down the sidewalk in the future there will be less room for everybody else. Some folks may even be forced near the curb and their chances of getting hit by a car or falling down a sewer grate are much larger. Since these folks never had a say in their displacement on the sidewalk, you might justify an intervention in obesity on those grounds. That conclusion does not follow despite what some intermediate microeconomics textbooks may preach to you.

However, these are rarely the two reasons people use to justify a “concern” for the obese or better stated, a concern for the issue of obesity. And as such, if we want to have an adult discussion of what to do about obesity, we need to be honest about the fact that we are largely making value judgments or that our concern is a consequence of other interventions that we’ve chosen to make. On the latter, it’s pretty clear that some people are concerned about obesity because, to paraphrase something I hear time and again, “we all pay for it.” Well, that can only mean that when someone is obese, they get sicker more often than a non-obese person, but it also means that when they get sicker the costs of treating them are larger, and that the overall medical costs of obese people are larger than non-obese people. Now, as we’ve explored before, this is NOT at all obvious. Despite the fact that my wife works on an ICU floor where nearly all of her patients have problems related to obesity, that tells us little about the right probabilities to look at – not all sick people are obese. It may very well be the case that being obese makes you die sooner than otherwise. It may very well be the case that the chronic diseases that afflict the obese are less costly to treat than the chronic diseases most of us are going to end up getting. So, just saying “obesity is costly” is merely a starting point at best. And remember, this is ONLY an issue if for some reason we are all forced to pay for the medical expenses of each other.

You might say that this point is not just germane to things like ObamaCare, Medicaid, Medicare and the VA. But you’d be wrong. Private insurers are not stupid. They have actuaries. If the obese are more costly to treat over their lifetimes, premiums would raise to reflect that. But of course, we’ve managed to regulate insurance in such a way as to make that impossible. So we’ve really converted “private” insurance into a de facto public “insurance” program that resembles prepaid medical care more than it does insurance.

A second reason people nominally claim to care about obesity is the idea that “we are just trying to prevent people from hurting themselves.” In other words, this is the traditional paternalistic justification for involvement in anything. I’d note that there is little economics here, and in fact little analysis done to justify the claims. To see why, let’s ask a few questions about obesity. Do you think folks that are obese or overweight are unaware of it? Is it plausible that they continue in their daily lives as their clothes get more tightly fit, as their cars get less comfortable, as they get more out of breath from walking, etc. and not notice it? Not at all plausible. Or how about this? Do you think folks that are overweight are unaware of the potential health risks from being overweight? Is it the case that “society” is silent on the risks of diabetes and heart disease? Do Cheerios not advertise that they are heart healthy? Do health food stores not exist? And what, exactly, is being taught in schools for 13 years about health? That being obese is great? Sorry folks, totally implausible.  How about this? Do you think that folks who are obese delude themselves into thinking that their wages and job advancement are improved by their condition? That when being compared to a fit person, someone who is obese thinks they have a better chance of securing a job as a delivery person, or a lawyer, or any number of jobs? Finally, do you think that the obese are somehow led to believe that they are deemed attractive by the majority of society? Do you think they believe they are the envy of society? I’ve got an ice cube to sell you if you believe any of this. Of course not. The obese are the object of jokes, scorn, ridicule, magazine covers, and much more. They are the subject of this very article. This is not revolutionary.

So, what, I ask, could possibly be the reasons folks concern themselves with obesity? I’ll suggest three. First is that it is simply something to talk about. I use to pooh-pooh those kinds of insights until I started working professionally on a college campus. Or visiting McDonalds for early morning coffee. But people need something to Bullshit about. They really do. And this seems something that is interesting to bullshit about. Like the weather.

Of course, I don’t think that is the primary reason folks are whooped up about obesity. The second reason is that we are all “getting revenge” for getting stuffed in lockers in high school. What do I mean by this? Well, about the only thing I can see in common in the obesity literature is the “holier than thou” attitude of many of the authors. They simply have a need to feel superior. They have a need to tell people what is good for them. They have a need to impose their view of the world on others. Please do try to convince me otherwise. And this is not unique to the obesity crusade, but many other crusades as well.

Finally, from reading student paper after student paper, and from reading magazine article after magazine article, it’s pretty clear to me that there is a huge anti-corporate “bias” at play here. The narrative is delicious. “McDonalds is making us fat!” Big Agriculture is pushing modified corn sugar. Big food companies are pushing unhealthy processed foods on all of us. And so on. Leave aside the issues of individual autonomy and sovereignty for the moment. But these sorts of arguments do seem to cause a tin ear like sound to me. After all, almost everything I read these days starts with the same claims. Except just replace the “unhealthy foods” with some other axe to grind like “treats workers poorly” or “discriminates” or “wrecks the planet” or “drains money and the life from local communities.” Our concern about obesity is simply another charge in the pre-ordained case against markets, capitalism or their ugly children the corporations. No analysis needed.  Don’t remind folks that if people wanted to eat lettuce, “big corporations” would make record profits trying to sell us lettuce. Don’t remind folks that “corporations” are actually made up of people just like you and me. Your neighbor works for a corporation. Your dad and mom. Your friends. Is it some nameless faceless rich white guy in a castle emanating a social arrangement from his perch that is doing all of this nefarious stuff?

Like I said, I went to McDonalds the other morning. They made some profits selling me a salad. How absolutely evil.