Everyone knows that obesity is a major health problem in the USA. One estimate suggests that 30% of health care costs – actually the cost of sickness care – can be attributed to the consequences of obesity.
Obesity clearly reduces productivity. Thus from the national commercial standpoint, obesity produces a double whammy: it both reduces revenue and at the same time increases costs.
While there are some endocrine conditions and genetic disorders that predispose to obesity, the vast majority of obesity is culturally driven and under conscious control.
If you exercise properly and eat right, most obese people would not be obese. Unfortunately, unhealthy foods are generally cheaper and much more available. Worst of all, people are programmed to think they taste better.
The production and distribution of unhealthy foods is very big business and highly profitable. Big food, like big pharma, is politically active and quite effective at defending their profitable position. (See Marion Nestle’s book titled “Food Politics.”)
Consider obesity from the standpoints of three different people: provider, taxpayer, and President. The health care provider doesn’t care about your weight other than the medical complications. It is part of their moral code to provider services to sick people regardless of all other factors.
Both healthy-sized people and super-sized people pay the same amount into the healthcare system. Yet the super-sized take more out because they require more health care services. The healthy-eating taxpayer feels this is unfair.
Finally, imagine yourself the CEO of Corporation USA, also known as President of the USA. Your primary goal is to protect and nurture the nation as a whole. In contrast to either the provider or the taxpayer, you have power. You can encourage passage of laws, rules and regulations. You have influence over the tax code.
You cannot legislate morality or behavior in the national best interest or even behavior in the individual’s best interest. Intellectually, people know they should eat ‘healthy’ but the bad stuff tastes sooooo good and besides, it’s cheaper.
So, Mr. CEO of Corporation USA, what can you do? You can change incentives. You know that incentives affect behavior and behavior determines outcome. If the people ate more healthy foods, they would be less obese. Health care would cost less andproductivity would increase (the reverse of the double whammy above).
Finally, Mr. CEO, you know that carrots work better than sticks. It is always better to offer a positive incentive to encourage the behavior you want than to punish the behavior you do not want.
If you want to reduce obesity, instead of punishing super-sized persons, subsidize healthy foods. Make them cheaper and more available. What if apples and legumes were easier to come by than coke, french fries and cheetos?
Imagine diverting 10% of what we spend now on obesity-care – say $60 billion – to subsidize healthy foods. How much less might we spend later on obesity-care – $100 billion, $300 billion? Then add the gains in productivity. Sounds to me like a win-win scenario.
What do you think about subsidizing healthy foods?
System MD
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1 comment so far ↓
Disappointmented in you – thought from other posts that maybe you had some sense, weren’t the typical medical establishment.
If diet & exercise worked (which it doesn’t, & not because all fat people cheat on either/both), we wouldn’t have obesity.
This totally lame-o theory of obesity doesn’t consider:
-People who win eating contests. Most of them are normal sized to slim. They train by pigging out daily. Most don’t exercise at all. Fat people who enter eating contests rarely win. One woman featured a couple years ago on our local TV station could demolish a 10 lb turkey in under an hour & won a contest by putting away 6 lb of turkey in 10 min. She proudly proclaimed she never exercised & told the interviewer she is a size 6. She looks it. And fat people disgust her because they eat so much! How about you figure out why that happens. Maybe there’s a clue in there. You know, if obesity truly worried doctors, they’d check this out. Proof the money you all can make off fat people is your sole real concern.
-3rd world obesity. Most of these people live in dumps & are lucky to manage one 500 cal. meal a day. So, how is their having a decent 1000 cal diet & exercise is going to fix this? They rove the streets all day trying to find work & food. That’s a lot of exercise. And not a lot of calories. Explain THAT, Dr. All Fat People Pig Out & Lie Constantly.
I’m no longer apologizing for being fat or failing at diets, because that was the intent of doctors all along. I refuse to stay quiet any longer. I am getting worse all the time from diseases that have nothing to do with obesity as a cause. I’m tired of doctors using fat & female menstrual cycles to deny people adequate care.
So, now I want to know: What did you all do to that researcher who claimed to have found a virus in most obese subjects, that he didn’t find in thin people? I guess you guys did to him what you did to those 2 MDs & the one researcher who, in 1991, found an undiscovered, uncatalogued retrovirus in 95% of CFS patients. They got trashed; they can’t get jobs for the ridicule. Meanwhile, some other doctor stole their research, because there are so many more CFS sufferers demanding research leading to treatments or cures, that the time was ripe for them to steal these people’s research as their own – the XMRV virus, I believe it’s called. And we already know the Brit doctor who claimed to have found the causative virus & a cure 5 yr ago disappeared. Not hard there – CFS research is protected under the Official Secrets Act there. Kinda gives those conspiracy theorists credibility.
I just love the one obesity drug that was such a success in Europe & Canada, that you all refused to let the FDA approve for use in the US. I can’t even recall the name, but here are the same people who killed/disabled thousands of fat people with phen-fen, claiming someone else’s research was bad! That’s a HOOT! The same ones who, in the 50s & 60s, gave speed to any woman who wore over a size 8 (which, BTW, is now considered being obese), to cut their appetite, & handed out tranks to put them to sleep at night. Some solution! These are the ones who think a drug that has a side effect of leaking greasy, foul smelling stool out a person’s behind is not a problem; they’ve even allowed a lower dose version to be sold over the counter! There are even more pharmaceutical gaffs out there in obesity treatment, one of which was to split phen-fen back up & only give one of them to the fatties. And still ruin their heart! And you say this other European drug isn’t researched & has “undesirable side effects”?? Last time I checked, leaking poop wasn’t a desireable side effect. Neither was pulmonary hypertension, global cardiomyopathy & congestive heart failure, bad heart valves, or mixing uppers & downers that have a super high rate of dependency. Depression can be treated if it occurs with a medication. Death is a bit tougher.
Doctors are going to protect this diet-and-exercise thing forever, because since they’ve made obesity into a global pandemic & silenced the virus researcher, they’re now guaranteed reimbursement for trying to make fat people thin. A good many of them had already started specialized bariatric clinics that pushed weird programs; some had written books & gone on the lecture circuit; so money’s there to be made.
And since the cycle of too-low-calorie diets that are doomed to failure, blame & accusations of cheating, patient relapse, & patient coming back for another try has made sure the patient loses less & less each diet cycle & hates themselves more & more each time. Too bummed out to start demanding a cure be found, they are easily led to accept weight loss surgery as an answer.
Oh, yeah?
The patient loses 60 – 80% of their EXCESS body weight. Now, do the math for anyone trying to lose weight; they’re always going to be overweight or obese with those numbers. So they’ll go through extreme surgery & nasty complications, get blamed for their own illnesses, only to lose the same amount they’d have lost on a diet. And whenever something goes wrong, the doctors will say the same thing they say when diets fail: that the person didn’t do what they were told or all the weight would be gone.
Before you start, yes, I know there are WLS patients who’ve managed to stretch out the pouch by pigging out, regaining the weight. But the shrink who clears them would probably have cleared someone with Jack the Ripper’s psych profile to keep the money flowing. Because, like you, they know when the nutcase fails, no blame will accrue to either of you for passing someone who really shouldn’t have passed those supposedly rigid psych evals for fitness.
More money to doctors’ coffers on that one – the rate of infection admitted to on the weight loss surgery patient sites where I’ve lurked, listening to the tales, is about 80%. That doesn’t surprise me; I’m a nurse. I know that from doctors to patient care techs, aseptic technique is omitted for obese patients to lessen the amount of time normal size people have to endure those they consider revolting, disgusting pigs. Of course you have to be nice to them while you’re in there; but since your actions are driven by hatred & disgust instead of compassion, you omit basic patient safety in a rush to not have to look at them. Your insides are far more disgusting than any fat person’s external appearance.
And you get away with blaming the patient for the infections – from “fat rolls crowding the incision” to “they’re too fat to get clean in a shower,” you have all sorts of rationalizations for omitting safety in their care. Meanwhile, you get reimbursed &/or they get bills for multiple patient care encounters that are all blamed on them. By the time they’ve gone through this for at least 6 months (the lowest sick time I found on the boards; most had at least 18 months of misery), they often have developed – or worsened – a pain syndrome such as CRPS or fibromyalgia.
That’s going to be the first in a long line of physical problems that will start appearing once you all stop monitoring them after 5 years (at least, as far as data collection goes). I have seen one, & only one, healthy WLS patient past 5 years, but she’s considered overweight. Of course, I am not including the celebrities; their healthcare will always be scrupulously aseptic technique on dressing changes, early attention to problems, rapid care at your offices to avoid their being discovered ill from WLS in an ER, because their success & endorsements ensure more suckers will sign up for the only surgery most doctors will allow – the roux en y. A redo of a Whipple procedure for advanced pancreatic cancer, & one every patient I’ve cared for who’s had it, has claimed is worse than the cancer. And THAT’S your Answer.
What I HAVE seen more than 5 years out (including articles that have been pulled from Medscape a week or less after they appear, because we have to silence anyone who tries to tell the truth & kill the goose that laid the golden egg), is premature aging. Diseases of the very old in 30 somethings 5 years out from their WLS. Osteoporosis, which causes the formation of bone spurs, aka osteoarthritis, meaning those joints you claimed would be saved have to be replaced far sooner than would’ve been necessary if they’d stayed fat. Compression fractures of the vertebrae, causing severe pain & making patients bedridden in many cases. Malnutrition & constant anemia, despite multiple supplements that are so large the person has no room in the pouch for food. The anemia starves the organs bit by bit & they start to fail, starting with the most vulnerable – the heart & brain. CHF. You know, that disease WLS was supposed to prevent? It moves on to sensitive hormone-producing organs that were already compromised because the gastric hormone production was altered by the radical surgery & the system is fully integrated. Meaning diabetes, the stuff the WLS was supposed to prevent. Avascular necrosis of the hip, requiring hip replacement with bones that are already compromised by osteoporosis borne of malnutrition.
And it all makes doctors money. And doctors have the unmitigated gall to claim WLS saves money. Saves WHAT, exactly? The cost of a blood pressure pill & a diabetes pill that cost $4 a month each at most pharmacies now? The cost of testing strips for people who test 2 times a day, when there are meters that work great on stips that are less than $1 each?
But if you find a real cure, the cashflow stops dead. So as long as you doctors can browbeat fat people by decimating self esteem under the guise of being helpful & using “tough love,” you’re not going to try to find the real reason. And you’re going to silence anyone who does.
Yeah, making food that’s good for you cheaper than food that’s bad for you would help everyone. And it’s overdue. But it’s not a complete solution.
Productivity loss? I think not. Psychological & medical research have shown that people who are unattractive to a boss, teacher, etc., are consistently given lower evaluations, grades, etc., than their slim counterparts who are working at the same or even a lower level. You’re basing productivity estimates on evaluations; well, there are very few bosses who evaluate fat people, especially fat women, positively, no matter how hard they work. I’ve watched it & I’ve been the victim of it. By the time my health was ruined so badly that I had to apply for disability, I was doing the work of 6 people. I don’t think ANYONE can call that unproductive. Well, you can – you’d just be lying.
And yes, as time passed with that workload, I had to see a doctor more often; I was ill more often. FROM OVERWORK. When I am in pain, I can’t eat. I’m too nauseated from the pain. When I’m tired, I can’t digest the food, either. The malnutrition that logically followed made me less productive, increased the pain, which increased the fatigue. After succeeding in working 22 yr with something that sends most thin people scurrying to the disability lawyers within 5 years (12 of those with 2 illnesses that usually cause disability within 5 years), this “lazy, fat, unproductive” nurse was done for. I have never recovered, although I desperately want to. I & my work ethic are not the only ones resident in a fat body; most fat people have to work much harder than their thin colleagues for even a mediocre eval, when we deserve much better. In fact, when I got the 2nd diagnosis, I was told to stop inpatient nursing. I have 2 degrees & was a self-taught informaticist. Just to keep working, this “lazy, fat” nurse took a 33% paycut rather than submit to the diseases. I’d only just gotten back to my night nurse salary after 11 years when I had to admit I was too ill to work. I’m not the only fat person who has a good work ethic.
As for the bad eating habits some of us return to, why not? We’ll be accused of them anyway, & at least crackers, chips, or even a candy bar can be grabbed if you’re desperate, when you know you won’t get a lunch hour & you’re starting to feel a bit shaky, any port in a storm.
Find a cure. I’m going to start demanding it, & I’m going to start trying to convince other fat people to stop feeling the way you all want them to feel – like evil people unworthy of life. I’m going to encourage them to do what CFS patients are doing – demand a REAL answer, REAL research, into obesity – not the fake research that rehashes “diet & exercise” from 50 different angles, but checking into thin people who overeat massively & don’t gain weight, trying to find that virus & see where it leads, trying to find out what’s causing 3rd world obesity.
As a PS, when my son developed type I diabetes, the doctor asked me if he’d always been heavy. He hadn’t; he’d started gaining weight, with no change in eating habits, after a bad cold one winter; he’d gone from slims to huskies & up 2 sizes in not quite a year. The pediatric endocrinologist said that was when he got the virus that caused the autoimmune destruction of his pancreas, causing weight gain from excess production of insulin. So, is it possible the worldwide epidemic of diabetes is causing some of the obesity? That the process acts differently in different people but is essentially the same as my son had?
OH, sorry, I forgot: Doctors already know everything there is to know about obesity, there’s obviously no need for these all knowing beings to condescend to consider themselves to have incomplete or – dare we say it? – faulty information on obesity.
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