The Costs of Obesity

Although the rate of obesity in the U.S. did not rise over the last year, (perhaps due the poor economy), it was reported in this morning's Dallas Morning News that in the U.S. more than two thirds of adults, and a third of children remain overweight. The percentage of "extremely obese" children and young adults has risen from 9 percent in 2000 to fifteen percent today. "We haven't turned the corner yet" said Dr. William Dietz, an expert on obesity with the Centers for Disease Control and Prevention. According to statistics, the majority of Americans are overweight. Sixty four percent of Americans are described as overweight. Thirty four percent of those are considered obese. Seventeen percent of children were reported as obese. Most of those children were "extremely obese" as measured by the body mass index. Ten percent of of babies and toddlers are "precariously heavy." The statistics, if nothing else, indicate that growth does not stop after puberty. The good news is that the rate of obesity, as troubling as it is, has remained steady over the last five years. The bad news is that the obese are getting even more obese.

The health care costs associated with obesity are substantial. The costs include not just the direct costs of treating obesity related illness, but also the loss of productivity and loss of work due to obesity related illness. Diabetes, hypertension, heart disease, and colon cancer are among the plagues that affect the obese at higher rates than those who are not obese. There is also the spectre of premature death hanging over the obese. According to the Department of Medicine, Brigham Women's Hospital and Harvard Medical School, "the direct costs of lack of physical activity, defined conservatively as absence of leisure-time physical activity, are approximately 24 billion dollars, or 9.4% of the U.S. health expenditures." The CDC reports that in 1998, $78.5 billion was spent on obesity related illness. In a 2006, report, the California Center for Public Health Advocacy estimated that the health related costs of obesity to California was $12.8 billion. The health care costs related to physical inactivity were pegged at $7.9 billion (That is a lot of money in a cash strapped state like California.) Smoking, on the other hand, was estimated to cost the U.S. $157 billion between 1995-1999. It is worth pointing out that while the number of smokers in the U.S. declines every year, the number of obese is rising.

A lot of money is being spent in the U.S. to treat illness caused or exacerbated by overweight and obesity. Once the government becomes involved in health care, a person's health will no longer be their own business. It will be the government's business as well. And you can bet the government will not be content to simply write checks. There will be pressure to use the power and influence gained by the government over health care to manipulate society to achieve health care goals desired by the government and special interests. One goal will almost certainly be to control the health care costs presented by the obese. The only way to control those costs will be to reduce the number of obese. The only way to reduce the number of obese will be to get people eat less and exercise more. This was the conclusion of the California report.

The most likely way to achieve the goal of reducing obesity would be through the usual method: manipulating the tax code. Indeed, the California report concluded that "policies must be established at all levels to promote healthy eating and physical activity." The traditional method of manipulating the behavior of the public is by adjusting the tax code. If this method is adopted, it would open a Pandora's box of legislation and regulation. Might there someday be tax breaks for fitness? Would cheeseburgers be taxed? Would french fries? Will there be tax breaks for vegetables? Will there someday be mandatory exercise? Will people be taxed according to their body fat index?

If manipulation of the tax codes doesn't succeed in getting people to lose weight and get into shape, I suppose the government could try shaming and exhorting them. Maybe every household in America should receive a free subscription to Vogue and GQ. After all, if regulation and taxes aren't enough help to reduce obesity and encourage people to get into shape, maybe vanity and shame will.

Like it or not, when national health care becomes law, we will all have a greater share in bearing the burden of the obese. Each American will have a stake in the health of his or her neighbor. Like with smokers, many will feel that since society must bear the costs of that vice, society has a right to insist that the obese desist in their unhealthy ways. Not only should those who are over weight be concerned, but those with bad posture or who do not eat their vegetables should be uncomfortable. They might be next. The ire of the left is rarely placated for long.