More on Obesity: Is the Government to Blame?

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Marc Ambinder, who has done a great deal of research on the subject, takes issue with what I have written about obesity.  Since he wrote carefully, I think it deserves a careful response.

McArdle approaches obesity as if it were a Foucauldian construct: a category invented by the government to justify an exercise of power. The government has no business intervening on the level of individual choice and it shouldn't get into the business of behavioral suasion because it always fails. She's right to note that information about health risks associated with overconsuming fat and sugar and salt are saturated throughout society, even supersaturated. Everyone knows how bad this stuff can be. For her, that's the end of the argument. Government can help to provide information about how to make better choices, but it cannot and should not try to persuade people to make better choices. Indeed, the push for people to make better choices produces the stigma that makes the bad thing bad in the first place.

That's not quite right.  Obesity exists.  For very heavy people, it's a serious health threat. It is to some extent arbitray, and indeed is invented by the government, which is true of many classifications.  GDP is also arbitrary and invented by the government, but it is no less useful a concept because of that.

I don't really care if the government tries to persuade people to make better choices.  But in general, government efforts to persuade people have failed. Government efforts at transparency are useful--it was the surgeon general's report on smoking and cancer that started the downward trend in cigarette consumption (and, natch, some of the upward trend in our waistlines).  Government coercion has also proven somewhat effective--cigarette taxation and anti-smoking laws have, as far as I can tell, helped cut into smoking quite a bit.  But the middle ground, where they just try to persuade us to change our ways, has given us genius moments like this:



. . . which have not made any noticeable dent in the behavior they were trying to change.  Now, if there were great misapprehension out there about the downsides of being overweight, the government might make a difference . . . though dieting is tougher than quitting smoking for most people.  But I don't think there are a lot of people in America who are under the illusion that being overweight is in any way desireable.

Of stigmatizing fat, Mark says:

This assumes that the stigma itself is misplaced. It isn't. Fat stigma is bad and harmful, and it ought to be reduced. But reducing fat stigma doesn't reduce the incidence of obesity; it actually seems to increase it in certain populations. What produces fat stigma is not a government or culture that hectors people to lose weight and exercise and then excoriates them when they can't; it's a government that expects individuals to lose weight on their own (which is next to impossible) while making policy that keeps people fat. The discrepancy between expectations and reality is cruel, especially for children.

I'm not sure what this means.  The stigma against fat people dates back into at least the early nineteenth century among the upper classes, and the late nineteenth among poorer people--writing diet books was a popular and lucrative pasttime in the 19th century (it is to that nascent movement that we owe many of the cereal companies of today).  Fat children have been brutally teased for decades.  I don't see this as primarily a result of government policy.

It's undoubtedly true that US government policy contributes:  lack of P/E in school, ag subsidies, etc., as Marc points out:

Labeling obesity a "problem" isn't a behavioral intervention: it's a social structure intervention. And here's where the individual model really breaks down, even for those who don't blame obese people, per se, for their obesity. Obesity is highly correlated with socioeconomic status. And it is a most acute problem among young minorities: African American women, Mexican-American boys, and Native American children have much higher rates of obesity than white children do. Poor kids tend to be more obese than wealthier or middle class children. The reason for these disparities are both obvious and counterintuitive: in general, people tend to eat what they can, which means that they buy the food they have access to. Wealthier people and people living in suburbs have access. Geographic location often correlates with lifestyle; history and social norms tend to be different, too, among ethnic groups. 

McArdle is right that it it's not fair for government to lecture people about weight loss and exercise, but she's right for the wrong reason: policy choices -- ag subsidies, zoning laws, education and budget priorities -- create a flow that, absent any intervention, are sweeping many young kids, particularly poorer kids of color, into obesity. Government's role isn't to scold; it's to make better policy choices. She's wrong about the interventions, too: some, like a physical education project in Somerville, Mass., seem to be working. Taking fast food vending machines out of schools and weighing children at least once a year has arrested the obesity growth rate in Arkansas.  Nationally, the obesity growth rate also seems to be be slowing.

I don't see how I'm "right for the wrong reason".  If lecturing people doesn't work, would it be nice or fair to do it even if the government hadn't contributed to the problem?  But I confess, I am more skeptical than Marc that this can all be laid at the government's door.  If US government policy is making people overweight, why is obesity rising all over the world?  It is worse here than most places, but if obesity is correlated with income, we would expect the problem to be worst in the richest country in the world. 

As for interventions:  lots of interventions work over short periods of time.  The problem is twofold:  1) they usually don't scale--educational projects with top notch researchers working with motivated families often run aground when they're rolled out into the real world and 2) the effects often go away as soon as the program ends.  Moreover, that last sentence seems to contradict everything else Marc is saying, since I'm aware of no significant changes in government policy that should be having any effect on the national obesity rate.

I'm not disputing that the environment has changed in ways that seem to make people get fatter--indeed, you'd have to be a total moron to dispute this.  Nor am I disputing that some of this can be laid at the door of government, like our ridiculous agriculture subsidies, and even our zoning laws.  On the other hand, it's also true that people really liked riding around in cars even before zoning--unless the landscape makes car ownership prohibitively expensive, people tend to embrace it, which is why car ownership is increasing so fast even in places like Europe.  Either way, this cannot be the only reason.  US government policy and bad zoning is not making people fat in Britain or Australia. 

Marc adds:

Lo and behold, government policy has helped ensure that the raw foodstuffs that go into all the starchy, sugary foods that we eat are much cheaper. And when compared to the consumer price index, fruits, vegetables and healthy foods are more expensive than they were 30 years ago. If government policy influences diet on a macro scale, and if there is evidence that the diet is harmful, then, in theory, there would be no additional intervention if, say, Congress began to subsidize tomatoes in the same way it subsidizes corn, just a change in policy.

None of this argues for a soda tax, or a tax on sugar, or a ban on, say, food marketing to children. It's just to say that if the obesity epidemic was nurtured by policy -- and it clearly was -- perhaps it can be undone by policy, too.

I think this is really, really optimistic.  First of all, while it is true that produce has outpaced snack foods in the CPI-U, there's reason to think that this is a statistical artifact of the way that CPI is calculated.  We have more fresh food available than ever before--year round raspberries, seventeen kinds of lettuce--and a lot more value-added products such as baby carrots and pre-washed lettuce.  When people pay more for unseasonable produce or prepped vegetables, this shows up as an increase in the rate of cost inflation.  If you look at the aggregate figures, we see that since the early 1980s (the time period from which the per-capita increases are usually quoted), per-capita consumption of fresh produce, particularly fresh vegetables, has increased dramatically.

The problem with all these sorts of theories is that they do an okay job explaining the latitudinal data--we're fat, we're subsidizing roads, we're subsidizing corn, so that must be making us fat!--but they don't explain the trend.  I have not done an exhaustive survey, but I've been unable to find any study that even attempts to establish in any sort of rigorous way that Americans have become more sedentary in, say, the last twenty or thirty years. 

The data is even less persuasive for other candidates.  Corn, and simple starches more broadly, have been the cheapest part of the American diet for centuries.  As a child, my mother didn't get any fresh vegetables at all eight months out of the year, because they simply weren't available.  She got frozen or canned, but their two winter staples were sugared homemade applesauce and butternut sqaush, both of which are basically pure simple carbohydrate.  Lean chicken was pricier than beef, but fatty pork was cheaper than either.  Look in a cookbook from the thirties or fifties and you'll find that recipes for some sort of mostly starch dish are at least 65% of the book.  And those weren't healthy whole grains, either.  They were white flour, or rice, richly laced with fat and sugar.

With the possible exception of corn subsidies (I don't have good data on the relative penetration of corn into the food supply chain), almost every alleged deficit that is "causing" our obesity epidemic, from highways to bad urban grocery stores, is either basically the same as it was fifteen years ago, or somewhat better.  So I find them deeply unsatisfying as a causal explanation for the sudden uptick in overweight people now.

To me, government behavior is at best an incredibly incomplete explanation of what's happening.  A better fit is simply that food--all food--has gotten much cheaper.  People spend less of their income on food than they did thirty years ago, despite consuming a lot more of it.   Stopping them from doing so will require a great deal more than subsidizing tomatoes.

Don't get me wrong:  I'm all for ending our moronic farm subsidies and unjust zoning laws.  But I'd be willing to bet that if we did, we wouldn't even see a blip in the broader trend.

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Megan McArdle is a columnist at Bloomberg View and a former senior editor at The Atlantic. Her new book is The Up Side of Down.

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