The case for naked paternalism in the war against obesity
The well-known statistics on American obesity were anecdotally confirmed for me on a recent layover in Canada, when I was struck once again by how easy it is to tell Canadians from Americans. Those who headed for the "American passport holders" line looked lumpy in all the wrong places. Those who headed for the "Canadian passport holders" line, on the other hand, were of a very different breed. One might hazard to call their appearance "healthy."
You would be wise and correct to point out that my observation suffers from both sample size bias - a passport line is not a statistically significant cross-section of anything - and confirmation bias, since Americans have a well-known reputation for plumpness. But this is a case where casual observation reflects a fundamental truth: Americans are remarkably fat and getting fatter, even though we are obsessed with asking ourselves, why?
The scale of our bigness -- 34 percent of Americans are obese, compared to 24 percent of Canadians -- is made more striking by the scale of our efforts to combat it. America spends more money per person than any other country on "health care" (yes, I put that in quotes), while achieving worse outcomes than most of our peers in almost every conceivable dimension. The trillions we spend relative to Canada (about twice as much, per capita) do not make it any harder to tell Canadians from Americans in the immigration line.
But the bridge between America and Canada can be found in an unlikely place: Japan.
DIETS AND DICTA
See, I am solidly in the "American" group when it comes to personal body maintenance - always trying to lose those last 35 pounds - and yet a funny thing happens to me every time I spend a summer or a couple of years in Japan. Within a couple months, I drop to a healthy weight. I begin to look (though not necessarily to dress) like a Canadian. This might be what one would expect, given that Japan has the lowest rate of obesity in the developed world. Books with titles like "Japanese Women Don't Get Fat" may sound smug and condescending, but, as in comedy, there is often truth in smugness.
Why are the Japanese so slender? There are three reasons, and none of them has to do with genetics. One is the traditional Japanese diet, which is heavy on fish, vegetables, and rice. The second is Japan's mass-transit-centered urban design, which encourages Japanese people to walk a lot more than Americans. But the third factor is paternalism. Japan's government takes an active role in combating any hint of an upward trend in fatness.
In 2008, Japan's diet passed a law designed to combat "metabolic syndrome," which is known to Americans as "pre-diabetes." The so-called "Metabo Law" requires overweight individuals, or individuals who show signs of weight-related illnesses, to go to dieting classes. If they fail to attend the classes, the companies that employ them and/or the local governments of the areas in which they live must pay fines to the federal government. In addition, companies with more than a certain percentage of overweight employees are fined directly.
Americans, of course, would never submit to this sort of violation of personal liberty. Where Japan places an emphasis on enforcing personal responsibility by government or corporate mandate, the U.S. prefers to encourage responsibility by forcing people to live with the negative consequences of their actions. But in this case, it is clear that the two different value systems have led to radically different outcomes in terms of the health of the populace. Japan has succeeded in keeping its people largely thin. America has not.
THE YOGURT RULE
It is time for a rethink of our approach to public health, specifically with regards to obesity. No, it is not possible to use the government to fight fat while adhering to a perfect libertarian ideal; however, it is not possible to do anything while adhering to a perfect libertarian ideal, so let's just start from the notion that we live in a world where outcomes matter along with ideals. I believe that it is possible to change our public health policies in ways that preserve our basic values of personal liberty while significantly improving health outcomes.