Tobacco: Why Not Obesity?

Major health problems associated with smoking account for about a tenth of our health care spending, about the same amount as illness and behaviors associated with obesity. Today, the Senate will vote to regulate tobacco like a drug and crack down on marketing. Costs associated with cigarette consumption will rise. A lot of folks wonder why the government can't borrow the tobacco approach and apply it to obesity, which also seems to be -- seems to be, I say -- a condition that results from an addiction to food? Arguably, the long-term costs associated with being overweight exceed those of nicotine addiction. Trouble is, obesity belongs to a different category of conditions. There is a social and psychological element to the smoking contagion, but its origins, effects and treatments are much more defined. 

Also, people can live without nicotine. They can't live without food.  And food advertising is already more tightly regulated than tobacco advertising. The correlation between tobacco advertising and consumption is much stronger than the correlation between food advertising and obesity -- so strong, in fact, that it's close to being unidirectional. 

Though policy makers are beginning to change their thinking, I'd wager that most still believe that obesity is, at its core, a condition that individuals ought to be able to control themselves. That's why the preferred response to obesity, so far, has been more study and prohibitions on lawsuits against the food industry. On the flip side, comprehensive national anti-obesity programs, like national nutrition labeling standards, are untethered to evidence that they work.   I'll be writing more about obesity and health care policy in the coming months, but suffice it to say that the tobacco model offers fewer clues for obesity treatment and prevention then one might assume.