Environmental Concerns

So it seems that James Fallows and Marc Ambinder and I all agree that the increase in obesity in the American population is environmental, though they seem to think I disagree, despite my having made this point several times, and have thus spent a fair amount of time disproving a point no one has made.  The very point of the height example offered in my first post was to note how environment interacts with genes.

It still remains to figure what the environmental change in America is that has caused this:  whether the government is largely responsible, and regardless of that, whether the government can stop it.

As I've said elsewhere, I don't think the government is all that plausible as the primary source of the problem.  Obesity is rising everywhere, even in poor countries.  It seems to be rising fastest in the anglosphere, but then, most countries outside the anglosphere rely on self-reporting data, which produces lower estimates.  Eyeballing it, people in other countries are a lot thinner.  But there are also a lot more fat people in Europe than there used to be.

But leaving culpability aside, what can the government reasonably do to make us healthier?  We could change our road building and build denser.  But of course, as I pointed out elsewhere, while being rural is correlated with being fatter, it's also correlated with being healthier (though that advantage may be eroding).  It's impossible to tease out the countervailing effects, so which should we do?  Build up dense areas in which people will be thinner, but maybe sicker from the stress hormones of living in a noisier, more crowded area?  This might be liking taking up smoking to lose weight.

We can eliminate agricultural subsidies.  Great:  high fructose corn syrup won't be so cheap!  But total corn subsidies in the US are about $10 billion, or about $33 per American.  Even poor households spend many multiples of that per capita for food.  You're talking about a difference of less than a dollar a week per person in the food budget.  Meanwhile, what else happens when we dismantle our ag subsidies?  The price of sugar, which is kept high by that same farm policy, falls by about 30-40%.  Perhaps you wanted to get rid of the corn subsidies while keeping the sugar price supports?  But the politically impossible job of slashing corn subsidies (we've been trying since the Reagan administration) will become even more unlikely if you don't also cut the cost of sugar to keep corn syrup competitive.

We could ban television advertising, a favorite of many public health types, and Marc.  But there's something interesting about that.  When I wrote this article, seven years ago (yikes!), everyone was very much up in arms about the problem of food advertising on television, particularly to children.  So I went looking for all the studies showing that advertising made people eat more junk food.  I couldn't find any.  Suspecting my google-fu was terrible, I enlisted the support of others.  No luck.  Ultimately, I called Eric Schlosser, whose book, Fast Food Nation, had argued against fast food companies largely on the grounds that their advertising campaigns turned children into helpless addicts.  At the end of the interview, I asked him for the studies he'd relied on.  He sounded confused.  He didn't have any studies indicating that fast food advertising spending made people eat more of the stuff. But, he argued, it stands to reason that if they advertise, it works.

Well, oddly, I have a little less faith in corporate America than a left-wing journalist.  Companies, even entire industries, do all sorts of idiotic things for surprisingly long times . . . investment banking and autos tend to spring immediately to mind right now.  And I still haven't found any evidence that advertising actually makes people consume more fast food.  It may make them eat more during the commercial, but there's no evidence that it even ups their overall food intake, much less sends them out to McDonalds.  Most of the studies of advertising I found show that it does a much better job at creating new product awareness or brand switching than creating new demand.

I mean, there's no evidence it doesn't make people eat more, and I don't think I'd get particularly worried if we banned food advertising on television, though I'm sure the networks would, since I"m not sure they'd be viable without it.  But the belief that this will help revolutionize America's eating habits is not very well supported.

We could change what's happening in schools: take vending machines out, make cafeteria meals healthier, and so forth.  Fine, but the kids are in school for six hours out of 24.  What's happening the rest of the time?  Child obesity increases most during summer vacation.

Marc goes into a lengthy paragraph about social capital and obesity:

The idea that anti-obesity activists think the problem will be solved by putting grocery stories in urban areas is kind of a myth. A grocery store is fine. Farmers markets are great. But food in them tends to be more expensive. Food companies don't advertise frozen vegetables because kids and parents don't buy them, but there is also evidence that kids and parents don't buy them because food advertising primes their hunger and increases their desire for bad foods -- foods that are constructed to make kids feel happy and energetic immediately.  Parents have less leisure time to shop. Kids are not encouraged to play outside because of crime rates. And poorer people with lots of material concerns don't have the  bandwith to pay close attention to the TV ads that saturate the lives of their kids. And lots of other things. We need to be careful about expectations setting; .everyone can process information the same way. But with an economic and social capital imbalance thrown in, it's terribly hard to blame anyone.  I'm harping on social capital because it does provide a different way of looking at the SES and racial disparities. Less social capital is correlated with more stress; there is also a relationship between social capital and the belief that things will get better in the future. The more capital you've got access to, the more optimistic you tend to be, and the more likely you are to think prospectively about health.

Most of that may be true, though one stat, which I too have heard from public health obesity researchers, simply isn't; leisure time has increased at the bottom of the income scale, as the relationship between income and working hours has inverted over the past half-century:  wealthy people now work more hours than poorer people.  This is probably multi-factorial:  more disability, better welfare benefits (since 1959), decrease in relative wages, slight increase in real wages.  But while the poor and working poor are certainly not enjoying lives of plenty and ease on the public dime, it simply is not true that they have less time for grocery shopping or cooking than they used to. They, like the rest of us, simply have more opportunity and income not to do it.

The other problem with this cluster of social ills as an explanation is the problem with a lot of other explanations:  it hasn't increased in recent years.  Kids weren't encouraged to play outside during the crack epidemic, either.  They watched a whole bunch of television. And their mothers were very stressed and had fewer emotional resources to supervise their children's activities.  These are perfectly fine explanations for the difference in obesity between 1955 and 1985.  They are not good explanations for the change between 1999 and today, when crime is going down and leisure is going up.

The bigger problem is that we don't have good examples of programs that make significant changes in these areas.  You can get very modest persistent changes from a high-quality early-child intervention:  fewer high school dropouts, fewer arrests. But those results don't turn poor people into middle class people; they turn poor people into the working poor.  They're hard to scale up:  pilot programs almost always work better, because of selection effects on both the workers and the subjects.  And they are fantastically expensive.  The Perry Pre-School Project remains the gold standard in early-childhood intervention studies; it took place in the late 1960's, and cost about $25,000 a head in today's dollars.

Which brings me to the last question:  even if all these things would work, could we do them?  Let's make a list of some of the ideas that come out of this:

  • Reeingineer America's urban infrastructure to discourage car transit
  • Eliminate all agricultural subsidies
  • Ban television advertising
  • Change the schools
  • Massive intervention into low income families
  • Solve the crime problem

When Marc says, essentially, "We're doing things that make us fatter, so can't we undo them?" he makes it sound like these are small changes.  But the political opposition these actions would face is absolute enormous.  Americans were not blindly seduced into an auto-based lifestyle by the paver's union; they voted for lots of roads because they like their cars.  Every president since Reagan has wanted to eliminate farm subsidies, and every president since Reagan has thoroughly, utterly, entirely failed.  Similarly, the food and entertainment industries are not going to stand idly by while you do away with 10% of advertising revenue.  "Fix the schools" and "fix crime" are two agendas that society is currently aggressively pursuing, with limited success.  And I'm skeptical that you're going to find something north of $30 billion a year for the kind of early-child interventions that really seem to make a difference.

I'm all for spending money "for the children".  But let's look at the actual record of Federal education policy before we start making big promises for obesity reduction on a national level--and the even more dismal record of poor school systems before we assume that schools that can't teach math or prevent 30-80% of their high school students from dropping out can somehow take on the job of preventing their students from getting fat.

It would be nice if we lived in this world with a super-competent bureaucracy that isn't constrained by special-interest politics . . . but we don't.  At this juncture, I will be accused by at least three (3) commenters and one (1) other blogger of blindly accepting--nay, endorsing--the status quo.   This is petulant nonsense.  I don't have to like something to recognize that I don't know how to fix it.  And I don't know how to fix this.  Moreover, I don't think anyone else knows how to fix it either.  They think it should be fixed, and that this ardent and well-meant desire somehow translates into the ability to do so, if only the rest of America will join them in really getting serious about the problem.  In my experience as a pundit with a jaundiced view of the likely success of any given government program, every single problem in America, including obesity, can be directly traced to our national frivolity. If only we'd get really serious, we could fix anything and everything.

I am skeptical, too, about the benefits of this seriousness, especially since at any given time, we're supposed to really get serious about at least a dozen problems, and there has to be a limit to even the vast untapped resources of our Federal seriousness reserve.  Since I don't know how to fix childhood obesity, I'm certainly not going to advocate that we, say, assume that we can fix it while pondering a national health care plan, or that obesity is among the prime avenues we should explore to lower our national health costs.  Nor, when all these efforts fail, as I am pretty sure they will, will I join the public health advocates in moving towards the increasingly coercive measures that they have started advising, like stiff taxes, to curb this "problem".  Unlike the public health advocates, I do think that there are worse things for a nation than being fat.