Having studied the latest research on the economics and politics of obesity, I've grown skeptical that a convincing case can be made that government-wide interventions can reduce obesity's cost contribution to the health care system in the near-term. The more one studies obesity itself and its effect on human beings, however, the stronger one feels a moral imperative to act. But how? If "we" knew, "we" would have figured it out by now.
The government's anti-obesity efforts are largely in a
pre-decisional stage; numerous federal agencies are working on numerous
projects; the Centers for Disease Control has been consumed by its
response to H1N1 flu; the White House is quietly writing a blueprint
for a national obesity strategy; states continue to experiment, but
experimental programs are among the first to be jettisoned during times
of economic duress. So far as the health care reform bills go, there
are a bunch of obesity-related items that House and Senate negotiators
have signed off on. They may -- or may not -- make a difference. In the
near-term, they will serve to correct some of the systematic imbalances
that feed the socioeconomic disparities in obesity prevention and
Here, per the Campaign to End Obesity
a multilateral consortium of business, health and academic groups, are
the relevant line items in the House and Senate bills, listed in order
(according to me) of impact.
Section 2713 of
the Senate bill requires insurers to cover obesity screening and
counseling; any and all conditions that receive an "A" or "B" level
rating from the U.S. Preventative Services Task Force are required to be
covered; in 2003, the USPSTF designated obesity as a "B"
level phenomenon. At the very least, this requirement would remedy
some of the information asymmetry that plagues obesity treatment. The
House bill includes similar requirements. Medicaid programs would be
required, under both bills, to cover obesity counseling.
flashiest anti-obesity plank in the Senate bill is the new menu label regulations. Establishments of more than 20 or more locations
-- i.e., big chains -- are required to list calorie counts on menus.
Certainly, forcing people to look at calorie counts effects the
psychology of purchase decisions, but there is no evidence from pilot
projects that menu labeling persuades people to adopt healthier
The House bill includes $34 billion
over five years for public health investments; childhood obesity and
chronic disease prevention programs in poor, urban communities are
likely to be the target of these grants. The Senate and House bills
each include $15 billion for a "Preventative and Public Health Fund."
Senate bill creates so-called "Safeway" grants for small employers to
create employee wellness programs. Safeway, the grocery giant, has
figured out ways to reduce its health care expenses by incentivizing
employees to lose weight. It is not clear
whether employees are healthier over the long-term, whether the program
is fair to poorer employees, or whether, if implemented nationally, it
would save as much as Safeway's CEO suggests.
Both bills require the Secretary of Health and Human Services to come up with a national anti-obesity strategy.
is also funding in both bills to encourage basic scientific research
about obesity; how to measure it, how to distinguish fat people from
unhealthy fat people; how to better define amorphous conditions like
"metabolic syndrome" and the like.
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is a contributing editor at The Atlantic
. He is also a senior contributor at Defense One
, a contributing editor at GQ, and a regular contributor at The Week