Map of life expectancy at birth from Global Education Project.

Wednesday, September 19, 2012

Fat Chance

JAMA this week is  a theme issue on obesity. You pitiful rabble are not allowed to read most of it, but they will let you in on this:

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I have to tell you, that's a very shocking picture -- more than 1/3 of adult Americans are classified as obese by BMI. It's not a perfect measure -- a few of these people may be very muscular, but most of them are just plain fat. Yes yes, it's starting to look like people on the lower end of the official obesity index may be okay, if they have good cardiovascular fitness, but most of these people are not at that lower bound.

Now listen up. This didn't happen because our gene pool suddenly changed, or people suddenly because lazy and gluttonous. Yelping mindlessly about "personal responsibility" isn't going to fix it. And it isn't just tough luck for all these folks, it's tough luck for all of us, because they are at increased risk for disability, and for costing the health care system -- which means all of us who pay insurance premiums and/or taxes -- a whole lot of money.

This happened for a combination of reasons. Fewer people do physically demanding work. When not at work, people spend more time in front of various kinds of electronic screens. High calorie, low nutritional density food is everywhere, comparatively cheap, and aggressively marketed. Humans evolved mostly under conditions of caloric scarcity, so we're wired to eat too much when food is easily available.

The solution, if one is to be found, has to be in public policy. Mayor Bloomberg wants to restrict sale of gigantic tubs of sugar water, which people are seeing as a violation of their personal freedom and the first step down the slippery slope to communo-fascism. It does seem like kind of a crude measure that largely misses the point.

But there are potential approaches that get at the problem at a deeper level. Obviously it doesn't help that we've been cutting phys-ed in schools, and we can certainly make school lunches more nutritious. Safer neighborhoods with more physical recreational opportunities, better mass transit, subsidies for vegetable farmers rather than corn farmers, programs to help neighborhood store owners carry healthier foods, limitations on marketing junk food to children (good luck with that) -- there's a lot we can do. But it requires an activist government that's looking out for the common welfare -- in smart ways that increase our freedom rather than limiting it.

Yep, that's right. Liberty doesn't grow up naturally when government gets out of the way. It has to be protected, and nurtured, by democratic government. That's one way that Paul Ryan and his sidekick are completely wrong. 

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