By DAVID GRATZER, MD
Call it the McVictim syndrome. Too many pundits, public health experts and politicians are working overtime to find scapegoats for America’s obesity epidemic.
In his latest book, former FDA Commissioner David A. Kessler argues that modern food is addictive. In it, he recounts how he was once helpless to stop himself from eating a cookie. In a paper in this month’s Journal of Health Economics, University of Illinois researchers join a long list of analysts who blame urban sprawl for obesity. In November, former Carter administration advisor Amitai Etzioni argued that it’s so hard for Americans to keep weight off that adults should simply give up and focus attention on the young instead.
The peak of the trend: A recently released Ohio study, using mice, suggests “fine-particulate air pollution” could be causing a rise in obesity rates.
How long before we’re told that the devil made us eat it?
The McVictim syndrome spins a convenient — and unhealthy — narrative on America’s emerging preventable disease crisis. McVictimization teaches Americans to think that obesity is someone else’s fault — and therefore, someone else’s problem to solve.
The truth: In the vast majority of cases, obesity is a preventable condition. So those of us in the medical community must be candid with overweight patients about the risks they face and the rewards of better health choices. But it’s also time for American policymakers to show the same level of candor.
All things being equal, the simplest explanation is often the right one. And the simplest explanation for the dramatic rise in obesity rates — roughly doubling as a percentage of the total population in just a quarter-century — is the surge in our daily caloric intake. Excess food now, excess weight later. And Americans won’t make better choices if the McVictim syndrome provides a convenient excuse to carry on as before.
Obesity is preventable, but its consequences seem difficult to avoid. Consider that the cost of treating resulting conditions such as diabetes is about 7% of all U.S. healthcare spending — and a significant drain on federal and state budgets. Obesity is a national security threat because it severely limits the pool of military recruits; in 2009, the Pentagon indicated that since 2005, 48,000 potential troops had flunked their basic physical exams because they weighed too much. Most important, obesity is a human threat, destroying otherwise healthy lives and increasing personal health costs, all for the sake of a few daily moments of instant gratification.
For these reasons, there is a role for government to play in attacking obesity. Public policy can help. School lunch programs shouldn’t push our children toward obesity at taxpayers’ expense. We should stop subsidizing agribusinesses; many are using taxpayer dollars to produce and market unhealthful foods. We should promote insurance reforms that support preventive medicine.
But we must also launch a direct attack on the philosophy behind the McVictim syndrome. Policymakers must accept the fact that a poor diet is almost always a poor personal choice.
Yes, it’s fair to say that many Americans try to choose better — and fail because they’ve chosen quack drugs or crash diets as the solution. Yes, it’s fair to say that losing weight solely for appearance’s sake isn’t a healthful choice. Yes, it’s fair to say we shouldn’t crush the self-esteem of those who’ve tried, and failed, to keep off excess weight. In other words, our society makes healthful choices tougher.
But even so, encouraging Americans to cut their dietary health risks is a responsible act of citizenship. And it’s absurd to pretend that Americans are helpless to make that choice — or that it’s too late for them to reap the benefits. Contrary to claims like Etzioni’s, even a modest, voluntary improvement in the average American diet could pay huge dividends.
Just as a little more weight causes more damage over time (to joints, to cardiovascular systems, to organs), a little less weight can produce dramatic health benefits. To take one example, a study cited in the Journal of the American College of Cardiology found that obese patients on a program of mild weight loss and modest exercise cut their odds of getting diabetes by as much as 60%. Imagine the benefits that would flow from keeping millions of future Medicare recipients from ever needing an insulin prescription.
The McVictim syndrome is far too prevalent, which promotes the notion that regulations and laws are the primary solution to the problem. But governments can’t micromanage your waistline for you. Even if governments could magically walk you to work, ban food advertising, regulate sugar out of food and suck those fat particles out of the air, in a free society you would still have the power to drive to the nearest restaurant, shake your salt shaker and order a second piece of pie.
That’s why understanding — and rejecting — the McVictim culture is crucial to obesity reduction policy. And the first step in that process is to reject the temptation to find an easy scapegoat
David Gratzer, MD, is a senior fellow at the Manhattan Institute. His research interests include consumer-driven health care, Medicare and Medicaid, drug reimportation, and FDA reform. The late Milton Friedman, Nobel Laureate in Economics, wrote that Gratzer is “a natural-born economist.” Gratzer’s most recent book, with Foreword by Milton Friedman, is The Cure: How Capitalism Can Save American Health Care (Encounter Books, October 2006).
Margalit and rbar –
Margalit – While obesity rates are higher among the poor than the middle class and wealthy, they increased for all groups over the last 30-40 years. Moreover, according to the Food Research Action Center, the gap in the obesity rate narrowed between low and higher income people, especially for children.
In addition to the increased prevalence of fast food restaurants and larger portion sizes, contributing factors could include the following: (1) Fewer people in the workforce are doing physically demanding work. The manufacturing sector in particular shrunk dramatically over the last 30 years. Even for those still working in the sector, more mechanized equipment, including robots, made many of these jobs less strenuous than they once were. (2) Plenty of middle class people now hire others to do chores they once performed themselves. For example, 30 years ago, most of the people in my neighborhood, including myself, mowed our own lawn. Now, most of us hire a lawn service. Instead of shoveling snow manually, we use a snow blower. (3) Children spend a lot more time in front of computers instead of running around outside playing. (4) Even getting off the couch to change the channel on the TV was eliminated by the remote control.
rbar – While I agree that CABG and joint replacements are expensive, as Nate notes, they are one time episodic expenses. By contrast, the average price for a year of nursing home care is now about $75K according to the AARP while in major metropolitan areas like NYC and Boston, it can be well north of $100K. New York’s Medicaid program is the most expensive in the country by far at approximately $50 billion including the federal share. Approximately half of that sum goes for long term care, including home health care. I know that care related to CHF can mount up as patients bounce back and forth between the hospital and home or a long term care facility when fluid builds up to dangerous levels, but I don’t know how many of those cases are related to diabetes. Expensive end of life care most typically relates to cancer in the hospital setting and Alzheimer’s and dementia in the nursing home setting. While I’m not looking to kill anyone off, I agree with your comment about smoking and alcoholism.
I don’t know if Alzheimer’s is more expensive than chronic diabetes. But looking only at the costs only tells you half the story. The other half is what that person contributes to society.
A person who is obese at 25, has severe diabetes at 35, has an amputation at 45, and dies at 55 is unlikely to have done much with his life. It is unlikely that such a person had a high-paying job or paid much in taxes. It is likely that the person was a burden to his family or to the taxpayer. On the other hand, a healthy person who has a productive career, starts a company, helps a lot of people, and then dies of Alzheimer’s at age 85 provides a much more useful service to society. His medical costs might have been higher, but his lifetime contributions are higher as well.
Nate – The Fruit and Yogurt Parfait at McDonald’s is essentially all sugar (21 g) and will to little to fill you up because it is only 160 calories with almost no fat/protein. No way that satisfied an average person if they are hungry.
‘Salads’ at McDonald’s even worse than eating the a double cheeseburger in some regards because they have even more calories, sodium, and fat if you include dressing.
Personal responsibility is an issue in the weight debate and no I don’t think there should be class action lawsuits against fast food companies or other food manufacturers. I just get tired of hearing the simpleton libertarian/conservative excuse that fat people are fat solely because of the choices they make. That’s BS. It is much more nuanced than that and doesn’t work like that.
One of the huge things that hasn’t been discussed here on which there is a huge amount of sociological and anthropological data on how Americans prepare food has radically changed in post WWII America. It wasn’t uncommon that the average family (almost exclusively women) spent over 2+ hrs a day preparing food and cooking. That has radically diminished for several reasons and simply isn’t a luxury available today to most American families.
Nate, my last comment was in response to this statement of yours: “I don’t read prevalance studies every week but I don’t recall seeing any reduction in smoking amoung the poor, and issue that has always annoyed me.”
You claimed that it “always annoyed” you, which sounded very much like you believed the data showed no decline in smoking among the poor. That is wrong. Smoking has declined over the years among the poor. The new Gallup poll you cited was a snapshot, not a time series, so irrelevant to that point.
I must have mixed up income with education as the target of your point, but it doesn’t matter which is chosen in this regard.
As for the comment about using race as a proxy for income and education, I was going from memory about a comment some months ago where you wanted to explain away the poor performance of the South (on education I thought) by pointing out that there are a lot of black people in the South and the effect disappears when you look at whites only. I thought you had done something similar before that as well. I may have been wrong, because I couldn’t find it after a quick googling.
Ironically in light of your last response to me, I did find this, though:
“I just tore apart a gallap poll last week, There is nothing scientific about what they do. They push a political agenda and try to pretend they can support it with fact.”
Anyway, we’ve reached the point of diminishing returns…perhaps long ago.
what increasing food portions? Thanks to the food nazi’s I can’t get a Super Size Coke at McDonalds any more. The social stigma as forced me to take my excessive eating to the shadows. Where I use to be able to go to one fast food joint and order now I have to go to 2-3 per meal to avoid being judged. Society needs to take a long look in the mirror in regards to how they treat big eaters.
Well, Nate’s brain needs loads of glucose from somewhere for all these comments …
I love how everyone’s debating healthy choices… in McDonald’s.
If you’ve got a car to drive to McDonald’s, surely you’ve got a car to drive to somewhere else? The whole notion of people in sprawling cities being helpless to eat anything but McDonald’s is predicated on the delusion that no one will drive any distance to buy food – yet most families have cars in America, regardless of income. And I’ve seen dozens of medically obese friends jump into their car late at night to drive five miles to the nearest 24hr McD’s for a 1,500 calorie “snack.” Ask them to drive half that distance to buy enough healthy food to last them two days at the same net cost, and the answer will be “forget it.” Not because they can’t. But because they “don’t like it if it’s healthy,” and they don’t know how to cook it, and they don’t want to learn because it’s easier to waste time doing something more leisurely.
Maybe personal responsibility is the wrong phrase… but anyone who doesn’t factor for personal carelessness or indifference as a major driver of obesity is just kidding themselves.