OP-ED

The McVictim Syndrome Could Kill Us

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).

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Brian
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Brian

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… Read more »

rbar
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rbar

Well, Nate’s brain needs loads of glucose from somewhere for all these comments …

Nate Ogden
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Nate Ogden

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.

Jonathan
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Jonathan

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… Read more »

MG
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MG

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… Read more »

Paolo
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Paolo

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… Read more »

Barry Carol
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Barry Carol

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… Read more »

Nate Ogden
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Nate Ogden

joint replacement is a one time treatment, once the surgery is done the expense is gone, and the cost of knees and such aren’t that expensive if not done in major metro areas.

rbar
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rbar

Barry, if I find any empiric data, i let you know, but I think you are plain wrong. All the conditions/problems that I have listed – joint replacement, kidney failure, CAD are very costly ones – I don’t know why you list yourslef as an example as you are not diabetic (the CABG is I believe somewhere between 60 and 90 K, and stents, don’t know, maybe 10 or 20? So that’s already a lot money). Don’t forget that diabetes is a risk factor for dementia (there is reasonable evidence that stroke risk in mid life correlates with dementia risk),… Read more »

Nate Ogden
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Nate Ogden

from a cost perspective i rather pay for an amputation then any of the degenretive diseases associated with old age. That is a short hospital stay compared to someone that is not capable of caring for themself and needs daily care till death.

Barry Carol
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Barry Carol

Margalit – Determining the cost of treating diabetics is complex. While there are, supposedly, more than 24 million people with diabetes in the U.S. today, millions of them have their condition under good control with inexpensive medication. For those with, say, CAD and hypertension as well, did the diabetes cause the latter two or was there a genetic pre-disposition instead? If, for example, just within the Medicare population, we looked at the cost of caring for 10,000 people with CAD and hypertension but not diabetes vs. 10,000 with CAD and hypertension plus diabetes, how would the costs compare? I have… Read more »

Nate Ogden
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Nate Ogden

” You like to look at race as a proxy for income and education,”
Please link to an example of this? I clearly said income and didn’t assign it to one race or the other so why do you choose to bring in the race strawman? Poor white people smoke just as much as poor black people, you might have to factor in chew, but they are pretty close.
This took 2 seconds to find, wonder why you didn’t link to income like I was talking about
http://www.gallup.com/poll/105550/Among-Americans-Smoking-Decreases-Income-Increases.aspx
clearly shows people who supposedly can least afford to smoke do so the most.

jonathan
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jonathan

“Recent legislation in the health reform bill, which has been the law in NYC for some time now, will require restaurants with 20 or more stores to post the calorie content of everything they sell. That’s a step in the right direction, I think.” Barry, there is already evidence on the effectiveness of this. Turns out it had no impact for most fast food purchases. The only place it had a (modest) impact was in higher end joints that seem to attract a wealthier or more health-conscious consumer. I believe there was a modest impact on healthier choices at Starbucks,… Read more »

Margalit Gur-Arie
Guest

Barry, I have a small problem with your math. You are looking at lifetime costs for an individual, but shouldn’t you be looking at population costs at any given time? For example a population consisting of 2 Alzheimer’s patients, 2 cancer patients and 1000 diabetics, will be spending most of its resources on the treatment of diabetes. “The fact that obesity rates in the U.S. are now far higher than they were 30 or 40 years ago cannot be ascribed to genetic changes in the population.” No, it cannot, but isn’t it equally implausible to ascribe it to sudden “character”… Read more »

Barry Carol
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Barry Carol

Peter –
For food purchased in supermarkets and convenience stores, drug stores, etc. as opposed to restaurants, there is already plenty of nutrition information on the label that informs people about calories, fat grams, sodium and sugar content as well as fiber. The information is there to allow people to make healthy choices. With all due respect, I don’t think we need to be vegetarians to live healthy lives.