As a fan of free markets, I recognize that sometimes intelligent government regulations (not always an oxymoron!) can improve markets by requiring companies to provide consumers with information that will help them make better choices. Informed consumers, after all, are a central ingredient of a successful free market. That’s why even most libertarians support regulations that ban fraudulent advertising.
That’s also why, at first glance, the federal government seemed to be promoting better markets when it passed rules requiring chain restaurants to post calorie counts next to their menu items. Research has shown that many consumers are horribly uninformed about the number of calories in most menu options, often significantly underestimating the amount in their favorite meals. Calorie count information should help these consumers make more informed, and therefore better, decisions.
But recent push-back from groups like pizza companies raises important questions about the proper size and scope of such regulations. More importantly, this controversy should remind all of us that, when debating government regulations, we should be humble, because it is often difficult to set a proper balance between helping consumers while at the same time allowing businesses to prosper.
To understand the push-back, it helps to take a guess – your best shot – at estimating the number of calories in a large Little Caesars pizza.
Stumped? You should be. There is no right answer to this question, because there is no such thing as a generic large Little Caesars pizza. Instead, there are hundreds of possible large pizzas one could buy from this company – cheese pizzas, pepperoni and sausage pizzas, mushroom green pepper and extra sauce pizzas . . . you get the idea. The number of calories in a large Little Caesars pizza depends on how many toppings consumers choose to put on top of their pies. This variability makes it hard for Little Caesars to post calorie counts on its menu.
Diet and exercise: they were supposed to be the answer to all that ails America’s obesity and health care cost problem.
Signs of this Utopian vision are everywhere. From entire government departments encouraging healthy lifestyles through fitness, sports and nutrition, government websites that encourage “healthy lifestyles,” and entire community efforts to partner with health care organizations to fight obesity with the hope of cutting health care costs.
What if, believe it or not, when it comes to people with Type II diabetes, diet and exercise don’t affect the incidence of heart attack, stroke, or hospital admission for angina or even the incidence of death?
Suddenly, all health care cost savings bets are off. Suddenly, we have to re-tool, re-think our approach, understand and appreciate the limitation of lifestyle interventions to alter peoples’ medical destiny. Suddenly we have to come to grips with a the reality that weight loss and exercise won’t affect outcomes in certain patients. Suddenly, there is a sad reality that patients might note be able to affect their insurance premiums by enrolling in diet and exercise classes after all.
These thoughts are so disruptive to our most basic “healthy lifestyle” mantra that few can fathom such a situation. Nor would any members of the ever-beauty-and-weight-conscious main stream media be likely to report such a finding if it came to pass.
And yet, that is exactly what has happened.
If all of us were simply to make better use of our feet, our forks, and our fingers — if we were to be physically active every day, eat a nearly optimal diet, and avoid tobacco — fully 80 percent of the chronic disease burden that plagues modern society could be eliminated. Really.
Better use of feet, forks, and fingers — and just that — could reduce our personal lifetime risk for heart disease, cancer, stroke, serious respiratory disease, or diabetes by roughly 80 percent. The same behaviors could slash both the human and financial costs of chronic disease, which are putting our children’s futures and the fate of our nation in jeopardy. Feet, forks, and fingers don’t just represent behaviors we have the means to control; they represent control we have the means to exert over the behavior of our genes themselves.
Feet, forks, and fingers could reshape our personal medical destinies, and modern public health, dramatically, for the better. We have known this for decades. So why doesn’t it happen?
Because a lot stands in the way. For starters, there’s 6 million years of evolutionary biology. Throughout all of human history and before, calories were relatively scarce and hard to get, and physical activity — in the form of survival — was unavoidable. Only in the modern era have we devised a world in which physical activity is scarce and hard to get and calories are unavoidable. We are adapted to the former, and have no native defenses against the latter.
Then, there’s roughly 12,000 years of human civilization. Since the dawn of agriculture, we have been applying our large Homo sapien brains and ingenuity to the challenges of making our food supply ever more bountiful, stable, and palatable; and the demands on our muscles ever less. With the advent of modern agricultural methods and labor-saving technologies of every conception, we have succeeded beyond our wildest imaginings.
So now, we are victims of our own success. Obesity and related chronic diseases might well be called “SExS” — the “syndrome of excessive successes.”
Several folks have been kind enough to point out this story, and suggest that I may have an opinion on it:
[A woman from] Shrewsbury, Mass., claims that Dr. Helen Carter, a primary care physician at the UMass Memorial Medical Center in Worchester, refused to treat her because she is clinically obese…
It seems the good doctor has decided not to care for anyone (it is unclear if the prohibition applied to all patients or just to females) weighing over 200 lbs. Apparently there was a nearby specialty facility capable of caring for obese patients, so no one was being sent away with no resource to medical care.
There is nothing either illegal or unethical about this policy, according to the AMA and others. Much hullabaloo has ensued in the various comment trails, with many people stating that it should be (illegal. unethical, or both.) They are wrong. The only thing this physician has done is set her weight limit unreasonably low.
Here are the magic words: Scope of Practice. It means that doctors have not only the right but the ethical and legal responsibility to limit the care they provide based on their capabilities, their training and their experience, which together also translate to “comfort level”.
Kaiser Permanente is a different kind of health system, as we all know. It has been a major funder of the HBO Series Weight of the Nation — reviewed by Kristin Molven in a companion piece on THCB today. Matthew Holt interviewed Raymond Baxter who is Kaiser’s Senior Vice President of Community Benefit, Research and Health Policy about the role KP plays in community and policy issues, and what we know and what we should can and should do about obesity.
Kristin Molven is a medical student at The University of Olso. She is currently a student in the Norwegian Entrepreneurship Programme at UiO and UC Berkeley, and is interning at Health 2.0.
HBO’s documentary series The Weight of the Nation made me sad. I was left with the feeling that the wealth my parents have provided and all prior generations’ good intentions to make it easier for us to gather food and survive, and the technologies they developed to make our lives easier now are destroying us. My generation is short-circuiting. When looking to satisfy our needs, we meet no obstacles, no resistance. Everything is readily available to us, and we are fast-forwarding towards the negative consequences of constant access. And the food industry makes a profit off our misfortune.
The Weight of the Nation campaign consists of four main films, a dozen of extra short films and an accompanying book and website. It was launched in May by HBO and the Institute of Medicine in association with the Centers for Disease Control and Prevention, the National Institutes of Health, Michael & Susan Dell Foundation and Kaiser Permanente.
The campaign abandons the idea that obesity is an individual shortcoming or to results from a lack of self-control. Instead the campaign holds society responsible for today’s weight problems. Come to think of it, this is not unreasonable as humans have the same mental capabilities as former generations that were not obese. What has changed is our behavior and surroundings. Physical activity has been engineered out of our daily routine, while unhealthy tempting food has become cheaper and more accessible. Let’s not pretend that our grandparents had higher moral standards by avoiding sugar and fat and took the stairs instead of the elevator. They surely would have made the same choices as us if they had the chance. Given that nobody intends to become overweight or obese, we have designed a society where it is just too hard for most of us to maintain a healthy weight.
Consequences and Choices, the two first films of The Weight of the Nation series, examine the physiology and pathology of weight gain and obesity.Continue reading…
Many observers believe that the economic realities of the food supply chain contribute to public health problems from heart disease to diabetes. A look at the disturbing economics of the Cheeseburger economy from the Center for Investigative Reporting.
Via The Center For Investigative Reporting.
See Also: The Economist Big Mac Index
Worried about the potential personal and economic costs of obesity? Never mind. It’s time to view obesity as a business opportunity.
As the press release for a new research report from Bank of America Merrill Lynch, Globesity—The Global Fight Against Obesity, points out:
“Increasing efforts to tackle obesity over the coming decades will form an important new investment theme for fund managers…Global obesity is a mega-investment theme for the next 25 years and beyond…The report…identifies that efforts to reduce obesity is a “megatrend” with a shelf-life of 25 to 50 years…BofA Merrill Lynch analysts across several sectors have collaborated to identify the sectors and companies developing long-term solutions.”
Given the worldwide increase in obesity, its high prospective costs, and the ever-present threat of government regulation, the report identifies more than 50 global stocks that provide investment opportunities for fighting “globesity.” These fall into four categories:
- Pharmaceuticals and Health Care: companies taking advantage of the FDA’s increased support for obesity drug development; tackling related medical conditions and needs including diabetes, kidney failure, hip and knee implants; making equipment such as patient lifts, bigger beds and wider ambulance doors.
- Food: companies accessing the $663 billion “health and wellness” market and reformulating portfolios to respond to increasing pressure such as “fat taxes” to reduce sugar and fat levels.
Yesterday, New York City Mayor Michael Bloomberg announced a ban on sales of sugary drinks larger than 16 ounces in restaurants, delis, sports arenas, and movie theaters.
The reactions have been ferocious, and not only from the soda industry, which placed an ad in the Times (see below).
The New York Times also weighed in with an editorial arguing that the mayor has now gone too far and should be sticking to educational strategies.
Alas. If only educational strategies worked. But they do not.
We know this from what it took to discourage people from smoking cigarettes. We also know this from research on eating behavior. This shows that it doesn’t take much to get people to eat too much.
Just barrage us with advertising, put food within arm’s reach, make food available 24/7, make it cheap, and serve it in enormous portions.
Faced with this kind of food environment, education doesn’t stand a chance.
That’s the point the Mayor’s proposal is trying to address, however clumsily. After all, a 16-ounce soda is two servings.
Sugary drinks—especially large ones—make sense as a target for a portion size intervention.
As the next act of the Massachusetts health care drama plays out on Beacon Hill, the same characters return to the stage with a tired script. The ostensible hero of the production, the patient, is left to watch the tragedy from the back row.
Legislation being debated on Beacon Hill ignores patient-centered health plans and health savings accounts, or HSAs, which are lower-premium insurance plans that direct pre-tax dollars into a bank account to cover an individual’s current health care and save money for future medical expenses. An HSA is the most direct way to engage patients in the health system. They cover out-of-pocket medical, dental, and vision expenses, are fully portable, and owned by individuals for their entire lives.
Unlike the self-interested solutions of insurers, providers, and government, HSAs are a proven way to contain the cost of care.
Nationwide, 11.4 million people of all ages and income levels purchase patient-centered plans, up over 250 percent from 2006, when they were created. Among HSA account holders, fully half earn less than $60,000; almost three-quarters have children; and about half are over 40.
Safeway, one of America’s largest supermarket chains, rolled out a patient-centered plan in 2006; per capita health care spending shrank 13 percent, and costs remained flat for four consecutive years.
Safeway’s plans have reduced employee obesity and smoking rates to roughly 30 percent below national averages. This health dividend is priceless as 70 percent of health care costs are directly related to lifestyle decisions.