According to this new paper (HT McArdle & WSJ), it constitutes a "true economic subsidy for obesity." As one of the WSJ economics blogs sums the paper up:
According to the paper, which estimates weight gain in terms of body mass index, a measure of weight related to height, “private insurance increases BMI by 1.3 points and public insurance increases BMI by 2.1 points.”
Economists have long been saying that fat people weigh on taxpayers’ finances. A 2005 study estimated that the federal government pays for roughly half the total annual medical costs associated with obesity, resulting in an average annual $175 in per-capita taxpayers’ costs to pay for obesity expenditures among Medicaid and Medicare recipients.
And a study released today revealed that the overall cost of obesity-related health-care treatment doubled in a decade to $147 billion, growing faster than obesity rates, which went up 37% during the same time period.
The new evidence fits well with what Bhattacharya, Bundorf, Pace and Sood argue: Health insurance isn’t simply a transfer of wealth from thin taxpayers to overweight ones, but a “true economic subsidy for obesity.” According to the study, health-care coverage literally encourages obesity, because people tend to become less careful about weight-gain when they know that insurance will cover at least some of the weight-related health costs in which they may incur.
Though the study found weak evidence that more generous insurance encourages greater weight gain, or that risk-adjusted premiums discourage it, there was “strong” statistical evidence that being insured increases body mass index and obesity.
I am both intrigued with and skeptical of papers purporting to find economic-sy rationales underlying cultural and, more exactly, biologically-grounded behaviors (food, eating, hunger, etc.). A quick (granted, very quick) read of the paper suggested that the details and qualifiers make it far more cautious than suggested by statements such as "insurance makes you fat" or that the fact of certain correlations quite so literally "literally encourages obsesity."
My own personal sense, as someone who always struggles with weight issues, is that the economics obesity accounts (this paper), or the political-ideological-social accounts (Fast Food Nation or David Kessler's new book) don't explain much about personal behavior. Well, let's be more precise. They don't explain much about my behavior - and, as my md-phd brother once remarked, think of yourself as the most exciting statistical series possible of 1: I'm the one who matters here (!).
At least in my own case, I think the more useful stuff lies at the level of appetite changes, set points, hormonal changes triggered by eating and digestion, research into what makes me eat at the biological level. I struggle every bit as much with weight and obesity as the obese African-American teenager who is apparently programmed to go to McDonald's every day, or the middle class white teen who spends all possible moments in front of the videogame and then goes to McDonald's. I suspect, for whatever prognostication on this most difficult of bio-behavioral topics is worth, that the most important work will come from understanding how what we eat now affects our eating at the next meal, along with the basic question of how much physical activity. I don't think it will come from calorie counts in restaurants - I don't mind them, but as a candidate for Jenny Craig, my interior calorie consumer tells me that it's not the fundamental issue.
That said ... look, I never thought I'd find myself admitting this in public or, frankly, anyplace else. I ran across the Seth Roberts thing from Freakonomics and thought, well, here's one that is (a) effortless (b) won't do any harm (c) worst downside is another 400 calories of monounsaturated fats a day (d) at an additional 400 calories a day, I'll know in a month or two what the verdict on the technique is, for better or worse ...
But I'll be danged if over the last two years, I haven't found myself gradually losing weight. Very gradually, and I've been working out more, especially in the deadly light-deprived winter - but, anecdotal series of one, I would swear that my appetite is simply less. I just don't have the same interest in food. Your results might radically differ and, who knows, it might all come back tomorrow or maybe it will cause some weird cancer of the big toe, and also you have no idea how embarrassing it is to be gratuitously plugging a thing called the Shangri-la Diet ...
Bottom line is I'll stick with both my health insurance, Congress and the President willing, thanks, and the Shangri-la Diet. I am also mildly worried that telling you all about how this seems to have kinda worked for me will - I don't know - jinx it or something. Maybe it only works if you keep it a secret. I'd like to keep those twenty pounds off, if possible. And if it's not possible for an academic with control over his time, it's not possible for anyone. It's not as if this diet has any scientific evidence behind it, as that same md-phd brother has further pointed out; it is based explicitly on the Seth Roberts series of 1.
(Update: Megan McArdle has a nice series of posts on obesity and health policy in America, including an interview with Paul Campos, author of The Obesity Myth.
I am extremely skeptical of statistical claims made in social science fields. I simply have a hard time believing it is possible to account for the myriad confounding factors that are present.
They use a health care experiment where people were randomly assigned to receive healthcare of not
Admittedly maybe this freed up other money to use for labor saving devices (cars..hence less walking) but it's a better result than one might think just from the summary above.
In an interview on the Canadian Broadcasting Corporation's Sunday Night program, nutritionist David Jenkins criticized the lack of scientific research validating the diet.[19] In the same program, Roberts responded, saying that the results are there for all to see and that "there was no need for a big study to demonstrate the obvious".
UH-huh.
The only reason that I'm not fat is because I have a high metabolism. I eat far more than the recommended amount of bad foods and consume copious quantities of non-diet soft drinks. Yet the health Nazis propose to tax me for this behaviour that to date has had no bad effect on my health. There will be no end of this type of regulatory behavior if we adopt nationalized health care.
After a high cholesterol test, I lost twenty pounds in four months by eating less and exercising more. Mostly my eating smaller portions. I was hungry a lot at first, but eventually you get used to smaller portions. (Just like you get used to larger portions from the other side.)
I've kept it off since then, which hasn't been hard since my appetite is less.
With a public option, you can choose between private and public health care.
If your private company in no way 'taxes' you for what it regards as poor health habits, you will be fine. Well, maybe not your liver, but your pocketbook will be fine.
I am a sample size of 1, which is large enough for me to report that the boldface statements are not true in my case.
After I was diagnosed as borderline diabetic, my gold-plated health-care plan (which is non-contributory, covers everything, and applies to me as a retiree) paid for diabetes-education classes, medical examinations, medication, and, above all, a nutritionist (whom I see quarterly). As a result, I lost about 30 pounds (and got my A1c under pretty tight control).
I still record what I eat, which helps the nutritionist and the doctor in their evaluations. My only problem is an addiction to chocolate, especially in the form of chocolate-chip cookies. I am working on it, but it is hell to have an office in Center City Philadelphia and know the location of every bakery, cookie-selling store, and chocolate shop in the area. So when I feel the need, I try not to eat other carbs.
Surely all the brilliant progressives could just start another private health care company to provide the benefits of the public option. What's so special about having the government do it, besides the thrill of knowing you're forcing people to do what you want?
I cut back a lot on snacking between meals and went to three meals a day, with maybe a snack in the evening. It was a little tough the first week, but just like my body got used to snacks, it got used to not getting them.
It's weird when you try to figure out how to outsmart your brain.
I have been told to eat snacks, ideally, three of them to go along with my three meals. Of course, there are snacks and there are SNACKS, but mine tend to be things like cottage cheese, orange peppers, and other items that help me keep my blood sugar from fluctuating too much. The nutritionist wants me to eat something every three hours. Sometimes I do not eat all of my meal and use the remaining part for a snack.
In those populations, weight loss is frequently a symptom of serious and costly illnesses, like cancer or renal failure.
Indeed, being overweight, as opposed to actually obese, increases life expectency in these populations.
If you want health outcomes, you should be measuring obesity percentages, not BMI.
The Grizzly Bear Diet: Weight-Loss Secrets of the Apex Predators
and feature lots of recipes with salmon and blueberries.
BMI of 25-27 or so seems to be the optimum.
"Normal" is 19-25.
Given these statistics, where many of these programs use all sorts of interventions, it would be pretty surprising if health care plans would be a more powerful effect.
That "live off your fat all winter" advice is going to cut your sales.
Depending on a lot of other factors — BMI is a notoriously crude tool in determining optimal weight levels, especially for men. Michael Phelps, for example, is barely below 'overweight'.
Other point: Given that the definition of "overweight" and "obese" has changed a few times over the last decade, usually, downward in weight and BMI--and the definition of "diabetic"/"pre-diabetic" also keeps dropping in terms of the test results, how realistic are the actual numbers for obesity and diabetes?
(Example: Six years ago, my mother took the test for diabetes, whch came back that she was diabetic. [No family history of diabetes, ate right, all other factors normal.] Turns out that if she had taken the same test six months earlier, she would not even been pre-diabetic, but normal.
Example: When I had blood work done a year ago, all numbers save two were in the normal range--the other two had been lowered three months earlier; had I taken the bloodwork before that, those two would've also been in the normal range.)
One of the best philosophies to bring to nutrition is the idea of replacements. It's difficult to change a lifetime of eating habits (although some do) but it's easier to work within those existing confines. You like bacon and buttered toast with your breakfast? Make that turkey bacon, and swap olive oil and a bit of sea salt for the butter. Get the sandwich you want for lunch, but get turkey instead of pastrami, swiss instead of provolone, and leave off the mayo. Get dark, semisweet chocolate when you've got that craving instead of Hershey's bars. That sort of thing. Especially for people who find they have a hard time refraining from the foods they love, finding healthier alternatives is a good way to trim calories.
Not to mention, foods like olive oil contain a number of phytochemicals that are actively good for you. A lot of diets suffer not so much from an excess of meat and cards, as a deficiency in fresh fruits, vegetables, nuts, and beans. Among other things, those phytochemicals have beneficial effects on regulating metabolism, including hunger pathways through the arcuate nucleus.
And it's really not about calories. I'm one of those folks with a hummingbird metabolism, barely above the minimum healthy weight for my size (if you go by BMI). A few years back, I suffered a string of medical problems that included wasting. Trying to gain that weight back afterward was incredibly difficult; it mattered far less if I added an extra shot of whipped cream to my milkshakes or extra cheese on my pasta, and far more if I was getting enough sleep, exercising regularly, and maintaining an elevated mood.
Hunger, satiation, and metabolism involve hundreds of chemical cascades, and we're finally starting to scratch the surface of the complexity. Just don't make the same mistake Amgen did in 1995.
Yes. This is exactly what my nutritionist does, although she is more concerned about my carbs than my calories. She never says "no, you can't." Instead, she will ask, sort of sweetly, "Have you considered ...?"
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