Questionable assumptions: the obesity problem
You can hardly read a day’s worth of news without hearing about someone whipping up the moral panic over obesity. Oftentimes, it’s busybody politicians trying to solve this putative problem with some heavy-handed government intervention (like this one). Proponents of such interventions almost always claim that they have the moral jurisdiction to impose them because obesity incurs health care costs that the public must bear. Now, the libertarian in me wants to object to the two-wrongs-make-a-right reasoning of forcing people to participate in broadly socialized medicine and then leveraging that to dictate any aspect of their lives that might have the faintest effect on their health. I’ll put that aside for now, though.
What I want to ask now is, is the evidence that obese people cost more in the long run really that strong? Yes, obese people incur higher health costs per year of their lives, but their lives are shorter, and our end-of-life health care spending is disproportionately large. Some of the nannies point to statistics that obese people take more sick days and, thus, are less productive to boot. But this is a bad argument for two reasons. First, most people find the difference between incurring a public cost and failing to add as much to the public coffers as morally relevant. Even if we grant that the former justifies government intervention, it hardly follows that the latter does. Second, once you start thinking along these lines, you start to see how hard it is to properly measure the net, all-in cost of obesity. Maybe obese people take more sick days, but what about total work hours? Do they spend more time at the office because they’re not taking extra-long racquetball lunches? Do they, on average, have fewer social engagements for which to shirk work duties? Does their early death lead to early retirement, causing them to exit the workforce before they become the highly-paid-yet-less-productive old guy at the office? I think it’s clearly impossible to hold a justifiable belief on this point without digging deeply into the data. And “digging deeply” does not mean citing a handful of studies without looking into their methodology. Given the difficulty of measuring something like this and the ease with which researcher bias can creep into such investigations, we need to see some highly robust results over a large number of investigations. And keep in mind that while “overweight” and “obese” refer to discrete BMI categories, the reality is more complicated. Being a little overweight can have much different implications for different variables than being really overweight, obese, or moderately overweight. Are these government interventions going to have the desired effect on people at every point on the spectrum? Highly unlikely.
I’m certainly not the first person to raise this objection. (A quick consult with Google turns up several articles like this one.) However, I think it bears repeating because its clear that the public dialog, at least, has not addressed it sufficiently. In fact, at this point, this should be the only issue in the public dialog. We shouldn’t even be talking about interventions at this point because there seems to be about as good a chance that these interventions, if they have any effect at all, will exacerbate our health care entitlement problem as improve it.
Some brave nannies might bite the bullet and say government meddling is justified regardless of its effects on health care spending. People aren’t doing what’s best for them, and government is here to fix it, dammit! However, this is just arrogance. Even though I obviously personally place a lot of value on staying slim and healthy, I’m not at all confident that other people share my preferences to a degree sufficient to warrant violating their autonomy here. Who am I to say that a person shouldn’t be allowed to trade a few years of his life for the ability to enjoy cheesecake worry-free every other day? Maybe he will be happier in the end. And while exercise almost certainly extends the lifespan of the average practitioner, high-level professional athletics very likely reduces one’s lifespan and quality of life in a number of respects. Are we going to ban sodas and footballs?
My guess is that most obesity nannies are driven primarily by the urge to control other people’s lives. They haphazardly dispense public finance-based justifications because they’re necessary to build public support. Hence, they’re not at all interested in subjecting those justifications to any kind of critical eye.