Obesity Policy Interventions

This will be the final entry in my series on obesity. I looked at demographics and causes, now the big question: What to do?

People have proposed a tax on fatty foods, which sounds somewhat reasonable. In general one would want a tax on foods based on their caloric density [1]; it’s not like you can’t get fat on sugar. The Danes tried this, without success, although that may be an implementation problem:

It could also be that Denmark’s tax was just high enough to become a nuisance for manufacturers — and to act as an incentive for cross-border cookie runs — without making a significant impact on how people actually eat.

A May British Medical Journal study found that ”fat taxes” would have to increase the price of unhealthy food by as much as 20 percent in order to cut consumption by enough to reduce obesity, and they should be paired with subsidies on fruits and vegetables so consumers don’t swap out one unhealthy habit for another.

So maybe their problem was that the tax wasn’t steep enough. Also people were crossing the border, but in a country like the US this wouldn’t be as much of an issue. People don’t cross national borders here to do grocery shopping. State borders, yes, which is an argument for national rather than state action.

One argument is that this hurts the poor the most by generally making food more expensive. Well yeah, that’s the point. Really you’d want a steeply increasing curve of cost v. calories. One problem is that the inflection point should be different for different people, depending on height and activity levels. Without some serious food rationing and even surveillance, this is impossible. Besides being highly immoral and rife for abuse, such a plan is expensive. Let’s be realistic here.

I’m curious to see how the NYC soda ban goes. If you want to get 32 ounces of soda, you can buy 2 16 ounce cups. But most people don’t want 32 ounces, they just some soda and pick the middle size. In a convenience store that’s 20 ounces, so we’re down 25% already. Perhaps similar rules could be made for restaurant portion sizes, forcing people to explicitly order more food instead of getting 1200+ kcal as part of a “value” meal[2]. Because most people don’t, they pick defaults. The NYC ban on trans fats seems to have been successful so far[3]

There are less nanny-state ideas, such as providing the services of a nutritionist to those who need it at lower/no cost. As somebody who believes in universal healthcare this seems like a no-brainer to me. It’s not like we don’t have treatments (diet + exercise work), we just need adherence. Having a trained professional guide and support patients makes that much more likely.

Really just educating doctors on how to talk to their patients could make a huge difference. The WHO report on obesity [4] part IV (section 8.4.2) claimed:

The majority of health professionals are pessimistic about their ability to help patients to lose weight by persuading them to change their lifestyles, and many consider obesity management to be frustrating, time-consuming, and pointless.

I don’t know if that’s wrong exactly, but believing it certainly makes it true. Seeing a patient once a year and telling them to lose weight isn’t going to do much, but a structured program with frequent contact with a professional is typically much more successful [5] than self-help, although still not incredibly effective.

Obesity isn’t going to destroy the species. The resulting diseases are non-communicable, and only kick in around age 40-50. Still, it would be nice if people decided that collective solutions to this problem are actually appropriate and really do work.

-Jacob

 

 

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  1. [1]because people consume more calories when the food is more calorie dense
  2. [2] Large fries ~ 400 kcal, large drink 310 kcal, sandwiches vary from 400-800 kcal. http://nutrition.mcdonalds.com/getnutrition/nutritionfacts.pdf
  3. [3]

    Cholesterol Control Beyond the Clinic: New York City’s Trans Fat
    Restriction

    Ann Intern Med. 2009;151:129-134

    http://www.annals.org/content/151/2/129.abstract

  4. [4]

    Obesity: preventing and managing the global epidemic

    Report of a WHO Consultation (WHO Technical Report Series 894)

    http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/index.html

  5. [5]Heshka, Stanley, et al. “Weight loss with self-help compared with a structured commercial program.” JAMA: the journal of the American Medical Association289.14 (2003): 1792-1798.

    http://jama.ama-assn.org/content/289/14/1792.full

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