Gene Expression

Disease & democracy

Fat Tax:

Which is why it is so striking to talk to Delos M. Cosgrove, the heart surgeon who is the clinic’s chief executive, about the initiative. Cosgrove says that if it were up to him, if there weren’t legal issues, he would not only stop hiring smokers. He would also stop hiring obese people. When he mentioned this to me during a recent phone conversation, I told him that I thought many people might consider it unfair. He was unapologetic.

“Why is it unfair?” he asked. “Has anyone ever shown the law of conservation of matter doesn’t apply?” People’s weight is a reflection of how much they eat and how active they are. The country has grown fat because it’s consuming more calories and burning fewer. Our national weight problem brings huge costs, both medical and economic. Yet our anti-obesity efforts have none of the urgency of our antismoking efforts. “We should declare obesity a disease and say we’re going to help you get over it,” Cosgrove said.

The proportion of smokers is declining, and now below 20%. The proportion who are obese is going in the other direction, and pushing above 25%. In any case, why not discriminate against older workers, who are presumably a public health liability? Probably because there’s a perception you can control your obesity, and not your age.

Comments

  1. #1 D. C. Sessions
    August 17, 2009

    Yet our anti-obesity efforts have none of the urgency of our antismoking efforts. “We should declare obesity a disease and say we’re going to help you get over it,” Cosgrove said.

    I can sort of see a pennies-per-calorie tax on food, but I’m having trouble with a ban on food in bars and restaurants.

  2. #2 Russell
    August 17, 2009

    Well, some people can control their obesity. No one can control their age.

  3. #3 sg
    August 17, 2009

    I feel sorry for fat people. I have never been overweight so it is hard for me to imagine being hungry unless I need to eat. Why do they feel hungry if they don’t need to eat? I am not one to make excuses for people’s behavior. I just figure there has be a reason why they feel hungry. I see all the same stuff everyone else does about diet and exercise but none of it gets to the point of why fat people feel hungry. When I don’t get up and walk or run in the morning, I just don’t feel as hungry and don’t eat as much. Why doesn’t that work for fat people? Every now and then I feel really hungry and eat a big meal, sometimes even for a couple of meals, or a couple of days but the feeling fades away and I eat less and I never gain weight. I have to think there is a real yet undiscovered reason that a person feels hungry even though they have stored plenty of energy. That is just my gut reaction, I don’t really keep up with what people say causes obesity. I am not young at all and have been at the same weight since I was about 14. It seems that should be normal or close to normal. I know a lot of people who are like I am so it’s not that uncommon. Is there as much focus on learning about normal weight people as there is on obesity? It seems maybe like dog breeds. I have a skinny dog, but I feed him as much as he wants. His bowl is always full but he never over eats. I have seen fat dogs. So I know some dogs will over eat. Same thing. Why are they hungry? Doesn’t make sense.
    OK, enough prattle.

  4. #4 Adela
    August 17, 2009

    Obesity is preventable and correctable old age is not.

  5. #5 Donna B.
    August 17, 2009

    I spent what I hope is the first half of my life dieting. I even had bariatric surgery to help. Now, I find that I truly don’t give a damn. I’m fat and I’m going to stay that way. I have literally ruined my health trying to lose weight.

    sg – thank you for at least taking a non-judgmental view. Weight is complicated. I have a granddaughter who is underweight yet eats much more than you would think her tiny body could hold. She’s a toddler at 99th percentile height and 10th percentile weight. She can still fit into 0-3 mos clothes if height is not a factor. Dresses are now tops, pants are now shorts.

    I cringe every time I see her at bath time. She is not overly active or hyperactive for her age. She’s met all other developmental milestones on, or ahead of, time. Both of her parents are overweight or on the verge of it.

    Normal is an elusive goal.

  6. #6 Rugosa
    August 18, 2009

    Obesity is more complex and less correctable than many think. If it were easy for a fat person to lose weight and maintain healthy weight, there would be very few fat people in America.

  7. #7 JThompson
    August 18, 2009

    @sg: I’m not overweight, but I’m from a family of overweight people. For some it’s just a screwed up satiation point.(Or lack of one) For some it’s a hormone problem. There’s probably as many reasons for obesity as there are obese people. (My mom, as an example, always battled her weight and lost, right up until she was diagnosed with hypothyroidism and given medication…After which she lost an average of 5 pounds a week for 4 months.)

    One of the reasons some obese people eat is because food represents comfort when they’re depressed. So all the people telling them they’re disgusting slobs that don’t deserve dignity aren’t exactly helping. (Depression seems to play a role in obesity for quite a few people. It’s hard to exercise when you can barely get out of bed.)

    @Rugosa: Yeah, I’ve noticed it’s always people that’ve never had weight problems that talk about how easy it is to lose weight. Funny how you never see a 400 pound man get to 190 and talk about how easy it was. (Unless he’s on cable at 3 in the morning trying to sell you exercise equipment.)

    The proportion of smokers is declining, and now below 20%.

    Yep, ex smoker here. When all smokers are ex-smokers, and all obese have been forcibly thinned down, they’ll start on drinkers next. Then we’ll see a real wailing and a gnashing of teeth.

  8. #8 csrster
    August 18, 2009

    Somebody should explain to Dr. Cosgrove that while the law of conservation of energy applies universally, it is not, or may not, be the case that calorie intake and calorie expenditure can be varied independently. Why do some people find this so hard to grasp?

  9. #9 omar ali
    August 18, 2009

    Mild overweight (using current definitions) is not “unhealthy”. Even significantly obese people can live very long and healthy lives. Most of the “studies” about the “costs of obesity” (or the costs of ANY disease) are smoke and mirrors. There are invalid and grossly oversimplified assumptions at every step in those calculations. If you add up the “costs” of 10 major diseases, you will probably exceed the total healthcare spending in the country by some huge factor (I have not tried it, but I strongly suspect that would be the case).
    Tomorrow we will find out that being a worry-wart is what “drive up healthcare costs” even more than being obese; what then? will we shoot all the worriers out there? On the other hand, we should also keep in mind that most of this is going to be new ways to create state mandates and make money for some lobby or the other. The system is corrupt, not efficient. Fat people will still be around and will get almost the same crappy coverage as any other less-than-rich person in America but those “fighting the obesity epidemic” will make more money. Smoking is down, but healthcare costs continue to rise. Even if obesity rates go down, costs will still go up. In any case, it may be that obesity rates are going to hit a plateau soon. The percentage of people prone to being obese may already be obese, the rest will just worry themselves to death over a risk that really is not their main problem in genetic terms.

  10. #10 Eric Johnson
    August 18, 2009

    > If you add up the “costs” of 10 major diseases, you will probably exceed the total healthcare spending in the country by some huge factor (I have not tried it, but I strongly suspect that would be the case).

    That is not unexpected. These costs are not limited to health care expenditures. Lost productivity is one of the largest costs.

  11. #11 Mike
    August 19, 2009

    If he believes it is a disease and yet would not hire based on that, does he also hold that view for all diseases?

  12. #12 Pooh-Pah
    August 20, 2009

    You CAN control obesity, Razib. It’s not a “perception”. Eat nothing but fruits, veggies, and lean meat. As much of those as you want, too. You will not be fat on a natural diet like this.

The site is undergoing maintenance presently. Commenting has been disabled. Please check back later!