Castro’s Cuba has seen a precipitous drop in obesity rates and in the deaths associated with cardiovascular risk:
Cuba’s economic crisis of 1989-2000 resulted in reduced energy intake, increased physical activity, and sustained population-wide weight loss. The authors evaluated the possible association of these factors with mortality trends. Data on per capita daily energy intake, physical activity, weight loss, and smoking were systematically retrieved from national and local surveys. National vital statistics from 1980-2005 were used to assess trends in mortality from diabetes, coronary heart disease, stroke, cancer, and all causes. The crisis reduced per capita daily energy intake from 2,899 calories to 1,863 calories. During the crisis period, the proportion of physically active adults increased from 30% to 67%, and a 1.5-unit shift in the body mass index distribution was observed, along with a change in the distribution of body mass index categories. The prevalence of obesity declined from 14% to 7%, the prevalence of overweight increased 1%, and the prevalence of normal weight increased 4%. During 1997-2002, there were declines in deaths attributed to diabetes (51%), coronary heart disease (35%), stroke (20%), and all causes (18%). An outbreak of neuropathy and a modest increase in the all-cause death rate among the elderly were also observed. These results suggest that population-wide measures designed to reduce energy stores, without affecting nutritional sufficiency, may lead to declines in diabetes and cardiovascular disease prevalence and mortality. (Emphasis mine.)
So I guess if you really want to cut obesity in half you should just bankrupt your entire nation.
Glibness aside, I actually have a point for posting this article. I take two things away from this paper:
1) As I have argued before, obesity is not primarily genetic. It is the consequence of an environment and gene interaction, and environment including diet and exercise plays a large role.
When I use the term environment and gene interaction, I think I am still confusing people so let me clarify what I mean. The environment — how cheap food is, how much exercise people get, etc. — determines the average rate of obesity for a society. (This is overwhelmingly demonstrated by the study where the Cuban society has undergone a “shift of the mean” as a consequence of government policy.) Genetics, on the other hand, determine the variation around that mean. If you have a predisposition to obesity and you are living in a society that has a high caloric intake on average, you are very likely to be obese. Likewise, in a society that has a low overall caloric intake, genetics may push you towards the high end of the distribution, but it will still be comparatively low.
2) I don’t know if anyone has looked at this (please tell me if someone has), but I have a theory about how you can combat obesity. To demonstrate my theory, I want to show a graph.
I argue that there is an Inverted U correlation between Wealth and Obesity rates.
At the extreme low end of the wealth axis, obesity rates are low because people are desperately impoverished. Just so people don’t jump on me for this, I am not talking poverty as in the US. The US has poverty, but not in the way that Ethiopia has poverty. We are talking really poor here.
At the extreme high end of the wealth axis, obesity rates fall again because obesity like most things health-related has a socioeconomic status (SES) gradient. This means that the richer you get the less likely you are to be obese.
Now you can debate a couple things about the top end of this graph. First, the factors that determine the SES gradient for obesity are complex. There is undoubtedly an element of education. Also, the relative contributions of race and social class as opposed to actual income are unclear. Second, the steepness of the downturn on the top end of the U is something that is fuzzy. For example, it isn’t clear to me whether if you made everyone richer you could get down to the obesity rates down to as low as you would get in the deeply impoverished.
However, keeping both of those caveats in mind, I think you could still reasonably argue that if you made people wealthy past a certain point you would lower the rates of obesity. Is that a fair assumption? I am curious to see if people agree.
Anyway, why would the existence of an inverted U matter?
Well, it matters when we look at public policy options for fighting the obesity epidemic. Look at it this way. Say we have a group of people in the middle of the U. I would say that this would comprise the majority of poor people in the US — not so poor that they are starving but clearly poorer than the other people in our society.
What policies could we create that would lower the obesity rates for people in the middle of the U? I can think of two.
- 1) We make food more expensive. We, in essence, simulate poverty for the purposes of food consumption. This does not mean making our economy more like the Cuban one. Instead, we raise taxes on food or take steps to make more expensive so that people will eat less. This may sound like a ridiculous option, but lots of people advocate various brands of libertarian paternalism — a term that I still reject as a contradiction — to fight obesity. They advocate policies such as taxing specific type of high calorie food to make people eat less of them, or they are arguing that we ban certain foods, which will have the indirect effect of making food more expensive.
- 2) We could try and make the people in the middle of the U richer. We exploit the fact that as people get richer they are more likely to exercise and eat right, that they are more likely to have access to the weight control measures that at present only the very rich have.
Thus far, I haven’t heard many people in the obesity debate argue for the second set of policies which is really a shame because I think that it would work. Further it involves significantly less government intrusion into people’s lives than the alternatives.
The argument I am making for the second set of policies is analogous to the effects of wealth on birth rates. All societies go through a demographic transition as they become more wealthy. This is because people actually have less kids — after a time — as they get wealthier. The most effective means of controlling population is not to restrict the number of births by government fiat; it is actually to help people get rich.
There is a prevailing assumption in some quarters that obesity is a direct and uncontrollable consequence of our society being wealthy, and that as a consequence the only way to fight obesity is to limit people’s access to food by government policy. However, I argue that this has the situation bass ackwards. The problem isn’t that American society is wealthy. The problem is that the wealth has not filtered down sufficiently to the people in the middle of the U. The poor in this and other rich countries have the money to buy high calorie foods but cannot afford access to good food and exercise. You solve that problem by making people richer not by restricting the high calorie foods.
What policies would be most effective then? Pro-growth policies, I guess. You might even argue that American society is going through a sort-of health transition where obesity rates will temporarily soar, but as people get richer will begin to fall again.
Alright, so let’s hear it. I am really curious to hear whether people think this theory has merit. I know that I am speculating, but I have been thinking about this subject a lot lately.
Hat-tip: Hit & Run