Obesity, Can’t the Government Help?

Small episodes can raise large questions in one’s mind and recently I observed one such episode in my local bakery (which, alas, is not a very good one).

A woman of the publicly-funded class was demanding to know which cake her son of about three years wanted. He himself was already slightly overweight, though not yet obese like his mother. To all appearances, he didn’t really want a cake at all, probably because he had been overfed already that morning, but she insisted. She almost badgered him, as if she were an evangelist for obesity. Eat sugar and it will set you free.

It hardly requires me to point out that obesity has become a greater threat to the health of the human population in most parts of the world than famine. There was a wonderful cartoon recently in the British magazine, The Oldie, which captured this perfectly. A mother is taking a plate of food away from her child, who is protesting. ‘Think of the obese millions!’ she says to him. When I was young, of course, we were told to finish what was on our plate and to think of the starving millions. Being a precocious little brat, I used to ask how eating what I did not want would help them. Let us just say that the reply was seldom well-reasoned, either in form or content.

It has now become an almost unassailable orthodoxy, at least in medical journals, that obesity is an illness in and of itself: that is to say, it does not merely have medical consequences, but — even without those consequences — is a disease. To be fat is, ipso facto, to be ill, in the same sense as to have Parkinson’s disease is to be ill.

Nor, according to the modern orthodoxy, is obesity to be considered the natural consequence of bad or foolish individual choices, a lack of self-control. That would be to blame the victim. The fat person is in effect the vector of forces that play upon him or her, without any contribution on his or her part.

This is an idea of long gestation. Reading an old text on obesity, published in 1975, and edited by one of my medical mentors, I came across the following quote from a paper written in 1962:

I wish to propose that obesity is an inherited disorder and due to a genetically determined defect in an enzyme: in other words that people who are fat are born fat, and nothing much can be done about it.

This is like saying that addicted people are born to be addicted, and until doctors discover a technical means of stopping their addiction, they might as well make no efforts on their own behalf. No doubt the people who adhere to this view – that obesity and addiction are illnesses simpliciter – think they are being generous but in fact they are forging psychological manacles. No doubt the obese woman in the bakery was at some level trying to prove to herself that obesity was a fatality and not under any possible individual control.

But is the theory in accord with the scene I have described above? In fact, the scene might lead us to a more nuanced or less categorical view of the problem of obesity (and, by extension, of other social problems) than we might at first adopt.

The mother was a responsible adult, complete with the franchise. To consider her not responsible for what she was doing would be to dehumanise her, to turn her into an object rather than a subject. I have little doubt that had I intervened on the child’s behalf, and pointed out that what she was doing was bad for her child, she would have told me to mind my own business, or said something much worse. I wouldn’t altogether blame her for doing so if she had. I had no reason to think that she did not love her child, or did not know what she was doing; and almost certainly she was not so ill-informed that she did not know that being fat was bad for you. Moreover, I haven’t met many fat people who, if given the chance to wave a magic wand to become slim, would not avail themselves of it.

Thus a fully-conscious woman, grossly fat herself and knowing perfectly well that obesity is bad for health, loving her child and also perfectly aware of what makes people fat, tried to force sugar on him (in the end successfully). Is this stupidity, lack of reflection, malice – or what, exactly?

Consider next the child: what chance did he have? I doubt that the scene I observed was unique in his life, very much the contrary. His mother would continue to ply him with junk food until he was like her. One can hardly talk of individual choice in the case of 3 to 8 year-olds. The child would be obese through no fault of his own; and the epidemiological evidence suggests that, if a life of adult obesity is not an absolute fatality for such as he, it is at least highly likely. If she were not quite determining his path in life, she was certainly putting an obstacle in his way.

Now of course it is possible, though not certain, that she was bringing her child up as she herself had been brought up, and she was therefore to be as absolved of responsibility for her obesity to the same extent as her child would be absolved once he had become an adult. Thus the the overeating of the parents shall be visited upon the children unto the third and fourth generation. But yet the pattern had to start somewhere and with someone, for it did not always exist and moreover has become much more widespread and commonplace with time. Since it is not immemorial, it cannot be explained simply by generation-to-generation inheritance. Something else must have changed.

Chief among suspects, of course, is what the population eats and how it eats it. And this naturally gives rise for the government to intervene, not only by means of educational campaigns, but by providing incentives and disincentives, usually by differential taxation of various food products. At the moment, fructose is one of the main villains of the peace.

The model is the largely successful reduction brought about in the smoking of cigarettes, a habit which everybody now knows to cause multiple diseases, though smoking is not a disease in itself. A combination of high taxation, legislation to restrict places where people may smoke, and propaganda has greatly reduced the prevalence of smoking. In 1963, three quarters of men in Britain smoked; in 2018, it was between one in six or seven, the proportion of smokers being inversely correlated with social class and level of education. The higher the social class, the fewer the smokers.

Taxation on cigarettes is therefore highly regressive, and those who can least afford it pay most. But one moral justification for such taxation is that those who are most likely to fall ill as a result of their bad habits are the most dependent on public services for their treatment of their illnesses. To demand uninterrupted or untaxed freedom to indulge in bad habits and make others pay for the consequences is surely unjust; but in a humane society, treatment cannot be withheld from those who need it. They cannot be left to die merely because their own conduct caused their illness and they cannot afford treatment for it. So that leaves taxation of the habit as the only means of restoring justice, as well, perhaps as providing an incentive to change habits so that illness does not arise in the first place.

Where everyone receives treatment from the public purse, therefore, there is no end to what the government may legitimately tax, once a connection between a habit or activity and ill-health has been established. He who pays the piper not only calls the tune, but has the right to call the tune.

It is not so very far from the little scene in my small bakery after all.

Reader Discussion

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on April 08, 2019 at 07:49:34 am

"To tax stimulants for the sole purpose of making them more difficult to be obtained, is a measure differing only in degree from their entire prohibition; and would be justifiable only if that were justifiable. Every increase of cost is a prohibition, to those whose means do not come up to the augmented price; and to those who do, it is a penalty laid on them for gratifying a particular taste. Their choice of pleasures, and their mode of expending their income, after satisfying their legal and moral obligations to the State and to individuals, are their own concern, and must rest with their own judgment.”
-Mill's On Liberty

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Image of Pigpen
on April 08, 2019 at 09:08:24 am

"Where everyone receives treatment from the public purse, therefore, there is no end to what the government may legitimately tax,...."

The NHS, perhaps?

Unless, of course, like Mick Jagger, you can afford to fly to the US and get heart surgery. Amazing, that anyone would want to pass up all that FREE medical care.

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Image of gabe
on April 08, 2019 at 09:48:23 am

after satisfying their legal and moral obligations to the State and to individuals

This sort of qualification is where Mill (he has a similar one in his definition of liberty) and others like him go wrong. Dalrymple's whole point is that one's "moral obligation to the State and to individuals" as understood today is precisely what justifies constraining personal choice in the area of eating, as well as smoking, drinking, sexual behavior, etc etc.

Behind the call for "socialism" in the US is a tacit and widespread acceptance of the State in Hegelian terms, as the collective to which we belong and only as part of which our lives have function and value. Its will--formulated and expressed through the class of persons who have consciously understood what the State is (i.e., "elites")--is our will: your will, my will; will that encompasses everything that is a matter of willing, which is to say everything. Dalrymple's "who pays the piper has the right to call the tune" is just a colloquial way to express this belief. It is, in fact, this belief that is being termed "socialism" today.

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Image of QET
on April 08, 2019 at 10:36:18 am

It's all about the incentives. I'm 50 and according to the government "morbidly obese" simply because at 6'1" I weigh 275 lbs. though it is mostly muscle and Neanderthal-like bones. I am heavier than ever but was always on the "heavy side" and I can tell you precisely why: I never took any illicit drug and barely drank alcohol. You have to do something to relieve the stresses of modern life, so I ate, and, according to the GOVERNMENT's now infamous Food Pyramid, so it was mostly carbs. More recently, I've thrived on an Atkins-like "keto" lifestyle and want reparations because the government messed up my metabolism with its pseudo-scientific claims. But seriously, if we had REAL health insurance in this country, i.e., health insurance premiums linked to our actual likelihood of making claims, I'd have a monetary incentive to lose weight if I am, indeed, overweight. But as it stands now, I pay 8% of my income for health insurance whether I am in perfect shape (whatever that is) or weigh 600 lbs. The advantage over taxing sugars is that it would be a direct tax on excess poundage, not on poundage twice removed (sugar intake does not lead inexorably to weight gain), and even the definition of excess poundage would be more nuanced and individualized as health insurers compete for business and consider tradeoffs between drugs, alcohol, weight, exercise regimens, and so forth. For instance, I would love to play softball a couple of nights a week but under the incentives I currently face, I can't justify the time. If it knocked off some of my health insurance premiums, though, I'd readily "Play Ball!" But no, we're stuck in this odd spot between free markets and socialism and wonder why our world is going to fat.

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Image of Robert E Wright
Robert E Wright
on April 08, 2019 at 11:12:16 am

In the US, obesity rates climbed after the government revised eating guidance via its "food pyramid", which embraced the health assumptions of the times, but was disastrously wrong and encouraged the consumption of carbohydrates vs proteins and fats.

Along with this came federal subsidies of corn growers and the production of cheap alternatives to cane sugar, the price of which was kept artificially high by tariffing imports of cheaper foreign sugar. So, the government took from the masses to enrich the corn and cane growers and fostered the massive production of cheap corn sweeteners which are, if my grade school science education still holds, are carbohydrates!

So, should the state intervene in what people are fed and how their medical bills are paid? Only to the furtherance of the production of unforeseen consequences and the demands for additional state interventions that follow...

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Image of OH Anarcho-Capitalist
OH Anarcho-Capitalist

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