I'm sitting in a café in Buenos Aires enjoying a meal after giving a talk on the causes and costs of rising obesity. I spoke to the International Federation of Health Plans: It's a nice gig with all expenses paid. I got the invitation because of a book I co-authored with my colleague and dear friend Neil Seeman entitled XXL: Obesity and the Limits of Shame. It's hard to concentrate on obesity when we're all indulging in wonderful food at a fancy hotel morning, noon, and night.
It's no surprise that most people are of the opinion that the obese should pay for their sins through higher insurance premiums or higher taxes for the food they eat. We know this from a survey of 53,000 people around the world on how governments should tackle the problem of obesity. (The survey was done by RIWI Corporation where Neil, my co-author, is the CEO.)
Only problem is, as I argued at the conference, the obese more than pay for their sins by dying earlier than most of us and thereby collecting less in government pensions and retirement income. Research also shows the obese are paid less because employers would rather hire people of normal weight. That's pure discrimination. And the non-obese may be getting the benefits of all the cardio-vascular medical breakthroughs done on the obese. Could it be that the obese are actually subsidizing normal weight people? (I have the economist Robert Whaples for this bit of insight.)
Why the change in the last 30-odd years? One convincing argument is the boom in food technology has lowered the time cost of food preparation. This finding comes from research by two Harvard economists Edward Glaeser and Jesse Shapiro. The evidence matches up nicely with weight gain from around the 1980s. Think back to the 70s when the cutting edge of pre-packed food was the awful Swanson frozen dinner. Now you can buy a range of prepared foods such as pre-cooked pasta almost as good, if not better, than you can prepare at home.
And the variety and quality is improving all the time. Economies of scale in food production have driven down the cost of preparing foods. That's why restaurants and fast food joints are super-sizing your meal. They could charge less, but it's better business to load up your plate with fries and pancakes.
One of the biggest technologies is the microwave oven that makes it cheaper and faster to cook. Because of this shift we're snacking a lot more. This brave new world is especially hard on those of us with weak will power. We live a world now of endless food temptations.
And where you find more microwave ovens, you find higher obesity rates. Consider that 80 per cent of U.S. households have microwave ovens. In Italy, where obesity is lower, only 14 per cent of homes have them. Italians spend about 20 minutes more per day cooking than heavier American and British adults. But technology doesn't seem to explain why Mexicans and Chileans are so fat.
But now we know something else. We know how difficult it is to lose weight, and why it may be the toughest thing you'll ever do. Because of our hormones, or fat cells, once they've been filled-up as we get fatter, that's where they want to stay. Our hormones have long memories and are very patient. Even if we diet hard, our hormones are determined to get their way waiting for us to drop our guard. That's evolution at work. Our bodies are trained to put on weight, not lose it.
So how do governments get people to eat better and take care of their health? Short of banning microwave ovens, not much it appears. Taxes are a clumsily and generally useless way to get people to eat less junk food. The Danes are trying it with a tax on saturated fat, but I doubt it will work. People find ways around these things. How about more calorie information? Sure, but that doesn't hold out much promise. At Harvard, cafeterias abandoned the idea when students chose low calorie foods, and avoided foods that were more nutritious. These tricks are just toys to our genes.
Neil and I argue that you have to get individuals to somehow take control of their health. Top down one-size-fit-all policies are expensive and don't work. Our idea is to take a page from the educational voucher program. Let people choose their own programs to lose weight by providing them with cash vouchers for pre-approved programs. Will vouchers work? A better question is, what else is there? And you can forget about science finding a pill to tame our genes. The side effects boggle the mind.
There are more details of how such a voucher program would work -- what we call Healthy Living Vouchers or HLVs -- in our book.
In the meantime, I've got to get back to my nicely marbled Argentinian steak and Malbec wine.