Everybody knows obesity is a massive problem in the U.S. It rivals smoking in terms of its health hazards, according to a report in the February 2010 American Journal of Preventative Medicine. As a society, we’ve made great strides, giant leaps even, in reducing rates of smoking. Smoking bans on airplanes, in public buildings, in restaurants, have helped. So have negative ad campaigns aimed at teenagers, higher insurance premiums for smokers and higher taxes on cigarettes. These measures have driven millions of smokers to quit and caused rates of lung cancer and heart disease to decline.
Yet whenever health officials propose using the same approaches with obesity, the American public tends to protest that the measures are too draconian or infringe on personal liberties or unfairly demonize people who are overweight. Given the fact that once gained, losing weight is harder for most people than quitting smoking, why are we being so passive about obesity?
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Granted, there is one key difference: nobody has to smoke but everyone needs to eat. Even so, there are lots of public health measures that could make a dent in rates of obesity. For instance, we could tax sugar-sweetened drinks, a tactic Denmark is trying. But in the United States, critics argue that the occasional Slurpee (all 325 calories of it) won’t make you gain weight and so a tax would infringe on the rights of responsible 7-Eleven diners and create a “nanny state.”
We appear to be equally unwilling to impose higher insurance premiums for people who are obese. According to a recent poll conducted by National Public Radio, the American people are opposed to having different health insurance premiums based on weight, despite being generally supportive of increased premiums for smokers. This might have to do with self-interest. Most of us don’t particularly like the idea of paying more for our health insurance, and there are many more overweight people in the U.S. than there are smokers. According to the CDC, nearly 70% of adults are overweight or obese. By comparison, less than a quarter of American adults smoke.
But this may not be the whole story. Even among thin people, who wouldn’t be affected by the surcharge (and who therefore might even see lower health insurance premiums, although the survey may not have explained that), support for the fat tax fell short of a majority. Why? Smoking is seen as being completely in the individual’s control, whereas obesity is viewed as a result of a combination of complex factors.
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We know that an individual’s weight and body mass index, the current term for degree of excess weight, are strongly influenced by genetics, and we’re generally skeptical of holding people financially responsible for their genetic predispositions. We live in an “obesogenic” environment, a society in which everything from the foods that are available to the way our cities and towns are built increases the chances of gaining weight. Living in poverty makes you more likely to be overweight, likewise living in a “food desert,” a neighborhood where there are few grocery stores and lots of fast food outlets. Even having fat friends may influence our own weight.
We could say the same thing for smoking, that nicotine addiction is partly genetic, that poor people and the mentally ill are more likely to smoke, that having friends and family who are smokers influences your chances of being a smoker. But smoking is still seen as a personal habit, whereas overeating and not exercising are increasingly seen as a social ills. What it really boils down to is our willingness to blame the smoker, and even shame him or her. “Smoking’s gross,” we tell them. “Just cut it out.” If you’re obese, we are more likely to blame society.
There’s one other aspect to smoking that finally tipped public opinion over, making it possible for state and local governments to enact regulations and laws that drove down rates of smoking: secondhand smoke. When non-smokers began to feel that their health was threatened by the behavior of others, they were willing to make life more difficult for smokers and impose strong financial penalties on them.
Maybe it’s time to be at least a little more willing to similarly demonize excess poundage. Our rapidly rising rate of obesity harms us financially, because we pay for health care collectively. Insurance premiums paid by the healthy subsidize the care of the sick. That means we are all paying for the costs of treating obesity and that treatment is one of the things that is helping to send health care spending through the roof. The war on smoking worked because it made smoking shameful and the public health measures needed to fight it permissible. It may take an even tougher approach to combat obesity, beginning with the recognition that it’s bad for all of us.