New Round Fired in Fat Wars

Published May 1, 2002

The March/April 2002 issue of Health Affairs magazine offers up new ammunition in the nation’s most recently launched War: not on terrorism, but on obesity.

In “The Effects of Obesity, Smoking, and Drinking on Medical Problems and Costs,” Ronald Sturm, a senior economist at RAND Corp., compares the effects of obesity, overweight, smoking, and problem drinking on health care use and health status based on national survey data. Sturm directs the economic and policy research program in the UCLA/RAND Managed Care Center for Psychiatric Disorders.

Sturm finds obesity has “roughly the same association with chronic health conditions as does 20 years’ aging,” a link he says “greatly exceeds” the associations of smoking or problem drinking. He finds obesity to be associated with a 36 percent increase in inpatient and outpatient spending and a 77 percent increase in medications. By comparison, he says, smoking is associated with a mere 21 percent increase in inpatient and outpatient spending and a 28 percent increase in medications.

As this issue of Health Care News went to press, Sturm’s work has attracted little press attention … but that’s likely to change. His findings play nicely into the hands of “nanny activists” seeking “Twinkie” taxes on high-calorie foods, mandatory “warning” labels on meat, food and beverage marketing restrictions, and publicity campaigns to get Americans out of fast-food restaurants.

“For years,” noted the Center for Consumer Freedom (CCF), an alliance of restaurants, taverns, and defenders of freedom of choice and consumer rights, “activists who have been taking on tobacco and alcohol have also taken aim at the right to make your own dietary decisions. Now, they’ve dropped their bunker buster: saying an ‘epidemic’ calls for immediate and extreme government action.”

Surgeon General Weighs In

The “bunker buster” referred to by CCF is a report issued by David Satcher, then U.S. Surgeon General, on December 13, 2001. While Satcher left the office on February 13 of this year, his report is expected to have long-term consequences.

In “The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity,” Satcher declared obesity to be a “public health epidemic.” He called for sweeping eating habit changes in schools, restaurants, workplaces, and communities to help combat the increase in the number of Americans who are overweight or obese.

Outlining the first national plan of action for the overweight and obesity wars, Satcher recommended schools make their lunch programs less fattening, restrict students’ access to vending machines selling calorie-dense foods and soft drinks, and resume daily physical exercise classes for all children and adolescents, as well as recess for elementary school students.

Satcher also suggested restaurants and fast-food establishments should offer more nutrition information. Communities should create safe playgrounds, sidewalks, or walking trails, particularly in inner cities, and encourage physical activity.

Employers should also do their part, said Satcher. They should include weight management and physical activity counseling in their health insurance coverage and allow employees time to exercise. Satcher believes obesity should be classified officially as a disease, so as to encourage insurance companies to reimburse for weight-control expenses.

Tobacco Deja Vu

Even before Health Affairs concluded obesity represented a greater health threat than tobacco, the anti-consumer activists had caught on.

“Just as nobody in 1964 could conceive of restricting citizens’ God-given right to smoke, few Americans today can imagine regulating something so personal as the way we exercise and eat,” wrote Self magazine’s Patti Wolter and the New America Foundation’s Shannon Brownlee in The Washington Post. But since “obesity is epidemic, as Surgeon General David Satcher noted,” we “may not have a choice.”

They concluded, “It’s beginning to sound like Joe Camel all over again.”

John Banzhaf, professor of law at George Washington University and executive director of Action on Smoking and Health (ASH), a “how-to-sue” activist organization, agreed. “There is a movement afoot to do something about the obesity problem and see it in terms of costs.”

Banzhaf told Fox News, “It’s appropriate that the cost shouldn’t be borne by everybody but confined to those who use the products and/or produce them.” Banzhaf refers to the “total direct and indirect costs attributed to overweight and obesity,” estimated by Satcher to be up to $117 billion dollars in health-care related problems for hefty Americans in the year 2000 alone. Satcher contends approximately 300,000 U.S. deaths a year are associated with obesity and overweight.

Fact or Fiction?

Just how accurate the numbers are is anyone’s guess.

According to J.D. Tucille, senior editor for the Spotlight, the cost estimate is an amalgamation of incomparable numbers, including health care costs handled by a variety of private insurance policies or by individuals paying their own out-of-pocket costs. “It also includes,” says Tucille, “extremely vague estimates of indirect costs, including reduced productivity and lost work days resulting from obesity.”

Tucille describes Banzhaf as a “professional busy body and one of the masterminds behind the lawsuits that extracted billions of dollars from tobacco companies.” According to Tucille, Banzhaf “suggested fast-food chains and snack companies deserve the same treatment.”

The next weaponry in what has so far been a war of words is likely to be lawsuits against corporations and government-centered schemes for modifying behavior. Among the possibilities are a fat-tax penalty for the production and consumption of supposedly unhealthy foods, a government subsidy for fruits and vegetables, and a tax deduction for staying healthy.

Brian Cohen of America’s Future Foundation speculates how this latter proposal would work. “We can only imagine: Different tax brackets for different cholesterol levels? Itemized deductions for healthy food? Extra exemptions for dependents who make the traveling soccer team?”’s Tucille reminds us,

“The ultimate ‘villain’ in America’s epidemic of blubber has more to do with lifestyle choices than nefarious businesses peddling fattening foods. Many people eat too much of whatever they eat, and don’t exercise enough. This may well harm their health, but obesity comes as a tradeoff for the pleasure that people take in eating and leading sedentary lifestyles. Some of us may not agree with that tradeoff, but we are free to make other choices.”

Joseph Bast, president of The Heartland Institute, a public policy think tank in Chicago, sees dangerous parallels to the tobacco wars.

“I don’t object to government officials, particularly elected ones, using their offices as bully pulpits to preach their beliefs,” said Bast. “If voters don’t like what they say or do, they can either vote them out of office or ignore them. But government has no Constitutional authority to use public funds or the force of regulation to impose the personal beliefs of a few on the lives of the many.”

Bast concludes, “A government-sponsored ‘war on fat’ will resemble the war on drugs, alcohol, tobacco, firearms, and other products disliked by the elite but valued by the majority. All these campaigns are sources of human suffering, public costs, and violations of individual rights that must be weighed against the slight benefits to public health they may engender.”

Conrad F. Meier is managing editor and Diane Carol Bast is editor of Health Care News.

For more information …

The Surgeon General’s December 13, 2001 report, “The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity,” is available on the Internet at A Webcast of the two-day December 2000 listening session is accessible on the Internet at: (requires Real Player).

The Web site of the Center for Consumer Freedom,, offers a wide range of resources aimed at protecting personal responsibility and consumer choice. It includes a link to CSPInot, explaining “why the Center for Science in the Public Interest is not science in the public interest.”