Saturday, July 01, 2006

Obesity and the state

I have earlier expressed my own ambivalence towards seeking an increased role for government in thwarting the obesity/diabestes epidemic sweeping much of the develloped and some of the developing world. Chris Berg from the IPA today undertakes the standard right-wing demolition of an earlier Ross Gittins piece on the role of the public sector in influencing people's food consumption habits. Berg argues government regulation is not the answer to obesity. His main points have been made on many occasions - many I agree with, some I would qualify and some I am unsure of.

Berg argues that even though the average weight of Australians is increasing:

Measures of obesity are flawed since many of the 21% of Australians classified as obese are 'big-boned'. That BMI measures are imperfect is correct but the weight shift being observed is not a subtle one - the broad impression is that we are getting genuinely fatter.

Our consumption habits suggest lower energy consumption at 125 kilojoules with reduced sugar consumption. This is interesting - there is aso not good evidence that we are not becoming more sedentary - but energy balance ideas suggest something here is factually wrong. More research needed.

Centres for Disease Control in the US found 'overweight' people had a lower mortality than those of normal weight. Correct - we have discussed this on this blog - but there was evidence that being obese did bring about higher mortality even if being merely overweight did not.

Technological change and supply-line innovation in food manufacturing have reduced costs in time and money of food preparation so it can be a rational economic decision to eat out. Agree.

Most of the recent growth in weight is not directly attributable to our food. Darius Lakdawala and Tomas Philipson found that only 40% of weight gain since the 1970s is due to changes in diet. Rather, the large part of our weight increase can be attributable to changes in lifestyle and work practices. $40% of course is still a lot! Nutrition survey data in Australia are poor so it is a bit difficult to evaluate these claims.

Government regulation doesn't work. Sweden has every program on the book to combat childhood obesity. Advertising aimed at children under 12 is banned. Sports programs are heavily subsidised. Healthy cooking is part of the curriculum. But numbers of overweight Swedish children have tripled in the past 15 years. Obviously the issue of the counterfactual is important here. This requires serious statistical analysis and a program evaluation.

The market is good at educating people on the negative consequences of their decisions. Balancing against the advertising for high-sugar snacks, television programmers have provided shows like What's Good for You and The Biggest Loser. This is unclear since I think advertising encourages very unhealthy fast food choices and record levels of high-sugar soft drink consumption. Messages about what constitutes good nutrition are frequently confused and shows like 'The Biggest Loser' seem to me to be potentiially dangerous and the competitions they encourage ill-advised.

These programs have been produced not by government, but by corporations eager to maximise their ratings, and therefore their profits. Yes, markets will emerge to deal with obesity issues. But information is a public good so we can expect it to be underprovided unless it services a private interest.

Data from the US indicates the number of food and restaurant commercials viewed by children declined over the last decade. I cannot comment as I am unaware of this data.

Consumers are becoming aware of the consequences of fatty and unhealthy food. This change in demand goes far past the salads at McDonald's. Juice bars, wheatgrass shots, bioengineered food and even sushi were unheard of to Australians 50 years ago. Agree.

The idea of government regulating to protect against obesity shows us how far debate has moved from personal responsibility to government responsibility. 'But is there a clearer area in which individual responsibility must take the fore than when choosing what we eat? Government regulation is not the solution to the obesity crisis'.

Examining this last claim is the point of my current research. It is not obvious that government action is inappropriate - governments have had success in reducing smoking and it may be that obesity and diabetes can be similarly dealt with. But I am keeping an open mind at this stage. The work that I am doing suggests there are basic problems with active intervention policies in addition to those identified by Berg. In particular it is unclear that encouraging people to loose weight is effective or that it improves health.


jack said...

I hate to be immodest but both Berg and Gittins merely echo my extensive essays on the subject, including my earlier posts here on Calumna. Both Berg and Gittins make fair points though Gittins and HC are silly in expecting that the "obesity epidemic" can be ameliorated by some kind of government intervention. I mean, that would be a bit loony. Think about it folks.

I wouldn't say that Berg's contribution to this debate is the "standard right-wing" response, even though, granted, the IPA is a rabid right-wing "think tank" started up by the tobacco and mining industry lobbies to protect their interests. But, as the agriculture industry* does not seem to be one of their patrons, we may assume that Berg's comment could be in good faith. And he is mostly right. I would merely quibble with his claim that we eat less sugar. This of course beggars belief. We eat more sugar and we eat more of everything else. We eat more because food is cheaper than ever and more available, with all kinds of facilitating agents such as supermarkets open at midnight on a Sunday (just when you're feeling peckish), fast-food outlets and ever more fiendish ways that food manufacturers and marketers create new food concepts. Things develop.

As I said, obesity is a byproduct of prosperity and the poor are fatter because what makes them miss out on better renumeration, i.e. lack of ability to plan for the future and delay gratification, also applies to eating. Hence, the poor have more opportunity to eat than ever before and they do, without aforethought. The poor also gamble and smoke more. (They are also taxed more, for the same reasons).

*The so-called "food pyramid" so avidly quoted by nutritionists puts carbohydrates as the massive basis for all eating (it is the base of the pyramid) was invented by the US Department of Agriculture
as a marketing ploy to sell more grains. If you want to blame anyone for the obesity epidemic, blame USDA. If you don't believe me, put "food pyramid" into Google and the first 30 hits are USDA sites, most of them aimed at kiddies. Just like cigarettes really.

hc said...

My guess is that obesity is due to more than just overconsumption of carbs. Aikins had a point but it wasn't everything.

I think government can provide info and tax certain goods and that these will have some effect.

I have written a long paper on the determinants on obesity in Australia - it is now with editor - and have just secured a very good data base to work on. I'll send you copies Jack and invite your comments on the empirical work.

Fuzzflash said...

As a practising nutritional neo-Cartesian, I eat, therefore I am. Often I'm troubled by the reality that a diminished calorific intake makes me less of a man. Thank you,Professor Harry, for providing me with so much food for thought on this important topic. Considered, cross discipline academic reflection is essential in any meaningful discussion on "Obesity and the state". Every bit as essential as soid government support in enhancing successful outcomes. Perhaps Senator Vanstone could provide a foreward to your upcoming paper on the determinants of obesity in Australia.

One anticipates it with relish.

jack said...

I think you are right H. It is a "guess". Nobody knows anything and much of the current debate about obesity is based on guesswork. What we need is decent empirical evidence about the "obesity epidemic". Especially if we are going to involve government in social engineering. With tobacco and alcohol the evidence is there. But with obesity it's a multifactorial problem but it is very hard to assign the proper weighting to each of the factors.

This is why it causes me severe mental anguish when Harry says, by inference, that I said that Atkins is everything (sic). How many times do I have to say it? Excess cosnumption of carbohydrates is not "everything", I never said that. Indeed I said something else. The argument goes nowhere if you put words into my mouth to suit your agenda, H.

Atkins aside, there is good, solid evidence that overconsumption of carbohydrates as a proportion of what we eat is an important factor in increasing obesity that is supported by evidence. But you wouldn't want to say this out loud because Keepers of the Truth will come down on you like a ton of bricks. See

But I say again, again Harry, aside from the carbo phenomenon, it is private car usage (the way we build and use our cities, the undercapitalisation of public transport, etc etc), and perhaps the atomisation of social institutions such as the pub, where we just drive home and sit in front of the telly.

Kyan gadac said...

It's worth remembering that fat and alcohol have 8 times more energy than sugar on a weight for weight basis. In the absence of factual data(as noted by all), might I suggest that fat and alcohol consumption could also be important.

Also, take-aways may not be as important as processed snacks from the supermarket in terms of overall consumption. Consider the correlation between chip packet(high fat)numbers and the trolley pushers weight - anecdotal but extensive! One needs to look at what people buy but it is pretty obvious that many popular processed foods are high in fat and sugar.

Processed snacks are within reach of even the poorest compared to take-aways. Coke and chips are the only food of some kids.

Processed foods are also prefered by poor people who don't have access to good refrigeration. A non-trivial purchase.

Lastly, if we accept that childhood history is a determinant of adult weight(likely), then intervention at school or during childhood generally makes sense.

This may come down to the politics of the school tuck shop - should we supply meals? milk? ban chips? etc? I would think that there is plenty of past experience that could suggest what works and what doesn't in this arena?

hc said...

Kyan, The Atkins supporters support your view on the calorie density of fats but argue that consuming fat and protein is self-limiting because these foods more effectively suppress appetite.

I agree with your point on changing habits amnong the young. I have already posted on the soft drinks ban in schools here

and will carry out a survey with a nutritionist to see if it is effective in changing habits.

jack said...

There is some evidence (Harvard Olestra study, see
olestra/o14.html that adduces that fat is not a good or efficient appetite suppresant. May I also point out, just in case there is some confusion, that alcohol is a carbohydrate and as such is metabolised into glucose by the body. Carbohydrates are combinations of carbon (C), hydrogen (H) and oxygen (O). When Kyan says that alcohol has 8 times more energy than sugar, what does he mean? How many people does he know drink pure alcohol? Even grain spirit is only about 92 per cent. Beer is around 5.5%. We consume far more sugar in the form of fruit, fruit drinks, soft drinks, mixer drinks with alcohol, bread, potatoes, pasta, chips than we do alcohol, although Kyan may be a special case, I don't know. If alcohol was responsible for widespread obesity serious drinkers would all be obese but that is clearly not the case.

Kyan gadac said...

good points Jack, what I was actually thinking about (but managed to mangle) was that sugar had been substituted for alcohol in low alcohol products.

Chuck said...

Your blog about cutting fat out of your diet is really cool.I'll be back to visit.