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12/11/2005

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Richard Mason

Posner: Political correctness may even be a factor. Jokes at the expense of fat people used to be a staple of comedy (remember Abbott and Costello?). No more. Political correctness has reduced the use of ridicule to enforce social norms.

When Bill Maher hosted Politically Correct on ABC, one of his favorite recurring themes was to make jokes about fat people and to complain that mocking fat people was no longer socially acceptable. It did not seem to occur to him that returning to this argument night after night on a nationally broadcast humor/talk show was self-refuting.

Abbott and Costello were before my time, but I wonder if Judge Posner is familiar with the movies of Chris Farley.

jeff

I agree with Posner's points. Obesity among the populace is rampant, and while studies may disagree on the cause, I think that the major cause of obesity is the lifestyle we have chosen to live. America lives at a terrifically fast pace compared to the rest of the world. Instead of kids playing by themselves, we have super scheduled them into activities where they are entertained. We are so busy, that fast food becomes a convenience because our kids can eat it quickly between activities in the car.

Our lifestyle will have to change before the epidemic of obesity changes direction.

birdwin98

Increasing obesity in the US is certainly one factor, among many, that has contributed to the rising cost of healthcare. How is this increased cost borne, however?

The portfolio effect of health insurance coverage at large employers insulates individuals from from price signals associated with the personal health risks and choices that individuals may make (a healthy person pays the same monthly premium as a an unhealthy person).

If group health insurance were more efficiently priced, and individuals paid premiums that truly reflected their unique risk of coverage... then I believe behaviors and attitudes towards obesity would begin to change. I know that if my healthcare premiums would significantly reduce if I lost weight, then I would probably try harder to lose weight. Conversely, if I knew that my healthcare premiums could significantly increase if I were to gain weight, I would try my best to avoid doing so. My level of effort, naturally, would be impacted by the amount of the potential premium increase or decrease.

I do realize that such pricing could be politically problematic, particularly when other genetic risk factors or disease come into play...and pricing could appear unfair or inhumane. Without more efficient pricing, however, healthy people will continue to subsidize unhealthy people.

John O.

Note to Lucia Malla:

The judge wrote: "If the cause were biological, the well-documented increase in obesity over the last several decades would be inexplicable."

The "biology" he was referring to wasn't human weight gain in general--it was referring to the argument that obesity is genetic; that is to say, some people are more genetically disposed to obesity than others.

If this were true then there wouldn't be any rise in obesity, unless our genetics had changed substantially over the last several decades.

Avi

Yet another arena in which people senselessly distinguish overeating from smoking.

Few Quick Questions:

Why don't we allow Joe Camel to pander to kids as blatantly as he used to?

Why don't we have cigarettes machines in schools?

Why do we openly speak disparagingly of smokers, but wait till we get home to mock fat people?

Why is so acceptable to show contempt for the smell of a smoker, but rude to gag at the profile of a fat person?

In short, why do we make the allowances for the fat which we deem unnecessary protections of the smoker?

As you might have guessed, I believe what's good for the geese...

Lucia

John, I think there are two concepts here:

1) Obesity is a caused by genetic predisposition to some people, so some obese people are expected in the population due to this natural variability. In this sense, I agree with you.

2) Overall obesity in the population is a consequence of an overburnt normal, standard system - our body - facing new challenges (sedentary behaviour, for instance), independent in some ways of personal genetic status but dependent of evolutionary trends.

Evolutionary trends fulfill the biological aspect as well, and that's what I pinpointed in my first comment. Biology is not only genetics, and that's what I tried to illustrate by commenting here. But I agree with you: at that particular sentence, judge Posner was just pointing the "improbability" of biology being the only one to blame for the obesity epidemy.

The world changed for Homo sapiens; we have comfortable technology that makes us sedentary, and overall, obesity can't be blamed only because of some genetic predisposition anymore. For some, yes, but not in the rates we see nowadays.

I don't know if I got your comment straight, John, but that's what I understood. Please let me know if I cleared or confused you more... :-)

Fred

Thank you, Avi, for pointing out the dangers of destroying freedom, even when it seems like such a good idea. It was easy enough to demonize the cigarette companies and take away their basic rights, and now that we've done that, there will always be many more Avi's who point to other areas where we still have freedom and say "hey, why don't we take away the freedom over there--we've done it before, let's do it again."

Paul Campos

This entire thread assumes that the definition of "obesity" as a pathological life-threatening condition is a well-established scientific fact, and that the USA faces some sort of health crisis because of the increased body mass of its populace. These assumptions are, to put it mildly, problematic.

For recent in-depths reviews of the issue see my THE OBESITY MYTH and Eric Oliver's FAT POLITICS. For a brief summary of the epidemiological evidence, go here: http://ije.oxfordjournals.org/cgi/reprint/dyi254?ijkey=5Z19Zq421PiNgMw&keytype=ref

Eric Gates

Professor Posner's final paragraph troubles me:

"The main costs of obesity, in increased illness and disability, are borne by the obese themselves, which greatly weakens the economic case for intervention. True, the obese are able to shift some of their medical and disability costs to others through the Medicaid, Medicare, and social security disability programs, which are subsidized health and disability programs that do not limit benefits to the obese even though the obese experience increased illness and disability as a consequence of their obesity. Yet the benefits of preventive health can be exaggerated."

Is he laying out a case of facts here, or trying to persuade us? I suspect mainly the latter. Why else would someone as obviously capable as he ignore the private health care system-- a pool nearly as collective as the federal government itself--and leave unstated the costs of manageable, yet nearly lifelong diseases, such as type II diabetes, elevated blood pressure, and high cholesterol, the main outcomes for people who are obese from an early age. I am no Posner, but the health care math surely doesn't make sense here.

Obese children who for example contract lifelong type II diabetes in their teens or twenties and live into their 60's or even 70's will surely cost more than elderly people, whose maladies last for far fewer years. Diabetics will pay more doctor visits, take more medications, require more surgeries, for perhaps 40 to 50 years. Then they too will get old and have other normal maladies not related to their diabetes alone. Drug companies will see to it that diabetics live a long time, taking at least one pill, and probably more, each day to prevent the death that would await them were they not to take their pill(s). All of this will be paid for by a weakening private health insurance system as well as the government programs professor Posner mentioned.

Can the government eradicate type II diabetes and thus save money. I'd say the odds here are better than winning the war on terror.

Paul Ferree

A significant difference between smoking and obesity is the negative externality of second-hand smoke, to which obesity has no counterpart. Obesity is a health risk to the obese person only, whereas smoking is a health risk to all the surrounding people who may or may not choose to smoke for themselves. This somewhat negates Avi's point; the reason it is ok to regulate smoking (and to socially demonize the activity) is to protect non-smokers from the harmful decisions of others. However, obese people pose no direct health threat to fit people.

To summarize: regulation of smoking is justified because it produces externalities, but regulation of obesity could not be justified on the same grounds.

MT

Prof. B, you don't think replacing junk food TV ads with healthy-diet public service messages would have statistically significant effect? Are you saying nothing on TV affects how much TV we watch? You're jumping from skepticism to an insinuation of positive claims that are more dubious than the authors'.

george

Well said. I totally agree with you. The point you are making here does make sense.

candace

I think tv is quite an important factor in this issue.

Avi

Paul makes a good point: smoking is a bad decision which affects us all. I have no doubt this is what's at play in the regulations which started in California and quickly took hold in Boston and New York.

What interests me more, however, is the paternalism inherent in the anti-smoking rhetoric. Tobacco companies are evil because they manufacture poison. Smokers are idiots because they poison themselves for very limited ends. We restrict tobacco advertising and tax it as heavily as we do under the guise of this paternalism, and also undoubtedly because it is just so damn profitable.

We can't tax McDonalds. It only works because it's so cheap. But what if we limited their advertising overhead the way Posner suggests? Could we keep the difference, like we do in the tobacco industry? McDonalds makes poison. There foods makes people fat. Fatness is as unhealthy as smoking.

This is my point. There is a distinction in the way we think about these things from a moral perspective that cannot be sustained, and is irrespective of the second-hand effects of smoking.

ben

Avi

I agree. The rationale for restricting tobacco because it is a poison is flawed because many things we consume is a poison, in the sense that they reduce life expectancy. Were the "poison rule" adopted consistently, we would ban many contact sports and outdoor activities, the majority of foods in a supermarket, and possibly even motor vehicles. It is not a matter of degree: provided people are informed then consuming especially strong "poisons" will only occur if the private payoff is large enough.

Anti-obesity advocates do not understand that each of us is constantly trading off quality and longevity of life. We make this trade-off in deciding whether to snack on chocolate or lettuce, or to ride motorbikes or in cars, and we make those decisions according to our preferences. Clearly, living long and being very healthy is not an objective shared by all, so having that objective imposed must be unhelpful. Unless externalities are especially severe in obesity, and they do not appear to be, welfare can only be harmed by government intervention.

Rejecting the "poison" standard in favor of an externalities test doesn't mean anything goes: when there are significant negative externalities associated with the use of a strong "poison", as there probably is with narcotics abuse, for example, then government intervention can still be justified on economic grounds.

nate

the link below takes you to the chicagoist blog.

there are many hidden costs to obesity.

http://simurl.com/bb-pp-mm

Think about this cost: buying new seats, installing the new seats, potentially less ongoing throughput and revenue, time spent by mgt looking to buy new seats, opportunity cost - mgt could have been doing other things, any other switching costs, etc.

ben

Nate

The cost you cite is irrelevant to policy setting unless there is an externality. I doubt there is one for bus seating because buses compete against other transport and users pay a fare to ride. Businesses constantly make adjustments to suit customers' preferences, and there is no reason to point to seat width as especially costly.

nate

You are right about business making adjustments. Businesses employ "price discrimination." Computers and technology enable a business to do all kinds of things unavailable a long time ago.

http://eyetrack.morris.com/story_pages/5_a/03.shtml

http://www.cswd.org/airseats.html

So if the buses were like a "business", in the sense that I think you use the word "business", the buses may charge overweight people more money to ride the bus. Maybe Posner can give us more legal background on this. Would it be legal to charge overweight people more to ride the bus? Otherwise, slim and disciplined people that use public transportation are subsidizing larger people.

"I doubt there is one for bus seating because buses compete against other transport and users pay a fare to ride"

Is it possible that buses may have a quasi-monopoly on transportation for certain segments and areas of the population?

nate

one more:

It may be important to redefine mores a little bit. I am not sure why "thin" is desirable. People should be comfortable, confident and have positive self-esteem regardless of weight. People should look for the beauty within.

Also, on being heavy: it seems to me like there are at least two types of overweight people. One type is a glutton: a person with no discipline who, given a lower cost of fat, will inevitably become overweight. The other type is a person who has some sort of genetic predisposition to being overweight. It is really hard to distinguish between these two types, and I am not God and do not want to commit Type I and Type II errors. As a fortunate "skinny" person (at least historically), I am okay subsidizing the cost of seating on public transportation, and even an airplane, due to the fact that some people are overweight for reasons beyond their control.

It should be noted that SW Airlines is consistently profitable. SW Airlines charged overweight people more to fly on airplanes.

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