It’s 2011 and it’s time for every American to begin a now time honored tradition: the diet. There is no doubt that many, if not most Americans—myself included—have listed a diet under their resolutions. People will be more irksome this month as they begin one of the hundreds of gimmick diets and deprive themselves of their daily fix of carbs, fats, or whatever radical change the regimen requires.
Why, year after year, do we perpetually engage in what is often times a foolhardy tribulation? Because we’re fat. We are bombarded with statistics that show how fat the U.S. is becoming in the media. A report by the Centers for Disease Control and Prevention (CDC) (available here) shows that over 25 percent of Americans are obese. The World Health Organization (WHO) classifies obesity as a disease. Most susceptible to this disease are non-Hispanic blacks, the poorly educated, and those who live in the South or Midwest, or America’s poor. Obesity is defined as having a Body Mass Index (BMI) of over 30kg.
We rarely hear about fat Europeans. Is this because there are none or a lack of awareness?
The data shows that Europe, like America is getting fat. While obesity rates are lower, and vary significantly across the continent, obesity has been deemed a serious issue and the EU has begun to commit resources to combat the problem (here). Central, Eastern, and Southern Europe are suffering the most from this disease, where it has reached epidemic proportions (Berghöfer et al, 2007).
State | Obesity prevalence/% men | Obesity prevalence/% women |
United States | 33.2 | 35.5 |
Italy | 18 | NA |
Poland | 20.8 | 23.8 |
UK—England | 22.1 | 23.9 |
Germany | 20.5 | 21.1 |
France | 16.1 | 17.6 |
Source: International Association for the Study of Obesity
So what is causing both America and Europe to fatten up? This is debatable and here I’m only going to speculate.
First off, while there are some genetic causes they do occur at a rate high enough to have caused the mammoth increase in obesity prevalence (Wilding, 2001).
Speculation 1: Cheap and abundant food
For a quick example think about the rise of membership wholesale clubs like BJ’s or Sam’s Club and the quantity of food you can buy at these establishments. What do bulk retail stores mean for consumers? When you can buy a twenty five pack of hamburgers or a five pound jar of peanut butter you are going to eat more. You have already paid the upfront cost, so the marginal cost of having one more hamburger or peanut butter sandwich is zero (the costs for eating the 24th and 25th hamburger are higher than eating the 2nd and 3rd). When you buy a smaller package the marginal cost of each burger is higher because you run out quicker.
You could buy five, five packs of burgers but this brings me to my next point…
Speculation 2: Marginal costs are higher for Europeans and city dwellers.
When I lived in Florence I didn’t have a Tesco nearby or anything equivalent to a Wal-Mart or Sam’s Club. I had to walk a mile to the grocery store and carry my groceries the mile back to where I lived. The cost of me eating me one more burger was a major pain in the ass, so I ate less. More Europeans live in urban areas than in the U.S. and fuel prices are also higher. Marginal costs are higher for city dwellers who have to walk and carry their food and for a European who has to pay more in gas if they decide to drive, than for an American, who pays less in fuel prices. Extremely rural areas would be an obvious caveat to this example.
Speculation 3: Cultural differences
In her blog for the New York Times (here), Catherine Rampell plots the obesity rate with the average time spent eating per day for several countries. She admits that the correlation of high obesity in the U.S. with quick eating times does not necessarily mean causation, but let’s consider the impact of cultural norms. The French spend a lot of time dining. Logically, one would think that this means they eat more, but it has more to do with diet norms than time spent eating.
Japan and Korea spend more time eating than the U.S., but less time than the French and have obesity rates lower than both the states. Japanese and Korean diets rely heavily on fish and this is often cited as the reason behind their longevity. The French spend a lot of time on their meals, but have fiercely resisted American style food that is calorie dense.
But the world is changing and the best example of this is Oceania. Samoa, Tonga, the Cook Islands are all among the world’s most obese states. This has occurred because their diet has changed radically due to globalization. Deborah Gewertz and Frederick Errington shed light on this issue in their book Cheap Meat: Flap Food Nations in the Pacific Islands. Islanders’ diets have shifted since WWII from fish and locally grown crops to meat cuts imported from the developed world, which are high in fat, cheap, and easily obtained because they are no longer isolated. Why fish for eight hours a day when you can buy cheap mutton?
Because high caloric food has become so cheap it is shifting cultural norms that once appeared impervious to globalization e.g. McDonald’s is being built in the Louvre!
These are, again, just my speculations based on a very brief review of a limited amount of literature.
While I can only speculate on what causes obesity, I do have a solution, but you’re not going to like it…
States have two options to give people an incentive to stay in shape.
The first is to tax the unhealthy food that causes a negative externality. Obesity produces a negative externality because of all the associated health problems such as, diabetes, hypertension, high cholesterol, etc. which lead to increased healthcare costs, loss of productivity and so on. This tax would look similar to the recent one imposed on tanning. Someone who chooses to spend three days a week in a tanning bed, drastically raising his/her chances of skin cancer, should be given a monetary incentive not to engage in a behavior that is going to lead to costly melanoma treatments for him/herself and also impose a cost on society.
The first is to tax the unhealthy food that causes a negative externality. Obesity produces a negative externality because of all the associated health problems such as, diabetes, hypertension, high cholesterol, etc. which lead to increased healthcare costs, loss of productivity and so on. This tax would look similar to the recent one imposed on tanning. Someone who chooses to spend three days a week in a tanning bed, drastically raising his/her chances of skin cancer, should be given a monetary incentive not to engage in a behavior that is going to lead to costly melanoma treatments for him/herself and also impose a cost on society.
These are the so called “fat taxes” that have little public support. These policies would tax sugary, salty and other unhealthy foods.
My second solution is even more unpalatable: tax people based on their BMI. BMI is the way that obesity is currently measured and is a simple measure of your weight and height. A BMI of over 25kg and less than 30kg puts you in the category of overweight. As mentioned before,a BMI of 30kg or over means you’re obese.
If we were going to tax people with high BMIs we would also have to tax people who are unhealthily underweight because of the associated health risks. A skinny tax would come compliments of a BMI tax.
How would this tax work? When filing your taxes in April, you simply list your BMI; declared BMI could be checked against your real BMI through a quick peek at your medical records by the IRS. This would also let the IRS know who is tax exempt because of a medical disability such as thyroid problems.
The IRS rifling through your medical records!? This may sound like something out 1984 rather than a sensible solution to obesity, but it is a simple, effective way to fight the disease that doesn’t limit your liberty.
How does a BMI tax not limit your freedom? Fat taxes will make sugary foods, which you might love, more expensive and push some out of your price range. A BMI tax won’t. If you are one of those lucky people—like my brother—who can live off Oreo cookies and Dr. Pepper and stay thin, go right ahead (granted, he would have to pay an underweight tax). Junk food prices may change because of shifts in demand (hopefully, a decrease) but they won’t change overnight as they would with fat taxes. Twinkies won't become the price of a fillet mignon.
Ultimately, you’re free to choose how you wish to pursue a diet or if you want to pursue one at all. The truth is that many people will value the unhealthy foods they eat more than the price of the tax.
This tax wouldn’t drive people into poverty. The CDC estimates that an obese person incurs an additional $1,428 in medical costs. The tax would alleviate these costs and take into account other factors such as loss of productivity, and could be spread out over the person's expected lifetime.
Many people complain about the demise of U.S. manufacturing. How are we supposed to reinvigorate U.S. exports when our labor force is overweight, not to mention who were competing with (China’s obesity prevalence for men and women is less than 4 percent).
There are two major problems with this ever becoming a reality.
The first is that BMI is pretty controversial and we could use a more accurate tool to measure the impact obesity will have on your health. BMI’s brilliance is in its simplicity, but this simple solution isn’t accurate 100 percent of the time. BMI does not take into account a number of variables that will affect the measure such as muscle to fat ratio; muscle weighs more than fat.
There are more advanced techniques, such as X-rays and skin fold measurements, which can be used to determine fat levels in a person’s body. It would be in a body builder’s interest to pay a doctor to perform one of these tests, which would allow him to be exempt from the tax.
The second critique of fat taxes is that they are regressive, meaning they will disproportionately affect the poor. This is absolutely true. A quick glance at the CDC report listed earlier will reinforce this.
But there are very few taxes that aren’t regressive. Because of their lower incomes, all taxes disproportionately affect the poor. Again, as I mentioned in my last post, this is a problem that must be addressed through policies that alleviate poverty, not ones that fight obesity.
The poor have been remarkably resilient at maintaining self-detrimental behaviors. Look at cigarette smoking. This vice is heavily taxed. In New York City a pack of cigarettes will run you over $10. What strata of society smokes the most? The poor. The poor have continued to smoke even given the monetary incentive to not. Without the poor, it probably wouldn’t even be worth it to levy the tax on cigarettes. Even if the poor continue to eat poorly, and remain the most obese group, this doesn’t mean that we shouldn’t tax the negative externality that the disease produces.
You should always be free to choose how you live your life, even if you engage in self-detrimental behavior. However, you are not free when your behavior produces an externality that negatively impacts others. This is the case with obesity; you are not just hurting yourself, but causing a welfare loss for all of society.
Europe and the U.S. need to address this epidemic, and it is nothing short of that. Will a BMI tax ever happen? Probably not. Will taxes on unhealthy foods be implemented? This is much more likely. But the problem needs to be addressed somehow and peoples’ behavior won’t change without the right incentives. The right incentive, most of the time, is money.
References
Berghöfer, Anne, Tobias Pischon, Thomas Reinhold, Caroline Apovian, and Arya Sharma. 2008. “Obesity prevalence from a European perspective: a systematic review.” BMC Public Health 8: 200
Gewertz, Deborah and Frederick Errington. 2010. Cheap Meat: Flap Food Nations in the Pacific Islands. Berkeley: University of California Press.
Wilding, John. 2001. “Causes of obesity.” Practical Diabetes International 18 (8): 288-292.
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