Is a fatter population an inevitable consequence of an advanced economy? Health economist Eric Finkelstein, co-author of the new book "The Fattening of America" (John Wiley), thinks so. Thanks to economic advances, he argues, we spend more time on our butts—at the computer, in front of the TV, in the car—than our parents and grandparents did, and we spend less time in the kitchen making healthful meals or outdoors burning calories. And everywhere we go we're tempted by a growing array of cheap, high-calorie, fat- and sugar-laden treats. The result: nearly two-thirds of American adults now qualify as overweight or obese. Can the same economic forces eventually help reverse the trend? Or should the government intervene? NEWSWEEK's Jennifer Barrett spoke with Finkelstein. Excerpts:
NEWSWEEK: How exactly is the U.S. economy making Americans fat?
Eric Finkelstein: There's a huge demand for low-cost, convenient, tasty foods, for labor saving devices that make us more productive at work and at home, and for sedentary leisuretime activities. And suppliers are responding. The net result is that we're eating more calorie-dense food and we have lots of cool sedentary leisuretime technologies—the Internet, DVDs, videogames, the list goes on—that basically crowd out physical activity. It's not that we have less willpower today than 30 years ago. It's that we have more choices, so we're making different choices that lead us to be less active and to eat more.
Not from an economist's perspective. We're fatter, but that does not mean that we are worse off. We could do without the low-cost food or the new technology, but most Americans would prefer not to. The reason is that the costs of being thin, in terms of what they would have to forgo, have just gotten so high that people are saying "I'd rather be fat" than make the increasingly difficult sacrifices necessary to be thin.
What about the costs to our health of carrying around a lot of extra weight?
Our research suggests that, even with this knowledge, many people will still choose to be overweight. We found that overweight individuals are aware that their excess weight makes them more likely to get diabetes, cancer, and heart disease. They also predicted a life expectancy [for themselves] that was several years shorter than the predictions for the normal weight group. It appears that they know obesity is putting their health at risk, but they also know how hard it is to eat less and engage in regular exercise.
You write that your Uncle Al, a rich, successful lawyer, made a rational decision that being overweight is in his best interest. How?
That's right. In fact, if he spent less time at the firm and more time exercising, it is very likely he would not be nearly as rich or successful. Like many of us, he chose a career that requires him to be sedentary for 40-plus hours per week. Not to mention the high-calorie client dinners a few nights a week.
Doesn't he worry about his health?
There was an article published in the Journal of the American Medical Association that shows that today's obese population has better cholesterol and blood pressure values than normal-weight individuals did 30 years ago. The reason, of course, is because they are very likely today to be on statins, blood-pressure medication and other drugs that treat obesity-related diseases. Medical technologies have lowered the cost of being fat. So rational overweight people like Uncle Al might think, "Maybe I'll live a little bit shorter and I'll have to take some drugs, but I can eat whatever I want and I don't have to spend my time eating healthy foods and exercising."
Come on. Is that really so hard?
I have a fairly well-paying job, but it keeps me at the computer for about 50 hours a week. The choice for me to quit my job and get one that's more active would mean a huge drop in pay. It's not worth it to me. Many people are in that situation. And when you get out of work, there are all these other things to do. A lot of people just aren't interested in carving out the time it would take to be physically active. Plus, it's cheap and convenient to consume lots of great-tasting food. I argue that obesity is a side effect of any advanced economy. When you mechanize a society to the degree that no one has to do anything, no one's going to do anything. Combine that with cheap, prevalent food, and the result is bound to be weight gain. We're seeing this now all over the world, including China and India, two countries whose economies and waistlines are growing rapidly.
You put part of the blame on well-intentioned government policies. Why?
Look at how we subsidize farmers, encouraging corn and soy production over other vegetables and fruit. Corn is used for high-fructose corn syrup, and soy is used in hydrogenated fats. They have become the sweetener and fat of choice because they are so cheap. As a result, any product with lots of added sugars and fats will generally be cheaper in part because of government subsidies. Another example is the way we build communities. Many communities have zoning laws that prevent mixed-use buildings, so homes go up in one part of town and businesses in another, and you can't get anywhere without driving your car. This really discourages pedestrian traffic. Or look at the No Child Left Behind Act. Many schools cut out PE because they need all the time they can [get] to teach the core classes. And kids are studying more, so there's less time for sports or other activities. Like many well-intentioned policies, this act may be inadvertently making kids less active.
Should the government step in?
When it comes to adults, the answer is not so obvious. But when it comes to America's youth, I say the answer is definitely yes, because they are unable to make rational decisions the way Uncle Al does. I would be in favor of mandatory PE with testing. No Child Left Behind should apply to physical education, too. I think that we should get the chips and cookies that are sold next to school lunches out if they are unhealthy, or price them in a way that discourages choosing them. I'd certainly remove soda from vending machines on school grounds.
Employers could adapt some of those ideas to combating obesity in the workplace.
Employers should use the types of strategies that are profit-maximizing. After all, that is what most [companies] are in business to do. I would subsidize healthy food in the cafeteria, maybe even have a fitness center. It's a nice perk and a great way to attract young, healthy workers.
But you don't think implementing weight-loss programs makes sense economically?
In order to be a cost-saving program, employees would have to lose enough weight, keep it off long enough and stay with the company long enough so that the reduction in health-related costs would be borne by the company. In reality, people change jobs every five years on average, so these programs are unlikely to pay off for most firms. Moreover, many of the costs of obesity occur after the age of 65, when Medicare covers the costs. Employers are likely not interested in saving these costs.
How optimistic are you that the economy that helped make Americans fat will also provide the solution?
People would prefer not to be fat; they just don't want to go through all the effort it takes to be thin. But if someone can make it easier for them, there will be a huge demand, even at significant cost. Markets are pretty amazing. If the demand is there, and I think it is, I am certain that there will be a lot more products and services to help people get thin. The solution could be a pill or a procedure. Public health folks won't be happy about that outcome, but Uncle Al probably will.