Should Governments Concern Themselves With Obesity?

sharma-obesity-policy1Yesterday, I blogged about the right-wing Fraser Institute’s report, which claims that the obesity problem is overstated and that government policies are misguided.

An interesting discussion in the report pertains to the fundamental issue of whether governments should at all concern themselves with obesity (even if the problem were really as big as is generally assumed).

The report looks at this from the perspective of whether or not obesity places an economic burden on society and whether or not it would be in the Government’s interest to intervene with the aim to reduce this burden.

Here is how the report views this:

“What is interesting here—and what is important in public policy terms—is the burden of the costs of obesity. A closer examination of the consequences of excess weight…finds that the majority of the costs of obesity are borne directly by the individual in terms of lower income, reduced employment opportunities, reduced enjoyment of life, greater illness, and a potentially shorter lifespan. The only area where these costs are not borne almost entirely and directly by the individual is the increased burden on Canada’s tax-financed health care system….From an externality perspective then (though this is not the only justification used for government intervention, as we shall discuss in the next section) the only area of the “obesity epidemic” where governments may have a legitimate role to intervene is to resolve the costs imposed by the obese [sic] on all taxpayers through the tax-funded health care system.”

However, as the report goes on to argue, the lifetime health care costs for obese individuals may not be all that much higher – in part, because of a shorter life-span.

Here the report quotes studies showing that,

“…while obese individuals incurred higher health care costs than normal-weight non-smokers during their lifetimes, over an entire lifetime normal-weight non-smokers incurred greater health care costs in total because of differences in life expectancy and the costs of care associated with additional years of life….These findings suggest that obese individuals may in fact not be a net burden to all taxpayers over their entire lifetimes, despite imposing a cost burden while they are alive. That finding is bolstered by considerations of reductions in costs associated with public pensions and other old age income supports .”

Thus, economic arguments that governments need to intervene to reduce the burden of obesity may not hold water – while being obese is sad for the folks affected (and they already pay for it dearly), there may not be all that much incentive for governments to  reduce the burden of obesity with an aim to “protecting” the economic interests of the non-obese majority.

Or, as the report puts it,

“…while there is clearly a health and economic cost associated with a high prevalence of obesity, the problem may be much smaller than many have claimed. Importantly, it may be that the serious health consequences lie at the higher end of the weight spectrum, thus affecting a relatively small proportion of the population. And many of the economic costs associated with obesity are borne privately by the individual and thus may not justify government intervention. That is the framework within which policy options should be proposed, and within which they should be considered.”

Thus, given the rather modest economic burden on tax-payers in general (most of who are not obese), it becomes even more important to look at the economic downsides of the government stepping in to impose policies that (even if effective) may not be worth the considerable impacts on taxpayers, on the economy, and on particular industries.

“Many of these interventions would require increased bureaucracy, for example an agency to determine which foods or beverages qualify for targeting or for particular food categories. Interventions may also create barriers to entry for smaller businesses or artificial constraints on growth, generate higher business costs or increase costs for consumers, increase travel times for consumers, impact business prospects, and potentially lead to job losses. Interventions may also result in a transfer of funds from one group of legal businesses to another simply because one provides a product that is disliked by interventionists.”

But irrespective of which side of the political fence you may sit on, it should be obvious that decisions about government spending have to consider more than just economic benefits.

Thus, even if there was a net cost to spending tax-money on preventing and better treating obesity, would this still not be a worthwhile investment?

Indeed, little (if anything) we do in healthcare saves money – or, as I sometimes point out, the cheapest patient is a dead patient. To me at least, healthcare is never about saving cost – it is about easing pain and suffering. Treating cancer and heart attacks does not save money – yet, they are fully worthwhile expenses.

So for obesity treatments the issue of whether or not government should get involved is rather straightforward. If we accept that obesity (at least in extreme cases) is a disease that causes pain and suffering then it is the job of healthcare systems (and in Canada this job falls to the government) to provide treatments that can ease that pain and suffering – anything else would be discrimination. As long as the treatment benefits the individual and is reasonably cost-effective (as compared to treatments for other conditions) there is no ethical argument to deny that treatment.

When it comes to prevention, the issues are less clear (as discussed in the report). Here the responsibility of governments must balance the needs of all of its citizens by broadening its view of the impact that policies would have on the entire population. Thus, the question is not just what impact certain policies would have on those who have obesity (or are at risk of getting it) but also how such policies would impact the majority of the population that neither has obesity nor is at risk of getting it.

This is where the Fraser Institute report stays true to its ideology in that any policies that limit choice or put boundaries on free enterprise are something that governments should stay out of. Rather, it may be best to leave this to the free market to sort out:

“The private sector might also be a source of solutions to concerns about the prevalence of obesity, and already provides a broad range of options for those who wish to alter their lifestyles and diets in search of a reduction in excess weight. For example, the diet and exercise industries are working to counter the prevalence of excess weight through books, videos, weight loss clinics, gyms, and exercise equipment, among other approaches. Restaurants and food producers are also involved in helping people reduce excess weight by offering lower calorie, lower fat, or other more healthful options. Many businesses also support weight loss through employer funded programs. We may also soon see medicinal solutions for excess weight and weight management.” 

The third section of the report goes on to discuss several proposed public-health policies including taxes, restricting access to certain foods and drinks, calorie and nutrient labelling, graphic health warnings, healthier school meals, advertising restrictions, and zoning  laws.

As may be expected, the report highlights the lack of effectiveness and/or the unintended consequences of these proposed policies. For anyone working in the area of public health and health promotion, these sections will make a challenging and perhaps infuriating read.

But then again, that’s exactly what political debates are about – the clash of ideologies where each side cherry picks whatever “facts” support their position.

At least we now better understand where the right stands on this issue – a first step to begin countering their arguments.

Edmonton, AB