Swollen Waistlines, Swollen Costs
Obesity Worsens Disabilities and Weighs on Health Budgets
Easier to Put It On
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The recent increases in obesity could be attributed to numerous economic and lifestyle changes within the past 20 years. The price of some foods—from fast foods to fats and sugars—has fallen relative to the Consumer Price Index, whereas the price of fruits and vegetables has risen (see Figure 8). Americans are eating out more, which often means eating food that is both more calorie-dense and heavier in fat and added sugars than food prepared at home. Meanwhile, as mentioned above, many environmental conditions have discouraged physical activity: desk jobs, long commutes, and urban landscapes hostile to walking and biking.
Tim Roesch, manager of the Charlie the Butcher restaurant, carves a "mini beef on plain" for a customer in Williamsville, N.Y., on Feb. 23. Like other Buffalo area restaurants, Charlie the Butcher is participating in a "Healthy Options" program by offering smaller turkey and beef portions on a plain low-sodium roll. |
To reduce smoking rates and alcohol problems, policymakers have applied environmental interventions (or relative price changes), from taxation to access controls such as indoor smoking bans. Comparable policies for food are beginning to appear in some locales. School districts, for example, have begun to remove soda machines, and a few states have passed some form of "Twinkie" tax on foods that are perceived as being less healthy.
But some of the simplest and least intrusive policy changes have yet to be made. Today it is virtually impossible for Americans to assess the nutritional content of food prepared away from home. This is becoming more problematic as Americans are consuming increasing shares of their food away from home.
The nutritional quality of food consumed away from home is lower, and the food tends to contain more fats and sugars. U.S. Department of Agriculture researchers have calculated that if food prepared away from home today had the same average nutritional content as food prepared at home in 1995, Americans would be consuming 197 fewer calories per day. This difference, by itself, is larger than the increased caloric imbalance—of calories consumed minus calories burned—that has fueled the obesity epidemic among adults.
The location of consumption thus appears to dramatically alter the nutritional content of food. This should come as little surprise. If adults lack information about nutritional content at the point of consumption, they will choose food based not on nutritional content but rather on the dimensions that can be easily evaluated—price, amount, and taste—the latter of which is easiest and most cheaply achieved by adding fat and sugar.
Nathaniel Cabrera, 4, right, stretches with classmates during a Head Start pilot program aimed at preventing childhood obesity at PS 5 in New York City. |
This pattern is a type of market failure. If nutritional quality is an important dimension but cannot be assessed by a buyer, the cheaper or larger or tastier competition will drive out the higher-quality products even if the latter would be preferred by buyers with morecomplete information. When informational problems such as these are sufficiently severe, regulation is needed to promote an efficiently working market.
Standardized labeling of the caloric content of menu items in restaurants would seem to be a simple first measure for policymakers to consider. Unless Americans know what they are eating, how can they make better choices? Of course, there is always the possibility of doing nothing, but then we had better brace ourselves for the higher public and private health spending caused by obesity.
Related Reading
"Are the Young Becoming More Disabled?" Health Affairs, Vol. 23, No. 1, January/February 2004, pp. 168–176, Darius N. Lakdawalla, Jayanta Bhattacharya, Dana P. Goldman.
"Does Obesity Contribute As Much to Morbidity As Poverty or Smoking?" Public Health, Vol. 115, No. 3, May 2001, pp. 229–236, Roland Sturm, Kenneth B. Wells. Also available as RAND/RP-952, no charge.
"The Effects of Obesity, Smoking, and Drinking on Medical Problems and Costs," Health Affairs, Vol. 21, No. 2, March/April 2002, pp. 245–253, Roland Sturm. Also available as RAND/ RP-1003, no charge.
"Forecasting the Nursing Home Population," Medical Care, Vol. 41, No. 1, January 2003, pp. 8–20, Darius N. Lakdawalla, Dana P. Goldman, Jayanta Bhattacharya, Michael D. Hurd, Geoffrey F. Joyce, Constantijn W. A. Panis.
The Health Risks of Obesity: Worse Than Smoking, Drinking, or Poverty, RAND/RB-4549, 2002, 3 pp., no charge.
"Increases in Clinically Severe Obesity in the United States, 1986–2000," Archives of Internal Medicine, Vol. 163, No. 18, Oct. 13, 2003, pp. 2146–2148, Roland Sturm.
"Increasing Obesity Rates and Disability Trends," Health Affairs, Vol. 23, No. 2, March/April 2004, pp. 199–205, Roland Sturm, Jeanne S. Ringel, Tatiana Andreyeva.
Obesity and Disability: The Shape of Things to Come, RAND/ RB-9043, 2004, 4 pp., no charge.
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