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Book Review: The Fattening of America – How the Economy Makes Us Fat, If It Matters, and What to Do About It by Eric A. Finkelstein and Laurie Zuckerman

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I was discussing obesity with a Pilates client of mine today.  She had just returned from a trip to Disney World with her children and grandchildren, and had some interesting observations on that state of weight in America.  Her first remark was that she had never seen so many morbidly obese people in her life.  Then she went on to give me some images: obese children with faces so fat you could barely see their eyes; 11 year olds squeezed into strollers to be pushed around instead of walking; adults on motorized scooters wheezing as they got on and off; adults and kids too heavy to go on certain rides. 

And then there was the food they ate.  "Individuals walking around gnawing on BBQ turkey legs big enough to feed a family of four (the official food of Disney) with extra large soft drinks and corn dogs as a snack.  Ice cream everywhere."  Apparently there are no lines for the also tasty healthier choices, so sushi and salads which necessitate taking a ride break were a bit more expensive and not as plentiful, but there were no lines.

It's not a pretty picture, but according to the latest statistics this is the face and body of America. Thirty-two percent of Americans are obese (and this crosses color and income demographics), and the average American woman weighs 20 pounds more than she did in 1970.  While some may argue that we are healthier, this is mostly due to better medications for cholesterol, high blood pressure, and joint pain.  There are over 100 over the counter diet pills and close to the same number of diet plans, which along with the accompanying books, "plus size" products, and related reality television programs, amount to a $49 billion dollar a year industry.  So how exactly did we get this way?

Health Economist Eric Finkelstein and writer Laurie Zuckerman try to answer this question in The Fattening of America.  After reviewing the depressing obesity statistics, they delve into possible causes and then how we can address them.  Basically, in economics terms, this "ObesEconomy" is caused by individual choices in utility-maximization made possible by technological advancements.  In lay terms, technological advancements have made it possible for us to knowingly choose to eat more, work more, exercise less, and still lead relatively healthy lives.

Advancements in farming and food production and distribution mean cheaper and easier-to-get food, and the proliferation of less expensive fast and prepared food means it takes less time out of the day to get and eat the food.  Physical activity costs more, in terms of opportunity, cost (personal time away from from work and leisure), and in actually paying for gym memberships, among other factors.  And the personal costs of obesity are much lower now that we have medications to help us maintain our blood pressure and cholesterol.  In the end, 2/3 of American adults have decided that "in today's ObesEconomy, the costs of maintaining a lower weight are just not worth the effort."

And we have decided this knowingly!  We know fatty food is bad for us, yet we eat it anyway.  We know that even light exercise keeps our muscles and bones stronger, yet we choose to ride instead of walk.  There is nobody out there who thinks the supersized Big Mac Extra Value meal with a Coke is healthy, yet it is a staple of the American diet.  Despite knowing what is in our food, knowing what choices we could make to be healthier and smaller, and knowing that obesity is increasing our health insurance premiums, increasing our taxes, and decreasing our business profitability, we continue to eat what we want and not exercise because it's the easier option!

This why The Biggest Loser TV show works.  "Consistent with basic principles of economics, when you take someone out of our obesity-promoting environment, give them plenty of time to exercise and unlimited access to healthy foods, and provide them with large incentives for weight loss, the end result is that the pounds drop off."  And with book deals, interviews, lectures, and sponsorship opportunities, there is added incentive for the winners to keep the weight off.

The one area where the authors see a compelling need for government regulation and intervention is in obesity in children.  According to them the government needs to protect youth from making decisions they may grow up to regret; provide them with information and education to allow them to make informed decisions (ultimately working for the greater good); and ensure that all youth have equal opportunity to engage in healthy behaviors.  While adults do know better and may still choose the easier route towards obesity, children can and should be taught healthier choices and behaviors.  

Where does this leave us?  The authors believe that slimming down is an issue of personal decision making and responsibility.  If we know better and still choose to behave in ways that cause us to gain weight and spend more money on medications and doctor visits, that is ultimately our own decision to live with.  And who knows, the same technological advances that have helped us gain weight may ultimately help us lose weight – a treadmill at the workstation perhaps? 

The Fattening of America is not a diet book but an exploration of how and why so many of us need to be on a diet, and in that the authors succeed tremendously.  If you are interested in how economists view health trends, are concerned about the costs of obesity, and are wondering what to do about it, read this book.

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