I've blogged before about low carb being a more expensive way of life, at least when it comes to the grocery store bill, so I was excited to pick up this book on the economy of obesity.
Eric A. Finkelstein and Laurie Zuckerman's answer to the question "Does the Economy Make Us Fat?" can be determined by a quick glance at the cover of their book, The Fattening of America. The subtitle, below a burger bun packed with twenty dollar bills, reads: "How the Economy Makes Us Fat, If It Matters, and What to Do About It."
So how does the economy make us fat?
Finkelstein and Zuckerman's first chapter asks "Craze or Crisis?" and provides some detailed breakdown of the rising obesity rates in the United States. One of the great things about this book is the clarity of the number crunching. The authors break down obesity rates between adults and kids, by race, by income level, by gender, and even a comparative graph by country. (Saudi Arabia, by the way, is the only country to top the US in obesity prevalence. Third and fourth go to the United Kingdom and Australia.)
As far as kids go, the rate of overweight 6-11 year olds tripled from 4% to 19% in the past 30 years, as did the rate for 12-19 years old, jumping from 6% to over 17%. For adults, the picture is no prettier: the US has seen a 38% increase in obesity prevalence since the early 1990s. Americans are, as the authors put it, "indeed fat and getting fatter". Combining these numbers with the long list of medical complications from obesity, the obvious answer to "Craze or Crisis?" seems to be, well, both.
Chapters 2 and 3 take a look at the two biggest factors in causing this crazy crisis: in short, eating more and moving less. This is perhaps no big shocker to anyone who reads about weight loss, but the interesting part about Finkelstein and Zuckerman's treatment of the subject is that they take a look behind the scenes. Here, you won't find any admonishing for lack of will power and people just lazily sitting around stuffing themseves. Instead, they point to concrete economic factors that produce an "obesity inducing environment".
Graphs show unhealthy food (soda, sugar and sweets, fats and oils) getting relatively cheaper, while healthy foods like fresh fruit and vegetables and fish get more expensive. (I do take issue with fats and oils being categorically placed in the "unhealthy" category here, but more on that later.)
Other factors include the ready availability of warm-and-eat meals. The powerful example of french fries speaks volumes. Fries, if made from scratch, take about 40 mins to prepare, complete with peeling, slicing and messy, splattering oil. Frozen french fries? Ready to eat in under 14 minutes if baked. To an economist, then, it is entirely unsurprising that the average American now consumes almost 60lbs of frozen potato products per year, more than triple the amount in 1965. Yep, sixty pounds! I don't know about you, but I feel lumpier just reading that...
They continue in this tone, pointing to the increase of high-fructose in corn syrup in food as an obvious effect of these economically attractive properties: highly-subsidized, cheap, easy to transport, with a long shelf life and good resistance to freezer burn. A frightening echo of the potato stat: the average American consumes 60lbs of high-fructose corn syrup a year.
So we have high energy foods which are easier to prepare, high in calories, and very tasty. What makes more economic sense, 80 cents for 1,000 calories of potato chips, or $4 for 1,000 calories of fresh carrots - which you'll then have to peel and chop? Some people choose the chips because they taste better, others choose them because they're simply cheaper.
We're also moving less as a result of increasingly sedentary jobs. Technological advances help the economy, but also leave workers burning less calories as they push a button or tap instructions into a computer. When it comes to leisure time, surprisingly, we have more free time, but we also have more lazy entertainment options: movies, hundreds of television channels, video games, computers.
Finkelstein and Zuckerman emphasize that small changes in diet and exercise patterns can, over time, lead to large increases in weight. They do outline some lifestyle changes that might induce weight gain. These include increased use of prescription medication with weight gain as a side effect, decreased sleep, pollution, increased use of air conditioners, as well as debunking ideas like the "fat bug" and the decrease in smoking. However, they conclude that "it's the economy, stupid." They find the most convincing explanation for the escalation in obesity rates the simple fact that technological and economic advancements have created an obesity-inducing environment.
One of the frustrating things I've found when explaining this part of the book is that most people go "Well, duh!" Ok, point taken - that there's way more cheap food around and we move a lot less isn't exactly headline news. I still found their explanation of the underlying factors extremely enlightening, bringing up factors that may seem obvious but I hadn't thought about before.
One such moment was when I read about the decreased costs of obesity to the individual. The argument here goes something like: an individual with health insurance is more likely to take risks with their health, just as drivers with car insurance take more risks on the road than those without. Sure, I may be overweight, but my health insurance will cover any side effects, so who cares? Also, the increase in drugs and treatments for obesity means that the symptoms of obesity are more treatable now than ever before. One shocking fact: obese individuals today have better cardiovascular disease risk factor profiles than normal-weight individuals had 30 years ago! Technology hasn't just made our jobs easier; we can also pop some pills or get clogged arteries cleaned out with relative ease, making the health costs of obesity appear lower.
The rest of the book continues to dissect various possible solutions, from the role of government and different public policy options for both adults and kids. The employer's dilemma is laid out with stark rationality: why should employers invest in their employee's health when the greatest likelihood is that another company, possibly a competitor, will reap the benefits? Sure, we can argue that employee morale will increase, productivity will improve and sick days will decrease...but here's the kicker: employees in today's job market change positions on average every five years. An employer who invests in obesity prevention or treatment for an individual will likely not see a return on that investment.
The solution offered by these economists, is, unsurprisingly, an economic one: lower the cost of health-promoting activities, and increase the payoffs for maintaining a healthy weight. Do the opposite of where the economy is taking us, and make it cheaper and easier to be thin, not fat.
This last sentence sums up the take-home message of the book. We are described as utility maximizers - a fancy economic way of saying that given all the possible choices we could be making, we're choosing options that make us best off. The two biggest factors constraining most people's choices are time and money, and The Fattening of America clearly shows that a healthy lifestyle costs more in both time and money.
Can a book be depressing and refreshing? I think so. Depressing in terms of the grim economic picture, refreshing in the simplicity of the number-crunching. Fat people are depicted not as moral failures, but as rational people who make rational decisions in an economy that provides an abundance of cheap, fattening food and little motivation to exercise.
Although I disagree with the authors' categorical condemnation of fats as unhealthy, I found little to argue with in their recommendations for weight loss. They even admit that different weight loss strategies will work for different people, and I believe following their simple dietary strategies could help anyone concerned about their weight. In brief: cut out sugary drinks, buy fresh foods and fewer boxes and cans, eat out less, and stay away from snacks.
I'd strongly recommend this book for anyone interesting in an economic argument about the obesity crisis. Well-written and easy to read (I flew through it one Sunday morning in bed), you'll come away with a fresh and intriguing perspective on why grocery shelves and Americans look the way they do today.