Culture War, Obesity and the New Puritans

I almost forgot I’m a blogger. Nah, not really, but it’s been difficult to keep up lately. I write longer posts, and want to take care to do the homework, so that I’m not producing something that’s misleading. For example, take this recent post by Paul Campos over at Lawyers, Guns and Money. Paul objects to the idea that public health measures involving promoting changes in lifestyle, specifically with what we eat or drink, might help reduce health care costs, or as he says it:

[i]n any case the notion we can cut health care costs significantly by getting people to drink less soda and eat fewer Doritos is unsupported by any evidence.

Riffing off of a post by Matthew Yglesias, Campos also makes lifestyle intervention – public health matters an outpost in the culture war, putting those of us who are interested in the social benefits of exercise and healthy eating into the bin of “cultural Puritanism. We’ll put aside for a moment the point that equating “puritan” with someone who disapproves of pleasure is a bit of historical misdirection. You can even find some evidence for his point that long-term health care costs are driven by old age and not lifestyle choices.

Last year, RIVM published a study modeling lifetime health care costs for cohorts of obese people, smokers and “healthy living” folks, defined as non-smokers with BMIs between 18.5 and 25. The results were that annual health care costs were highest for obese people earlier in life, until age 56, and were highest for smokers in later years. However, the overall highest lifetime health care costs were for the healthy-living folks. Life expectancy from age 20 is reduced by 5 years in obese people and 7 years in smokers. Healthy-living people live on to incur greater medical expenses, more than compensating for the expenditures related to smoking or obesity.

So, I should start smoking again and eat like this to do my part to control health care costs. However, before you shout “gotcha”, take a look at the commentary traveling along with this article. Compare a lean and obese population with the same age and sex distribution, and the latter will have greater health-care costs throughout life. So during the productive adult years of your life, when you should be spending money on other things, such as books, vacations and family, your're spending it on health care. There are other costs associated with obesity such as absences from work and lost productivity, in addition to health care costs. In the UK, these extra costs are estimated to be about four times as great in obese than in lean people.

The problem in the health care debate that no-one seems to want to talk about is that people want to live forever, and it in those years at the end where the health care costs are highest. However, living longer shouldn’t be the goal, rather maximizing the number of years free of disease burden. For me at least, I’d rather not be clomping around on knee or hip replacements, being treated for diabetes or putting up with erectile dysfunction.

Holding ED at bay. . . ok, now we’re getting to why I really pay attention to exercise and what I eat. I’m so transparent. See you in the gym.