HEALTH CARE/Joan Retsinas

The Tsk-Tsking of Obesity

In Sarah Ruhl’s play The Clean House a woman dying of cancer is eating chocolate ice cream with two friends. One woman sighs, “It must be what God eats when he is tired.” I agree. Whatever damage ice cream does to the lipids, it boosts the soul. Carrots, edamame, beets - they don’t salve the soul. So I discuss obesity with my feet planted squarely in front of the refrigerator. At the same time, though, I recognize the gravity of our nation’s girth. It is Big, but not surprising, News. The Centers for Disease Control has proclaimed obesity an epidemic. In another 20 years, almost half of Americans may be obese.

Newsweek recently showed a baby on the cover, predicted it will grow into a 300-pound blob. Obesity is even taking its toll on organ donations: one transplant center rejected one-quarter of donors because they were too fat. (Kristina Fiore, MedPage Today, May 13.) The Cassandras are counting up the obesity-related tab, pegged at $550 billion over the next 20 years. The Pollyannas promise we can pare the budget by paring our avoirdupois: fleshy fat for budgetary fat, a neat trade-off.

Yet we continue to eat more than we burn; we sit more than we walk; we are gulping our way to diabetes, heart disease, cancers, obstetrical complications, bariatric surgeries, and more. We tsk-tsk through the media barrage, agreeing that the epidemic is awful, but doing little to curb our collective appetite for calories. By now most analysts concede that nudging individuals to slim down won’t work: we know the risks of obesity. If those risks haven’t spurred more of us to diet, then we’re not likely to change our ways to cut national spending.

So we need community-wide initiatives to encourage – force — us. But we reject the ones that might work.

Consider a few. Children should exercise more. They need gym classes, sports, and time to play. In short, they need longer school days that incorporate physical activities. Yet cash-strapped communities are stripping schools of “extracurriculars,” shortening the day, sometimes shortening the school year. Along with proficiency in English and math, we could insist upon a level of physical fitness as a prerequisite to high school graduation. Imagine the uproar.

Children should eat healthier foods. Yet getting schools to bar vending machines that spew forth sodas and chips is a battle: revenue versus health. Some schools “grade” the lunches and snacks children bring from home – teachers identify “red light,” “yellow light” and “green light” (nutritious) foods, urge children to bring only green light food, urge parents to send only green light food. And teachers urge children to forswear red light foods at home. This Orwellian oversight works well with families who already stock their larders with hummus. Not so well with “yellow” and “red-light”-eating parents. Indeed, when Massachusetts tried to ban school cupcake sales, parents objected: the move was silly, discouraged parental involvement, would reduce fund-raising.

The most effective strategy is economic. Super-taxing cigarettes discouraged smoking, more than the warnings on packages. We could make all those sugary “drinks that refresh” into luxury elixirs. We could do the same with chips, cheese curls, fritos – the omnipresent munchies. We could tax into being the $5 candy bar. The mega-industry behind these products would object. So would the sippers and the munchers. But demand would decline.

We could up the tax on restaurant meals. Increasingly, we Americans are eating out, and restaurant-meals tend to be larger, fattier, more caloric than the food we’d make at home. Imagine the backlash, not just from restaurants but from patrons. Imagine the outcry if restaurants halved their portions, or substituted vegetables for deep-fried favorites.

We could tie employment to weight. One hospital in Texas will not hire obese nurses and physicians. The hospital argues that it is hypocritical for overweight clinicians to tell patients to diet. I suspect somebody will challenge, successfully, this edict. Police and fire departments can reasonably set standards for physical fitness. For most jobs, though, obesity will not predict performance; and civil libertarians will object.

If we wanted to reduce our collective girth, we could. But we don’t. Any solution would restrict our freedom to do what we want. So we gulp, sit, munch, and tsk-tsk.

Joan Retsinas writes about health care from Providence, R.I. Email

From The Progressive Populist, July 1-15, 2012

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