Thursday, July 30, 2009

Passing thoughts:

Megan McArdle has been blogging up a storm about obesity and health care, including here and here. That second "here" is an interview with Paul Campos, who thinks that 1) the obesity epidemic is overblown and 2) there's nothing we can do about it anyway. The interview is interesting and gets right up to a couple points then fails to actually reach them.

First point: Has obesity increased? Apparently, but that might mean less than it would seem. Imagine the following: Ten years ago, 20% of the population was overweight, and 20% of the population was within 5 pounds of being overweight. Imagine that half that 20% gained ten pounds. Now, 30% of the population is overweight. Going from 20% of the population being overweight to 30% of the population being overweight sounds like a big deal. But if that same 10% suddenly started eating healthy, exercising and avoiding the kind of life events that screw you up, and so they lost the ten pounds, then all of a sudden only 20% of the population would be overweight again. Would we then get headlines about a healthier America?

It looks to me like yeah, we're getting fatter, but I think there are two things going on here. 1) People are carrying around 20 pounds more than they need instead of 10 pounds more than they need, so they're overweight instead of at the upper bounds of a healthy weight. It's not good, but it's not as bad as it sounds. 2) Improved technology (not just medical, but the little scooters and such) are making it possible for the obese to live somewhat longer and somewhat better. If people at their target weight continue to live about as long as before but people who are severely overweight start living rather longer than before, that's going to skew the aggregate stats over time, not because the morbidly obese are increasing in number, but because they're failing to decrease in number relative to the population through reduced morbidity. There's a lot of talk about increases in type II diabetes and its correlation with obesity, for example, but we don't know whether obesity causes type II diabetes, whether type II diabetes causes obesity (because the body stores sugar as fat since it doesn't know how to use it) or whether factors that lead to obesity also lead to type II diabetes. What we should know, however, is that if people with type II diabetes are receiving better care and are able to live longer and better with the condition, then over time there will be more obese people with type II diabetes - not because new people are joining the group at a faster rate, but because old ones aren't dying as quickly.

Second point: If we were serious about reducing obesity in this country, giving the rest of the population fifteen minute walking breaks instead of just giving smoker fifteen minute smoke breaks would help re-skew the statistics. It wouldn't actually solve the problems of the morbidly obese, but it would give just enough people the exercise time they needed to lose a few pounds and the aggregate statistics would indicate that something really marvelous had happened. But this is the hard part of the obesity "crisis" - it takes people who can't even walk across the room anymore and throws them in with people whose spare tires are full size instead of just a donut. The trouble is that while people like me, if we took it seriously, could lose that last ten or fifteen pounds, that doesn't help the people who are in really rough shape and for whom a little exercise and calorie cutting just aren't going to be enough.

posted by gbarto at 1:04 PM


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