The Fattening of America

In The Fattening of America, renowned health economist Eric Finkelstein, along with business writer Laurie Zuckerman, reveal how the U.S. economy has become the driving force behind our expanding waistlines. Blending theory, research, and engaging personal anecdotes the authors discuss how declining food costs—especially for high-calorie, low-nutrient foods—and an increasing usage of technology, which make Americans more sedentary, has essentially led us to eat more calories than we burn off.

Introduction: Answering the Age-Old Question: Why is Uncle Al So Fat? ix

Chapter 1 Craze or Crisis? 1

So Why Now? 2

My Soccer Team Eats Oranges 3

So How about Adults? Are We Gaining, Too? 7

A Growing Waistline Can Be Bad for Your Health 10

But Are We the Only Ones Gaining Weight? 13

The Longer You Stay, the Bigger You Get 16

Chapter 2 I’ll Take a Deep-Fried Coca-Cola 17

First Things First 18

Cheap Food Gets Cheaper 19

The Rise of French-Fried Potatoes 22

Please Pass the High-Fructose Corn Syrup 24

A Full Pound of Sausage, Bacon, and Ham: Have a Meaty Morning 28

Too Much of a Good Thing 31

Kids Are Also Drinking the Kool-Aid 33

When is Enough Enough? 34

Chapter 3 Why We’re Moving Less (Hint: It’s Not Just the La-Z-Boy) 37

But I Don’t Have Time! 38

Not Quite the Jetsons, But . . . 40

Just Be a Marathon Runner 44

We’re Not Farmers Anymore 45

Sprawling Out 47

Our Kids Are Also Slowing Down 48

Wrapping It Up 49

Chapter 4 So Where Else Can We Lay the Blame? 51

Blame Mom and Dad 52

Then Just Blame Mom (You Know You Will Anyway) 55

Blame the Meds 56

Blame the Cigs (One More Theory Goes Up in Smoke) 59

Blame the All-Nighter 61

Blame the Air Conditioner (Not Cool) 62

Blame Pollution (It’s a Dirty Business) 63

Blame That Nasty “Fat Bug” 64

It’s the Economy, Stupid 67

Chapter 5 Beware: Moral Hazard 69

Just Bill My Health Insurance 71

Is Obesity as Bad as It Used to Be? 74

Just Take a Pill or Get a Procedure 76

Chapter 6 So We’re Fat—Who Cares? 81

Is Uncle Al Overweight? 82

C’mon Now, We’re Only Utility Maximizing 85

Now, Let’s Tear This Argument Apart (and Put It Back Together) 88

So Should Dad (and the Government) Care that Uncle Al is Obese? 91

Just Follow the Money 93

Chapter 7 The Role of Government 101

Market Failures 103

Externalities 105

Market Power 107

Public Goods 108

Obesity and National Defense 109

Imperfect (Asymmetric) Information 111

Is There a Role for Government? 115

Chapter 8 Weighing the Public Policy Issues (for Adults) 117

Equity 118

Irrationality 122

Compelling Public Need 123

Revisiting Past Policy 125

The Road Ahead 138

Summing Up 151

Chapter 9 Weighing the Public Policy Issues (for Kids) 153

First, a Step Back 155

Child Abuse? 160

School-Based Regulations 161

Your Mouth Will Really Groove 175

In Closing 179

Chapter 10 The Employer’s Dilemma 181

Why Don’t Businesses Invest More in the Health of Their Workforce? 182

The Dirty Secret about Employee Wellness Programs 189

So What’s an Employer to Do? 192

Could These Programs Get Me in Legal Hot Water? 201

Chapter 11 The ObesEconomy 203

Just How Big is the Weight-Loss Industry? 204

Just Take a Pill 209

Bigger and Better 214

Invest in New Technology 219

In the Name of Progress 221

Chapter 12 How to Lose Weight Like an Economist 223

Economic Weight-Loss Techniques 226

A Few More Secrets to Success 231

Conclusion 234

Notes 239

About the Authors 267

Index 269

“Fatty, fat, fat, fat,” chants Bart Simpson. He has a point. Americans are getting fatter. But health economist Finkelstein (public health economics program, Research Triangle Inst.; coauthor, with Phaedra S. Corso and Ted R. Miller, The Incidence and Economic Burden of Injuries in the United States) and business writer Zuckerman (coauthor with Mary Cantando, Nine Lives: Stories of Women Business Owners Landing on Their Feet) analyze the finances behind the fat. They trace some of the familiar causes of the bulging American waistline that Greg Critzer identified in Fat Land: How Americans Became the Fattest People in the World. They weigh in on the economics of obesity, which they trace back to predictable sources such as school lunch rooms, fast food, television, commuting, and working moms. Then they target some surprising causes, including health insurance. On the flip side, they detail the economic consequences of obesity. For instance, obese employees take more sick days than do normal-weight employees-and their paychecks are slimmer. The authors highlight fascinating new scientific research into the causes of obesity and offer tips on lightening your load over the long haul. This book serves up a healthy selection for public and academic library business collections.—Carol J. Elsen, Univ. of Wisconsin, Whitewater (Library Journal, January 2008)

Everyone knows Americans are growing fatter, but health economist Finkelstein crunches the economic figures behind the nation's obesity epidemic and the results aren't pretty. Along with health-care writer Zuckerman, researcher Finkelstein delves into how modern technology reduces the cost of producing higher-calorie processed goods, decreases our activity level and puts our health in danger. Finkelstein debunks myths about the long-range cost of food production and consumption and scrutinizes the impact of genetics and U.S. fiscal policy on the nation's waistline, frequently using economics metrics in his analysis. Generous with summaries of major points, Finkelstein simplifies current stats to explain how the country's thunderous weight gain is straining Medicare and Medicaid and hurting our military readiness. The only positive effect he sees from the obesity epidemic is the creation of the “ObesEconomy”—a market sustained by gyms, diet drugs and other products and services designed to curb weight gain. Horrified by studies that reveal that obese children have a quality of life similar to children with cancer, the investigatory economist even throws in some health tips on dropping pounds. Despite a frequent reliance on economic tools and indicators, this combination study/motivational guide makes for a pleasant educational read, comparable to a vegetable puree snuck into a dessert. (Jan.) (Publishers Weekly, December 3, 2007)

“Finkelstein’s tone is chatty and accessible…obesity is ultimately bad economics.” (Financial Times, Saturday 16th February 2008)

“The authors show there is a casual relationship between the growth of the waistline and the changing shape of the economy.” (Securities & Investment Review, March 2008)

ERIC A. FINKELSTEIN, PHD, MHA, is a nationally acclaimed expert on the subject of economics and obesity. He is a health economist with the research organization RTI International in Research Triangle Park, North Carolina, and teaches health economics at Duke University. His work focuses on the economic causes and consequences of health-related behaviors, with a primary emphasis on obesity. Finkelstein has published over thirty peer-reviewed articles on the economics of obesity and related behaviors. His research has been featured on the front page of USA Today and has been covered in the Economist, the New York Times, Forbes, the Washington Post, and many other newspaper, radio, and television outlets.

LAURIE ZUCKERMAN left her corporate PR job in 1999 to make writing her full-time career. She contributes columns and feature articles to a number of business journals and lifestyle magazines, and writes for businesses ranging from Fortune 500s to startups, with a focus on health care, high tech, and business.

Over two-thirds of Americans are overweight or obese. What's alarming about this statistic is not just the volume of Americans who have tipped their scales—but the velocity at which they're doing it. Over the past three decades, the number of obese Americans has more than doubled. The increase occurred up and down the socioeconomic spectrum, for all racial and ethnic groups, and, most dramatically, for America's children.

What's behind the sudden, explosive rise in obesity rates? In a word, it's economics. Author Eric Finkelstein, a renowned health economist who has spent much of his career studying the economics of obesity, with the help of coauthor Laurie Zuckerman, reveals why America's growing waistline is a by-product of our economic and technological success. Because of declining food costs, especially for high-calorie, low-nutrient foods, and increasing usage of technology, which make Americans more sedentary, the environment has changed in such a way that we're eating more calories and burning off less.

The issue is not that Americans don't care about their increasing waistlines—quite the opposite, in fact. But the reality is that in America's (and increasingly the world's) obesity-inducing environment, the sustained changes in behavior required to lose the weight and keep it off are simply too difficult—and becoming more difficult all the time. Moreover, generous insurance coverage and vastly improved medical treatments have lowered the health costs, if not the monetary costs, of excess weight. So carrying a few extra pounds is not as bad for one's health as it used to be.

Finkelstein and Zuckerman blend theory, research, and engaging—sometimes hilarious—personal anecdotes to break down the causes and the consequences of America's obesity epidemic. One by one, they explore the media's claim that obesity is making our businesses less competitive, pushing good jobs overseas, hurting our military readiness, increasing our taxes, and helping to bankrupt the Medicare and Medicaid programs. Along the way, the authors also reveal how the obesity epidemic has spurred tremendous demand for all sorts of new products and services, creating a flourishing new market that they call "The ObesEconomy."

The Fattening of America outlines the issues we must deal with to confront obesity. The authors explore the role that business and policymakers play in America's obesity epidemic, and explain that successful obesity prevention strategies need to do exactly the opposite of where the economy is taking us. They need to make it cheaper and easier to be thin—not fat. However, because obesity is a natural by-product of an expanding economy, the authors question whether or not obesity prevention efforts, even if successful, would actually leave some individuals worse off.