Economic Incentives and Weight Loss

We have several pills to control blood pressure, decrease cholesterol levels, and fight type II diabetes, but what about a pill that makes people take responsibility for their own health?

Two thirds of Americans are overweight and close to one third are obese ( Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002) . "For the first time in human history, the numbers of overweight and underweight individuals are about the same, at 2.1 billion each." To emphasize how uncontrollable the obesity epidemic has gotten, consider that there are starving people in Sub-Saharan Africa while in the US we have competitions (The Biggest Loser) about weight loss!

High blood pressure, high cholesterol levels, diabetes, several types of cancer, joint disorders, and complications after surgery have all been shown to be affected by weight. Simply put, the more you weigh, the more complicated your medical course, and subsequently the more your medical care costs to yourself and to society (Medicaid spending for obesity related health problems has soared over the last 20 years)! Obesity related health care costs have risen dramatically over the last 20-30 years and medicine's only response has been to encourage better eating and more exercise -- something that Dr. PD White emphasized in the 1950s! Obviously our emphasis on better lifestyle is falling on deaf ears! Not surprisingly, when we are competing against the marketing budgets of Coke and Pepsi, the explosion of all you can eat buffets, and the growing emphasis on fast food. Complicating this, healthy food (fresh fruit/vegetables) is increasingly more expensive. People eat unhealthy because the food tastes good and its cheap!

What happens if we make fast food more expensive and healthy food cheaper? You can offer individuals a break in insurance premium and tax benefits for losing weight or joining a gym (and demonstrating active membership). Small studies have shown that financial incentives to promote weight loss work in the short term (Effects of outcome-driven insurance reimbursement on short-term weight loss. International Journal of Obesity. 2003). My current insurance plan will pay half of my gym membership dues.

Another option would be to focus your efforts on the companies that are facilitating unhealthy eating habits. We can make fast food more expensive by taxing it and make healthy food cheaper by providing tax breaks to companies that supply healthy food. Studies have shown that as taxes for other unhealthy products (such as tobacco and alcohol) have increased, use of these products has decreased.

Of course, we would have to have a process to define unhealthy/healthy food. I think we can all agree that a Big Mac, large order of fries, and a large coke isn't the breakfast of champions.

Some of you will read this article and think that no matter how expensive we make unhealthy food, people will still eat it. I've seen Bradley, a friend of mine from high school, scarf down several Wendy burgers and milkshakes in one sitting and I doubt increasing the price will affect his desire to eat this food. Somehow he manages to retain his girlish figure despite his eating habits -- a testament to the importance of genes and exercise, but that is a topic for another day. My response: So what. Let them eat unhealthy. Let people be overweight. But at least this way they will be contributing to their own health-care costs. The taxes gotten from this program should go to fund local health-care infrastructure. Just as we tax tobacco we should tax unhealthy food and use this money to improve our health-care system.

Either this program works and the prevalence of obesity declines and health care costs decrease or this program doesn't work, obesity rates continue to increase, but we have a way to fund the increasing demand in health care. Either that or we get to work on a pill that makes people care about their health.

Fast Food Calorie Counter