March 18, 2008

As Hobbes Almost Said, Life is Short, Nasty & Obese

It's difficult to improve on reality sometimes. Almost always, really. I mean, how do you top the finding below?


"Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures." PLOS Journal (open access)

America is a very fat nation. This is perceptually reinforced whenever we find ourselves in the waiting area of a foreign airport on the trip home. Americans don't look like other nationalities. It's like spending a month in the Serengeti photographing gazelles and then suddenly encountering a herd of elephants (no offense to pachyderms - their size is adaptive and useful). Americans are stupid, too - try to imagine another cogent explanation for the presidency of George W. Bush. However, you can't cover everything at once.

31% of Americans are obese (Body Mass Index >30) and 64% of Americans are overweight (BMI >25). Somehow these numbers don't do justice to what we're talking about, but they'll have to do. Still: 60 million really, really fat people.

They're the subject of discrimination, too, as reflected in the snarky tone of this blog piece. That is why I commend the study undertaken by the National Institute for Public Health and the Environment (RIVM), Centre for Prevention and Health Services Research, Bilthoven, The Netherlands, quoted above (not an American study--the Dutch must be unusually fastidious, because most of them seem to measure in at about 6' 6" and weigh 160 lbs). You can read about Americans, however, at The point of the study is simple: while they're alive, fat people are a health problem. But then they die, sooner than their svelte countrymen, and relieve the medical "system" in America of their blubberized problems right at that stage in life when medical expenses become routine and (especially in America) astronomical. The healthy people are the ones who really cause the system to groan under their weight - they just go on living, seeing doctors, replacing joints, taking drugs, checking into the hospital.

In the study, the Dutch divided the groups into three cohorts of health-freak sub-25 BMIs, slobs (BMI >30) and smokers who were otherwise "healthy" (that's what it says). Smokers are the true heroes of medical cost-containment, of course. Like the tubs, they front-load their medical problems into the first sixty years of life, and they do hog the budget disproportionately while they're around. But the health freaks just hang on. And on.

I take back what I said about Americans being stupid. Intuitively, they have seen the light and have been practicing what the Dutch can only talk about. It is credibly predicted (who would argue?) that by the year 2025, 50% of all Americans will be obese. Next time you're near a school yard, take a look and see if that seems unreasonable. That's an improvement of 20% in cost containment volunteers in only 18 years. Let's round off and say that obesity increases at the rate of 1% per year. You see where we're going with this. We'll hit that magic mark of Universal Fat Ass no later than 2078.

Frankly, I think we'll do much better than that. It's my enduring belief in Yankee ingenuity. Once a critical mass of massiveness is reached, I think the process accelerates (indeed, it's accelerating now). Fat begets fat. Meals will keep getting larger, SuperSize giving way to GargantuanSize, then to RidiculousSize. No one will notice that anyone else is fat, and with a worthless dollar, no one will travel and encounter what homo sapiens is supposed to look like.

That's why I don't believe in doomsday scenarios, like the "unaffordability" of healthcare BS you hear so much about. Nursing homes, assisted living, all of that stuff -- none will be necessary in the long run. Americans, waddling toward an early sunset, will always find a way.

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