AEI’s Andrew Biggs has a totally reasonable piece arguing that Americans’ unhealthy lifestyles are a major cause of America’s high COVID mortality rate:
Americans entered the Covid pandemic in much poorer health than citizens of other developed countries. For instance, over 27,000 U.S Covid deaths list diabetes as a comorbidity, accounting for 16% of total Covid-related fatalities. But what if instead of having the highest diabetes rate among rich countries the U.S. had the same rate as Australia, with less than half the U.S. level? The same holds for obesity, listed as a comorbidity in 4% of Covid cases. Forty percent of Americans are obese, the highest in the developed world and over twice the OECD average. U.S. death rates from heart disease are also higher than most European and Asian countries. Hypertension is listed as a comorbidity in 22% of Covid deaths. If Americans simply had the same health status as other high-income countries, it is likely that tens of thousands of lives could have been saved.
The obvious upshot is: Individuals can and should reduce their COVID risk by switching to healthier lifestyles. Yet Biggs strangely declares the opposite:
General practitioners tell me that their Type 2 diabetes patients can tell you their weight and know how it relates to their illness. They know that by losing weight their can reduce their risk of blindness, limb amputations or death. They simply aren’t able to do it.
If anything is obvious, however, it is that they simply are able to do it. Anyone can. Eat fewer and smaller meals… and you will lose weight. Exercise more… and you will lose weight. Everyone knows this. And everyone can apply their knowledge. Put less food in your mouth, move your body more, and your risk of dying of COVID will crash.
Why then do so many people remain unhealthy, even the midst of an historic pandemic? Because they prefer (the pleasure of food and idleness plus the attendant health loss) to (the pain of hunger and exertion plus the attendant health gain). To quote Al Pacino in Scent of a Woman:
I always knew what the right path was. Without exception, I knew. But I never took it. You know why? It was too damn hard.
If this is all undeniable, why do so many smart people refuse to assent? Social Desirability Bias, naturally. When the truth sounds bad, people say – and perhaps even believe – the patently untrue. As I’ve explained before:
“Sorry, I can’t come to your party.” This common excuse is almost always literally false. You’re working? Unless your boss chains you to your desk, you can come to the party. You’re in Paris, and the party’s in DC tomorrow? If you can beg, borrow, or steal airfare, you can come to the party. The same goes for most social uses of the word “can’t” – everything from “We can’t be together” to “I can’t help myself.”
Why say, “I can’t” when the truth is “It’s too costly for me” or “I don’t feel like it”? Because “I can’t” sounds better. It insinuates, “The only reason I’m not doing X is because I lack the ability to do X. Otherwise I would totally do it.” “It’s too costly for me” and “I don’t feel like it” are insulting by comparison. Both blurt, “X simply isn’t my top priority. Get used to it.” In short, the way we use the word “can’t” is a clear-cut case of Social Desirability Bias: our all-too-human propensity to lie when the truth sounds bad.
The literally-false “can’t” is hardly alone. Social Desirability Bias permeates our diction – i.e., the specific words we choose to use.
What’s so awful about sugarcoating the harsh reality that the obese are fully capable of reaching a healthy body weight?
Simple: Sugarcoating distracts and confuses. Self-help is a virtually foolproof solution for obesity; as long as you strictly follow the recipe, you won’t be obese for long. Ignoring or denying the possibility of self-help discourages people from fixing – or even saving! – their own lives.
One could scoff, “Human beings are weak. What’s the point of telling them to diet and exercise for the rest of their lives when we know they won’t? We might as well just spare their feelings.”
Perhaps, perhaps.
Consider, though, this parallel argument: “Anti-vaxxers are crazy. What’s the point of telling them to get vaccinated when we know they won’t? We might as well just spare their feelings.”
Can you think of any decent objections? Because I definitely can.
1. There’s a continuum of crazy. Some anti-vaxxers are beyond hope. Others will only bend the knee in the face of overwhelming shame. A great many, however, are only skin-deep crazy. Moderate shame – or persistent persuasion – will eventually get the vaccines in their bloodstreams.
2. Crazy is contagious. If no one challengers anti-vaxxers, undecided bystanders are more likely to adopt their crazy ideas. These “converts,” in turn, can easily go on to corrupt others. Given how conformist human beings are, the anti-vax movement can spread even in the absence of deliberate recruitment efforts. Initially non-crazy people notice the rising prevalence of crazy ideas – and casually become crazy themselves.
3. Someone’s gonna get blamed. If you refuse to blame anti-vaxxers for their own bad choices, people are likely to look around for someone else to blame. For example: “People would probably be happy to take vaccines, if doctors weren’t so arrogant.” The result: Instead of “sparing people’s feelings” in the aggregate, you wind up redistributing the hurt feelings over to innocent bystanders.
What then is the right message to send? This: “Anti-vaxxers are totally able to get vaccinated. The are making bad choices. They should make better choices.”
This isn’t merely helpful; it is true.
The same goes for obesity. The right message is not: “They are simply unable to lose weight.” The right message is: “The obese are totally able to be thin. They are making bad choices. They should make better choices.”
This isn’t merely helpful; it is true.
The same principle holds for self-help generally. Self-help is like a vaccine: When used, it works wonders. The fact that many people refuse to do what works is a flimsy reason to humor them. And it is a terrible reason to endorse clear-cut errors like, “They just can’t do it.” Anyone can get vaccinated; just roll up your sleeve and let the doctor stick you with the needle. Anyone can be thin; just eat moderately and exercise regularly. And anyone can improve his own life; just stop making excuses and follow the path of prudence.
READER COMMENTS
robc
Sep 30 2020 at 11:46am
There is a common counterargument that violates what I call my two-sigma rule.
Yes, there are weird exceptions, but if its a small enough number of cases that it isn’t within 2 sigma of the norm, then it doesn’t defeat the argument. And Bryan’s argument is valid for for obesity and vaccines. Yes, there are are some oddball medical cases in which obesity cannot be fixed with self help and there are oddball medical cases in which people can’t take vaccines. But neither of those defeat the general rule, they are exceptions. Adopt the general rule first, then apply exceptions.
Thomas Hutcheson
Sep 30 2020 at 12:06pm
Self help messages are fine and good, although they need to be supplemented with other-help messages because bad behavior can have external effects. We do not tell people to wear masks for their own good, but to protect others.
However, public policy should not necessarily be limited to sending self-help and other-help messages. At the least, we can sometimes try to create incentives so that the costs that people’s behavior imposes on others are internalized. Sometimes this is feasible (a tax on net CO2 emissions) and sometime not (a non-mask-worn-when-around-other-people per hour tax).
More problematic is what if any the public policy response, beyond messaging, should be when the cost of the bad behavior is mainly born by the bad behaver (smoking, over-eating/under exercising) and the main external cost is the social contagion or means tested transfers to remediate the bad behavior (Medicaid financed treatments for emphysema and kidney failure).
Philo
Sep 30 2020 at 12:16pm
No, no–you are blaming the victim. Society did it!
KevinDC
Sep 30 2020 at 1:30pm
Just tossing out a nugget of personal experience here on the weight loss issue.
Several years ago, I lost a pretty fair amount of weight. Enough that when I see pictures of myself from before my reaction tends to be “holy crap, I look like a completely different person.” After I had shed the weight, people around me (coworkers and friends) noticed and many of them asked me how I managed to lose the weight. My answer was always some version of “I stopped eating unhealthy food and started exercising regularly.” What surprised me was the universal reaction to hearing that was somewhere between annoyance and anger. It was like people just didn’t want to hear that, and by saying that I lost the weight through the old fashioned and obvious way, I was somehow personally attacking them. I’ve never been quite sure what to make of this.
DeservingPorcupine
Sep 30 2020 at 1:37pm
I’ll leave it to you to incorporate this (or not) into your point about obesity, but both commonsense observation and research have shown there is a world of difference between 1) never getting obese in the first place, and 2) getting thin again after you have been obese for any significant period of time. The latter is much, much harder. Of course it’s still possible, but for the vast majority of people the psychic cost of doing so is orders of magnitude harder than simply never getting obese. See Stephan Guyenet’s The Hungry Brain for reasons why. Or for a shorter discussion, see https://www.precisionnutrition.com/the-biggest-loser-study.
(As an anecdote from The Biggest Loser, note that Olympic gold medalist wrestler Rulon Gardner also gained a lot of his weight back after the show, despite undoubtedly having far, far greater capacity for physical discipline than the average person.)
It’s why I think the public campaign against obesity should have long ago shifted focus from exhorting people to lose weight to exhorting people to be careful about gaining weight. We shouldn’t view that holiday gluttony or the “freshman 15” with such lighthearted indifference.
Scott Sumner
Sep 30 2020 at 1:59pm
You omitted a strong argument in your favor. If people cannot control themselves, then how do the Australians end up with so much less diabetes?
robc
Sep 30 2020 at 2:15pm
Weak counter-argument: there could be a genetic difference between Australians and Americans.
nobody.really
Sep 30 2020 at 2:44pm
A fine question. Do you have a fine answer to go with it?
Caplan argues that Americans adopt unhealthy lifestyles because “they prefer (the pleasure of food and idleness plus the attendant health loss) to (the pain of hunger and exertion plus the attendant health gain).” Brilliant! Except … do we not also expect the same to be true of people in Australia, or indeed, anywhere? So Caplan’s brilliant observation seems to fall pretty short when it comes to explaining systemic differences.
Sumner responds, the difference simply reflects self-control. Again, brilliant! But kindly explain why we observe more of this explanatory variable (“self-control”) in some places than in others.
Now, perhaps there really are systemic differences between locations that explain the different outcomes. Perhaps there’s something about Australian culture the teaches self-control. Or, as robc suggests, maybe there are differences in the genetic stock of the people living in different areas. Or maybe some places have different gut cultures that tend to increase or decrease obesity. Or whatever.
Once we find that explanatory variable or variables, to what extent to we think those variables will be a function of individual volition? For example, to what extent do people choose their genetics, or their gut cultures, or the culture in which they were raised? Indeed, unless we find attributes that are pretty much randomly distributed in a population, I don’t see how I can avoid the conclusion that the attribute is a function of factors beyond mere volition.
Caplan’s arguments are akin to the farmer’s statement to the balloonist: Perfectly accurate, and perfectly useless. I struggle to imagine how his insights could have any bearing on public policy.
nobody.really
Oct 1 2020 at 10:10am
Upon reflection, that last paragraph was unfair.
I read Caplan’s argument to basically suggest that a culture with fewer euphemisms and more blunt talk might influence people’s calculation about the cost and benefits of bad health habits. He argues for candor ‘cuz he values candor–but also because it might “nudge” people towards socially desirable behavior. And “nudge” arguments are policy arguments.
So let me apologize and retract my last bit of snark. (Don’t worry; there’s more where that came from.)
AMT
Sep 30 2020 at 3:07pm
Well, I think Bryan simply states the lack of control argument is false, it’s really about preferences. Particularly:
So Bryan says people do have control. I don’t think there is a need to explain why control over these personal choices is the same no matter what country they live in.
nobody.really. It’s about preferences. Maybe America is just much more culturally accepting of obesity.
Ian S.
Sep 30 2020 at 3:32pm
I don’t know Australia very well, but do they have a terrible food culture like the US does (the infamous standard American diet, SAD)? What proportion of their (poor) population lives in food deserts, where you can’t find proper food? I’m not saying I have all the answers, but simplistic arguments do not cut it here.
anonymous
Oct 1 2020 at 12:37pm
Poverty in the U.S. after tax and transfers is about 2%. I understand food deserts are now considered to be a myth of sorts.
Philo
Oct 1 2020 at 2:33pm
Give me only the simplistic arguments: I don’t want to strain my brain!
Daniel Hill
Sep 30 2020 at 4:30pm
As an Australian living in the US, I’d say there are cultural factors at work in Australia which tend toward greater incidental exercise and lower calorie consumption. Though overall obesity trends are unfortunately in the same direction.
An example on increased exercise: it is common for a middle class city dweller to take the bus to work walking to and from the bus stop at either end, vs the standard US approach of driving door to door. Multiple deeply embedded factors at work, including denser cities (most offices are in downtown high rises, not suburban office parks), higher taxes on gasoline, plus the lack of the racial history that makes buses transport for poor/black people.
In terms of calorie consumption, Australians prefer less calorie dense foods and portion sizes are (much) smaller. My guess is that is based entirely on historical accidents. In the same way that southern food, which is very calorie dense, reflects the South’s unique history.
None of that detracts from Bryan’s basic point – if you burn more calories than you consume you will lose weight. This has been my experience. I gradually put on weight from my late twenties until by my early fifties I was 40 pounds overweight (at 5’7″). Lost all of that over nine months (and have kept it off for four years) by controlling my calorie intake (smaller portions, less calorie dense foods). It isn’t rocket science, but it is hard. Really hard. Really, really hard.
DeservingPorcupine
Sep 30 2020 at 4:35pm
I don’t know, but I suspect the cultural pressure against obesity is just higher in Australia, like it is in much of Asia. I can say with great confidence that Japanese parents, for example, don’t show any signs of reluctance telling their kids they’re looking fat and need to put the damn chopsticks down sooner.
drobviousso
Oct 1 2020 at 10:47am
Australians are in a vastly different food environment than in the US. At a bare minimum, comparable food items cost 2x to 3x what they do in the US.
I doubt anyone would argue that people in different food environments would have different outcomes, would they (not that the twin/adoption studies listed below will have everyone in the same food environment, though that’s not directly addressed).
AMT
Sep 30 2020 at 3:20pm
Although I completely agree with Bryan on this topic, I think this complaint is very bad:
You are taking people WAY too literally. According to you, people are very wrong for saying “No, I can’t, I’m married,” if someone wants to sleep with them. People just say “can’t” and don’t elaborate all of the reasons why it is a bad idea for them. This is just very basic, ordinary communication. Everyone knows what everyone else means by this, and there is nothing wrong with using such a commonly understood abbreviation.
AMT
Oct 1 2020 at 12:18pm
Another symmetrical example: Bryan would say a bank teller is incorrectly saying they “had” to hand money over to the armed robber ordering them to do so at gunpoint, because they could have just refused. The same holds true even if this is the second teller, who just observed the first teller refuse, and was shot and killed.
Just to clarify, when people say “I can’t lose weight” this is very different because it is clearly within their capability and contrary to their stated preference of losing weight and being healthier.
Nathan
Sep 30 2020 at 3:23pm
There is a new kind of unemployment.
Hello Bryan, I have an article that explains why since 2000: business investment has been weak; the fall in the U.S net labor share; the decline in the prime age U.S labor participation rate vs large gains elsewhere; the rise in deaths of despair. The article is called Skill Stalagmites, Technology Stalactites and can be found here https://seekingalpha.com/article/4361570-skill-stalagmites-technology-stalactites. I have split the piece into two parts: a 1500 word article for the general reader and a longer piece for the more sophisticated reader. There is a link to the latter at the end of the first piece.
The punchline to the article is that the 4-5% gap in the lfpr between the U.S and peer economies is a form of disguised unemployment. And this is a novel kind of unemployment, which is not caused by a fall in aggregate demand.
The actual cause is that firms are imposing higher effort levels on workers. I can summarize the argument you will find in the main article; it goes like this:
1. Firms impose higher effort demands on workers; workers have to complete more tasks (for a higher wage) or be fired.
2. The higher wage does not compensate workers for their lost work leisure; thus workers look for less demanding job positions (or refuse to move up to more senior roles).
3. If one imagines a skill ladder, then all workers attempt to drop down a rung. This is easy for higher skilled workers, but what happens to workers at the bottom?
4. The lowest skilled workers compete for job openings with somewhat more skilled workers. Firms prefer to hire the more skilled worker, resulting in the lowest skilled workers being pushed out of employment altogether.
5. This assumes that employers can always identify the highest skilled worker from their pool of applicants. This won’t always be the case; if the higher skilled worker has a bad interview or the weaker candidate has positive chemistry with the interviewer, then the objectively weaker candidate can win a job offer.
6. Thus provided the lowest skill workers are willing to keep searching for jobs they will eventually obtain a job offer and regain employment.
7. This means though that workers on the second lowest skill rung will be unable to drop down to the lowest rung unless they also increase their job search activity. And in turn this forces the workers above them to increase their job search.
8. Any person wanting a job now has to apply to many more job positions before they can get their first job offer. But after a string of failures, job seekers become discouraged and temporarily withdraw from the search process. It is this temporary withdrawal that is responsible for the drop in lfpr. For those who are the main breadwinners, the period of withdrawal will be short – perhaps only a few months. But for workers who are more marginally attached to the labor force, it could be years or forever.
9. Evidence for higher effort in the U.S can be found in the higher U.S productivity growth since 2000 vs peer economies.
10. Evidence of higher job search can be found in the elevated duration of unemployment, which in 2019 was still equal to recessionary levels. The American Time Use Survey also shows higher than normal time spent on job search.
The questions of why this is happening post 2000 and not before, and why only in the U.S and not elsewhere, are taken up in the full article.
Hope you enjoy reading and please do spread word of the article around.
Best,
Nathan.
P.S The article is published on Seeking Alpha, but don’t let that put you off. Though I don’t have a formal background in economics, I do keep up with the relevant literature.
Ian S.
Sep 30 2020 at 3:50pm
You miss a big point, one that is the subject of more and more research, namely the role of gut flora and its impact on neural functions such as regulating eating. It is possible that obese people feel an imperative need to eat, similar to what you would feel if you were about to starve. Most of us don’t know this imperative need because most of us have never come close to really starving. But if we did, we might understand it better. It’s linked to our survival instinct, so strong that it can’t be controlled. Under the pretense of dispassionate analysis, you are in fact simply projecting your own experience onto others.
JayT
Sep 30 2020 at 4:08pm
There’s an issue here, which is that the US doesn’t actually have a high COVID mortality rate. The US has a lot of COVID deaths because it has a lot of COVID cases, but the actual fatality rate is actually very low in the US. Here are some comparisons:
Italy – 11.51%
UK – 9.57%
Canada – 5.87%
France – 5.71%
Spain – 4.20%
Germany – 3.28%
Australia – 3.27%
USA – 2.87%
Michael Stack
Sep 30 2020 at 4:10pm
Yes, people should take more ownership over things under their control. However, despite the costs of poor health, we observe that many people still choose to be overweight. Why?
Also, as nobody.really pointed out, the simple observation that people can exercise control over their weight doesn’t get us anywhere. Why is there such a huge difference in obesity levels from country to country?
Lastly, from a policy perspective, we have to take behavior largely as a given, and start planning there. A plan that anticipates everyone loses weight is a plan doomed to failure.
Jose Pablo
Sep 30 2020 at 8:15pm
Having control over your weight does not mean you lose it. Actually, your gaining weight after following a very specific behavior, shows you do have control over it.
People do use their weight control abilities to gain weight (instead of to losing it), because gaining weight has for them bigger “utility“ (given the way that this very same people ad and discount “utility”).
Losing weight has a different “cost” for the average person in different countries (due to genetics, type of food prevalence and availability, etc…). Also the pleasure of participate in “weight gaining events” differs by country (due to culture, quality of food … i.e. living in Chile or Spain makes “not gaining weight” much more harder, while “tasty English food” is known to be an oxymoron. Could you socially survive in Texas or Tennessee not attending barbacues?).
So, not having significant different obesity rates in different countries would be very surprising.
Jose Pablo
Sep 30 2020 at 8:24pm
It was “living in Peru or Spain” … not Chile, sorry …
Michael Stack
Oct 1 2020 at 11:31am
Yes I agree with everything you wrote. In hindsight my post wasn’t very clear.
Even if we accept that people have some amount of self-control over their weight (and I think you and I both accept this, though we may quibble about the amount), from a policy perspective, it doesn’t mean much. Policy must either take human behavior as a given, or provide incentives to change it.
Zach
Sep 30 2020 at 5:11pm
Another possibility is that what we think we know about obesity pathogenesis is wrong. That eating less and exercising more will not, for many people, lead to sustained weight loss.
A family history of Type 2 Diabetes (T2D), consistent weight gain, and a very high triglycerides to high-density lipoprotein cholesterol ratio (TG:HDL) motivated me to research obesity and T2D. What follows is a brief and almost certainly over-simplified summary of my understanding.
Normally, our body is very good at balancing energy, feeling hungry when energy is depleted and feeling satiated when energy is replenished. When we eat, energy is temporarily stored as fat and then slowly released so that we do not need to eat constantly. When our temporary fat stores become depleted, we eat again and the cycle repeats.
A hormone called insulin disrupts this cycle by signaling our fat to stop releasing energy—and for good reason. When we consume easily digestible carbohydrates, we process them as glucose, elevating blood-sugar. High blood-sugar is toxic, and so we release insulin to signal our fat to stop releasing energy and begin storing it, removing the glucose and lowering our blood-sugar.
Lingering insulin prevents our fat from releasing stored energy, causing both fat accumulation and quickly-returning hunger. Continued carbohydrate consumption keeps insulin elevated, causing overweight and obesity (see Gary Taubes’s Why We Get Fat). Long-term exposure to high insulin levels causes insulin resistance and T2D (and has a hand in everything from heart disease to dementia to infertility, see Benjamin Bikman’s Why We Get Sick).
We have evolved to consume primarily fat and protein, because that is what we have eaten for almost all of the two to three hundred thousand years we have been around. We only began consuming significant amounts of easily digestible carbohydrates within the last few thousand years and sugars within the last few hundred (surging within the last fifty).
Obesity is a hormonal imbalance. We are, to varying degrees depending on our individual genetics, long-term carbohydrate-intolerant. We have been removing fat from our diet and replacing it with carbohydrates for decades in response to bad science and corrupt interests, and the result is an epidemic of obesity, T2D, and heart disease (see Nina Teicholz’s The Big Fat Surprise).
More resources:
This article is a good summary of the science
This paper is a good summary of the research
Documentaries are always sensationalized and one-sided, but Fat Fiction is probably the best one out there
JFA
Oct 1 2020 at 11:36am
“We only began consuming significant amounts of easily digestible carbohydrates within the last few thousand years and sugars within the last few hundred (surging within the last fifty).” Given that vast swathes of the human population became able to digest cows milk about 6000 years ago, the idea that humans are not able to digest carbs (like wheat and potatoes that have been cultivated for 10,000 years) very well just needs a lot more evidence than actually exist.
We also began doing less physical activity and increasing the total consumption of calories in the past 50 to 60 years. So what’s the solution. Eat less… move more. Yes, it might take a bit to adjust the set point for energy balance in one’s body, but given that obesity has increased dramatically in the last 30 years, color me skeptical when someone says individual behavior doesn’t explain most of the rise.
Dylan
Oct 1 2020 at 4:49pm
There’s also some evidence supporting the weird theory that obesity could be an infectious disease. The linked piece discusses a paper from 2013 showing how mice that are given an injection of Enterobacter, a gut bacteria found in obese patients, put on substantial wait while maintaining the same exercise and diet as they previously had. There’s also the interesting observation that, supposedly, if you map obesity prevalence geographically over the last few decades, the spread very much resembles a slow moving infectious disease.
Alex
Sep 30 2020 at 9:36pm
BMI is highly heritable, some estimates put it as high as 0.9. For millions of people losing weight is a daily battle of the bulge. Sure, anyone can stop eating at a particular moment in time, like 5:40 pm every Wednesday. But to stop eating continually, that is a different story. For millions losing weight is a daily battle of the bulge. It is a mistake to rely on introspection, because we are different and the effect of food on our body and on our brain is different.
JFA
Oct 1 2020 at 10:03am
I will emphasize the difference between heritable and inheritable. Just because something is highly heritable does not mean it is genetic. Political affiliation and religion are highly heritable as well.
People are commenting on the differences across countries, but I think the most relevant comparison is across time. Here’s a chart looking at non-hispanic whites and asian/pacific islander in US between 1992 and 2011 (https://www.researchgate.net/figure/Trends-in-obesity-and-overweight-prevalence-among-the-Asian-Pacific-Islanders-API_fig1_258405349). Percent obese and percent overweight has increased quite a bit in both populations. I don’t think our genetics related to digestion and weight regulation changed much (if at all) over that time. So when we say BMI is heritable, it is almost certainly caused via environmental route. If you have trouble motivating yourself to eat healthy and exercising just to benefit yourself, then perhaps doing it for your kids would provide more motivation. When my life choices have large impacts on my kids, I think about them much more than if they just affected me.
My parents were overweight/obese. My brother ran cross country and was in quite good shape. I was a fat kid. It wasn’t about genetics. It was because I sat around eating and doing little physical activity. After high school, I chose to stop drinking Coke and started jogging. I was 215 lbs (at 5’8″) graduating high school. By the time I was 23, I was 170 lbs (at 5’11”) and had run a couple of marathons, and my fastest half-marathon was 1 hour 31 minutes. Then I decided I wanted to get stronger, so I ran less and lifted more. Over the past 10 years I’ve keep the same waist size and put on 20 lbs of muscle. Weight loss and body composition ain’t complicated. So put that KFC drumstick down, toss a boneless skinless chicken breast on the grill or skillet, steam some frozen veggies and get control of your weight.
Mactoul
Oct 1 2020 at 12:35am
Obesity is biological, a consequence not to over-eat, which is biologically not sustainable, but to store more calories. It is a storage problem that the body decides to store energy rather to consume it.
The storage problem arises due to modern pattern of eating. In particular, eating more polyunsaturated fats will disorder the control systems that body employs to store energy.
Americans simply consume more poor-quality food than people in other developed nations.
A question of quality, not of quantity. Exercising doesn’t work –it will only make you more hungry. +-
Brian
Oct 1 2020 at 11:31am
but do exercise to strengthen the heart and vessels but not to the point of causing you to eat much more. If your heart is fine, the American Heart Association can get off your back with their promotion of soybean, corn, and sunflower oil.
Jens
Oct 1 2020 at 2:55am
It seems difficult to me (as others have noted) to call a problem a problem of the individual level that consists in the fact that in one place individuals systematically make bad decisions and in another place individuals systematically make good decisions. Of course, the distinction between a good decision and a bad decision can be completely relativized. One then says: The good decisions there are bad decisions here and vice versa. But if I remember correctly, Caplan rejected this kind of relativism elsewhere. Therefore this text surprises me a little. Someone like Donald Davidson might have said that the same configuration of mind would have made bad decisions there and good decisions here, and that therefore it makes no sense to separate mind and place (in making a moral judgment).
Shane L
Oct 1 2020 at 5:01am
I found that a bizarre argument. As others have mentioned, there are stark differences in obesity rates by country. Our World in Data list countries by obesity rate in adults from 1975 to 2016 (using World Health Organisation data). I list a sample below of the 2016 rates:
1) Nauru 61%
2) Cook Islands 55.9%
11) Kuwait 37.9%
12) United States 36.2%
22) New Zealand 30.8%
36) United Kingdom 27.8%
63) Spain 23.8%
80) Germany 22.3%
89) France 21.6%
109) Italy 19.7%
192) Japan 4.3%
In the US, 36.2% of adults were obese, compared with 4.3% in Japan!
Well I can shed a bit of light on that from my year living in Japan in 2007-08. I was amazed at how easy it was to eat healthily there. Vending machines sold iced tea instead of cola. Chocolate bars were less sweet than their equivalents in the West; when my mother sent me some Mars bars in a Christmas package I could barely eat them as they felt so cloyingly sweet after six months in Japan. There was an intense interest in food and it was easy and relatively inexpensive to eat delicious, nutritious food in restaurants.
With no increased will power and no change in preference on my part, I ate more healthily because it was easy to.
The WHO data also show that obesity rates in the US in 1975 were just 11.9%. Are we to believe that nothing has changed since then but preferences? I suggest the environment has changed, making it harder for people to keep at a healthy weight.
robc
Oct 1 2020 at 9:35am
Jan 14, 1977 is when Congress published the Dietary Goals for the United States, pushing carbohydrates instead of saturated fats.
Coincidence? Probably not.
JFA
Oct 1 2020 at 10:11am
Choosing a small fry (220 calories) rather than a large fry (490) at McDonalds doesn’t take that much will power. Choosing the grilled chicken sandwich over the fried chicken sandwich does not require that much will power. It’s definitely easy to eat unhealthy foods in the US. It’s also easy to eat healthfully. You just have to choose to do so.
AMT
Oct 1 2020 at 11:43am
No way! I keep getting told that it is far more expensive to eat healthy, so it’s much more difficult! It must just be a massive anomaly that for some reason the prewashed caesar salad kit at my local walmart is $3, whereas a big mac meal is about $7…
Dylan
Oct 1 2020 at 5:00pm
I moved into a low-income area that was in the early stages of gentrifying about a decade ago. One of the things that really hit home was produce was very low quality AND very expensive. A neighborhood blog also noticed this fact and did a price comparison of 5 local grocery stores and a Whole Foods and Trader Joe’s in the city for a standardized basket of goods. The shocking conclusion (to me at least) was that the local grocery stores were almost all more expensive than Whole Foods (there was one exception IIRC, but that was a store that was too far away for me to patronize).
The neighborhood rapidly gentrified and stores got a lot nicer (we have quail eggs and draft beer on tap now), but also prices went down by a LOT. Still no $3 salads though. The prepackaged ones at my store are $11.99 and not very big. I can get like 5 tacos for that!
Jose Pablo
Oct 1 2020 at 1:40pm
¨It is easy to eat unhealthy food in the US¨.
I keep reading this in many comments. As if the availability of unhealthy food were the ¨cause¨ of obesity. It is, actually, the other way around: unhealthy food is everywhere because the demand for it is very strong: it is tasty, convenient and cheap.
Alcohol was as unavailable during the Prohibition as it can get, and still demand for it was pretty strong (maybe stronger than before). We learnt that alcohol availability was not the cause of alcoholism, despite the contrary opinions of the pious ladies of the Salvation Army at that time.
In fact, obesity is the “right” kind of pandemic: we, humans, have been striving to have this illness for millennia. People starving in Ireland in the 50s of the XIX century willingly move to cities like Chicago with the hope of developing obesity (despite the fact that the river there was so filthy, it spontaneously caught fire). Even today a huge fraction of the world population fight starvation daily.
Rubens’s paintings pay tribute to the canon of beauty in the XVI-XVII centuries. They were not promoting slimness.
We have been successful (under some, not all, production systems) beyond our ancestors’ wildest dreams. Our genetics are, very likely, still to adapt to this new situation of high calorie food availability. We have moved too fast; our genetics need to play catch-up (in some countries/systems, in others they are still the right ones).
drobviousso
Oct 1 2020 at 10:43am
Brian – As the author of Selfish Reasons to Have More Kids, I’m disappointed that you didn’t look into the literature of twin and adoption studies that look at obesity.
Start here
https://pubmed.ncbi.nlm.nih.gov/19752881/
In this systematic review, we aimed to collect together all previous twin and adoption studies on childhood and adolescent obesity up to the age of 18 years. Using several sources, we identified nine twin and five adoption studies; all of these studies had used relative weight as an indicator of obesity. Except the two twin studies from the Korean population, all studies represented Caucasian populations. In a meta-analysis of these twin studies, we found that genetic factors had a strong effect on the variation of body mass index (BMI) at all ages. The common environmental factors showed a substantial effect in mid-childhood, but this effect disappeared at adolescence. Adoption studies supported the role of family environment in childhood obesity as correlations were found between adoptees and adoptive parents; however, correlations were substantially stronger between parents and their biological offspring, further supporting the importance of genetic factors.
Furthermore, it is not as simple as eat more and move more in practice. The human body has a property called adaptive thermogenesis, which reduces the “calories out” side of the equation once a person has lost ~5% of their body’s weight. This is the main driver of the “Biggest Loser Problem” referenced by a commenter above.
Further, just look at the success rate of people who try to lose and keep of >30% of their body weight. Its about 1% without bariatric surgery. If a drug had a 1% success rate, no one would buy it. If a childhood outcome was 1% influenced by an education intervention, you would say it was useless. If you administered a test that 1% of students passed, you wouldn’t say “Its easy, just put in the correct answers instead of the wrong one!”
Human energy storage is a thermodynamic problem that can be modeled in terms of energy in and energy out. But so is scramjet, a liquid salt cooling system for a nuclear reactor, and and the hardening process of tool steel. But no one says they are “simple” or “easy”
JFA
Oct 1 2020 at 11:21am
Given the dramatic rise in obesity and overweight over the past 40-50 years, I’m not sure if genetics is going to be the biggest factor in explaining population obesity. I posted this above (https://www.researchgate.net/figure/Trends-in-obesity-and-overweight-prevalence-among-the-Asian-Pacific-Islanders-API_fig1_258405349). Non-hispanic whites and Asian/Pacific islanders (API) saw large increases in the prevalence of obesity and overweight between 1992 and 2011. Obese and overweight percentages doubled in the API population. Obese rate in non-Hispanic whites doubled and the overweight rate increased by 50 percent. In order to explain these trends with genetics, those who are overweight/obese would need to have much higher reproductive success than those who are not overweight/obese. The magnitudes would have to be implausibly large.
Here’s a better explanation. People consume more calories than they burn because they eat a lot and move around very little. Your friends have a big impact on your habits. If you are fat and lose lots of weight, it might all come back if you keep hanging out with your fat friends who just sit around and eat. If your internal motivation is low, probably best to get at least a few non-fat friends to keep you honest. For me… if my pants start getting a little tight, I know exactly what I need to do… drink less beer, eat fewer cheese fries, move around a little more.
drobviousso
Oct 1 2020 at 11:29am
The food environment in which those populations has changed dramatically over that time period, and really since the industrialization of the food supply in the last century. Calories have never been cheaper. Food has never been more palatable.
Genetics loads the gun. Environment pulls the trigger.
Everyone understands this in the realm of recreational drugs. Take a thousand people living in a dry southern town in 1950 where there are no hard drugs to be had, put their kids in a wet northern town with easy access to opioids, weed, and acid, and you’ll see a dramatic rise in drug-related negative outcomes because the people with a genetic propensity to over-indulge are able to do so more easily.
JFA
Oct 1 2020 at 12:11pm
That argument might work for something like alcohol and Native Americans (though you can just say to Native Americans, “Don’t drink”… much like I would say to everyone, “Don’t do heroin”), but not for the entire white population in the US and food. The food environment did not change that much between 1992 and 2011. People’s food choices changed. You remember when you could super size your value meal? (Sidenote: just googled it and found out Super Size became an option in 1992). People chose to do that. All the fast food restaurants have been shelling out slop for a while (that didn’t change over the course of the past 30 years). You’re going to have to show me that there has been some sort of exogenous change in the food environment such that people cannot actually choose to eat less than they are eating. Also, people have chosen to be more sedentary: https://en.wikipedia.org/wiki/Exercise_trends#/media/File:Leisure_inactivity_2007.jpg
Calories in, calories out. You don’t get fatter by eating less and exercising more. You just have to choose to live healthily.
drobviousso
Oct 1 2020 at 2:06pm
“The food environment did not change that much between 1992 and 2011”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558394/
“Mean food prices increased by about 37% from 2004 to 2016, as summarized in Figure 4. Ultra-processed foods (grains, fats and sweets) rose in price less than did unprocessed foods (fruit, vegetables and fresh meat, poultry and fish). On per calorie basis ($/100 kcal), price increases were $0.14 for ultra-processed foods $0.13 for processed food, and $0.41 for unprocessed foods, and 0.04$ for culinary ingredients.”
All reasonable researchers agree that ultra processed food is the most calorie dense, hyperpalatable, nutrient sparse, and apatite-increasing food type out there. Ditto that unprocessed is the most calorie sparse, hypopalatable, nutrient dense, apatite-suppressing food type out there.
On an econ blog, I assume it would be obvious to a reader to know that consumers will substitute one good for another if there is a relative price change, right?
https://pubmed.ncbi.nlm.nih.gov/28646894/
“Proximity to and density of supermarkets, fast-food, full service restaurants, convenience stores, and bakeries increased over time for residential, workplace, and commuting environments; exposure to grocery stores decreased.”
On an econ blog, I assume it would be obvious that reducing the travel distance hyperpalatable food and increasing the travel distance to unprocessed foods (in aggregate, grocers have least processed, followed by super markets then restaurants) will change consumer behavior, right?
The fact that its hard to notice doesn’t make it not real.
AMT
Oct 1 2020 at 2:42pm
drobviousso, pointing out the cost per calorie is a terrible comparison, because the entire point is about people choosing high calorie foods! E.g. Why do people choose the ten dollar burger at a restaurant than the ten dollar salad? Of course the burger is cheaper “per calorie” because the problem is the excessive number of calories it has! The fact is no one who actually prefers to be healthy can legitimately argue it is too expensive, especially if they ever consume fast food, or ever consume food at any restaurants. Cost has nothing to do with those choices. Literally no one is buying a bag of chips because it is cheaper per calorie than a bag of apples.
JFA
Oct 1 2020 at 3:16pm
I think you missed my qualifier (my fault for not making it clearer): “You’re going to have to show me that there has been some sort of exogenous change in the food environment such that people cannot actually choose to eat less than they are eating.”
The exogeneity is important for everyone one making the point that it’s just our genetics responding to the food environment. As AMT astutely points out, all those food prices emerge out of the choices people make. The suppliers are responding to the consumers purchasing behavior. There is a reason that there are 1000 colors of Oreos and god knows how types of Snickers bars and peanut butter cups.
If people want to eat healthily, they can. Beans, rice, frozen chicken, and frozen veggies are super cheap and are quite tasty when the right spices are applied. So if the goal is to eat healthfully, one can certainly do that and (at least for frozen veggies) it is cheaper in 2020 than in 2004: https://www.in2013dollars.com/Frozen-vegetables/price-inflation/2004-to-2020?amount=20. The frozen veggies that would cost $20 in 2004 would cost $23.47 in 2020, but that $20 from 2004 would have the purchasing power of $27.52 in 2020 (https://www.in2013dollars.com/us/inflation/2004?amount=20). So I can buy the same amount of veggies in 2020 as I did in 2004 and still have $4 leftover. This is at the same time the real price of a Snickers has increased.
I understand that the relative prices may have changed, and people may substitute to unhealthy foods at the margin (though at least on the Snickers/Frozen Veggie decision, the numbers seem to indicate moving towards healthy food, put that is a one off example and not the result of a rigorous analysis). But if the desire to actually be healthy were there, we would not have seen such a dramatic increase in overweight and obesity. People just prefer cheese fries and Big Macs.
Anon
Oct 1 2020 at 12:58pm
I find it easier to make the decision at the time of purchasing. If you only buy healthy foods, then when it is time to eat you can only select from healthy options. Deciding not to eat the chocolate bars sitting in front of you is much harder. That does make it harder at the holidays when you are eating at other peoples’ houses, and I get frustrated when my wife buys junk food for the kids. But overall it seems to work well. Maybe if you eat out a lot then it works less well. But for me anyway there is not much strain on my willpower to buy healthy foods that I like.
[Note: The commenter Anon is the same as the commenter Anonymous above in this thread–Econlib ed.]
drobviousso
Oct 1 2020 at 2:09pm
I didn’t want to talk about myself personally, but I will say that this is one of the best ways to modulate one’s food intake in my experience – by removing decision making processes from the consumption process.
I lost over 100 lbs by sitting down each Sunday night, calculating my macros for the week, and designing my diet for the week to hit those macros. Then I prepped food for the week, turned off my brain, and ate only in response to my schedule and not the signals from my body. This is a more extreme version of what you are talking about, and for someone who doesn’t need as extreme an intervention as I did I think its a great idea.
Jose Pablo
Oct 1 2020 at 2:16pm
Though experiment:
1.- If obesity was (mainly) related with the lack of will power, then their prevalence in groups of the population should be correlated with the prevalence of other characteristics also related with will power
2.- Income (or education levels) are (very likely) correlated with will power (as per the marshmallow experiment)
3.- So, if this is the case, income levels and obesity should be correlated.
Interesting enough, what we find (looking at the CDC data) is that this is true for women but not for men.
https://www.cdc.gov/nchs/products/databriefs/db50.htm#:~:text=Hispanic%20white%20men.-,Among%20women%2C%20obesity%20prevalence%20increases%20as%20income%20decreases.,are%20obese%20(Figure%201).
Possible explanations:
1.- Neither obesity nor income level/ academic success are related with will power.
2.- Will power is stronger in human females. I have never seen this conclusion in a study but sure there is plenty of anecdotal evidence supporting that (miniloans schemes come to mind).
3.- There are other (as significant) forces at work in the correlation. For instance, obesity prevalence could be also related with the influence obesity has on individual’s access to sex. If this effect was different for human male and females this could be an explanation of why the initial correlation works for women but not for men.
You will need obesity affecting much less male ability to mate than female ability. I have not seen any study on this topic but if this was the cause, you will expect significant cultural differences in the correlation between obesity prevalence and income level. In fact, the CDC analysis shows that the correlation between obesity and income level exists for non-Hispanic whites but do not for non-Hispanic Blacks and Mexican Americans.
4.- ??
[“Anyone can [control his weight]”, this is for sure an “overstatement” from Bryan. Some comments are successful in pointing out that this is not the case. But still, within the “2 sigma” space that robc mentioned, I tend to think that Bryan thesis is right]
Mark Brophy
Oct 1 2020 at 10:41pm
I’m an anti-vaxxer because the virus is unlikely to hurt me, I’m lean and younger than 70. The slight probability of being hurt by the virus is less than the the probability of being hurt by the vaccine. Everyone who worships the government should watch the YouTube video of Mike Wallace on 60 Minutes exposing the 1976 Swine Flu scamdemic because it’s very similar to today.
JFA
Oct 2 2020 at 11:40am
So what do you think the probability of an adverse effect is from the vaccine, and what are you basing that probability on?
Kevin Jackson
Oct 1 2020 at 11:33pm
You claim that weight loss is simple: eat less and exercise more. But you also say that the reason people are overweight is because they prefer to eat more and exercise less. This implies that to lose weight, people need to change their preferences. So which is it?
If it’s the former, then the preference can’t exist. It can’t be a matter of temporarily ignoring the preference: if an overweight person needs to override their preferences to lose weight, this isn’t a one time action, but one that needs to be taken multiple times a day for years (essentially the rest of their life). Any preference that can be overriden that frequently and consistently can’t be called a preference.
So unless you’re willing to throw preferences out the window (I’m going to assume you aren’t), then weight loss is not a simple matter of eating less and exercising more, but instead a matter of changing preferences. You don’t go into that in this post, but it’s easy to see that there are some big obstacles. The payoff from healthy habits are a long time coming, but the costs (muscle soreness, less satisfying food, less recreation time, etc.) are immediate and powerful. To balance that out, I would expect that something significant needs to be in the other side of the scale. A heart attach could do it. Kids might be another one.
After all that, though, I can’t disagree with your final point. If communities were less accepting of excess weight, that would provide an incentive and make the change of preferences easier. So I agree with your conclusion, but not with the arguments you make to get there.
Kevin Jackson
Oct 2 2020 at 8:33pm
Here’s another way to put it: weight loss is complicated (many people struggle to lose weight, despite the obvious benefits, and many people who have lost weight and enjoyed the benefits regain the weight and more besides. And the science of hunger and satiety are certainly complicated.) Your perspective on weight loss is simple. By your own syllogism, we should ignore you.
john hare
Oct 2 2020 at 4:37am
the work environment has hanged in the last half century as well as the relative wealth. poor manual laborer will average burning many more calories than a middle class office worker.
Jose Pablo
Oct 2 2020 at 9:51am
And much more calories than the average tenure professor …
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