Weight a Second …

The HBO series The Weight of the Nation aired the first two of its episodes on Monday. The second two aired Tuesday, but all of them are available for viewing at HBO's website.

As I write this, I've only seen the first two episodes. I've also read and listened to some interviews with the folks behind the series, and I've read the articles collected at HBO's website. The gist of the series is that the percentage of the adult population who are overweight or obese is so high that it constitutes a crisis.

The statistics are staggering: 70% of adults are either overweight or obese according to the body mass index (BMI) standard. To find out where you stand on the BMI scale, check out this calculator. Input your height and weight, and it tells you where you fall in the range of underweight, healthy weight, overweight, or obese. Epidemiological studies show that folks who are overweight or obese incur a much higher risk of multiple serious health problems, including diabetes, high blood pressure, coronary artery disease and osteoarthritis.

What's also amazing is that the percentage of adults and children who are considered overweight or obese has steadily increased in the last 40 years. Research, much of it conducted by the Bogalusa Heart Study, indicates that childhood obesity is far more dangerous than previously known. If you are overweight or obese as a child, it turns out that you are very likely to be overweight or obese as an adult. That's not really shocking; what the Bogalusa study showed was that the disease process can begin as early as five.

There can be no question that an epidemic of obesity costs all of us. The money needed to treat people for obesity-related disease is growing all the time, and with limited dollars to pay for health care in the first place, we could very well be facing a catastrophe.

So what do we do? Many of the interviews with physicians and public health experts suggest that much of the blame lies with the fast food industry. Specifically, advertisements geared at children. There are proposals to limit or eliminate advertisements for fast food in much the same way that advertisements for cigarettes and other tobacco products have been limited. Other proposals are to re-zone the areas around schools to prohibit fast food restaurants from being located within walking distance, and eliminating fast food from schools which allow students access on-campus.

What troubles me, I suppose, is the ease with which many of the experts in the HBO series analogize fast food to tobacco. They argue that the fast food industry designs its products to appeal to us by making them taste good. The argument is that companies like McDonald's are trying to “hook” consumers on their product; the consumer's health be damned. In the first episode of the series, one of the interview subjects laid it out clearly: government is designed to solve social problems that affect us, and which we can't solve ourselves. Meaning, government needs to step up and do something about the problem of obesity, and specifically about the dangers of fast food.

Here's the problem: what do we do? I've heard proposals with which I can more or less agree – removing fast-food kiosks from schools, prohibiting advertisements on TV, or re-zoning the areas around schools to prohibit fast-food restaurants within walking distance. But there are also proposals to increase taxes on fast food to discourage consumption similar to the taxes levied on tobacco products. I can see the logic behind this, and personally, I don't think it's all that bad an idea.

But we should be clear about this: raising taxes on fast-food restaurants will impact lower income folks more than higher income earners. And the question I have is, how do you define “fast food?” Would a law that calls for an increase in taxes on the fast-food industry also impact po-boy shops? How can you effectively draft a law that says a Big Mac is going to be taxed at a higher rate, if you don't also tax fine-dining restaurants serving foie gras?

In Denmark, the government decided to levy a tax on any food containing saturated fats. It became known as the “fat tax,” or the “butter tax,” because it seems the Danes love their butter. New York City has been fighting trans-fats and salt for some time now.

Here's my problem with this – it places the responsibility on making decisions about what to eat on the government, rather than on individuals. I don't eat fast food as a general rule, and I don't drink soft drinks either. If the government decides to limit advertising for the big chain restaurants, or to add a stiff tax to the purchase of hamburgers and fries, it's not going to affect me all that much.

But once you start down that slope, how do you logically not also tax the steak at Ruth's Chris, or the guanciale at Domenica, or the pork belly sandwich at Cochon Butcher? Yes, the price alone means that the number of people who eat those things is exponentially smaller than the number of folks who eat a bacon double cheeseburger, but logically if they both contain the same calories and saturated fat content, why let the “fine-dining” folks slip by when the fast-food kids are taking it on the chin?

There's a lot more to this than I can go into here, and I'm honestly not entirely sure where I stand on the issue. It's clear that something needs to be done, but I wonder how we balance the concepts of personal responsibility and freedom with the clear need to change how the majority of Americans eat. I'd love to hear your suggestions. I'd also love to hear your thoughts on the series generally. I find it fascinating and very well produced, even if I'm not 100 percent on-board with the concept.

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