Politics with Marc Ambinder

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Jun 8 2009, 3:19 pm by Marc Ambinder

Tobacco: Why Not Obesity?

Major health problems associated with smoking account for about a tenth of our health care spending, about the same amount as illness and behaviors associated with obesity. Today, the Senate will vote to regulate tobacco like a drug and crack down on marketing. Costs associated with cigarette consumption will rise. A lot of folks wonder why the government can't borrow the tobacco approach and apply it to obesity, which also seems to be -- seems to be, I say -- a condition that results from an addiction to food? Arguably, the long-term costs associated with being overweight exceed those of nicotine addiction. Trouble is, obesity belongs to a different category of conditions. There is a social and psychological element to the smoking contagion, but its origins, effects and treatments are much more defined. 


Also, people can live without nicotine. They can't live without food.  And food advertising is already more tightly regulated than tobacco advertising. The correlation between tobacco advertising and consumption is much stronger than the correlation between food advertising and obesity -- so strong, in fact, that it's close to being unidirectional. 

Though policy makers are beginning to change their thinking, I'd wager that most still believe that obesity is, at its core, a condition that individuals ought to be able to control themselves. That's why the preferred response to obesity, so far, has been more study and prohibitions on lawsuits against the food industry. On the flip side, comprehensive national anti-obesity programs, like national nutrition labeling standards, are untethered to evidence that they work.   I'll be writing more about obesity and health care policy in the coming months, but suffice it to say that the tobacco model offers fewer clues for obesity treatment and prevention then one might assume.

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Comments (6)

Ascian

Nicotine is a chemical in same family as cocaine that interacts with the neuroceptors in the brain in the same way that seratonin and dopamine do. After receiving nicotine for a few days the brain compensates by creating more neuroceptors. As a result the brain needs nicotine to feed the new neuroceptors just to feel normal and addiciton is established.

RaptureBaby

You can find a picture of Mr. Ambinder here:

http://www.mediabistro.com/fishbowlDC/original/marc1.jpg

... strange that as a non-smoker he supports higher tobacco costs, but as a clearly overweight man he finds the obesity epidemic to be a much more nuanced issue. This leads to insights like "people can live without nicotine. They can't live without food."

I don't think anyone is proposing that we starve people to reduce obesity. But many cases of obesity aren't caused by an "addiction to food"; they're caused by an addiction to sitting on the couch/at a computer with minimal physical activity for most of the week.

We tax smokers to support children's health care, why not support an obesity tax as well? Certainly obesity is a more lethal epidemic than smoking, especially after 25 years of anti-tobacco campaigns. If the Democrats get their way and succeed in creating a public health option, then the obese should have to carry more of the weight since they will eat up more of the resources.

Chaz

RaptureBaby, a few points:

Marc didn't say anything all that aggressive about cigarettes. He didn't propose restricting their use further or even banning their advertisement (beyond a vague "crackdown").

If you think reducing obesity is as straightforward as reducing smoking, you're nuts. Pretty much up everyone in this country ends up weighing more than they want to eventually, without ever choosing to and usually despite a little or a lot of effort to stay thin. On the other hand, the number of people who have chosen never to smoke and are dying to their smoking is just about zero. I admit that it's very hard to quit smoking, but it's very easy to never smoke in the first place. It is not easy to never eat too many calories and always get lots of exercise, without even getting into genetic factors. That means that if the government can convince more people not to start smoking, that will be effective. If the government convinces people not to get fat, they will get fat anyway.

Personally, I'm still young and thin. I make a pretty serious effort to get exercise and eat well. But whenever I got overworked and short of sleep at college, which was almost always, did I get much exercise? No I did not. And I gained weight. Even if that problem disappears I would still bet that I will end up a bit overweight just because most people do.

And how would you implement a fat tax anyway? I guess you can tax pork rinds, but how are you going to tax lack of exercise? Maybe you'll push everyone up onto a scale for examination? Even if you do it won't make much difference because no one wants to be fat in the first place.

Riggsveda

The best source for understanding the complexities of weight gain within the context of American culture (and by extension, the rest of Western-influenced culture) has got to be David A. Kessler's "The end of overeating". He deals with the physiological roots of why we succumb to a diet so terrible for us, as well as the brainwashing we are exposed to that facilitates it. Add to that Michael Pollan's body of work, Eric Schlosser's "Fast Food Nation" expose, and toss in Morgan Spurlock's funny but sobering documentary "Supersize Me", and you get a clear picture of how we got into this mess, and what's keeping us ensnared.

Oh, and let's not forget how car culture pushed virtually every other mode of transport off the map and how pandering to its needs has produced a landscape that prevents us from getting any normal amount of exercise. Let's also not forget how kids have been deprived of outdoor play activity by helicopter parents, and have adopted video gaming as a substitute. Let's also not forget how our starvation of the education system encouraged schools to seek other revenue streams, and opened the Pandora's box of sugary drinks and fast-laden snacks to the captive audience of our children.

Dealing with the problem of tobacco is a breeze, compared to weight.

Ted T.

Actually steps government can take are simple and obvious: end all corn subsidies immediately and shift some of that into subsidizing green vegetables, especially of the sustainably farmed and organic variety. The absurdity of broccoli or green beans costing more than a burger has to end.

The American supermarket has actual food around the edges, and nothing but processed, packaged, obesity inducing garbage in the middle. Educate the public that real food does not come in a box, can, or package. It has only one ingredient per type of food (yes even good quality dry pasta has only one ingredient: flour). The only exceptions are freshly baked bread, cheese and yogurt. Once people start cooking with fresh, simple ingredients, half the battle is won.

The other half is exercise, and of course the simplest form is walking. There is a reason why there is far less obesity in New York City with its sidewalks and many non car owning residents. Just like corn subsidies should be killed, so should car/road/fuel subsidies (wars, involvement and billions in aid to the Middle East are a form of gasoline subsidy in case you were wondering). Spend that money on public transportation, sidewalks and re-urbanization. Problem solved.

My point is really it is as simple as a few acts of congress redirecting spending priorities. I do realize the political will for this doesn't exist.

kathleenr

Tobacco is an agricultural product, recognized as an addictive drug, processed from the fresh leaves of plants in the genus Nicotiana. Tobacco has long been in use as a entheogen. However at the arrival of the Europeans, it quickly became popularized as a trade item and as a recreational drug. "Also, people can live without nicotine. They can't live without food." Both come we very hard to solve issues. Kathleen - UK Web Hosting,Reseller Hosting