The Price of Pudge (Retail)

Hardly a day passes now without a new study or warning about the medical consequences of obesity. Unfortunately, such proclamations will likely have a limited impact on changing the behavior that causes us to be fat. Why? Because they do not address a prime reason so many Americans stay fat these days. It is this: Being fat--at least so far--makes economic sense.

Think about it in terms of classic supply and demand. For generations, our national girth was held in check by two larger forces, the high cost of processed foods and food eaten away from home--at restaurants and, later, fast-food joints--and the high expenditure of calories on the job. It was easy to spend excess calories and hard to buy them.

But beginning in the post-war period and accelerating quickly in the early 1980s, great advances in technology threw those forces out of whack. As two economists point out in a recent Rand paper, technological change “raised the cost of physical activity by making household and market work more sedentary and has lowered the cost of calories” through gains in agricultural efficiency.

Think of it another way. In the past, we used to get paid for expending calories; now, we get paid for being sedentary. It’s part of the job description. “Demand” for weight is up. We, as the “sellers” of our weight, like it that way, and so we resist any attempt to alter our “market.” On the supply side, ubiquitous “super-size” options provide an economy of scale for overconsumption. This means that you can talk to us about the benefits of weight loss until you’re blue in the caboose--and we’ll still be munching Fritos all the way to the Barcalounger. After all: It’s so cheap to be fat! Slimming down--that’s a pricey and time-consuming thing, and its benefits are so abstract.

But what if we experienced things differently? What if we felt the true cost of eating high and living large? (Other than not being able to wear any clothes from Banana Republic.) Would that help shift us back to balance? A growing number of folks who deal with the medical consequences of obesity are proposing ways to do just that.

Here in California, state Sen. Deborah Ortiz (D-Sacramento) has introduced legislation (SB 1520) that would levy a tax on all non-diet soft-drink sales, designating the funds for programs that treat and prevent obesity and tooth decay. The tacit message of such a tax--both to sellers and consumers--would be similar to the tax on cigarettes: If you want to play with fire, you’ve got to pay the full price. Gauging by the number of attorneys for the beverage industry who showed up in Sacramento for last week’s hearing on the bill--and the invective they leveled--some part of the message is getting through.

Yet, even if SB 1520 is passed--a good thing if only for the health-care revenue it would raise--such a tax will not discourage most consumers from drinking their daily Big Gulps. Indeed, even as the legislation looms, fast-food outlets are pushing ever-larger, ever-cheaper fixes. Controlling the impulse to gulp would require another kind of cost-obesity consciousness. In essence, we must find a way to get middle- and working-class folk, many of whom still think of exercise as something that, according to one recent survey, “may do as much harm as good,” to think about food and exercise the way their more affluent counterparts do. It may sound elitist, but it is hard to deny: Old-Money folks--both those who’ve had it for a long time and those who want to live long enough to think of themselves as such--have always known that one price of abundance is restraint. They also know that the price of leisure is vigilant--and vigorous--exercise, which is probably why JFK was such a natural early fitness advocate.

One way to implant such a consciousness, says James O. Hill, associate director of the Center for Human Nutrition at the University of Colorado at Denver and one of the reigning deans of modern obesity studies, would be to give everyone an inexpensive device known as a step meter, which counts the number of steps its wearer takes on any given day. (The professor already has distributed 6,000 in his home state). The goal would be 10,000 steps--an amount equal to the surgeon general’s recommendation of 30 minutes of moderate to vigorous exercise, daily. If anything, such a device--as I discovered--would remind us just how sedentary we are.

That such cognitive approaches mark a turn back to behaviorism. That they can work in practice was demonstrated, albeit on a small scale, by the eminent British obesity scholar John Garrow. In the late 1970s, Garrow was looking for ways to prevent his slimmed-down patients from lapsing back into overeating. In a famous experiment, he equipped one group with elastic waistbands, tied just tight enough to become uncomfortable if subjects began to gain weight. The other group went band-free. The results were unequivocal: In the control group, the predictable weight gain commenced full throttle. In the group with the waist cords, however, there was no significant weight gain. And the effect seemed to be a lasting one. Patients were continually reminded of the cost--in discomfort--of overeating.

The “true-cost-of-fat” equation could also be applied to the workplace. Hill would have most employers, who require their workers to be sedentary, begin to pay the full cost of maintaining such a workforce. “So far, they have gotten off cheap,” he says. If people spend at least half of their waking hours at work, why shouldn’t they get a 15-minute fitness break? And since daily fitness hinges in part on access to safe sidewalks and walking areas and even parks, why not require large businesses wishing to expand to file a “healthy environment impact report,” or HEIR, showing how they would provide such essentials. Think of it as a kind of Occupational Safety and Health Administration for the office worker.

In Los Angeles, where an increasing number of low-wage workers hold sedentary jobs, a HEIR requirement might go a long way toward helping to redress age-old class imbalances in access to safe recreation space. As an investment in public health, it would make enormous economic sense. More playgrounds, parks, pools and gyms would be an effective tonic to today’s most vexing, if unrecognized, job hazard: fatness. Let’s get stepping!