Fat People and Government Hostility

Stephen Kershnar
Should the government target fatties?
Dunkirk-Fredonia Observer
August 6, 2010

In the U.S., the federal and state governments hate smokers but not fatties. They tax the hell out of the former, but not the latter. They sponsor harsh public-relation campaigns that vilify smoking, but not obesity or overeating. At issue is whether the different treatment is justified. Those who love freedom probably think that the government shouldn’t be in either business, but let us leave their concerns aside.

Consider the taxes and bans on smoking. Governments at the federal and state levels target smokers with a vengeance. For every pack of cigarettes, the U.S. government taxes it by $1.01 and the states often tax it more. For example, New York taxes every pack $4.35, which is the highest in the country. Thus, in New York, a smoker pays $5.36 in taxes per pack. Other lefty states like Connecticut ($3 per pack) and Massachusetts ($2.51) do the same. 394 colleges now ban smoking. These bans are spreading like wildfire. In 2005, only 18 colleges did so.

Smoking is less common than obesity. In the U.S., only about 16% of adults smoke daily and only about 20% smoke at all. In contrast, a 2010 study in the Journal of the American Medical Association found that roughly 34% of adults are obese. The rates of obesity are exploding. The American Journal of Preventive Medicine notes that in 1993 only 14% of adults were obese. Among women, weight problems are getting out of hand. Roughly 36% of women are obese and 64% are overweight. The average woman now weighs roughly 165 lbs. and the most frequently worn size is a 14 (this is plus-size). Among minorities, things are worse. The Centers for Disease Control and Prevention (CDC) using 2006-2008 data found that black and Hispanic women are much more likely than white women to be obese.

What could justify the government’s policy of targeting smokers but not fat people?

Differences in heath-care costs do not justify different treatment. One 1997 study from The New England Journal of Medicine found that smoking reduces long-term health-care costs because smokers die early and a significant portion of medical costs are incurred by the elderly. That is, it is not even clear that smoking produces health-care costs rather than savings. In contrast, the head of the CDC, Thomas Frieden, estimates that obesity costs the country $147 billion per year (2008 figure). Note these figures are controversial.

Nor is the different treatment justified because smoking is more dangerous than obesity. A 2001 study by two RAND researchers Roland Sturm and Kenneth Wells found that obesity is more risky than is smoking. They found that the obese suffer higher rates of suffering from a chronic illness than do smokers. Chronic illnesses include diabetes, hypertension, asthma, heart disease, and cancer. The researchers found that the obese also spend more on health-care services and medication than do daily smokers.

General disgust or dislike probably doesn’t justify the different treatment. First, it is doubtful that the government should target something just because people disapprove of it. Second, it is plausible that the majority disapproves of obesity more than smoking. Consider several studies cited by Stanford University law professor Deborah Rhode. One survey showed that college students would prefer a spouse who is an embezzler, drug user, or shoplifter than someone who is obese. A second found that 90% of formerly obese individuals would rather be blind than return to being fat. A third found that obesity carries as much sigma as AIDS, drug addiction, and criminal behavior. A fourth found that roughly 90% of obese individuals reported humiliating comments from family, friends, or coworkers. While I could not find any data to support this claim, I suspect that smokers are not subject to as much or as intense disgust. In addition, consider the following thought experiment. Would you prefer your spouse be a thin smoker or an obese non-smoker? My guess is that most readers, and especially younger adults, would prefer the former.

The difference isn’t explained by harm to others. It is widely reported that second-hand smoke harms non-smokers. Less frequently reported is that obesity is contagious. A 2007 study in the New England Journal of Medicine found that a person’s chances of becoming obese increase by 57% if they have a friend who becomes obese, 40% if they have a sibling who does so, and 37% if a spouse does so. If this is correct, then allowing obese people into a school or workplace poses a risk to others. Perhaps the discussion of harm is too quick given the role of choice in the different types of second-hand harm.

Perhaps the difference is explained by the difficulty of change. Diets tend not to work. UCLA psychology professor Traci Mann and fellow researchers found that one to two thirds of dieters regain more weight than they lost on their diets and that this probably underestimates the degree to which dieting is counterproductive. Even when dieting produces weight loss, Mann and associates found that it is not clear that this improves dieters’ health. In addition, Rhode argues, stigma is not an effective way to deal with obesity and in fact it is more likely to cause obese people to overeat than to eat less. Attempts to quit smoking are more likely to work. For example, a number of countries, including the U.S., have more ex-smokers than smokers. Smoking also appears to be under our control in a way in which weight is not. Rockefeller University Jules Hirsch and Columbia University researcher Rudolph Leibel estimate that 70% of the variation in people’s weight is inherited and that people can control their weight only within a relatively narrow range. It is unclear how this fits with the data about the skyrocketing rates of obesity.

Taxes are also an effective way to lessen smoking. For example, for every 10% increase in the price of a pack of cigarettes, youth smoking rates decrease by 7%. There is no indication that a similar policy would lessen obesity.

So perhaps what justifies governments’ decision to target smokers rather than fatties is that the former are more malleable. This assumes that the government should be in the business of telling people how to live their lives and this assumption is questionable.