The Fattening of America

ERIC A. FINKELSTEIN, PHD, MHA, is a nationally acclaimed expert on the subject of economics and obesity. He is a health economist with the research organization RTI International in Research Triangle Park, North Carolina, and teaches health economics at Duke University. His work focuses on the economic causes and consequences of health-related behaviors, with a primary emphasis on obesity. Finkelstein has published over thirty peer-reviewed articles on the economics of obesity and related behaviors. His research has been featured on the front page of USA Today and has been covered in the Economist, the New York Times, Forbes, the Washington Post, and many other newspaper, radio, and television outlets. LAURIE ZUCKERMAN left her corporate PR job in 1999 to make writing her full-time career. She contributes columns and feature articles to a number of business journals and lifestyle magazines, and writes for businesses ranging from Fortune 500s to startups, with a focus on health care, high tech, and business.

Introduction: Answering the Age-Old Question: Why is Uncle Al So Fat? ix

Chapter 1 Craze or Crisis? 1

So Why Now? 2

My Soccer Team Eats Oranges 3

So How about Adults? Are We Gaining, Too? 7

A Growing Waistline Can Be Bad for Your Health 10

But Are We the Only Ones Gaining Weight? 13

The Longer You Stay, the Bigger You Get 16

Chapter 2 I’ll Take a Deep-Fried Coca-Cola 17

First Things First 18

Cheap Food Gets Cheaper 19

The Rise of French-Fried Potatoes 22

Please Pass the High-Fructose Corn Syrup 24

A Full Pound of Sausage, Bacon, and Ham: Have a Meaty Morning 28

Too Much of a Good Thing 31

Kids Are Also Drinking the Kool-Aid 33

When is Enough Enough? 34

Chapter 3 Why We’re Moving Less (Hint: It’s Not Just the La-Z-Boy) 37

But I Don’t Have Time! 38

Not Quite the Jetsons, But . . . 40

Just Be a Marathon Runner 44

We’re Not Farmers Anymore 45

Sprawling Out 47

Our Kids Are Also Slowing Down 48

Wrapping It Up 49

Chapter 4 So Where Else Can We Lay the Blame? 51

Blame Mom and Dad 52

Then Just Blame Mom (You Know You Will Anyway) 55

Blame the Meds 56

Blame the Cigs (One More Theory Goes Up in Smoke) 59

Blame the All-Nighter 61

Blame the Air Conditioner (Not Cool) 62

Blame Pollution (It’s a Dirty Business) 63

Blame That Nasty “Fat Bug” 64

It’s the Economy, Stupid 67

Chapter 5 Beware: Moral Hazard 69

Just Bill My Health Insurance 71

Is Obesity as Bad as It Used to Be? 74

Just Take a Pill or Get a Procedure 76

Chapter 6 So We’re Fat—Who Cares? 81

Is Uncle Al Overweight? 82

C’mon Now, We’re Only Utility Maximizing 85

Now, Let’s Tear This Argument Apart (and Put It Back Together) 88

So Should Dad (and the Government) Care that Uncle Al is Obese? 91

Just Follow the Money 93

Chapter 7 The Role of Government 101

Market Failures 103

Externalities 105

Market Power 107

Public Goods 108

Obesity and National Defense 109

Imperfect (Asymmetric) Information 111

Is There a Role for Government? 115

Chapter 8 Weighing the Public Policy Issues (for Adults) 117

Equity 118

Irrationality 122

Compelling Public Need 123

Revisiting Past Policy 125

The Road Ahead 138

Summing Up 151

Chapter 9 Weighing the Public Policy Issues (for Kids) 153

First, a Step Back 155

Child Abuse? 160

School-Based Regulations 161

Your Mouth Will Really Groove 175

In Closing 179

Chapter 10 The Employer’s Dilemma 181

Why Don’t Businesses Invest More in the Health of Their Workforce? 182

The Dirty Secret about Employee Wellness Programs 189

So What’s an Employer to Do? 192

Could These Programs Get Me in Legal Hot Water? 201

Chapter 11 The ObesEconomy 203

Just How Big is the Weight-Loss Industry? 204

Just Take a Pill 209

Bigger and Better 214

Invest in New Technology 219

In the Name of Progress 221

Chapter 12 How to Lose Weight Like an Economist 223

Economic Weight-Loss Techniques 226

A Few More Secrets to Success 231

Conclusion 234

Notes 239

About the Authors 267

Index 269