London goes after the mushroom

Let's hope she doesn't lead the child astray.

The picture accompanies this story from The Telegraph (UK):

Fat people will be offered cash incentives to lose weight and take regular exercise under a radical Government strategy announced yesterday to tackle the obesity epidemic.

Employers will be encouraged to set up competitions with money, vouchers and other rewards for people who give up junk food in favour of healthy eating and living. Those losing the most weight would earn the biggest prizes.

Ministers believe that by giving people incentives to do something about their weight now, it will help avoid larger costs associated with treating cancer, heart disease and diabetes caused by obesity. Similar schemes have worked well in America and British medical insurance companies already offer discounts for people who go to the gym regularly.

People respond to incentives. But be careful about the design. What's to stop me from bulking up first and then entering the competition to lose the most weight?

Extreme weight loss plans

1. Move-to-China plan:

IANJIN, China (AFP) – Three American men have taken the unusual step of moving to China in an extreme attempt to shed huge amounts of weight at a fat reduction clinic -- and have become surprise local celebrities.

Alonzo Bland, 33, and brothers Walt and David Anderson, 56 and 50, have lived in the northern Chinese city of Tianjin since the middle of this year as part of an effort to break away from their unhealthy lifestyles back home.

Together, they have lost a combined 192 kilogrammes (427 pounds) and are aiming to shed over 100 more.

"The reason why I think it works here is that China is away from everything, all the stuff that I'm familiar with," said Alonzo, who has lost 103 kilogrammes from the 291 kilos he weighed when he first arrived in Tianjin.

He decided to come after winning a contest organised by China Connection, a US firm promoting traditional Chinese medicine, and was being treated free of charge for as long as it took to lose his target weight -- like Walt and David.

2. Lose-a-lot plan:

For every pound less than 60 (!) that Ray fails to lose in the next 9 months he has agreed to pay Ted, $1000. Thus as much as $60,000 is on the line. Ted has made the same bet with Ray.

Both of these are for real.

The Economy Makes Us Fat

That headline is the one Newsweek uses, and it's the subtitle of a new book. But actually that's not accurate. Unless we're being force fed, overeatting is a choice. The question is, why are we overeatting? From the article:

Is a fatter population an inevitable consequence of an advanced economy? Health economist Eric Finkelstein, co-author of the new book "The Fattening of America" (John Wiley), thinks so. Thanks to economic advances, he argues, we spend more time on our butts—at the computer, in front of the TV, in the car—than our parents and grandparents did, and we spend less time in the kitchen making healthful meals or outdoors burning calories. And everywhere we go we're tempted by a growing array of cheap, high-calorie, fat- and sugar-laden treats. The result: nearly two-thirds of American adults now qualify as overweight or obese. [A similar proportion of the poor Americans are also obese.]

From the interview it's clear Finkelstein and I agree individuals are responsible for their own obesity, not the economy:

Worse choices?
Not from an economist's perspective. We're fatter, but that does not mean that we are worse off. We could do without the low-cost food or the new technology, but most Americans would prefer not to. The reason is that the costs of being thin, in terms of what they would have to forgo, have just gotten so high that people are saying "I'd rather be fat" than make the increasingly difficult sacrifices necessary to be thin.

What about the costs to our health of carrying around a lot of extra weight?
Our research suggests that, even with this knowledge, many people will still choose to be overweight. We found that overweight individuals are aware that their excess weight makes them more likely to get diabetes, cancer, and heart disease.
...
Employers could adapt some of those ideas to combating obesity in the workplace.
Employers should use the types of strategies that are profit-maximizing. After all, that is what most [companies] are in business to do. I would subsidize healthy food in the cafeteria, maybe even have a fitness center. It's a nice perk and a great way to attract young, healthy workers.

But you don't think implementing weight-loss programs makes sense economically?
In order to be a cost-saving program, employees would have to lose enough weight, keep it off long enough and stay with the company long enough so that the reduction in health-related costs would be borne by the company. In reality, people change jobs every five years on average, so these programs are unlikely to pay off for most firms.

People do want to lose weight and that's why they're willing to pay for diet advice, or pills or procedures. Some economists are even hoping to make money with the economics diet.

And here is a Freakonomics post on the economics of obesity.

Woman too large for New Zealand

The Guardian

New Zealand has added another cruel cut to the myriad indignities visited upon those of larger girth: anyone with a dangerously high body mass index (BMI) is likely to be denied permission to emigrate there. Richie Trezise, 35, a Welsh submarine cable specialist, was initially rejected because of a BMI of 42 (25 or higher is regarded as overweight); he lost weight, but his wife Rowan, 33, has not found it so easy. For months she has tried to slim down enough to join her husband; if she can't do it by Christmas, he will have to give up his job and come home.

The government's reasoning is simple: it will take only immigrants of an "acceptable standard of health", ie those "unlikely to impose significant costs or demands on New Zealand's health or special education services" (a requirement that raises the even more controversial possibility of applicants being turned down for mental health reasons). Obese people are more likely to suffer from heart disease, diabetes, strokes and high blood pressure; ergo, obese people are not allowed.

The Sun has pictures.

New Zealand can't be blamed for Mrs. Trezise's weight. It can be blamed for causing its own citizens to be overweight. Its healthcare policy has weakened the incentive to stay fit.

Evidence? Obesity is an epidemic in New Zealand. As one news source points out,

The country's health care system cannot afford to open its doors to overweight immigrants, a spokesman for New Zealand's Fight the Obesity Epidemic explained to the Daily Mail.

Over half of New Zealand adults and nearly one-third of New Zealand children are already overweight or obese, according to the group. Those figures are expected to rise, as are the health problems associated with being overweight, such as high blood pressure and diabetes.

The UAE does not limit immigrants by weight, but then it doesn't let them participate in the health plan for citizens. Obesity among UAE nationals is a considered a social problem and is related to the high rate of diabetes.

Second-hand fat?

Attention students of economics. Do you see an externality here? Or not?

Dr Tickell, a leading nutritionist and author, told the BBC that society should take a more hardline stance against obesity and get tough on fat airline passengers. He said that Australian airlines should impose charges on their overweight clients, as they do for excess baggage, because heavier loads increase fuel costs. It's not fair to single out those people who have a problem, which is already impacting greatly on their life, and make them feel like pariahs

"I fly Sydney to Perth - five hours - and being totally disadvantaged by some huge person next to me literally flopping over into my seat. Why should I pay the same as them?" he asked.
...
But the chief executive of the Australasian Society for the Study of Obesity, Dr Tim Gill, said penalty charges should not be imposed on overweight passengers. "It's not fair to single out those people who have a problem, which is already impacting greatly on their life, and make them feel like pariahs," he said.

A spokesman for the Australian budget airline, Jetstar, said it had no plans to charge larger passengers more for their seats. Airlines are, however, monitoring long-term trends in the size and shape of their customers, the BBC's Phil Mercer in Sydney says.

(BBC)

Isn't there a straightforward solution here? If there is an externality the airline could eliminate it and increase its profit by charging the obese passenger more for a bigger seat. (No, I don't want to be the airline employee who enforces this policy.)

What I'm reading

1. Globalization of labor. Is labor getting a smaller share of income and yet a larger income? Yes says the IMF.

2. Driving alone, in traffic. Putnam redux.

3. The Constant Economist. Rachel Friedberg, economist, takes a busman's holiday.

4. The Obesity Conjecture, by David Friedman, "an academic economist who teaches at a law school and has never taken a course for credit in either field." Excerpt:

Over time, although the hardwired elements of behavior do not change--evolution is slow--the cultural elements do. Instead of demonstrating how wealthy and generous you are by urging your guests to have a second and third helping of dinner, you do it by providing them smaller amounts of particularly tasty, sophisticated, or expensive dishes.

Obesity in UK could bankrupt National Health System :: BBC

Another one for the "people respond to incentives" file.

Quote:

Professor Sattar, an expert in metabolic medicine, said research had linked obesity to a range of diseases and disorders, including heart disease, cancer, depression, back pain, diabetes and skin problems.

He said: "The problem of rising prevalence in obesity may get much worse - rates could climb still further, bankrupting the health system and leading soon to reductions in life expectancy.

"So we need to think out of the box, nothing that has been looked at so far seem to have worked."

He said while individuals "clearly have some responsibility for their health", the rest of society should also play more of a role.

Actually, the rest of society is playing a role in the UK - by funding the NHS through taxes. That's the problem. Individuals do not have financial responsibility for their health choices.

Here's an interesting suggestion - shame:

[Experts] said action was needed by all of society and even recommended a helpline for people who bought larger clothes.

The number should be promoted on the labels of all clothes sold with a waist of more than 40in (102cm) for men, 37in (94cm) for boys, 35in (88cm) for women, and 31in (80cm) for girls.
. . .
But Janice Bhend, a former editor of Yes magazine, which targets larger women, said the idea of a clothes phone line was a "ghastly idea".

"We need to come at it from a different angle but I don't think the fat police need to start telling us to phone a helpline."

She added it was enough to make people depressed.

Yes, and many people gain weight when they are depressed.

Curves: obesity and law of demand :: Greg Mankiw's Blog

Why have been Americans been growing for the last 150 years? It's not just that incomes have increased. The price of food has fallen considerably relative other goods, especially processed foods.

No doubt the same factors have been at work on Emirati waistlines since the 1970s.

Modern life is healthy :: New York Times

Those wacky microeconomists are looking in places where the average Joe would be surprised to find an economist (no, most of us have no expertise in stocks, bond and foreign exchange). So reports the New York Times.

New research from around the world has begun to reveal a picture of humans today that is so different from what it was in the past that scientists say they are startled. Over the past 100 years, says one researcher, Robert W. Fogel of the University of Chicago, humans in the industrialized world have undergone “a form of evolution that is unique not only to humankind, but unique among the 7,000 or so generations of humans who have ever inhabited the earth.”

The difference does not involve changes in genes, as far as is known, but changes in the human form. It shows up in several ways, from those that are well known and almost taken for granted, like greater heights and longer lives, to ones that are emerging only from comparisons of health records.

The biggest surprise emerging from the new studies is that many chronic ailments like heart disease, lung disease and arthritis are occurring an average of 10 to 25 years later than they used to. There is also less disability among older people today, according to a federal study that directly measures it. And that is not just because medical treatments like cataract surgery keep people functioning. Human bodies are simply not breaking down the way they did before.
. . .
Dr. Barker of Oregon Health and Science University is intrigued by the puzzle of who gets what illness, and when. “Why do some people get heart disease and strokes and others don’t?” he said. “It’s very clear that current ideas about adult lifestyles go only a small way toward explaining this. You can say that it’s genes if you want to cease thinking about it. Or you can say, When do people become vulnerable during development? Once you have that thought, it opens up a whole new world.”

It is a world that obsesses Dr. Barker. Animal studies and data that he and others have been gathering have convinced him that health in middle age can be determined in fetal life and in the first two years after birth.
. . .
But not everyone was convinced by what has come to be known as the Barker hypothesis, the idea that events very early in life affect health and well-being in middle and old age. One who looked askance was Douglas V. Almond, an economist at Columbia University.

Dr. Almond had a problem with the studies. They were not of randomly selected populations, he said, making it hard to know if other factors had contributed to the health effects. He wanted to see a rigorous test — a sickness or a deprivation that affected everyone, rich and poor, educated and not, and then went away. Then he realized there had been such an event: the 1918 flu.

The flu pandemic arrived in the United States in October 1918 and was gone by January 1919, afflicting a third of the pregnant women in the United States. What happened to their children? Dr. Almond asked.

He compared two populations: those whose mothers were pregnant during the flu epidemic and those whose mothers were pregnant shortly before or shortly after the epidemic.

To his astonishment, Dr. Almond found that the children of women who were pregnant during the influenza epidemic had more illness, especially diabetes, for which the incidence was 20 percent higher by age 61. They also got less education — they were 15 percent less likely to graduate from high school. The men’s incomes were 5 percent to 7 percent lower, and the families were more likely to receive public assistance.

The effects, Dr. Almond said, occurred in whites and nonwhites, in rich and poor, in men and women. He convinced himself, he said, that there was something to the Barker hypothesis.

If life in the womb and in the first two years has such a large impact, that bodes well for Jeffrey Sach's program of concentrating development aid on direct relief of extreme poverty: people will be able to lead much more productive lives. And, no, I have not lost track of the opposite direction of causality that Fogle points to: the Industrial revolution has allowed people to live longer with fewer disabilities.

Economic development even seems to be a cure for cancer:

“Suppose you were a survivor of typhoid or tuberculosis,” Dr. Fogel said. “What would that do to aging?” It turned out, he said, that the number of chronic illnesses at age 50 was much higher in that group. “Something is being undermined,” he said. “Even the cancer rates were higher. Ye gods. We never would have suspected that.”

Economics development in the last century has so improved lives that Fogel is suggesting the world's population carrying capacity is 50 billion.

Life for UAE nationals was quite harsh up until 40 or 50 years ago. The first two years of life for someone born here in 1960 was quite different for someone born here in 1980. Yes, we are seeing lots of childhood obesity. But is that extra weight due to a good start in life or to an unhealthy lifestyle? Moreover, even if it is the latter going back to the economy of the 1960s would be literally unhealthy.

Obesity levels in UAE have yet to peak - Gulf News

Overeating and a sedentary lifestyle. In prosperity all peoples -- in an arc from the USA to the UAE -- tend towards these choices, but they are choices. Krispy Kreme may have boomed and busted in the USA already, but I see Krispy Kreme in the future for the UAE.

Diabetes is a consequence of the lifestyle choices. Question: Do those making the choices bear all the costs of those choices? Or are their health care costs subsidized by others? If they are subsidized, then their overeating and under exercising is inefficient.

Blunted incentives. I'll have more to say on that subject in future posts.