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July 21, 2009

For Obesity, Try Soda Gas Taxes
When I mentioned the fact that many and varied changes in policy will likely be required to address the obesity epidemic, I wasn't specifically thinking about gas taxes. But clearly, I should have been. Matt Yglesias points to this news from Forbes of research indicating that increasing gas taxes could have a significant effect on obesity rates:
Charles Courtemanche, an economist at the University of North Carolina at Greensboro, has produced a study suggesting that permanent hikes in gas prices may slash obesity rates. The amount is hardly nominal: A sustained $1 increase in the price of a gallon of gasoline equals a 10% dip in the nation’s obesity rate--that's about 9 million fewer obese people clogging up health care systems and costing society (and themselves) money. "The price of gas is a powerful lever when it comes to medical expenses and mortality rates," Courtemanche says. "There’s a savings in this for all of us."
Americans' sedentary lifestyle has long been known as a major contributing factor to the obesity crisis -- but the policy focus has of late been almost entirely on food, e.g. junk food taxes, health food subsidies and calorie labeling. Courtemanche offers compelling evidence that transportation and energy policy deserves its place in the mix. He provides a fairly complete mechanism as well:
Courtemanche found evidence in his data that rising gas prices resulted in more Americans walking and more Americans bicycling. Perhaps just as important, he noticed that, as gas prices increase, people eat out at restaurants less. In addition to more strolling and cycling, people use public transportation more, Courtemanche says, and that, too, burns far more calories than sitting in a bucket driver’s seat, sipping coffee, and flipping through radio channels. People who use subways, buses, trolleys or commuter rail services need to get to and from mass transit stops, and that probably means more walking on both ends. A $1 rise in gas means 11,000 fewer lives lost to obesity-related causes and $11 billion per year saved on health costs, Courtemanche says.
Good stuff. The connection to rising gas prices and reduced restaurant visits is fascinating and one that I certainly would not have immediately recognized. The same goes for the fact that public transportation use burns more calories than driving -- obvious in retrospect but still easy to overlook.

And once gas gets up north of $6 a gallon, according to Courtemanche anyway, that's when you'd start to see a transformation away from a car-centric culture as gas prices start to affect housing and relocation decisions. Of course, we may not need gas taxes for all that -- economic recovery plus peak oil may yet get us to the same place. It's just a further indication that our policy choices for addressing obesity need to include "all of the above."

Photo by caseyhelbling used under a CC license

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July 17, 2009

Blight of the Tomatoes
First peanuts. Then pork. Then ground beef. And now: tomato plants.

Sadly, I have not just described the menu at the annual Beyond Green BBQ. Rather, each of the above have been implicated in a recent infectious disease outbreaks. And each outbreak has been exacerbated, if not explicitly caused, by the "big-box" economic mentality -- national distribution networks that aggregate huge numbers of products in confined spaces and then move them across long distances to many destinations in a short time. Experts have repeatedly warned of the dangers inherent in a food system that does this. Now we learn that even the garden centers of large retailers like Home Depot and Wal-mart can put agriculture at risk.

The NYT is reporting that these retailers have helped spread a vicious outbreak of "late blight" in tomatoes -- the same plant disease that caused Ireland's Potato Famine:
A highly contagious fungus that destroys tomato plants has quickly spread to nearly every state in the Northeast and the mid-Atlantic, and the weather over the next week may determine whether the outbreak abates or whether tomato crops are ruined, according to federal and state agriculture officials.

...William Fry, a professor of plant pathology at Cornell, said, "I've never seen this on such a wide scale."

Professor Fry, who is genetically tracking the blight, said the outbreak spread in part from the hundreds of thousands of tomato plants bought by home gardeners at Wal-Mart, Lowe's, Home Depot and Kmart stores starting in April. The wholesale gardening company Bonnie Plants, based in Alabama, had supplied most of the seedlings and recalled all remaining plants starting on June 26.
Now it's important to keep in mind that the fungus that causes late blight is ubiquitous and wasn't "imported" into the Northeast and mid-Atlantic by these infected garden center plants. But what these plants did do is introduce active infections -- and with them instantly airborne spores -- which could quickly spark an outbreak. At the same time, if not for the unusually wet, cool weather, the blight was unlikely to have taken hold. And taken hold it has. But what's shocking is how quickly the blight jumped from home gardens to commercial operations -- both home gardeners and professional farmers from NY and PA are already destroying infected plants. The real possibility of a near-total loss of the region's tomato crop exists.

So what to do? Well, for one thing, in the future we should all stick to locally-grown seedlings -- smaller producers can't spread infections regionally or nationally. For another, root for some heat:
Hot, sunny weather, which can kill late blight, could dramatically slow or eliminate the fungus's spread over the next week, experts said.
Speaking of which, I wish there was some ray of sunlight that I could pass on regarding the issue as a whole. But big-box stores and national distribution networks aren't going anywhere. I wonder what other pleasant side-effect they'll give us next.

Photo courtesy Meg McGrath/Reuters
/NYT

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Milk Monopolists
Earlier this year, the Obama adiministration's top antitrust enforcer, Christine Varney, announced a new effort to crack down on monopolist practices in industry. Some of us were particularly interested to observe that Varney's first speech specifically mentioned agribusiness as a top target. This is understandable since, from fertilizer to meatpacking to seeds, four companies or fewer control up to 80% of each of these markets.

But right now nowhere are the oligolopolists doing more damage than in the dairy industry, where prices have fallen faster and deeper than any time since the Great Depression. And, joining ranks with tens of thousands of desperately struggling dairy farmers, Sen. Bernie Sanders of Vermont has had enough -- he has called on the Justice Department to investigate the dairy giant Dean Foods as a monopolist.

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July 16, 2009

Dennis Wolff, Ed Rendell and the Peter Principle
Here's a little rumor-mongering for fun, if not profit. Yes, as reported, Dennis Wolff is for sure heading the list of candidates for the top food safety post at the USDA. But that's not the fun part. The fun part involves the reason Dennis Wolff is heading the list of candidates for the top food safety post at the USDA.

It's long been known that Wolff's main backer for a USDA post has been his current boss, Pennsylvania Gov. Ed Rendell. Many folks in the food policy world have wondered why Rendell so enthusiastically backs a guy who caused him such embarrassment -- referring of course to Wolff's failed attempt to ban "rBST-free" labels on milk.

Well, according to an impeccable source the real motivation is right out of an episode of The Office. Rendell wants nothing more than to be rid of Wolff. He's dearly hoping that Vilsack swoops in and gets Wolff the heck out of Harrisburg. That's right. Wolff screwed up so badly in the state capitol, there's no place for him to go but up -- to USDA HQ.

But instead of dumping him in some meaningless job, the rocket scientists at USDA, cheered on by Big Ag, decided that Wolff--despite no real background in the subject--should be in charge of one of the nation's main food safety operations. Insiders have also noted the utter absence of a high-profile Pennsylvanian among top administration officials. With the White House already thinking about 2012, this oversight has team Obama searching for someone, anyone, from "purple" PA to name to a senior post.

The logic, at least to them, is inescapable, though it does suggest that their commitment to reform is, um, a bit lacking. But honestly, this is one Pennsylvania export we probably should keep to ourselves. As a Philly resident, I'm willing to bite the bullet and leave Dennis here. Maybe then the top food safety job would go to a committed, experienced, consumer-minded reformer and not some hack state Ag Sec cast-off. If only hope were a plan.

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July 15, 2009

What's it Mean to "Solve" the Obesity Epidemic?
Ezra Klein, WaPo blogger and now food columnist, has, of late, been particularly dour regarding attempts to address obesity. His "Gut Check" piece today on the limited policy tools available to fight the obesity epidemic confirms it:

Over the past 50 years, however, some privileged humans have been faced with a largely novel problem: the consequences of too much food and drink. For a while, the primary impact seemed to be extra lumps of flesh, which had their downsides so far as mating went but, overall, weren't too bad. But in recent years, the problem has become much worse. In particular, the modern, privileged human has developed such chronic ailments as diabetes and heart disease. Unlike acute starvation, these diseases kill slowly, painfully and, above all, expensively.

The consequences are not confined to the individual. As I write, Congress is considering an overhaul of the health-care system. But the concern isn't health: It's money. If trends continue, health-care costs will chew up 100 percent of the gross domestic product by the end of the century. And estimates suggest that half to two-thirds of that growth is coming from chronic diseases related to diet. We're eating our way through the national budget.

He goes on to consider two currently favored approaches: taxing junk food and labeling calories. The problem? Both may work, but both also have mild effects. One study indicated that a 10% tax might reduce consumers' BMI by a mere 0.6% (to put that in context, a BMI of 30 is considered obese) while labeling might reduce a small percentage of meal purchases by 100 calories. While these reductions compound over time, they remain "blunt tools." Klein clearly favors calorie labeling, but admits that even its potential is "highly speculative."

But this analysis dances around the fundamental question regarding obesity: What exactly does it mean to "solve" it. We are after all swimming in calories. We are destined to be Chub Nation no matter what we do. Our goal can't possibly be to make every American male an Adonis and every female an Aphrodite. Indeed, as you will invariably hear in any discussion of obesity, BMI is a weak and imprecise measure -- only used out of, ironically, convenience. The CDC sets the definition of obesity as a BMI of 30, e.g. a 5'9" person who weighs just over 200 lbs. Right now, all we know is that we want fewer people with BMIs over 30 and as few as possible over 40 (the definition of "morbidly obese"). But how many exactly?

And as for money, we have new data that tells us an obese senior has annual medical costs between $1400 and $6000 higher than a non-obese senior. We know we can't afford to treat 20% of the population for Type II diabetes -- but, while they have higher rates, the obese are not the exclusive sufferers from "diet-related diseases" like heart disease, stroke, high blood pressure and some cancers. So how many obese people can we afford to treat? And what do I even mean when I say "afford"? Must we give up -- to paraphrase health economist and Obama adviser David Cutler's famous formulation -- our flat-screen TVs?

The fact is that no one has really established the criteria for "victory." That said, "victory" is the worst way of looking at the endpoint. It can't be a War on Obesity -- the obese will always be with us. It is about getting obesity to a manageable level. But no one (that I know of) has yet declared exactly what that level is.

No wonder Ezra isn't optimistic. It's hard to hit a target when you don't know what it looks like or where it is. As a result, people tend to search for the largest, most diffuse, most dramatic effects in evaluating their weapons. But it may very well be that aggregating several, smaller effects will get us to a sustainable place. Or not.

Ultimately, it's the uncertainty that leaves us casting about for the perfect solutions. And -- while I believe that if asked to choose among "x, y, z, 1, 2, or 3" policy solutions for obesity, the answer will likely be "all of the above" -- I also believe that until someone can properly identify the target for our actions against obesity every policy proposal will appear to fall short.

Public health experts: Get cracking!

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The Kitchen Garden Strategy

For anyone still doubting the food-related ambitions of First Lady Michelle Obama, the WaPo's Jane Black wishes to disabuse you. In an article that charts the internal strategizing over how best to leverage the success of the White House Kitchen Garden, Black indicates that the First Lady and "the White House [are] grappling with the very issues that have challenged the so-called good food movement for decades: How do you simplify and sell a new way
of eating?"

Firstly, let me say, "Welcome to the club, Mrs. Obama!" And secondly, let me observe the signiicance of the fact that the First Lady's policy director Jocelyn Frye is, according to Black, deeply involved in the grapple. Frye's role is a sign that the First Lady may intend to do some serious heavy-lifting that goes beyond inspirational speeches and towards an attempt to meaningfully influence policy debates. In short, Michelle Obama is just getting started.

So what's next? Sam Kass -- the Obamas' personal chef who is now "White House Food Initiative Coordinator" -- spills the beans:

"We're focusing on kids..."

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July 10, 2009

USDA Shilling Around with Food Safety
I love it. Big Ag seriously knows how to pick them. Tom Philpott at Grist is reporting that our very own Dennis Wolff, Pennsylvania's Secretary of Agriculture, is a finalist for the USDA's top food safety post -- the Under secretary for Food Safety. His name has been floated for a number of USDA positions (including Ag Sec) and now his backers have found a new spot for him. And what expertise in public health, food safety or science does he bring to the post? Would you believe, "none"? As Philpott puts it:
Dennis Wolff would be an odd choice for this job--especially in an administration that promises change, or for that matter, experienced professionals in key roles. A look at Wolff's official bio reveals no discernible experience as a food-safety regulator. (Many states run offices that inspect meat plants; Pennsylvania is not among them. All meatpacking in Pennsylvania is overseen by the USDA, not Wolff's ag department.)
Here in PA, Wolff is known best for his attempt to ban "rBST-free" (i.e. "artificial hormone-free") labels on milk, which only failed after a massive public outcry and a rebuke (in the form of a veto) by Gov. Ed Rendell. But in that effort at least he knew what he was doing -- to this day he has a Holstein operation (though now reportedly in the genetics business, not dairy production). Having a large-scale Holstein man making abrupt changes in milk labeling policy smelled a bit funny to me. That, I remember thinking at the time, was not conflict of interest we can believe in.

Indeed, if you really want to get deep in the weeds on all things Wolff, go here and see how laughably and closely tied he is to industry and advocacy groups (and, of course, Monsanto) who have been pushing for the expanded use of rBST for years. He comes off as little more than a shill, full stop. The capper, as Obamafoodorama observed last November, has to be Wolff's creation of his own little astroturf group "made up of Big Ag lobbyists and Monsanto employees" to provide wonkish cover for the labeling change. Good times.

Oh and he's also a big supporter of a nasty Pennsylvania law (again via Ob Fo) which:
... gives the Pennsylvania state attorney general's office the authority to sue municipalities over local farm ordinances deemed to exceed state law... The ACRE initiative is essentially a grassy version of eminent domain that's skewed to benefit Big Ag and demolish family farms, organic growers, and anyone who's interested in keeping Big Ag off the local land.
And what, you have a right to ask, does any of this have to do with food safety? How's this for an answer: absolutely nothing. The USDA's (and Big Ag's) response to the food safety crisis and the sudden boost in food safety authority given to the FDA appears to have been to hunker down. They want a guy they can rely on to insulate them as much as possible from any radical change.

In the process, they have accomplished something really amazing -- they have made former Monsanto exec and new FDA Special Advisor for Food Safety Mike Talyor look like a breath of fresh air. If, that is, your breath hasn't already been taken away by the idea of a shill lacking any meaningful background or accomplishment regarding food safety in charge of your meat.

In fairness, it's true that Vilsack just appointed a Deputy Under secretary of Food Safety -- Jerold Mande, most recently of Yale -- who appears to have an appropriate background. But you only make Dennis Wolff Mande's boss if you want to make sure Mande toes the industry line.

At a certain point, it just makes you want to throw up -- your arms at least -- in surrender. Because if these rumors are true and Tom Vilsack at the USDA appoints Dennis Wolff to run food safety there, Big Ag will have taken Obama's message of reform and responded with that Reagan-era chestnut: Just Say No.

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July 8, 2009

Screw the Climate!
Does this sound like someone who thinks climate change is a big deal?
"I just generally don't like many things about the House bill.... But I'm open to discuss how we can move forward to make our energy grid greener. How we can move to the next generation of energy supply, and most importantly how to get American energy secure. That goal cannot be done without increasing traditional oil and gas production."
--Sen. Mary Landrieu (D-LA) on the Waxman-Markey climate bill

Ah, the US Senate. Full of deep thinkers...

Via the Wonkline

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July 7, 2009

Will a Junk Food Tax Work or Not?
Ezra Klein came across a RAND study that indicates junk food taxes may not be effective:
A recent study conducted by researchers at the RAND Corp. used evidence from the Health and Retirement Study -- which is generally considered to provide very high-quality data -- to estimate the impact of a 10 percent reduction in the cost of all calories (they use a reduction because, well, food prices have been going down, so that's where we can find real-world data on how people respond to price changes in food). The data isn't very encouraging.

In the short-term, the impact is very small. Over two years, body mass index increases by 0.6 percent. Over time, the impact compounds, so after 30 years, it's a 4.2 percent increase in BMI. To put that in perspective, clinical guidelines say that you need a 10 percent reduction for meaningful health benefits to overweight individuals. And this isn't out of line with other estimates: The paper also has a section surveying similar experiments, and it turns out that this paper is actually more optimistic than many.
I took a look at the study myself and found it somewhat opaque. But with some help from Beyond Green's resident statistician (i.e. my wife Julia Lynch, Penn polisci prof/public health expert/quant jock) I was able to get my brain around it -- and I was underwhelmed.

First, it's worth noting that this study was not a policy analysis. It did not examine the effects of existing food taxes. The study did two things. It proposed a mathematical model linking the caloric content in a basket of goods at a particular price to BMI. And it linked metropolitan-level data on changes over time in food consumption and food prices to data on BMI from the longitudinal Health and Retirement Study to see how well that mathematical model predicted how changing food prices might affect BMI. If nothing else, it's one heck of an ambitious model.

Now, I'm the last person to dismiss a good empirical test of a mathematical model. But in this case, there are issues worth noting. As Klein observes, the study had to model price reductions rather than increases, since food prices have historically gone down more than they have gone up. The authors appear to assume that consumers will react to negative price signals (i.e. lower prices) in the same way as positive price signals (i.e. higher prices). That might be true. But it very well might not. Indeed, we know from past research on investors' decision-making that people assess downside risk differently than they do upside risk (people generally fear a small loss more than they are attracted by a small gain). I'm not using that example to assert that there is definitely an asymmetric reaction to higher prices than to lower. But I do assert that there might be.

It would also be a mistake to conclude from this study that taxes on junk food won't reduce obesity because -- and the authors explicitly warn us of this -- the messy nature of their data likely leads them to underestimate the effect of price changes on BMI. In fact, the authors write in their conclusion that:
[O]ur results are best viewed as lower bounds on the true effects, due to the possibility of measurement error and simultaneity bias.
And there was an effect. Though the short-term effect they found was small (and likely of sub-clinical significance), they actually identified a fairly large effect, in the long run, of increasing prices on calories. To the extent that we believe the results at all, the takeaway should be that, hey, junk food taxes work -- and the longer they're in place, the better they work. The authors say as much with the final line in the paper:
[O]ur results suggests the importance of treating weight as a dynamic process, and emphasize the cumulative effects of economic incentives on body weight.
Speaking of which, I'm surprised that they ignored similar products whose price and consumption patters vary in a similar manner. It would have been interesting to see if how their model performed with something like, say, beer.

As it happens, a recent study by Duke University Prof Philip Cook looked at how beer consumption changed in response to a tax increase. Guest posting earlier this year at Klein's old digs at the American Prospect, public health expert Harold Pollack summed up Cook's results:
Cook argues that a 10-cent tax per ounce of ethanol (the amount contained in two drinks) would reduce ethanol sales by 12 percent and would reduce motor vehicle fatalities by about 7 percent. An estimated 80 percent of these taxes would be paid by the 13 percent of American adults who are heavy drinkers.
That's a pretty nice effect. And frankly, I would surmise that "heavy users" of junk food would be similarly affected -- and it's those on the extremes who need the signal the most. The idea isn't that you're going to eliminate all consumption, but you will reduce it. And maybe it's true that a 10% tax isn't enough. Ten cents on a dollar bag of chips doesn't strike me as quite the policy innovation we're looking for.

So, Mr. Klein. I see your RAND study on food taxes and raise you a Duke study on beer taxes.

Now, will junk food taxes "solve" the obesity problem? Clearly not. But we absolutely do need to reduce consumption of junk food. Word has it that I said this recently:
Junk food--and that includes any processed food that crosses the line from nutritious to purely caloric--has to get more expensive. Period.
Well, that's my story and I'm sticking to it.

Photo by awrose used under a CC license

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Henry Waxman: Destroyer of Industry

Here's Henry Waxman, as interviewed by Ezra Klein, on the effect on indusry of two of the reforms he spearheaded:

It was a big battle to get food producers to put uniform labels advising people about calories and sodium and carbohydrates and other nutrients on food. But I think most people take it for granted that they can see those labels when they go into the store and use them to make their decisions. But the food producers said they were going to go bankrupt if they had to put these labels on, it would be such a burden, it would be excessive. Finally we got it passed. And I don't think most people give it a second thought today. It's just there.

...I also talk about the Clean Air Act, which is the most successful environmental law on the books today. There was a huge fight over a one--year period to get that legislation enacted. But now people in the Northeastern parts of the United States that were seeing acid rain don't have that problem any more. And the cost turned out to be a tenth what they said it would be even though different industries argued that our economy would go to hell. Invariably they met their requirements, met them ahead of time, and met them at a fraction of the predicted costs. So we've had very successful laws. But very few people talk about government in those terms.

Listening to these industries' complaints would be enough to make you think that Henry Waxman was the greatest enemy to private enterprise since Lenin. Only he wasn't. Because his reforms either had no effect on corporate bottom lines or, in the case of the CAA, probably led to even greater innovation. That's worth keeping in mind during debates over food system reform and climate change legislation. At worst reforms won't hurt them and at best reforms will help them. So, why don't these companies just back off a little.

On a related note, the NYT reports that new government regulations on lightbulb efficiency has -- despite industry complaints that it would cause the demise of the much-loved but inefficient incandescent bulb -- touched off a torrent of innovation. It may be that an incandescent bulb that is 100% more efficient than current bulbs isn't too far away. Not that regulation can spark innovation, of course. Any "very serious" person will tell you that only markets can cause innovation. But, you know, those capitalists really aren't very good listeners. Just ask Henry Waxman.

Photo courtesy the Washington Post

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Convenience Foods: Not So Convenient

Among all the responses to the new data showing we're getting sicker and fatter, I was most struck Kerry Trueman's comment at Civil Eats that what we are really suffering from is "kitchen illiteracy." Now, that's the kind of insight which seems easy to dismiss. We all know it's not about a lack of interest or knowledge -- it's about a lack of time, right? As I once asked, how can you fix the food system when you have to fight convenience? Working parents are forced by circumstances outside their control to buy processed food because cooking real food takes too long. These folks don't have time to boil pasta much less prepare a healthy meal.

Well, what if I told you that assertion might be wrong? What if "convenience foods" aren't actually all that -- for lack of a better word -- convenient?

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July 6, 2009

The People Problem in Politics

There's no better way than that to refer to the Washington Post's fascinating graphic which illustrates the revolving door of Congressional lobbying. The WaPo determined that "nearly half of former Capitol Hill aides hired by major health-care companies to lobby Congress in the first quarter of 2009 previously worked for" the Senate Finance Committee -- the entity taking the lead in drafting health-care legislation. This led the WaPo's Ezra Klein to observe that:

In some ways, this sort of thing worries me a lot more than the actual money being pumped into the system. Jesse Unruh, the legendary speaker of the California state assembly, famously said that "if you can't take their money, drink their whiskey, screw their women, and vote against 'em anyway, you don't belong in the Legislature." My sense is that there are actually quite a few politicians in Washington who, after years of being badgered by lobbyists and special interests, can do exactly that.

But saying no to your former friends and confidantes is a whole other thing entirely. Suppressing your instinct to trust a former chief of staff and legislative director is a hard thing to do. Refusing to return the calls of favored staffers and colleagues goes against every social grain in our bodies. It should be easy to separate professional responsibilities and personal feelings. But it isn't.

I bring this up because this issue looms just as large for food policy (in fact I'd love to see this analysis applied to the Senate Agriculture Committee). Congress is equally awash in money from agribusiness and food companies -- and experts like Marion Nestle have called for restricting corporate money in politics as the best means to change the direction of food policy in this country. But short of making it illegal for former Congressional aides to lobby their former employers ever, it's hard to see how you can take the personal appeal out of the equation. Maybe the Senate really is just more trouble than it's worth...

UPDATE: Ob Fo makes explicit the connection that many Finance Committee Senators do in fact sit on the Ag Committee as well. The lineup: Sens. Charles Grassley (IA), Max Baucus (Mont), Blanche Lincoln (Ark), Kent Conrad (ND), Mike Crapo (UT), Debbie Stabenow (Mich), Pat Roberts (Kan). Ob Fo goes on to point out that this group of Senators represent some of Big Ag's biggest supporters in Congress: "it's worth pondering what kind of an influence they--and their staffers-turned-lobbyists--could potentially have on reform debates." No kidding.


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July 1, 2009

The United States of Obesity
The AP reports on a new state-level study of obesity rates. And the news is, well, terrifying:
Obesity rates among adults rose in 23 states over the past year and didn't decline anywhere, says a new report from the Trust for America's Health and the Robert Wood Johnson Foundation.

...[W]hile the nation has long been bracing for a surge in Medicare as the boomers start turning 65, the new report makes clear that fat, not just age, will fuel much of those bills. In every state, the rate of obesity is higher among 55- to 64-year-olds - the oldest boomers - than among today's 65-and-beyond.

That translates into a coming jump of obese Medicare patients that ranges from 5.2 percent in New York to a high of 16.3 percent in Alabama, the report concluded. In Alabama, nearly 39 percent of the oldest boomers are obese.

But wait, say the contrarians! This isn't a crisis. The obese die sooner -- they cost less to treat over their lifetimes so no need to worry. Right? Wrong.

Health economists once made the harsh financial calculation that the obese would save money by dying sooner, notes Jeff Levi, executive director of the Trust, a nonprofit public health group. But more recent research instead suggests they live nearly as long but are much sicker for longer, requiring such costly interventions as knee replacements and diabetes care and dialysis. Studies show Medicare spends anywhere from $1,400 to $6,000 more annually on health care for an obese senior than for the non-obese.

And when you start multiplying those thousands of extra dollars by the millions of obese baby boomers out there, pretty soon you're talking about real money.

But it's all about personal responsibility in the end, isn't it? As corporate front groups like the Center for Consumer Freedom and lobbying outfits like the American Beverage Association incessantly remind us, if people just made the right decisions there wouldn't be a problem. So, kids, it's high time you started taking responsibility for yourselves -- especially you all in Mississippi, Alabama and Georgia where childhood obesity rates are 44%, 37.5% and 37.3% respectively. There. I did it. Problem solved.

The study also reiterates the fact that the obesity epidemic is correlated fairly highly with income -- states with lower per capita incomes have the highest obesity rates. And vice versa -- Connecticut and Massachusetts have some of the lowest obesity rates in the country (although even in those states obesity has at least doubled since 1985). And when you think about it, it makes sense. Healthy food is expensive while junk food is cheap and, as I wrote about regarding food swamps, ubiquitous.

But the headline here is the fact that reforming health care can't happen without reforming the food system. Indeed, it's been observed that our health system may soon collapse in the face of the obesity epidemic -- no system can handle diabetes rates of 25% or more. As a result, the only health care "cost control" that matters for obesity is attacking the root cause. And reforming the food system means, among many other things, beating back the tsunami of high-calorie, low nutrient food products. At a minimum, we really need to stop pretending that we can surf it -- because sooner or later -- directly or indirectly -- we're all going to drown in it.

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