Obesity and Responsibility: Paternalism and no-fault insurance won’t fix our most serious health care problem
Obesity, the most serious public health problem in America, has yet to be honestly discussed.
After studies in the 1960s clarified the health impacts of cigarettes, smoking became an object of concerted public-health efforts. Smokers were increasingly ostracized, greatly reducing the incidence of smoking in the United States. Yet holding obese people responsible for their condition is still considered not only politically incorrect but discriminatory and prejudiced.
Indeed, U.S. trends in smoking and obesity have headed in opposite directions. Over the past fifteen years, smoking rates have declined 20 percent, while obesity rates have increased 48 percent. Since virtually everyone in America knows that both smoking and obesity worsen one’s health—and since millions of Americans have chosen to quit smoking or take steps to lose weight—it’s reasonable to conclude that others have decided to continue those behaviors and accept the adverse long-term effects.
We need to usher in a new era of personal responsibility in health care, and obesity should be our highest priority.
The first important step is to admit that although some people may be more predisposed than others to harmful behaviors and adverse outcomes, increasing rates of obesity are primarily due to overeating and insufficient exercise. Although the causes of obesity are complex, only a limited number of cases are primarily due to genetics. The genetics of populations change far too slowly to account for the sharp increase in obesity rates of recent years, and genetics cannot explain the increasing prevalence of obesity in the United States, first and most severely, and subsequently in developing countries.