Introduction Answering the Age-Old Question: Why Is Uncle Al So Fat? Ever notice that as your parents get older, you tend to have the same conversation with them over and over? For me, the conversation typically begins at baggage claim when I pick them up for a weekend visit. Mom will whisper, much louder than I would like: "There are a lot of people here who could participate in your study." She is referring to a paper I published a few years back that quantified the increase in medical expenditures resulting from obesity in the United States.Translation: "There are a lot of fat people here." At this point in the conversation, my dad proclaims, with no effort to keep his voice down: "You know who's fat? Uncle Al. Uncle Al is fat and getting fatter!" And we're off and running. On the one hand, I should be flattered that my parents have taken an interest in my work. As a health economist, I have spent the past seven years studying economic issues related to obesity. On the other hand, the rift between my dad and Uncle Al (my dad's half brother) is well known in the family circle, and Dad rarely misses an opportunity to take a jab at Uncle Al regardless of the conversation topic. But I have to admit, Dad has some interesting points. First, he notes, with some reluctance, that Uncle Al is no dummy. Clearly, he must know that his excess weight increases the risk of a host of medical problems, some of which Uncle Al has already developed. Second, he points out that Uncle Al is a partner in a successful law firm and is in the top income bracket in the country. Surely, he can afford to buy the healthiest foods, join the best gym, and pay whatever price is required to maintain a healthy weight.Why then, is he still fat and, according to Dad, getting fatter? Usually, we are in the car and heading to my house when I ask the same question I pose every other time we've had this conversation: "Why do you care whether or not Uncle Al is fat?" "I don't care," he answers immediately. "As far as I'm concerned, Uncle Al can do whatever the hell he wants." But as it turns out, maybe we should care. For Uncle Al is not the only one who's fat. As Dad often points out, Mom could stand to lose a few pounds herself, as could one of my sisters. Uncle Al's son, my cousin Carl, is at least 20 pounds heavier than he was in his early 20s, although as we discuss in Chapter 2, the father and son have gained weight for very different reasons. In fact, if you were to weigh in the entire Finkelstein family, you would find that my family is pretty typical of the U.S. population. About one third of us are fat and another third are on the brink. The government, by the way, refers to fat adults as obese and fat kids as overweight. We'll stick with their terminology, although I'm not convinced these terms truly lessen the blow. In total, including Uncle Al, Cousin Carl, my mom, and my sister, there are over 62 million adults in the United States who are obese.An additional 12.5 million kids are overweight. So maybe you should care. For the rise in obesity rates is having a profound impact on the U.S. economy-and on our wallets. There is a nearly endless barrage of news stories describing how obesity is making our businesses less competitive, pushing good jobs overseas, hurting our military readiness, increasing our taxes, and helping to bankrupt the Medicare and Medicaid programs. And, by the way, it also turns out to be pretty bad for your health. Usually, by the time we reach our house, either Mom has forbidden us to continue talking about Uncle Al or Dad and I are no longer on speaking terms. Since we never get to finish the conversation, and because your family has an Uncle Al too, it seems appropriate to put my thoughts into writing and finally explain to Dad why Uncle Al is fat, just why we might care about that, and what should (or shouldn't) be done to address rising rates of obesity. America's Growing Waistline Two thirds of Americans are overweight or obese. Over the past three decades, the number of obese individuals has more than doubled. The increase occurred for all population subsets, including children, the elderly, and all racial/ethnic groups up and down the socioeconomic spectrum.

How This Book Is Organized

Chapter 1 gives you the lay of the obesity landscape. It describes how America-and the world, for that matter-has seen a significant growth spurt in obesity rates over the past several decades. The chapter then briefly discusses the adverse health consequences of obesity. Chapter 2 begins to hone in on the causes behind the obesity epidemic, concentrating on "calories in." Chapter 3, which focuses on "calories out," continues the argument that economic forces, which have simultaneously lowered the cost of food consumption and increased the cost of physical activity, have largely driven the sudden obesity rise. In Chapter 4 we take the discussion beyond the calories in/calories out equation to evaluate other factors that may (or may not) be contributing to an obesity-inducing environment. We continue this discussion in Chapter 5, and look at the role that health insurance and medical technology play in reducing the costs associated with obesity. When considering costs, we focus not only on the monetary costs, but also on the time and other opportunity costs associated with undertaking certain activities. Chapter 6 switches gears from causes to consequences. We ask and answer the key question: So we're fat-who cares? The chapter explores the implications of obesity for taxpayers, for the U.S. government, and for employers whose business model does not involve selling products and services to obese consumers. In Chapter 7 we look at the government's role in response to the obesity epidemic from an economic standpoint, and actually question whether they should have any role at all. Chapter 8 specifically addresses the pros and cons of proposed government strategies aimed at reducing obesity rates in adults, and Chapter 9 presents a similar analysis for strategies that target youth. Chapter 10 then lays out some groundwork for how businesses can respond to problems related to obesity. It presents private-sector strategies for reducing rates of obesity and gauges their likelihood of success. Chapter 11 goes on to examine the flip side, what we call the ObesEconomy, the multibillion-dollar market that America's ballooning waistline has created for obesity-related products and services. Finally, even though this is decidedly not a "how to lose weight book" (God knows, there are enough of those out there already), we couldn't resist the temptation to offer some advice on how to lose weight like an economist. That's served up to you with a portion-controlled grain of salt in Chapter 12.

Is Obesity a Problem Worth Fighting?

Before you begin reading this book in earnest, it's important to get one thing straight. Contrary to what "Mary" (I prefer not to disclose her real name) recently implied after I gave a presentation on the economics of obesity at the National Institutes of Health, I am not a "fattist."That is to say, I have nothing against obese people. Mary, a member of the Medical Advocacy Project of the Council on Size & Weight Discrimination, a self-proclaimed "size acceptance" group, told an audience of several dozen obesity researchers that my presentation sounded like "fat people are bad for business, fat people are bad for government, fat people are just plain bad...." She then began to cry. Needless to say, it was not a good scene. I never got a chance to mount a rebuttal. If I had, I would have told her that while not everyone can be skinny, I believe the vast majority of overweight people could weigh less than they currently do if the environment were more conducive to weight loss. What do I mean by that? America's obesity epidemic has been shaped by economics. A basic tenet of economics is that people respond to their environment in predictable ways. If the cost of a particular product or activity decreases, or the benefits of that product or activity increase, then people will consume more of that product and spend more time doing that activity, and vice versa. As we discuss throughout this book, obesity is a product of our economic and technological success.Thanks to declining food costs and the ever-increasing usage of technology, we're eating more calories and burning off fewer. As a result, we are gaining weight-lots of it-a consequence that any economist worth his weight would predict. However-and this may come as a shock to many of you-to economists, it is not entirely clear that obesity is a problem worth fighting (certainly not the way we've been attacking it). Sure, obesity is bad for your health, but the fact remains that good diet and exercise are extremely difficult to sustain, especially in today's environment. In fact, as the world now stands, many, including my Uncle Al, may prefer to be "fat and happy" (as my dad puts it) rather than make the sacrifices necessary to be thin. And isn't it their choice? Moreover, even if we are convinced that obesity is worth fighting, we are not going to significantly reduce rates of obesity solely through public health or media campaigns.These programs often do a good job of raising awareness, but they fail to address the core issue. If we are to reverse the rising tide of obesity,...