Don’t Sweat the Obesity Dividend

DrRich | August 11th, 2010 - 7:25 am


DrRich has pointed out several times that it is very important to our new healthcare system, as a matter of principle, to be able to discriminate against the obese.

The obese are being carefully groomed as a prototype, as a group whose characteristics (ostensibly, their lack of self-discipline, or their sloth, or their selfishness, or whatever other characteristics we can attribute to them to explain how their unsightly enormity differentiates them from us), will justify “special treatment” in order to serve the overriding good of the whole.

The obese are a useful target for two reasons. First, their sins against humanity are painfully obvious just by looking at them, so it is impossible for them to escape public scorn by blending in to the population, unlike some less obvious sinners such as (say) closet smokers, or pedophiles. And second, since true morbid obesity almost always has a strong genetic component, successfully demonizing the obese eventually will open the door to the demonization of individuals with any one of a host of other genetically mediated medical conditions.

Readers who wonder why this is a big deal need to go back and study the original Progressives, for whom some form of genetic purification was an indispensable step toward achieving societal perfection. This was true not only for notorious eugenicists such as Woodrow Wilson, H. G. Wells, George Bernard Shaw, and Margaret Sanger, but also for the kinder, gentler Progressives we generally revere even today, such as Theodore Roosevelt, Winston Churchill, and even Mohandas Gandhi.

This sort of thinking fell out of vogue, for obvious reasons, after World War II. So it is no longer cool to talk openly about genetic cleansing.

But discriminating against people who have genetic health disorders (in the name of achieving an optimally efficient healthcare system for the purpose of cost saving) would be a start. And the obese have been selected as the most acceptable prototype for such treatment.

In this light, a recent article in the Public Library of Science Medicine Journal has created something of a problem for the anti-obesity movement. This article compared the lifetime cost of healthcare (beginning at age 20) for obese individuals and for smokers to the lifetime cost for non-smokers who maintained a healthy weight. Naturally, the study concludes that the healthy individuals can expect to live longer than the obese and the smokers (84 years vs. 80 and 77 years, respectively). However, the healthy young people will consume $400,000 in lifetime healthcare costs, vs. only $365,000 for fat people and $321,000 for smokers. (The cost savings in the obese and the smokers arise from their relatively premature deaths.) Therefore, healthy people, over their lifetime, are a bigger drain on the healthcare system than the obese and the smokers.

The reason this study presents a problem  is that it appears to contradict a central axiom of our present program. Specifically, it places in some peril our deeply held conviction that the obesity epidemic is one of the major threats to the stability of our healthcare system.

The added costs which the obesity epidemic poses to our healthcare system has become a touchstone, to the extent that it has become acceptable even in polite circles to openly discriminate against, if not overtly disdain and humiliate, the obese. Mississippi is considering legislation to prevent the obese from eating in restaurants. And in Britain, whose healthcare system has been held up as a model for Americans, doctors themselves are saying that obese patients should be barred from receiving medical services. (Though, in defense of his physician colleagues, DrRich wishes to point out that these same medical humanitarians are also calling for the withholding of medical care from the elderly and smokers – so perhaps they are not being unusually unkind to the fat.)

In light of this, what are we to do with this new study which says that obesity saves money for the healthcare system? Do we reverse course, and embrace this “obesity dividend?” Do we encourage supersizing, and, far from refusing to serve them, offer the overweight free second portions? Do we give them deeply discounted heavy-duty suspensions? Better yet, do we give away free Marlboro starter packs to the fat? (Just think how much money we’d save with obese smokers.)

Thankfully, no.

DrRich has pointed out innumerable times the absurdities we find ourselves promoting when the chief purpose of the healthcare system becomes avoiding costs rather than maximizing health, that is, when its chief job is covert rationing. It is therefore gratifying to say that this is one of those cases where we don’t have to engage in such absurdities. Let’s be plain about it: We don’t need to reevaluate our current vilification of obesity (and smoking) just because people who have these conditions may save us money in the long term.

The reason? We don’t care about the long term.

Who cares that, in 50 or 60 years, today’s healthy 20-year-olds are going to cost us a lot of money? They’re likely to be entirely free to our healthcare system for at least several decades. In contrast, today’s obese and today’s smokers, what with their chronic diabetes, heart disease, kidney disease, joint replacements, strokes, lung disease, &c., are costing us a lot of money right now.

If we actually cared about the long term, we’d be doing something about the Social Security and Medicare entitlements we’ve already signed up for, which in a little more than 20 years will require confiscating more than 50% of each American paycheck, just in payroll deductions. (Never mind income tax.) Heck, just looking at their pay stubs will probably cause most of today’s healthy 20-year-olds to die of apoplexy by the time they’re 40. In any case, the entitlements we’re obligated to provide will threaten societal disintegration long before today’s healthy young adults ever need elder care. Consoling yourself with the idea of projected long-term savings when you’re facing such a fiscal catastrophe is like consoling yourself with the idea of beautiful spring alpine flowers when you’re directly in the path of an onrushing avalanche. Projected long-term savings are completely irrelevant.

The obesity dividend is just smoke, and can be safely ignored. For the greater good of our social welfare, we’re far better off doing what we’re doing today – castigating and humiliating the obese into right actions, and if that fails, then (following the example provided by the British healthcare system which Dr. Berwick and others urge us to use as a model) discriminating against them when they need healthcare. Once we’ve established this useful prototype, we can apply it to whatever additional groups we can identify as targets of our collective indignation.

Whatever it takes to avoid confronting the rationing issue head on.

6 Responses to “Don’t Sweat the Obesity Dividend”

  1. Pavlov says:

    Glad to see you citing this study I’ve been rambling about for the last three years !

    “chief purpose of the healthcare system becomes avoiding costs rather than maximizing health”. You are right, as always. The sole objective of the system has become its own unchallenged survival.

    Here, in Québec, I constantly hear our Obama-like politicians talk of “investment in healthcare” (as if expecting any monetary return, which is utter nonsense). Likewise, doctors (or healthcare providers, as we have to say now) who practice retainer , outside of the dominant public system, are continuously accused of “putting the *system* in jeopardy”.

    Individuality never mattered to government, and never will.

  2. I wrote a post awhile back about the importance of velocity of age and the magic of economic compounding and why living healthier would not cost more than being a fat smoker who dies young.

    Not to mention all the economic benefits that come with being a healthy net producer to society.

  3. Kristin says:

    Possibly Dr. Rich should focus on himself and other physicians who fail to properly diagnose chronic illnesses that cause obesity. I am a Cushing’s disease survivor, (pathology proven in both pituitary and adrenal glands, post-op bilateral adrenalectomy) who for 8 years had physicians ignore the whole picture and tried to write off my symptoms as a prolem caused by being overweight. Not all overweight people are overeaters who are lazy. Many of us actually fight off the weight for years while the symptoms pile on and get worse. Yes, I drained a lot of money from the healthcare system (private insurance as I fought to continue working during my illness). However when I first suspected Cushing’s disease was three years from when I finally got treatment. Who is to blame for three extra years of these costs? Myself or the 2 internists and 3 endocrinologists that ignored biochemical and physical evidence that I was not just sick because I was fat.

    • DrRich says:


      Your 5 doctors missed your diagnosis for so many years because they were not paying attention to detail. Bad doctors, like the poor, will always be with us. I am glad somebody finally got to the root of the problem in your case.

      The message I attempted to transmit in my post is that demonizing obesity is bad. If we think of obesity as a self-induced condition – instead of one that is most commonly related to genetic predisposition, or (as in your case) sometimes a condition secondary to an underlying illness – then we will systematize the error your original doctors made, as well as set a very dangerous precedent that might be applied to other medical conditions that are inconvenient to society.

      I tend to employ irony in my posts for selfish reasons – I enjoy it – and so I take full responsibility for your mistaking my actual message.


  4. Kristin says:

    Thank you for replying to this and clarifying your pov. This quote is what set me off and made me think that you practiced this descrimination. “DrRich has pointed out several times that it is very important to our new healthcare system, as a matter of principle, to be able to discriminate against the obese.” I did get the ironic messages throughout the rest of the article and knew that the author felt this practice was wrong. However beginning with this opening statement made it seem as though Dr. Rich was not the author and I assumed wrong. I stand corrected. Thank you again for setting me straight.

  5. Praveen says:

    Lifecycle analyses of the total cost/benefit of anything is difficult, and such an analysis on a class of people – whether or obese, healthy, or otherwise, is even moreso.

    The principle problem I find with medical studies of this nature, even if we were to take them seriously, is that they ignore the revenue side of the equation.

    What is a smoker’s total economic impact? Do they earn more or less than the healthy? What about the obese? Do healthy people earn more and work for more years to offset their long lives? Who knows?

    When this kind of cost/benefit is applied to a human life, be prepared for ugly and unexpected answers, because you’re basically asking how profitable each group of human can be.

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