The Health Care Debate on Fat is a Bunch of Baloney

If you’re following the national shouting match on health care reform, you may have noticed a hue and cry against fat people. If you Google the phrase “obese people should pay more for national health care,” you’ll see a slew of articles, blogs, and comments on the subject. Many people who say “amen to that” are being pretty judgmental. They characterize obesity as the self-imposed condition of slackers who refuse to change their willfully poor food and exercise choices. Commentators describe payment as punishment and health care as burden. As in, thin people are being punished by having to pay for fat people’s choices. Fat people should shoulder the higher financial burden of their care.

I call bullsh…. um, baloney.

I don't disagree that being fat is a health risk or that it costs more in care dollars. I call baloney on the terms of the debate. We should not be asking how culpable people are for their fat. Our national obesity epidemic is a symptom of a larger issue. And we, as members of a democratic society, are collectively accountable for the conditions that foster it. Our food policies are part of the problem:

  • Foods that are affordable are not nutritious.
  • Foods that are nutritious are not affordable.
  • Public education about nutrition is slanted because it is designed by the same entity charged with providing a market for certain food products.

The population most vulnerable to this combination of pressures—low-income Americans—is the same population most likely to be overweight. (See these stats.) These are the people being berated for laziness and poor choices.

But where is the bright line of personal choice? Let’s not be lazy, ourselves, in giving the answer. Personal choices are influenced by context. Let’s take a look at the conditions under which people make their food choices.

How are more and more people getting fat? The ubiquity of cheap processed foods is certainly a culprit. Processed foods are full of corn syrup, white flour, and partially hydrogenated oils.  These caloric ingredients preserve shelf lives, increase flavor, and are dirt cheap to manufacture. In fact, they are cheap partly because they’re made of corn, wheat, and soybeans, which our government subsidizes. Processing things out of cheap ingredients is a way for food companies to add profit margin while still keeping products more affordable than the unsubsidized fruits and vegetables we know we’re supposed to eat.

Or do we know we’re supposed to eat them? In public school, where most Americans get their educations, children learn the USDA’s Food Guide Pyramid. It recommends that we eat a gracious plenty of processed starches: six to eleven daily servings of bread, pasta, cereal, and rice. In his book Eat, Drink, and Be Healthy, Dr. Walter C. Willett recommends a Healthy Eating Pyramid of unprocessed grains, seeds, beans, plant oils, vegetables, fruits, lean meats, and exercise. Dr. Willett’s pyramid is based on medical research. The USDA pyramid was created by a government body that is also in charge of marketing the products it underwrites.

Speaking of markets, we have watched food prices rise in the last few years. This forces everyone to use a bigger proportion of their income on food. For people with little or no disposable income, the criteria of personal choice will shift. It may no longer be “Should I eat baloney sandwiches or tofu and spinach.” Maybe now it’s “What can I afford that will be enough to fill all the stomachs in my household?”

Is this lazy? Is it willful? How much latitude do people have in this choice? Are the concepts of social burden and punishment, in the context of paying for health care, meaningful here? Are they appropriate?

Rather than punishing fat people—or even rewarding thin people, as has also been proposed—why can’t we undo some of the policies that contribute to the circumstances around rampant obesity? What could we do to make chard as cheap as corn chips? What if we taught schoolchildren to eat a plant-based, unprocessed diet and then actually served them one in our school lunch programs? What if AFDC included an option for an attractively-priced CSA box that was as easy to get home as a grocery bag full of breakfast cereal and Hamburger Helper? Couldn’t changes in national food policy make a change in the terms of our debate on health care? Couldn’t it actually make us all healthier to start with? And wouldn’t that be treating the cause rather than the symptom?

Amy Boland is a Twin Cities writer and food enthusiast. This is her first article for Simple, Good, and Tasty. You can read more of her food musings on her blog Cook 'Em if You Got 'Em

This post was proudly submitted to Food Renegade's Fight Back Fridays.