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.


Amy - an EXCELLENT commentary! Charging fat people more for health care is only putting a band-aid on a gaping wound. There is a lot of education needed on how to make healthier food choices on a limited budget.
Heck, it's only been in the last month or so I've come around to dried beans over canned (and I'd like to think I make good food choices in general). Cheaper by far and much better for you without all that added salt. Too many people don't know how to cook and rely on the crutch that is cheap, empty calorie, food-like products.

There is a segment in the movie "Food, Inc." that illustrates your point perfectly. A family is deciding between an apple and a less healthy alternative. The less healthy choice would feed more of them and fill them up more. The apple would provide more nutrients and fewer unhealthy fats. It's not a hard leap when you have $1 to spend to buy the unhealthy food. Sending your children to bed hungry breaks a parent's heart, and saying "But the smaller portion of healthier food you ate is better for you!" does nothing to quell the hunger pangs or guilt.

The food industry, poorly written and executed governmental regulations, the school lunch dumping grounds (oops, I mean program) and advertising all share a piece of the blame pie.

Wonderful article Amy, and raises a point that no one will during this national health debate. Our government's food policy needs to shift as much as we need to reform our health care system. Teaching and allow people to take care of themselves by eating healthy will only lead to decreased health care costs. Thanks for writing this.

I'd like to recommend "Good Calories, Bad Calories" by Gary Taub. Taub's book was full of really good scientific backing every step of the way, and it supports Amy's perspective here that the food pyramid was too politically influenced and the conventional wisdom about low fat foods is incorrect. He's not explicitly proposing a specific diet, but rather researching the health impact of the foods we eat.

Great discussion! Building on what Amy and other commenters have suggested,

They say an ounce of prevention is worth a pound of cure. To have any chance of stemming the obesity epidemic and the impact on health care costs, changes need to be made to the front part of the equation.

In my mind, it starts with our kids, educating them about healthy food and getting them in the habit of eating (and enjoying!) fresh, unprocessed foods.

Broader picture, until we make it affordable for people to eat fresh, high quality unprocessed foods, improve access to healthy food options and in general make eating healthy cool, we may not be able to make much headway.

I'd like to see a government campaign making it sexy to eat whole foods!

Kris makes a good point. The wild card is that many people are often so exhausted from working that they don't want to take the time to cook, or they don't know how to cook. How to address this?

Also the cost of becoming a healthy weight is large. I'm currently overweight and I am really trying to lose weight. I have problems with emotional eating and being lazy.

So, I go to WeightWatchers, which is about $40 a month. I could have chosen a nutritionist, different weight loss plans, or a book. Most of these would be much more expensive. I cannot do it alone, just like most Americans can't.

My husband and I have joined the gym. That's $90 a month. I grew up playing sports, so I know what I'm doing. Many people don't and would really need the help of a personal trainer or a good friend to get real results.

My insurance doesn't pay for these things. But they would pay for my diabetes medication if I became a diabetic, my stay in the hospital if I had a heart attack, or my stomach stapling. There should be money for healthy activities written into the health care bill for all Americans actively losing weight or maintaining a healthy weight.

Amy P - I think the cooking issue is one that needs to be addressed with the rest as you suggested, with kids. However until those kids grow up and are cooking for themselves, this is something that doesn't have an easy answer. Not wanting to cook is one issue. Not knowing how is another, although more easily addressed.

I'm willing to go one step further than saying the food problem is a contributing factor to the poor health of the country. It is THE factor. You can't call anything "health care" reform unless the false diet of this country is changed. Otherwise, reform is a shell game.

I am very glad you write this article, Amy. I completely agree and think more people need to realize what you have written.

Great American Plan. Charge people to make themselves sick and fat on lousy food, then charge them for "cure" or punish them and withhold "cure."

This is the profit-motive run amok!

Great article and I couldn't agree more about eating healthy. That is why I buy local produce and order premium organic breakfast cereals from Serial Cereals at

Even better than buying cereal, make your own granola from oats, seeds, and nuts from the bulk section of your local co-op!

I had an interesting experience this year. My wife wanted to have some workout mates so I rented a local gym and purchased everything she needed to do an aerobics class. My main concern was my wife's health and not the profit so we offered it for free to anyone who wanted to participate. We only had a few people who tried and gave up.

I actually speculated in advance that this would be the result. Good intentions don't really account for much it's the result that matters.

So regardless of our good intentions, whether eating right or exercise, if peoples behavior don't change then obesity is going to remain a problem. The question is where do we draw the line when dealing with other peoples behaviors. As a county we've educated people about diet and exercise and I think that's about as much as we should do. Taxing the poor seems ridiculous to me.

Wow! All sorts of good, smart comments. Thanks so much for, um, weighing in. The experiences you mention are great ones, and raise important points related to our food system, our behavior, and what we've learned and experienced. Our current healthcare system does not differentiate between those who make good and bad decisions, and until we start doing a better job with education and policy, it's clear that we'll all continue to pay one way or another.

Nice work, Amy. And a great comments section too. I agree with what has been said here about food production, costs and nutrition education. The food industry and the health care industry being profit based have caused a lot of damages, none of which will be easily rectified. Please forgive me if my comments seem to swerve away from the topic of food, but there is so much more to the story.

I would like to state that a focus on "fat" in any discussion on health care is myopic. Not every fat person is inherently unhealthy, nor is every thin person healthy.

I eat a healthy diet. Well into middle age my cholesterol is on the low edge of the normal range, my sugars are fine, my blood pressure is on the high side of the preferred range, but not bad when looking at my genetic background. Eating good food makes me feel good, too! My point: I am overweight, and also healthy.

Using Fat-Blaming as an argument against a national health care policy is a despicable attempt to cash in on people's prejudices. It shifts the conversation away from the topic and feeds an emotional response. Consider this: Should we monitor alcohol consumption and charge higher premiums to drinkers because such behaviors can lead to an increase of certain medical conditions? Smoking? Heritage? Shall we charge more to people with anorexia/bulimia because they are unhealthy, or do they get a pass because they are thin?

Healthy food choices help make people healthy. Some people don't have a choice much of the time. Some people don't realize the difference. Education. Accessibility. Affordability. I couldn't agree more thoroughly with the points that Amy and her commentators have made. The focus of the discussion on health care reform should be on health: attaining it, maintaining it, and caring for people in the process, rather than marginalizing (or scapegoating) the weak/poor/sick/fat.

Great Commentary! In thinking about food choices-fresh vs processed- where do we, in cold climates, find decent fresh produce in , say, November thru April? Our grocery stores in Duluth, a relatively large Northern MN town, offer little decent, fresh stuff in summer, let alone winter. Produce shelves are loaded with sub-standard-quality, imported goods. Our choice of stores is very limited with the Coop offerings too pricey for many. Summer farmers markets are finally becoming popular, but their choices are not nearly what you have in Minneapolis and St Paul.

I see you arguing for systematic change but not recognizing the power that people have in their own everyday choices. While some people do not have a choice about the food they eat, I think that a majority of the middle class does have a choice. They just choose not to eat as healthy as they could (me for example, I just a had a cosetta Pizza slice, so yummy and not healthy). I also have to make it a priority to exercise so that I stay in shape. I don't always like to do it, but I do it anyway.

If privledged people take personal accountability for the choices that they make, then industry will hopefully respond. I think that is why there are so many co-ops in the twin cities. People are consciously choosing to eat differently. One thing I debate often with my friends is how do you get people to take personal responsibility for the choices they have made in life? We all must take into considersation culture, situation, access to resources, etc. But what I want to learn more about is resiliancy. So many people are successful in spite of the odds (and that is definately not easy).

You are SOOOO RIGHT about the food pyramid and schools. What a big lie the food pyramid is. How the food Pyramid is tied into research done by the government that subsidizes the product is rediculous.

Fun to read, thanks for making me think.

Hey, Healthy in the Heights--

Thanks for your challenging and thoughtful comment... it might be the closest thing to dissent on the comment board thus far!

I am not arguing that people are not accountable for their personal choices. I'm arguing that it is counterproductive to narrow a complex set of circumstances down to an arbitrary, black and white determinant of who is blameworthy and who isn't. Everyone's responsible for what they choose to do. But few people are individually and directly responsible for the context of their choices, i.e. for the options they have to choose from. Handing down judgments, blame, and moral comparisons is no way to run a health care system. The idea of demonizing fat people, as Judy says, is arbitrary, irrational, and ultimately counterproductive. I am suggesting that if we are really interested in providing health for all people, we will start addressing the roots of unhealth.

Do you and I have some common ground here? My hope is that people on all sides of the debate can find that with each other and work toward long-term solutions that make us all better off, even though we all sometimes eat a piece of pizza.

Amy, you are awesome.

Your comment about AFDC made me think about my daughter and the WIC program ( My daughter receives WIC (special supplemental nutrition program for Women, Infants and Children). She went in the other day for an appointment and was told that her 14 mo daughter was 1) drinking too much water, 2) not drinking enough milk - a minimum of 3 cups a day of whole milk - and 3) not enough fruit juice. This is the same agency whose coupons push the dairy (milk & cheese) and juice (aka sugar water), some eggs and a choice of dried beans, bread or tortillas, but limit the [combined] fruit and veggie purchases to no more the $6.

To top it off, I just discovered that they have Farmer's Market Nutrition Program. "Each farmers market season in [specific state], each WIC recipient in a household receives $20 in automated Food Instruments (AFIs) to purchase locally grown fruits, vegetables or fresh herbs. Local WIC agencies issue the farmers market AFIs and provide nutrition education on the importance of including fruits and vegetables in the diet daily." We have over 20 participating markets in our county. In the year and a half - two farmer's market seasons - my daughter has been on this program no one has *ever* mentioned it to her.

Boggles the mind.

This was great--and took the thoughts right out of my head. I find it amusing that one of the proponents of this is favorite part of an NPR piece on it the other day was when the CEO was asked whether Safeway would consider increasing prices or taxes on unhealthy food products and reduce prices on good ones. Bet you can guess the answer to that one! And, I can bet you THAT would be a bigger incentive than higher health care costs. It really made me angry, as a person with an obesity problem. I try and actually eat rather well, and exercise...just not quite enough to solve the problem. The problem is that our world is set up to not help matters, as you've aptly pointed out in a much more coherent manner than I could. I don't debate that it's better to not carry excess weight, but I think even the studies that examine health impacts of obesity have a bias against fat people. I've known many big people who lived long healthy lives. Seriously! It's very frustrating...another healthcare issue faced by obsese people is bias from medical professionals. I've had doctors write off legitimate problems because they attributed it to me being overweight. And, I get thin friend who goes to the same doctor never exercises and would eat rather badly, but got none of the "eat healthy and exercise" lectures. It just contributes to the problem I have--which is that I learned to turn to food for comfort when I was little and made fun of for being fat! It's a viscious cycle...anyway, thanks for the thoughts!

Understand the point but disagree with the basic premise. An apple, a can of tuna and piece of whole wheat bread is not more expensive than a big Mac! Baloney is expensive. Chips are expensive. Soda Pop is expensive. Water is cheap. Milk is less expensive than soda pop! American children are now having 3 snacks a day. AND we have become a culture of people that should not have to EVER feel hungry. We are supposed to get hungry. BEING HUNGRY IS NOT A BAD THING!
Demonizing fat people? Are insurance companies who charge sky high premiums demonizing drivers who speed and become involved in wrecks? YES Should a car have a governor so that the car can not go over a certain speed limit. Is the car manufacturer who makes the car capable of going 100MPH responsible for the person who drives it that fast? NO If the person chooses to drive that fast and there are negative consequences, then they have to pay for their choices. Even if they were driving fast because they had an emergency or were late for work. I am tired of excuses and blaming someone else for ones personal decisions.

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