All Commentary
Saturday, June 1, 2002

Government Needs to Lose Weight

Being Overweight Is a Private, Not Public, Health Issue

How ironic that just as an already bloated government is taking on major new powers, it is exhorting us to lose weight. That’s exactly what former Surgeon General David Satcher did before leaving office. In his “Call To Action To Prevent and Decrease Overweight and Obesity,” Dr. Satcher wrote that “Our ultimate goal is to set priorities and establish strategies and actions to reduce overweight and obesity.”

This requires more than a chuckle, a shrug, and a “there they go again,” for it’s indicative of a seriously flawed view of government’s relationship to what used to be private matters. The line between public and private health has long been smudged and is on its way to being erased altogether. Not to be an alarmist, but advocates of individual liberty should be alarmed.

It’s not as though people haven’t heard that being fat might be unhealthy. Books, websites, talk shows, and commercials every day bombard us with that message and the various ways to shed pounds. Have you seen Jared at your local Subway sandwich shop yet? Have you heard of Slimfast? Few have gone broke promoting a fad diet. If anything, people worry too much about their weight.

That great debunker of junk science, Steven Malloy, writes that the government’s statistics on overweight and obesity are based on “suspect research,” such as unverified telephone surveys and “an arbitrary definition of ‘overweight’ based on ‘body mass index.’” Malloy adds that the government’s estimate of 300,000 deaths a year is “unadulterated junk science.” The New England Journal of Medicine also finds the data unreliable, Malloy says. He further criticizes Satcher’s report because it ignores important differences between being overweight and being obese. Obesity is unhealthy, Malloy says, “But the evidence supposedly linking mild-to-moderate overweight with increased health problems is murky, based only on flaky statistics.” Malloy even debunks the alleged relationship between childhood and adult weight problems: the evidence is lacking.

But forget all that. Even if all the medical alarmism were justified, why is it any of the government’s business? Conceded, that question sounds outlandish these days, accustomed as we are to believing that everything is the government’s business. But once we remind ourselves that, as George Washington is reputed to have said, “Government is not reason; it is not eloquence. It is force,” we should be wary of its portly scheme to slim us down. That scheme consists of a long “menu” of “activities and interventions in five key settings: families and communities, schools, health care, media and communications, and worksites.” In other words, we are to have more intrusion from Washington, D.C., in everything from our family and community lives to our jobs in order to get us to lose weight. Where in the Constitution is the central government delegated the power to do this?

The menu of activities contains these ominous items, among others:

“Empower families to manage weight and health through skill building in parenting, meal planning, and behavioral management.”

“Educate parents about the need to serve as good role models by practicing healthy eating habits and engaging in regular physical activity in order to instill lifelong healthy habits in their children.”

“Establish worksite exercise facilities or create incentives for employees to join local fitness centers.”

“Establish a dialogue to consider classifying obesity as a disease category for re-imbursement coding.” (Emphasis added.)

And on and on. It is obvious that this plan will take state coercion to new heights.

It’s easy to make fun of this kind of government intervention, but it is serious. As seen in the last item quoted, the Satcher plan is another step in the medicalization of the normal challenges of life, which Thomas Szasz has long cautioned against. Overeating and being overweight are typically not illnesses or symptoms of disease; they’re choices or the result of previous choices. Likewise, resisting gastronomic temptation is not essentially a medical matter. It’s a matter of self-control.

Public health used to refer to contagious diseases, where person A could infect person B without either actually doing anything more than, say, walking down the street. (The quarantining of tuberculosis sufferers was not to protect them but to protect others from deadly germs.) I have yet to hear of anyone catching obesity. Being overweight, if a health issue at all, is a private, not a public, health issue. That line is worth restoring and maintaining.

Notice the reference to “reimbursement coding.” That’s the tip-off. This is really about getting someone else to pay for weight-loss services through health insurance or government. It’s finance, not medicine, which is only debased in the process.

The consequences of third-party payment for medical services, which has its provenance in government policy, are never-ending. If the government and insurance companies are going be the direct payers for medical care, they must monitor people’s spending if it is not quickly to get out of hand. (Goodbye privacy.) Some services will be disqualified for reimbursement on the ground that they are not real medical services. But that will cost vendors and would-be buyers money, which will make them unhappy. They thus have an interest in lobbying to have their favorite services declared reimbursable. And to do that, they must have the conditions addressed by those services declared “diseases” or “disorders.”

Thus does the medicalization of life go into a gallop. Habits are easy to form. In short order, virtually everything in life is taken to be medical, which is ominous because people readily accept government edicts about health that they would never accept were they about morality. Medical problems are typically seen as happening to people; unlike moral problems, they are not regarded as the result of choices (though it is untrue that we are not responsible for any of our health problems). The more things we define as medical, the fewer we define as moral—and the more scope we allow for coercive intervention by state-deputized doctors.

An unpleasant aroma arises from the government’s interest in our health. The Nazis and communists, who believed that the individual belongs to the collective, saw maintenance of the people’s health as an essential duty of the totalitarian state. The Satcher plan suggests that dietary decisions are not our own business because we are the property of the state. What else are we to conclude? The document says, “The Nation must take action to assist Americans in balancing healthful eating with regular physical activity.” But what is the Nation if it is not Americans? The reification of the Nation by the minister of physical and mental hygiene should concern anyone who values his freedom.

  • Sheldon Richman is the former editor of The Freeman and a contributor to The Concise Encyclopedia of Economics. He is the author of Separating School and State: How to Liberate America's Families and thousands of articles.