Obesity is on the rise but so is a push to accept healthiness at any size. The costs of managing obesity are becoming unsustainable. So who should pay for it?
This seems like a simple question, but I think the subject is more complex. But as a first attempt, let's focus just on the healthcare aspect, e.g. who should pay for healthcare for people who are overweight. In the US, healthcare is a shared cost, generally, with people paying some amount personally (via cash, copays, insurance premiums etc), with some amounts being paid by employers and some by government at various levels. The specifics vary a lot, with the poorest paying the least share out of pocket, and the richest paying the most. I think your argument is generally that "fat" people are more expensive than lower weight people for the government portion of healthcare expenditures, and that it is that portion of their cost you care about (the public burden portion). And your base argument is that their condition is a choice, and because it's a choice it shouldn't be a public burden.
That same "your choice" argument could be used for drug overdoses, motorcycle or scooter accidents with head injuries, auto accidents by speeders, smoking related lung cancer, heart attacks due to lack of cardio exercise by thin people, people who jay walk and get hit by a bus, run of the mill measles by people who chose to forgo vaccination, etc. As a society we'd have lower shared burden medical costs, and a lot more people dying on the streets and sidewalks. So, if you can put a label on it, and say "it was their choice" and deny care, then only people of financial means will have care, because everyone who suffered a health event due to a "choice" would be denied the public cost sharing portion. I'm not sure that's actually what people want, but perhaps it is. Hard to think of something that can't be labeled a "choice" at some level.
You could also look at "fat" as a spectrum. If your BMI is 25.1. should you pay a little more than a 'non overweight' person. If your BMI is 26? When it's 30 and classified as obese should you be charged a higher fee at the doctors office, or higher insurance. Or at BMI of 35? And what about the anorexic patient or the cancer patients wasting away. Should they get rebates because they are thin?
Or we could look at the public policy aspect. Since approximately 74% to 76% of adults in the United States aged 25 and older have a BMI over 25, meaning they are classified as either overweight or obese, this is a huge voter block. Do you think it's likely that 3/4s of the US voters would vote to penalize themselves by decreasing the public share of their health care costs? Particularly when it is the "catastrophic insurance" coverage portion that can keep them out of bankruptcy or death?
Another way to look at Approximately 74% to 76% of adults in the United States aged 25 and older have a BMI over 25, meaning they are classified as either overweight or obese, is to say that 3/4s of US adults are already paying their "fair" share, and 25% are paying more, or overpaying. Kind of like men paying for pregnancy, or women paying for prostate cancer care. In the public portion you pay a share for things that personally you may not suffer. That's just the yin/yang of public services.
I do see obesity as a choice, specifically morbid obesity. There's a whole genre of YouTubers who voluntarily consume family-sized meals 3-4 times a day. They may suffer from addiction or some other issue, but at the end of the day no one is holding a gun to their head forcing them to consume that much food.
You raise good points about shared responsibilities in public services. But at what point do we hold people responsible for their actions? Being a little overweight is one thing; being so heavy that you need a flatbed to transport you to the hospital is something entirely different.
Taking this to the logical extreme and keeping the context of AI adoption in mind, employer-provided health insurance is going to continue getting worse before it ultimately disappears. If a 600+ lb person who can't bathe themselves I'm assuming they can't work and are therefore on public benefits.
As the pyramid inverts you'll have an increasing number of people dependent on publicly-funded healthcare. And if obesity trends continue, you'll have a growing number of morbidly obese people dependent on that system and their costs will be substantially higher for the reasons laid out in this essay.
I think we actually are entering into a healthcare system where only those with financial means are able to afford it. We already have concierge medicine. Elon Musk and Jeff Bezos have access to a totally different healthcare system than you and I do. My argument is I think this trend will continue as healthy people who take care of themselves are forced to cover the costs of those who don't.
As this problem continues to fester, I think there's going to be real animosity towards people who don't take care of themselves. That's going to require political change. Like I said in the essay, I don't see a world where Ironman triathletes willingly pay more so cast members of My 600 lb Life can have subsidized medical care. At some point fair is no longer going to be fair and the people who can opt out increasingly will.
On recent flight from DC to Sacramento it was shocked at the number of XXL and XXXL passengers. Thankfully my 115 lb wife did not take up much room in the center seat, because the kid next to her was 300 lbs with much of it spilling out into her seat space. The guy in front of me was so big that he about knocked my laptop off my tray table every time he leaned back… and I was in extra legroom class seats.
My problem is that we have friends who are fat. I have brothers that are overweight. I have cousins, nieces and nephews that tip the scales. My new daughter in law and my other son’s live in girlfriend are big. I have to keep myself from any judgement. My wife and I, and our two sons, have always stayed fit and healthy body weight. It bothers me because it is a sign of weakness… lack of self control. The people at the airport standing in line for pizza and Chick Fil-A far exceeded the lines where fresh salads could be purchased. The portions people eat are huge. The only fast food I get is and In-and-Out protein style burger, or Subway turkey and avocado on flatbread or a wrap… with lots of veggies and mustard only. I don’t eat a lot of carbs… except some rice. I am a home chef, so we eat well. Made chicken piccata tonight, with roasted summer squash from the garden. Smaller portions. Apples, oranges, grapes, celery and carrots for a snack. Maybe some humus dip. I walk. It isn’t that difficult. I do love cheese, but again, smaller portions.
It's interesting you bring up your recent experiencing flying because airlines seem to be a top priority for the fat acceptance movement. Most airlines have a "passengers of size" policy which allows obese people who cannot comfortably sit in a seat to have an additional seat at no charge.
We all know airlines don't exactly make much profit to being with. But giving away free seats? That gets back to the original question -- who pays for it?
A lot of people struggle with weight -- and for good reason -- but there's a difference between being overweight and being obese. Morbid obesity signals you don't respect yourself or those around you. To demand special treatment for what can only be described as self-induced gluttony is problematic for society.
I am so supportive of the Trump and RFK Jr. MAHA movement. We need something at a national level to lead people away from their terrible eating habits. It is crazy though how stubborn and militant people are about their high-fat, high-calorie food intake.
A number of psychologists including Jordan Peterson make the case that people pursue status almost in excess of everything else they pursue. As much as it can get out of control and be abusive, I think some fat shaming is necessary to provide a sort of negative status that helps motivate them to improve their habits. But when 50+ percent of the people getting on the plane are significantly overweight, it starts to ease their feeling that they are out of place.
Also, Madison Ave., does a great job convincing people that they are high status consuming all the branded fast food and junk food.
Watching videos of kids attending a concern in the 60s, 70s and 80s... it was rare to see any overweight people. Today it is rare to see a majority of people with healthy body weight.
I worked with a friend of mine on a healthy fast-food restaurant concept. We canceled the project after doing the test market work after determining that people would not choose it over a greasy hamburger or burrito. Also, the cost of ingredients and the labor to cook and prepare it was higher than for other fast food.
I would advocate for some tax and regulatory benefits for these types of restaurants to offset the increase cost.
I am overweight. Didn’t use to be this way, it just happens. I have been size zero in clothes and size 22. When I worked, I also paid insurance through my employer. So that means I paid for those who had cancer, mental illness, diabetes, prenatal care, fertility treatments, the list goes on. I also paid my taxes which went for schools primary, secondary, high school, I paid for roads and public transportation. I don’t have kids, so I got no benefits directly, I also have used public transportation, and many other taxes including a rain tax.
We all pay taxes, for things we use and don’t use. I accept that because of the direct and indirect benefits I have received over the years. What I hate is that the system is setup to be against the average individual. The whole fat issue is far more complex it is bases in societal expectations, food addiction and additives, what a woman should look like at every stage of her life, sex, the population at large, genetic modification of our food, the list goes on and on.
If all the Ai, job losses that are predicted happen a whole lot of people will be sitting home, with nothing to do but eat, and eat. We deserve better.
You raise a really good point about our social contract. We all pay into things that we don't necessarily benefit from. Public schools are a good example.
That said, we've entered a period where bad choices are inverting the availability of resources for collective services.
No one seems to understand that personal responsibility is collective responsibility. Everything is me me me me my wants my needs. There's no recognition that the choices we make individually have consequences that affect everyone else.
Looking through the lens of obesity, there's a difference between being overweight and struggling with a broken food-healthcare system, and choosing to gorge yourself with unhealthy foods. There's a whole genre of mukbang videos on YouTube where morbidly obese people literally film themselves eating enough chicken McNuggets to feed a small army.
A lot of these influencers push "fat positivity" because in doing so, it provides them cover to continue doing what they're doing. And sadly, a lot of them have died in their 20s and 30s.
It's one thing if you're overweight and trying, it's a whole other thing to choose obesity and expect society bends to your whim.
I'm deeply terrified of the point you make about people sitting at home eating. That's exactly what WALL-E foreshadowed. If we don't reconcile the choice aspect of obesity and empower people to make healthier choices, I think we're going to head down that road.
And then that brings us to the initial question of who pays for it? How do you convince an Ironman triathlete to pay for the medical care -- and food -- of a morbidly obese mukbank YouTuber? We're quickly reaching a point where that just isn't tenable.
Thanks for your perspective. You gave some things to think about thatI hadn't initially considered.
You bring up many great points for reflection. A few of my thoughts:
- I do not have the stats to back it up, but I have read that the higher health costs in the US are partially due to end of life care.
- The increase in the cost of insurance over the past 10 years is partially tied to the basket of services that the ACA requires to be included in all policies.
- "Health at any size" movement has gotten completely twisted. My first memories of this slogan were that everyone should be active & eat healthfully at their current weight. Don't wait until you can wear Lululemon XS before you go to the gym. I saw that as a very positive development. But the perspective that you can be morbidly obese & healthy is just wrong.
- We have to eliminate the judgement of heavy people as having moral failing. This is a very personal issue for me. I've lost 105 pounds through diet, exercise & taking Zepbound. The first week on the medication stunned me. For the first time in my life, I experienced being uninterested in food. I forget to eat. We don't fully understand the drivers of metabolic health. I am accomplished in every area of my life except my weight. Yet, I am judged for being weak & undisciplined. Nope, there is something missing in my body chemistry that Zepbound fixes.
- The MAHA movement brings a fresh energy to improving America's health. We need education that choosing health is easy. We're conditioned that a bag of Fritos is a quick way to resolve hunger. But there are loads of healthy, tasty and easy options that resolve hunger even better.
You raise a really good point about the perception of all of this being a moral failing.
The issue people don't realize is all of our food has been deliberately engineered to be addictive. I believe I read somewhere that cigarette companies started buying up food companies once the health effects of smoking became more well-known and demand for cigarettes fell. They're in the addiction business and they moved to food.
When you consistently eat ultra-processed addictive foods, it rewires your brain. You begin craving more of what you eat. But that also goes the other way. If you eat kale salads everyday, you change the composition of your microbiome to begin craving kale salads.
I do believe there's a bigger Big Food-Big Pharma conspiracy afoot. They engineer foods they know are addictive and have bad consequences for our health then sell us pharmaceuticals and medical procedures to fix the problem.
The health at any size movement undermines basic biology and science. There's something to be said for accepting people who are trying, but the math doesn't lie: if you eat 3,600 calories a day and only burn 1,000 you're on your way to being cast for My 600lb Life. There's nothing healthy about the way those people live.
Definitely food for thought. You forgot to factor in age. It is easy to see yourself in a health share arrangement in your 20s and 30s but there are typical things that come up with old age. Still, lots of people maintain healthy, independent lifestyles well into their 70s and 80s, including my parents. But that is because they make purposeful, intentional decisions on how they live their lives. They should be rewarded for that. Great ideas, we definitely need to start thinking about this issue before it overtakes us. Fat normalization is a definite no for me.
That's a good callout. I did not consider age in this. And I am definitely biased, I don't have recurring issues and rarely go to the doctor myself so I'm more pre-disposed toward catastrophic emergency plans.
As you get older, healthcare definitely becomes more complicated. That said, I listened to a 90 year old marathoner on a Rich Roll podcast once and I was deeply inspired. Like your parents, there are people who are living proof that if you take care of yourself and make different decisions you can have a good quality of life as you get older.
This is a very useful overview of the problem headed our way. It really could tip our economic scale into collapse. (Pun intended.)
I'm unclear , though, how a fat tax would work when large numbers of obese people are low income or no income, relying on tax-funded social services. Someone who receives SNAP seems unlikely to be someone who pays taxes, much less for their weight. Unless the entire tax system is overhauled and restructured so that people at the bottom of the economic ladder , who are likely to be larger than average, are paying taxes rather than aborbing them, taxing weight seems an unlikely way to solve anything.
I'm also not clear how opting out of the main problem—tax-subsidization of obese people—can work, because even people who opt out of private health insurance still pay taxes. So they aren't opting out of the model that allows obese people to remain unhealthy on the tax-payer dime. Maybe I missed your point.
Like I said, though, this is a good overview and a conversation that really needs to happen. Fat positivity is one of those blatantly cruel pretenses that spread harm in the cause of being "compassionate" and "loving." The whole charade relies on gaslighting everyone into refusing to acknowledge the evidence of their eyes and what they know to be true—what we've long known to be true—about the reality of health and the human body.
This is a good point: "Someone who receives SNAP seems unlikely to be someone who pays taxes, much less for their weight." I think a tax is necessary to incentivize people to change their behavior but to your point, it will be difficult to implement.
With opting out, I think we're going to see an implosion of government subsidized health insurance. The only reason the ACA "worked" was because they initially had a requirement to show proof of insurance when you filed your taxes. If you didn't, you were penalized (I think it was originally a $750 fine). To some extent you still are because there's a tax credit you don't receive if you opt out.
The entire insurance racket only works so long as people continue participating in it. But as employers downsize their labor force/offload work to AI, the supply of employer-provided insurance will decline, the whole thing will implode on itself. Unemployed and freelance workers will be forced to use the exchange. But the options on the exchange are abysmal. Those who can, will start using a combination of healthshares and self-monitoring to manage their health.
Capital is going to flow out of health insurance to new alternatives. We've already reached a point where the medical system isn't sustainable, I suspect it'll only get worse. The government will have to raise revenue somehow to keep it afloat. I think a lot of people have tolerated high taxes for a while, but I don't see a world where Ironman triathletes willingly accept higher taxes to subsidize obese YouTube mukbangers.
I think this issue is part of a larger social issue that will necessitate a bigger conversation about taxes. Should healthy people subsidize obese people? Should homeschooling parents continue subsidizing a broken public school system? Should taxpayers continue subsidizing higher ed through the student loan program? Should people who are trying to work subsidize people who have completely given up? Should citizens support the livelihoods of non-citizens?
Some of these questions have already been asked and that's why we're seeing fault lines emerge with illegal immigration and DEI/"woke" activism in schools. I think fact acceptance is another fault line that is beginning to emerge.
This seems like a simple question, but I think the subject is more complex. But as a first attempt, let's focus just on the healthcare aspect, e.g. who should pay for healthcare for people who are overweight. In the US, healthcare is a shared cost, generally, with people paying some amount personally (via cash, copays, insurance premiums etc), with some amounts being paid by employers and some by government at various levels. The specifics vary a lot, with the poorest paying the least share out of pocket, and the richest paying the most. I think your argument is generally that "fat" people are more expensive than lower weight people for the government portion of healthcare expenditures, and that it is that portion of their cost you care about (the public burden portion). And your base argument is that their condition is a choice, and because it's a choice it shouldn't be a public burden.
That same "your choice" argument could be used for drug overdoses, motorcycle or scooter accidents with head injuries, auto accidents by speeders, smoking related lung cancer, heart attacks due to lack of cardio exercise by thin people, people who jay walk and get hit by a bus, run of the mill measles by people who chose to forgo vaccination, etc. As a society we'd have lower shared burden medical costs, and a lot more people dying on the streets and sidewalks. So, if you can put a label on it, and say "it was their choice" and deny care, then only people of financial means will have care, because everyone who suffered a health event due to a "choice" would be denied the public cost sharing portion. I'm not sure that's actually what people want, but perhaps it is. Hard to think of something that can't be labeled a "choice" at some level.
You could also look at "fat" as a spectrum. If your BMI is 25.1. should you pay a little more than a 'non overweight' person. If your BMI is 26? When it's 30 and classified as obese should you be charged a higher fee at the doctors office, or higher insurance. Or at BMI of 35? And what about the anorexic patient or the cancer patients wasting away. Should they get rebates because they are thin?
Or we could look at the public policy aspect. Since approximately 74% to 76% of adults in the United States aged 25 and older have a BMI over 25, meaning they are classified as either overweight or obese, this is a huge voter block. Do you think it's likely that 3/4s of the US voters would vote to penalize themselves by decreasing the public share of their health care costs? Particularly when it is the "catastrophic insurance" coverage portion that can keep them out of bankruptcy or death?
Another way to look at Approximately 74% to 76% of adults in the United States aged 25 and older have a BMI over 25, meaning they are classified as either overweight or obese, is to say that 3/4s of US adults are already paying their "fair" share, and 25% are paying more, or overpaying. Kind of like men paying for pregnancy, or women paying for prostate cancer care. In the public portion you pay a share for things that personally you may not suffer. That's just the yin/yang of public services.
This is a great comment -- lots to consider here.
I do see obesity as a choice, specifically morbid obesity. There's a whole genre of YouTubers who voluntarily consume family-sized meals 3-4 times a day. They may suffer from addiction or some other issue, but at the end of the day no one is holding a gun to their head forcing them to consume that much food.
You raise good points about shared responsibilities in public services. But at what point do we hold people responsible for their actions? Being a little overweight is one thing; being so heavy that you need a flatbed to transport you to the hospital is something entirely different.
Taking this to the logical extreme and keeping the context of AI adoption in mind, employer-provided health insurance is going to continue getting worse before it ultimately disappears. If a 600+ lb person who can't bathe themselves I'm assuming they can't work and are therefore on public benefits.
As the pyramid inverts you'll have an increasing number of people dependent on publicly-funded healthcare. And if obesity trends continue, you'll have a growing number of morbidly obese people dependent on that system and their costs will be substantially higher for the reasons laid out in this essay.
I think we actually are entering into a healthcare system where only those with financial means are able to afford it. We already have concierge medicine. Elon Musk and Jeff Bezos have access to a totally different healthcare system than you and I do. My argument is I think this trend will continue as healthy people who take care of themselves are forced to cover the costs of those who don't.
As this problem continues to fester, I think there's going to be real animosity towards people who don't take care of themselves. That's going to require political change. Like I said in the essay, I don't see a world where Ironman triathletes willingly pay more so cast members of My 600 lb Life can have subsidized medical care. At some point fair is no longer going to be fair and the people who can opt out increasingly will.
On recent flight from DC to Sacramento it was shocked at the number of XXL and XXXL passengers. Thankfully my 115 lb wife did not take up much room in the center seat, because the kid next to her was 300 lbs with much of it spilling out into her seat space. The guy in front of me was so big that he about knocked my laptop off my tray table every time he leaned back… and I was in extra legroom class seats.
My problem is that we have friends who are fat. I have brothers that are overweight. I have cousins, nieces and nephews that tip the scales. My new daughter in law and my other son’s live in girlfriend are big. I have to keep myself from any judgement. My wife and I, and our two sons, have always stayed fit and healthy body weight. It bothers me because it is a sign of weakness… lack of self control. The people at the airport standing in line for pizza and Chick Fil-A far exceeded the lines where fresh salads could be purchased. The portions people eat are huge. The only fast food I get is and In-and-Out protein style burger, or Subway turkey and avocado on flatbread or a wrap… with lots of veggies and mustard only. I don’t eat a lot of carbs… except some rice. I am a home chef, so we eat well. Made chicken piccata tonight, with roasted summer squash from the garden. Smaller portions. Apples, oranges, grapes, celery and carrots for a snack. Maybe some humus dip. I walk. It isn’t that difficult. I do love cheese, but again, smaller portions.
It's interesting you bring up your recent experiencing flying because airlines seem to be a top priority for the fat acceptance movement. Most airlines have a "passengers of size" policy which allows obese people who cannot comfortably sit in a seat to have an additional seat at no charge.
We all know airlines don't exactly make much profit to being with. But giving away free seats? That gets back to the original question -- who pays for it?
A lot of people struggle with weight -- and for good reason -- but there's a difference between being overweight and being obese. Morbid obesity signals you don't respect yourself or those around you. To demand special treatment for what can only be described as self-induced gluttony is problematic for society.
I am so supportive of the Trump and RFK Jr. MAHA movement. We need something at a national level to lead people away from their terrible eating habits. It is crazy though how stubborn and militant people are about their high-fat, high-calorie food intake.
A number of psychologists including Jordan Peterson make the case that people pursue status almost in excess of everything else they pursue. As much as it can get out of control and be abusive, I think some fat shaming is necessary to provide a sort of negative status that helps motivate them to improve their habits. But when 50+ percent of the people getting on the plane are significantly overweight, it starts to ease their feeling that they are out of place.
Also, Madison Ave., does a great job convincing people that they are high status consuming all the branded fast food and junk food.
Watching videos of kids attending a concern in the 60s, 70s and 80s... it was rare to see any overweight people. Today it is rare to see a majority of people with healthy body weight.
I worked with a friend of mine on a healthy fast-food restaurant concept. We canceled the project after doing the test market work after determining that people would not choose it over a greasy hamburger or burrito. Also, the cost of ingredients and the labor to cook and prepare it was higher than for other fast food.
I would advocate for some tax and regulatory benefits for these types of restaurants to offset the increase cost.
I am overweight. Didn’t use to be this way, it just happens. I have been size zero in clothes and size 22. When I worked, I also paid insurance through my employer. So that means I paid for those who had cancer, mental illness, diabetes, prenatal care, fertility treatments, the list goes on. I also paid my taxes which went for schools primary, secondary, high school, I paid for roads and public transportation. I don’t have kids, so I got no benefits directly, I also have used public transportation, and many other taxes including a rain tax.
We all pay taxes, for things we use and don’t use. I accept that because of the direct and indirect benefits I have received over the years. What I hate is that the system is setup to be against the average individual. The whole fat issue is far more complex it is bases in societal expectations, food addiction and additives, what a woman should look like at every stage of her life, sex, the population at large, genetic modification of our food, the list goes on and on.
If all the Ai, job losses that are predicted happen a whole lot of people will be sitting home, with nothing to do but eat, and eat. We deserve better.
You raise a really good point about our social contract. We all pay into things that we don't necessarily benefit from. Public schools are a good example.
That said, we've entered a period where bad choices are inverting the availability of resources for collective services.
No one seems to understand that personal responsibility is collective responsibility. Everything is me me me me my wants my needs. There's no recognition that the choices we make individually have consequences that affect everyone else.
Looking through the lens of obesity, there's a difference between being overweight and struggling with a broken food-healthcare system, and choosing to gorge yourself with unhealthy foods. There's a whole genre of mukbang videos on YouTube where morbidly obese people literally film themselves eating enough chicken McNuggets to feed a small army.
A lot of these influencers push "fat positivity" because in doing so, it provides them cover to continue doing what they're doing. And sadly, a lot of them have died in their 20s and 30s.
It's one thing if you're overweight and trying, it's a whole other thing to choose obesity and expect society bends to your whim.
I'm deeply terrified of the point you make about people sitting at home eating. That's exactly what WALL-E foreshadowed. If we don't reconcile the choice aspect of obesity and empower people to make healthier choices, I think we're going to head down that road.
And then that brings us to the initial question of who pays for it? How do you convince an Ironman triathlete to pay for the medical care -- and food -- of a morbidly obese mukbank YouTuber? We're quickly reaching a point where that just isn't tenable.
Thanks for your perspective. You gave some things to think about thatI hadn't initially considered.
You bring up many great points for reflection. A few of my thoughts:
- I do not have the stats to back it up, but I have read that the higher health costs in the US are partially due to end of life care.
- The increase in the cost of insurance over the past 10 years is partially tied to the basket of services that the ACA requires to be included in all policies.
- "Health at any size" movement has gotten completely twisted. My first memories of this slogan were that everyone should be active & eat healthfully at their current weight. Don't wait until you can wear Lululemon XS before you go to the gym. I saw that as a very positive development. But the perspective that you can be morbidly obese & healthy is just wrong.
- We have to eliminate the judgement of heavy people as having moral failing. This is a very personal issue for me. I've lost 105 pounds through diet, exercise & taking Zepbound. The first week on the medication stunned me. For the first time in my life, I experienced being uninterested in food. I forget to eat. We don't fully understand the drivers of metabolic health. I am accomplished in every area of my life except my weight. Yet, I am judged for being weak & undisciplined. Nope, there is something missing in my body chemistry that Zepbound fixes.
- The MAHA movement brings a fresh energy to improving America's health. We need education that choosing health is easy. We're conditioned that a bag of Fritos is a quick way to resolve hunger. But there are loads of healthy, tasty and easy options that resolve hunger even better.
You raise a really good point about the perception of all of this being a moral failing.
The issue people don't realize is all of our food has been deliberately engineered to be addictive. I believe I read somewhere that cigarette companies started buying up food companies once the health effects of smoking became more well-known and demand for cigarettes fell. They're in the addiction business and they moved to food.
When you consistently eat ultra-processed addictive foods, it rewires your brain. You begin craving more of what you eat. But that also goes the other way. If you eat kale salads everyday, you change the composition of your microbiome to begin craving kale salads.
I do believe there's a bigger Big Food-Big Pharma conspiracy afoot. They engineer foods they know are addictive and have bad consequences for our health then sell us pharmaceuticals and medical procedures to fix the problem.
The health at any size movement undermines basic biology and science. There's something to be said for accepting people who are trying, but the math doesn't lie: if you eat 3,600 calories a day and only burn 1,000 you're on your way to being cast for My 600lb Life. There's nothing healthy about the way those people live.
Congrats on your weight loss! It's not easy.
Definitely food for thought. You forgot to factor in age. It is easy to see yourself in a health share arrangement in your 20s and 30s but there are typical things that come up with old age. Still, lots of people maintain healthy, independent lifestyles well into their 70s and 80s, including my parents. But that is because they make purposeful, intentional decisions on how they live their lives. They should be rewarded for that. Great ideas, we definitely need to start thinking about this issue before it overtakes us. Fat normalization is a definite no for me.
That's a good callout. I did not consider age in this. And I am definitely biased, I don't have recurring issues and rarely go to the doctor myself so I'm more pre-disposed toward catastrophic emergency plans.
As you get older, healthcare definitely becomes more complicated. That said, I listened to a 90 year old marathoner on a Rich Roll podcast once and I was deeply inspired. Like your parents, there are people who are living proof that if you take care of yourself and make different decisions you can have a good quality of life as you get older.
This is a very useful overview of the problem headed our way. It really could tip our economic scale into collapse. (Pun intended.)
I'm unclear , though, how a fat tax would work when large numbers of obese people are low income or no income, relying on tax-funded social services. Someone who receives SNAP seems unlikely to be someone who pays taxes, much less for their weight. Unless the entire tax system is overhauled and restructured so that people at the bottom of the economic ladder , who are likely to be larger than average, are paying taxes rather than aborbing them, taxing weight seems an unlikely way to solve anything.
I'm also not clear how opting out of the main problem—tax-subsidization of obese people—can work, because even people who opt out of private health insurance still pay taxes. So they aren't opting out of the model that allows obese people to remain unhealthy on the tax-payer dime. Maybe I missed your point.
Like I said, though, this is a good overview and a conversation that really needs to happen. Fat positivity is one of those blatantly cruel pretenses that spread harm in the cause of being "compassionate" and "loving." The whole charade relies on gaslighting everyone into refusing to acknowledge the evidence of their eyes and what they know to be true—what we've long known to be true—about the reality of health and the human body.
This is a good point: "Someone who receives SNAP seems unlikely to be someone who pays taxes, much less for their weight." I think a tax is necessary to incentivize people to change their behavior but to your point, it will be difficult to implement.
With opting out, I think we're going to see an implosion of government subsidized health insurance. The only reason the ACA "worked" was because they initially had a requirement to show proof of insurance when you filed your taxes. If you didn't, you were penalized (I think it was originally a $750 fine). To some extent you still are because there's a tax credit you don't receive if you opt out.
The entire insurance racket only works so long as people continue participating in it. But as employers downsize their labor force/offload work to AI, the supply of employer-provided insurance will decline, the whole thing will implode on itself. Unemployed and freelance workers will be forced to use the exchange. But the options on the exchange are abysmal. Those who can, will start using a combination of healthshares and self-monitoring to manage their health.
Capital is going to flow out of health insurance to new alternatives. We've already reached a point where the medical system isn't sustainable, I suspect it'll only get worse. The government will have to raise revenue somehow to keep it afloat. I think a lot of people have tolerated high taxes for a while, but I don't see a world where Ironman triathletes willingly accept higher taxes to subsidize obese YouTube mukbangers.
I think this issue is part of a larger social issue that will necessitate a bigger conversation about taxes. Should healthy people subsidize obese people? Should homeschooling parents continue subsidizing a broken public school system? Should taxpayers continue subsidizing higher ed through the student loan program? Should people who are trying to work subsidize people who have completely given up? Should citizens support the livelihoods of non-citizens?
Some of these questions have already been asked and that's why we're seeing fault lines emerge with illegal immigration and DEI/"woke" activism in schools. I think fact acceptance is another fault line that is beginning to emerge.