Fattening of America

ERIC A. FINKELSTEIN, PHD, MHA, is a nationally acclaimed expert on the subject of economics and obesity. He is a health economist with the research organization RTI International in Research Triangle Park, North Carolina, and teaches health economics at Duke University. His work focuses on the economic causes and consequences of health-related behaviors, with a primary emphasis on obesity. Finkelstein has published over thirty peer-reviewed articles on the economics of obesity and related behaviors. His research has been featured on the front page of USA Today and has been covered in the Economist, the New York Times, Forbes, the Washington Post, and many other newspaper, radio, and television outlets. LAURIE ZUCKERMAN left her corporate PR job in 1999 to make writing her full-time career. She contributes columns and feature articles to a number of business journals and lifestyle magazines, and writes for businesses ranging from Fortune 500s to startups, with a focus on health care, high tech, and business.

“Fatty, fat, fat, fat,” chants Bart Simpson. He has a point. Americans are getting fatter. But health economist Finkelstein (public health economics program, Research Triangle Inst.; coauthor, with Phaedra S. Corso and Ted R. Miller, The Incidence and Economic Burden of Injuries in the United States) and business writer Zuckerman (coauthor with Mary Cantando, Nine Lives: Stories of Women Business Owners Landing on Their Feet) analyze the finances behind the fat. They trace some of the familiar causes of the bulging American waistline that Greg Critzer identified in Fat Land: How Americans Became the Fattest People in the World. They weigh in on the economics of obesity, which they trace back to predictable sources such as school lunch rooms, fast food, television, commuting, and working moms. Then they target some surprising causes, including health insurance. On the flip side, they detail the economic consequences of obesity. For instance, obese employees take more sick days than do normal-weight employees-and their paychecks are slimmer. The authors highlight fascinating new scientific research into the causes of obesity and offer tips on lightening your load over the long haul. This book serves up a healthy selection for public and academic library business collections.—Carol J. Elsen, Univ. of Wisconsin, Whitewater (Library Journal, January 2008) Everyone knows Americans are growing fatter, but health economist Finkelstein crunches the economic figures behind the nation's obesity epidemic and the results aren't pretty. Along with health-care writer Zuckerman, researcher Finkelstein delves into how modern technology reduces the cost of producing higher-calorie processed goods, decreases our activity level and puts our health in danger. Finkelstein debunks myths about the long-range cost of food production and consumption and scrutinizes the impact of genetics and U.S. fiscal policy on the nation's waistline, frequently using economics metrics in his analysis. Generous with summaries of major points, Finkelstein simplifies current stats to explain how the country's thunderous weight gain is straining Medicare and Medicaid and hurting our military readiness. The only positive effect he sees from the obesity epidemic is the creation of the “ObesEconomy”—a market sustained by gyms, diet drugs and other products and services designed to curb weight gain. Horrified by studies that reveal that obese children have a quality of life similar to children with cancer, the investigatory economist even throws in some health tips on dropping pounds. Despite a frequent reliance on economic tools and indicators, this combination study/motivational guide makes for a pleasant educational read, comparable to a vegetable puree snuck into a dessert. (Jan.) (Publishers Weekly, December 3, 2007)“Finkelstein’s tone is chatty and accessible…obesity is ultimately bad economics.” (Financial Times, Saturday 16th February 2008)“The authors show there is a casual relationship between the growth of the waistline and the changing shape of the economy.” (Securities & Investment Review, March 2008)

• Introduction: Answering the Age-Old Question: Why is Uncle Al So Fat? ixChapter 1 Craze or Crisis? 1So Why Now? 2My Soccer Team Eats Oranges 3So How about Adults? Are We Gaining, Too? 7A Growing Waistline Can Be Bad for Your Health 10But Are We the Only Ones Gaining Weight? 13The Longer You Stay, the Bigger You Get 16Chapter 2 I’ll Take a Deep-Fried Coca-Cola 17First Things First 18Cheap Food Gets Cheaper 19The Rise of French-Fried Potatoes 22Please Pass the High-Fructose Corn Syrup 24A Full Pound of Sausage, Bacon, and Ham: Have a Meaty Morning 28Too Much of a Good Thing 31Kids Are Also Drinking the Kool-Aid 33When is Enough Enough? 34Chapter 3 Why We’re Moving Less (Hint: It’s Not Just the La-Z-Boy) 37But I Don’t Have Time! 38Not Quite the Jetsons, But . . . 40Just Be a Marathon Runner 44We’re Not Farmers Anymore 45Sprawling Out 47Our Kids Are Also Slowing Down 48Wrapping It Up 49Chapter 4 So Where Else Can We Lay the Blame? 51Blame Mom and Dad 52Then Just Blame Mom (You Know You Will Anyway) 55Blame the Meds 56Blame the Cigs (One More Theory Goes Up in Smoke) 59Blame the All-Nighter 61Blame the Air Conditioner (Not Cool) 62Blame Pollution (It’s a Dirty Business) 63Blame That Nasty “Fat Bug” 64It’s the Economy, Stupid 67Chapter 5 Beware: Moral Hazard 69Just Bill My Health Insurance 71Is Obesity as Bad as It Used to Be? 74Just Take a Pill or Get a Procedure 76Chapter 6 So We’re Fat—Who Cares? 81Is Uncle Al Overweight? 82C’mon Now, We’re Only Utility Maximizing 85Now, Let’s Tear This Argument Apart (and Put It Back Together) 88So Should Dad (and the Government) Care that Uncle Al is Obese? 91Just Follow the Money 93Chapter 7 The Role of Government 101Market Failures 103Externalities 105Market Power 107Public Goods 108Obesity and National Defense 109Imperfect (Asymmetric) Information 111Is There a Role for Government? 115Chapter 8 Weighing the Public Policy Issues (for Adults) 117Equity 118Irrationality 122Compelling Public Need 123Revisiting Past Policy 125The Road Ahead 138Summing Up 151Chapter 9 Weighing the Public Policy Issues (for Kids) 153First, a Step Back 155Child Abuse? 160School-Based Regulations 161Your Mouth Will Really Groove 175In Closing 179Chapter 10 The Employer’s Dilemma 181Why Don’t Businesses Invest More in the Health of Their Workforce? 182The Dirty Secret about Employee Wellness Programs 189So What’s an Employer to Do? 192Could These Programs Get Me in Legal Hot Water? 201Chapter 11 The ObesEconomy 203Just How Big is the Weight-Loss Industry? 204Just Take a Pill 209Bigger and Better 214Invest in New Technology 219In the Name of Progress 221Chapter 12 How to Lose Weight Like an Economist 223Economic Weight-Loss Techniques 226A Few More Secrets to Success 231Conclusion 234Notes 239About the Authors 267Index 269