The big, fat myth of government prevention programs

‘Tis the season to over-indulge and gain a few pounds. According to government statistics, the nation is fatter than ever.

Dieting — or perhaps a forgiving tailor — may help us squeeze into that little black dress by New Year’s Eve, but the government has its own plan to help with the battle of the bulge.

Unhealthy behaviors like smoking and eating poorly, the argument goes, raise the cost of health care for everyone. So if the government did more to discourage or prevent such behaviors, then we’d all pay less.

Such thinking is a cornerstone of President-elect Barack Obama’s plan for healthcare reform. Former Republican presidential nominee John McCain was sympathetic to the argument as well.

On the surface, it seems logical for the government to help people stay fit. With healthcare costs spiraling upward and taxpayers on the hook for more and more of the country’s healthcare expenses, maybe it’s time for the government to step in and curb unhealthy behaviors before they develop into expensive health problems.

But the government’s record on healthy-living initiatives is dismal. To date, they’ve not only been unsuccessful, they’ve often worsened the very problems they set out to solve. And in the process, they’ve driven up overall healthcare costs. In many cases, we’ve become less healthy, while dollars which could have been better spent were wasted.

Take food labeling. In 1994, the federal Nutrition Labeling and Education Act mandated that nutritional and caloric readouts be placed on all packaged foods. The idea was that if Americans knew the facts about what they were ingesting, they’d choose to eat healthier.

Yet since the program began, with calorie counts staring out at us from every bag of Fritos, Americans have become fatter. Between 1995 and 2007, the percentage of obese Americans increased by two-thirds.

The anti-obesity crusade has been gathering steam for years. And it’s related to the decades-old movement to banish cigarette smoke from just about everywhere. To date, some 3,000 municipalities and most states have enacted restrictions on smoking. Such bans now apply to two-thirds of Americans at some point during their day. The smoking-ban movement has effectively swept the nation.

In fact, Obama admits he is desperately trying to quit smoking before his January move into the White House, a workplace made smoke-free by, of all people, former First Lady Hillary Clinton.

It’s not clear that smoking bans do much good. Thomas Lambert of the University of Missouri argues that stringent smoking bans “may actually increase the incidence of smoking among young people” through what he calls “norm backlash,” the common tendency of young people to rebel against the authoritarian forces — read “anti-smoking Puritans” — of their society.

And, according to Dr. Daniel Horn, one of the researchers who helped nail the link between smoking and cancer, “You could stand on the rooftop and shout ‘smoking is dangerous’ at the top of your lungs and you would not be telling anyone anything they did not already know.”

So people know smoking is bad for them. They do it anyway because they choose to, not because they are ignorant.

But surely we must do something to discourage these behaviors, particularly if they’re responsible for society’s rising healthcare bill, right? The failure of past programs doesn’t necessarily mean that all prevention programs are doomed — does it?

Sure, some prevention programs work. The problem is that much of the research touting the savings afforded by these programs is sketchy at best. And even when prevention programs do — by carrot or stick — get us to eat more healthily or quit smoking, they may actually increase long-term costs.

Take the case of Deborah Ortiz, a former state senator from California who has been one of the leading advocates for government-run preventative healthcare legislation. While in office, Ortiz pitched an ambitious ban on sugary soda in California schools. Her bill was based in part on the aggressive hypothesis that girls who consumed soda were more likely to develop bone fractures.

The problem? The clinical study on which her legislation was based never benchmarked the bone density of its subjects and never bothered measuring how much soda the subjects consumed.

Ortiz’s bill also claimed that “each additional daily serving of sugar-sweetened soda increases a child’s risk for obesity by 60 percent.” That was a bit of a stretch, as the author of the study she cited wrote that “there is no clear evidence that consumption of sugar per se . . . causes obesity.”

Unfortunately, alarmist assertions by sky-is-falling types are all too common. John Foreyt, a medical expert from Baylor College, has predicted that, if current trends continue, every American will be overweight by 2040.

These kinds of patently absurd claims often are creatures of vague or changing definitions. For instance, government standards for what constitutes “overweight” and “obese” are less than scientific.

The standard metric for obesity is the body-mass index, or BMI. The BMI works by calculating the ratio of an individual’s height to weight. Although this sounds straightforward, it often yields inaccurate, implausible, or simply ludicrous results.

A healthy BMI prior to 1998 was anything less than 27. Then the government suddenly decided that 25 was the healthy number. So 25 million “normal” weight people were suddenly considered overweight.

According to the government’s BMI standards, many professional athletes and Hollywood heartthrobs are overweight, including such notable figures as Tom Brady, Brad Pitt, and Matt Damon. Not your typical fatties.

With wild measuring methods like this, it’s no wonder the Centers for Disease Control and Prevention attributes 400,000 deaths per year to obesity, when, in fact, the figure is closer to 26,000. It’s a matter of who is doing the measuring and what metrics they’re using.

Not only are the metrics bad — it’s not even clear that keeping people alive and healthy saves money. Mounting evidence suggests that the most successful prevention programs make health care more expensive.

Why? Healthier people live longer. Individuals who live longer into old age require some of the most expensive health care available — late-life care.

As people age, they become more susceptible to illnesses like osteoarthritis, prostate cancer, osteoporosis, and Alzheimer’s disease. Treating diseases like these makes the final years of a person’s life incredibly expensive.

A study in the British Medical Journal found that in countries with low mortality rates, such as the United States, “elimination of fatal diseases by successful prevention increases healthcare spending because of the medical expenses during added life years.”

The Dutch health ministry arrived at a parallel conclusion, stating, “Obesity prevention is not a cure for increasing health expenditures.”

Keep such research in mind the next time you hear a politician promising to lower healthcare costs through preventative medicine programs.

Government prevention programs don’t reduce healthcare costs. And worse, they are an infringement upon our most basic freedoms. We should resist government control over our health choices, even as we resolve to lose that 10 or 15 pounds of holiday-induced cheer chub.

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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