Monday, April 4, 2011

The Ethics of Weight Loss

Benjamin Franklin put it best: “An ounce of prevention is worth a pound of cure.”

Imagine if that were our national health care policy? We would not be consumed by an obsession about how to care for those who fall ill. We would be hard at work ensuring that we all stay healthy.

Considering how much money we spend on providing health care for people who suffer from preventable illnesses, wouldn’t it be a great idea to have a health policy, instead of a health care policy.

If, as seems reasonably clear, the federal government is going broke, one of the principal reasons is the rapidly rising cost of health care. Think of it, if we all improved our health, we could save the Republic, too.

Dare I say that this is not news. Everyone knows it. Too few people do anything about it, and most of what is done is ineffective. That must certainly count as a major enigma.

Take heart disease. It is not the only illness that is cultivated by bad personal habits, but is an important one, and it costs the country $272.5 billion a year. This being the case, it is logical that the town of New Ulm, Minnesota would have instituted a series of preventative measures to decrease the number of heart attacks. Link here.

I do not really need to tell you what was involved in this program, because you probably know it better than I do.

Before the program started 73% of the town was overweight or obese. After 15 months the heart attack rate in New Ulm had dropped 24%

Cardiologist Thomas Knickelbine of the Minneapolis Heart institute said: "Preventive care is the number one factor responsible for reducing cardiovascular mortality in the United States over the past 20 years." One hopes that Ben Franklin feels vindicated.

A similar and well-known program has been in effect in Safeway stores for quite some time, and has offered similarly positive effects. My comments about the topic here.

However well we know the formula for prevention, we should not overlook the salient fact that the small community of New Ulm undertook prevention as a group effort.

Good habits and a healthy lifestyle became part of the local culture. The same applied at Safeway.

This means that if you want to develop healthy habits, it’s easier to do it with others. If you, your friends, your family, your colleagues undertake such a program together, you will have a better chance of succeeding than if you do it on your own. Being a solitary cyclist is not motivating.

If you do not have a ready-made group, try exercise classes. The more often you go, the more familiar the other faces become, the easier it will be to stick it out when your impulse toward sloth threatens to undermine your program.

But, what does it mean when we all know something but are not practicing it. It suggests that we lack the discipline, the focus, the will power to undertake regular exercise and healthy eating habits. It also suggests that something in our culture is militating against good health by pushing people into bad habits.

We do want to identify those cultural precepts and principles that have managed to produce a nation full of slothful gluttons. Or better, a nature that is has managed to convince itself that pleasure is the meaning of life and that anything less than full indulgence of your cravings will make you neurotic.

Yet, few people are thinking that we cannot solve the problem unless we readjust our moral compass, revise our cultural attitudes, and return to a day when we were made of sturdier stock.

This morning Matt Ridley explained that we all know we have a problem. And that we have tried a number of solutions, all of which have failed. Link here.

In his words: “Some 32% of adult American men and 35% of women are clinically obese. The proportion hasn't swelled in recent years, but it hasn't shrunk either, a study of 2008 data suggests. School posters, virally marketed videos, healthy-eating classes, mandatory swimming lessons, minimum school-recess times, celebrity chefs in charge of school-meal recipes, bicycle lanes, junk-food ad bans, calorie-content labels, hectoring physicians, birthday-cake bans, monetary rewards for weight loss—they've all been tried, and they've all largely failed.”

Think about it. A third of the country is clinically obese and we have just discovered that school posters and bans on junk food do not work.

Mandatory swimming classes are a great idea, but that only pertains to school children, not the population at large.

Hectoring physicians do beg their patients to exercise more, but good Americans take pride in their independent judgment. They are not going to let some physician tell them what to do.

A century’s worth of therapy has taught people that it is healthier to rebel against authority.

When it comes to the obesity problem, how’s that working out for the nation?

Ridley also argues that shaming does not work. If, by shaming we mean telling people that they are obese, he is probably right. Telling people they are fat is rude and most of us prefer to avoid such frontal assaults on our friends and neighbors.

Shame is a very tricky and difficult concept. Most of those who enter into its domain get it seriously wrong.

There’s a lot more to shaming than name-calling and putting people into the stocks.

Try a different angle. If you belong to a group where everyone is working out, eating healthier, and losing weight, you will feel peer pressure to do the same.

If everyone is getting healthy and you are wallowing in gluttony and sloth, you will feel embarrassed, even ashamed, at your appearance.

Thus, shaming is the emotional support of your healthy lifestyle.

This raises another question, one about the epidemiology of phenomena like the obesity epidemic. If your friend is overweigh and you do not want him to feel badly about it, one thing you could do-- hopefully, you won’t-- is to put on a few extra pounds.

Perhaps some people eat too much and exercise too little because they do not want their obese friends to feel ashamed of their weight.

Of course, the culture has other ways of promoting bad habits. It does so through three basic principles, one of which I already mentioned today, all of which I have identified at some point on this blog:

1. Disrespect authority.

2. Let your cravings be your guide.

3. Assume that someone else will save you from the wages of your bad habits.

Put them all together and they spell out a narrative: when you ignore the good advice that is being given you, when you feel morally obligated to satisfy your cravings, you do not fear the consequences because you are convinced that a brilliant physician will cure you.

In the old days when Ben Franklin walked the earth, people respected authority. They were thrifty in the expense of their resources and energy, and they did not assume that someone would always come along to rescue them.

We, however, admire people who live life to the fullest, with gusto, who have the most fun by finding happiness and pleasure in fulfilling all of their cravings.

You might notice that while our culture has been telling people to act out all of their sexual cravings it has also been imploring them to suppress their alimentary cravings.

I doubt that it helps when cultural policies descend into incoherence, but clearly the principle that is guiding behavior is the one that tells us that thrift, restraint, self-control, and discipline are bad for us.

The third principle is disseminated by the endless debate about how best to provide medical care. Telling people that we are going to care for them when they get sick is not the same as showing them how to stay healthy.

We have many television shows where brilliant and dedicated physicians can cure just about anything and we have armies of politicians who are promising that we can have affordable, high quality, universal health care.

The first is a fiction, most especially because it says nothing about the quality of life the sick can achieve.

The second is a flat-out lie. Even if we factor in the endless stories about how the pharmaceutical industry is going to cure cancer and everything else, the truth is, that we are going broke taking care of people who refuse to take care of themselves.

And while we are spending the national treasure on people who refuse to exercise, we are spending less on the research that would lead us to find cures for those illnesses that are not caused by gluttony and sloth.

I would add one more cultural distortion. The culture keeps telling us that it's about weight loss. It isn't. It's about health.

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