The "Girth-Wealth" Gradient

About 9 percent of health-care costs are directly attributable to obesity, which led Dubner to wonder if we should assess a fat tax (on fat food, that is, not people) as a way of picking up the tab. One strong objection would be that such a tax would likely be extremely regressive: “[S]ickness, poverty, and obesity are spun together in a dense web of reciprocal causality,” writes Daniel Engber regarding what he calls the “girth-wealth” gradient. To sum it up: the poorer you are, the fatter you’re likely to be; and the fatter you get, the poorer you’re likely to become. So it may be that the obesity fight and income inequality are one and the same. [%comments]


There's also the argument that fat people tend to die sooner. They could end up actually saving the system money even though it costs more to treat them when they are alive. Even a very fit person will rack up a lot of medical bills in his or her 80's or 90's and a fat person will be dead by then and won't cost anything to treat.


I see two problems with a fat (food) tax. One is that EVERY food can make people fat. If you eat enough carrots, you're going to get fat.

Michael Phelps and Haile Gebrselassie would be heavily impacted by such a tax, but they need the calories in "fat" foods to keep them alive after they burn 5,000+ calories in a day.

David S

One reason the poor tend to get fat is that junk food has more calories per dollar than health food. So if you are trying to maximize the amount of calories you can consume with a limited budget, junk food is the way to go.

Maybe instead of a taxing the junk food, we should just shift what agriculture we subsidize. Instead of subsidizing the corn syrup industry, why not subsidize real fruits and vegetables?


It's regressive how? You will hurt poor people by preventing them from getting fat on fattening foods? Won't that help stop the cycle? Maybe the problem is that healthful foods are too expensive. So use the fat tax to subsidize them.

The objection that every food can make you fat is specious. Who is going to eat that many carrots? Not many people. Even if you get fat from too many vegetables, your health is going to be better than getting fat from too many donuts.


A somewhat related issue: why don't airlines give people an overall weight limit, i.e., you and your bags together. I mean, weight is apparently the issue when airlines impose a weight limit on luggage, right? Then the obese among us can truly pay their fair share for flying.


It would make more sense to tax sugar or corn syrup or just processed foods in general. Fats are essential to a healthy diet, added sugars not so much.


No, the problem is health care cost associated with obesity. Therefore the fat tax should be assessed on their health care cost.


Forget the tax.

Remove the farm subsidies on corn, sugar, and wheat (and give their monies to broccoli and other greens) and you'll take care of the problem without creating another layer of infrastructure.


For those of us who beleive in low carb diets it's pretty cut and dry what's going on. Meat and dairy are very expensive when compared to grain, sugar and other refined carbohydrates. Granted there aren't any studies on this specifically in the US, but there is data to corroborate it elsewhere. Check out Good Calories, Bad Calories by Gary Taubes if you want to see how obesity and starvation can sit side by side by people of equal economic means in Africa. Of course the book also covers all the actual science that's been done this country on weight loss, and was quite an eye opener for me.


Michael Phelps could afford it. But for the normal population, it's a retrogressive tax.


But you wouldn't be able to stuff down enough saturated fat to make you fat. The Army did studies of excess calorie diets in the 60's and 70's. Those on the eat 3000 calories of fatty foods/day simply couldn't do it. They would sit and stare at plates full of steaks and pork cutlets.

Fat satisfies, carbs do not. Fats and carbs together are the worst of all worlds.

The established knowledge is blaming the wrong macronutrient...

Interestingly, as soon as you realize that, the French paradox disappears. They're thinner and have better heart health because of the saturated fat, not in spite of it.


Where's the causation?

Much has been made of studies showing how many more fast food places there are in poor neighborhoods than there are produce stores and groceries. Part of the problem just may be that "fat food" is cheaper. A meal from McDonald's can be much cheaper in time and money than buying the ingrediants and preparing a balanced home-cooked meal.

Go into any fast food restaurant and you'll be confronted with compelling visual evidence of why poor people are fat.

So if the problem is this tax is regressive, the solution is to use it to tip the scales from fast food being cheaper to produce being cheaper. Why not subsidize retail produce and whole foods in some way with the money generated by the tax? If it's a zero sum equation, then the only way this is arguably regressive is if poor people continue to prefer obesity-related food. That seems pretty just to me.


An individual from Africa I knew of trying to secure a visa was asked why he wanted to come to the U.S. "I want to live in a country," he said, "where the poor people are fat."


The poorer you are, the fatter you are? A great irony in comparison to the bottom third of the world!


"the poorer you are, the fatter you're likely to be; and the fatter you get, the poorer you're likely to become."

Due to the poor not having access,money, knowledge to purchase healthy foods or lacking the time to excersize the weight off?

Other observations often seen: ultra expensive SUV being driven by a skinny woman with no passengers then cheap economy car being driven by an obese woman with multiple passengers.

Birds of a feather flock together? What ultra wealthy man would take an obese woman as a "trophy" wife when he is all about looks and high end items?


It would be a real tragedy if we found that junk food is a Griffin good....


There's also the argument that fat people tend to die sooner. They could end up actually saving the system money even though it costs more to treat them when they are alive. Even a very fit person will rack up a lot of medical bills in his or her 80's or 90's and a fat person will be dead by then and won't cost anything to treat.

For the same reason, government anti-smoking campaigns may not be cost effective.


Any attempt at "fat tax" would be struck down immediately. We know that obesity is actually a matter of Intake-Output in calories per day, with a "fudge" factor for the specific dynamic activity of the food you take in, i.e., the calories it takes to metabolize the food itself.

And, as one of your reporters demonstrated in an attempt to survive (?subsist) on $1/day, the poor will invariably gravitate to high carbohydrate foods, think white bread, white pasta etc. (Unless they also develop a garden, but that wasnt included. ... or learn which "weeds" are edible.) The reporter noted that any fruits and vegetables were an absolute godsend because it was so difficult to fit it in on the "budget."

We forget. As much as we decry the agricultural food subsidies which were initially designed to help family farmer in the depths of the Great Depression when ALL prices were so low that they could not break even, we also forget that some of these surpluses that the government took on were used to maintain the poor - the subsidized school meals were primarily of these products - the milk, cheese, butter, potatoes and pasta (why else do you think we go so much mac and cheese!)

There is an argument that the industrial revolution did so much better in northern Europe compared to southern (Mediterranean) Europe because the highly concentrated energy source that is the potato is so much more portable than pasta. It kept the worker(s) fueled for working, without the need for prolonged breaks to boil water and cook the pasta! LOL!

And, by the way. Data demonstrates that all other things being equal, yes, fat people dont live as long as skinny people. But the real key is aerobic fitness. So someone who is "fat" or heavy but aerobically fit is less likely to end up with a cardiovascular event than someone who is skinny (thin/lean) but not physically fit. .... And, there is a difference between apple and pear fat - abdominal/visceral fat and buttock/thigh fat and risk for disease/death.

As I have mentioned in the past, as ERISA does not allow any discrimination based upon risks, rather we should provide rebates, like cents-off, for achieving certain goals -
- non smoking status (measurable by urinary or salivary cotinine)
- Body Mass Index if not aerobic fitness (former requires height and weight, latter requires V O Max by treadmill)--- if you are going to be a big person, will want to have that treadmill to demonstrate fitness rather than take the hit for being big!
- HbA1C to assess for good glucose control (will be normal if not a diabetic and even if a prediabetic, but will be "normal" if a controlled diabetic (working with a good doctor))
-Blood Pressure (one of the first correlates with death - cardiovascular, stroke, kidney)
- urinary microalbumin - signs of kidney disease, hypertension, other potential diseases including poorly controlled diabetes
- urinary drug screen .... welllll.......
- the big question is whether you give a rebate to those who are immune to Hepatitis B (the largest cause of primary liver cancer in the world, but less of one in the US, HCV is the one for the US - and no vaccinations yet available.)
- ?proof of receiving recommended immunizations, e.g. tetanus, measles, mumps, rubella, HBV (see above), influenza
- pap smears for women of age; similarly for mammograms
- colonoscopy for all of age (>50 or high risk).
- the big question is whether to include screening questionnaire for alcohol abuse since there are otherwise not clear cut biomarkers -
- do you give credit for lack of fatty liver? - but it could be "normal" range because you already have cirrhosis too!


Cyril Morong

Joe, in #16. Did you mean Giffen good? Or is there something out there called a Griffin good?

The final statement is interesting:

"To sum it up: the poorer you are, the fatter you're likely to be; and the fatter you get, the poorer you're likely to become. So it may be that the obesity fight and income inequality are one and the same."

This mixes poverty and inequality. They are not necessarily the same thing. Do this thought experiment. Suppose you are in the bottom income bracket (quintile). The people in the top bracket make 5 times as much as you do. Then next year, it is 10 times as much. How does that cause me to become more obese? Do I feel bad about the bigger gap? So I eat less healthily or exercise less? What if my income had grown too, but not as much the people in the top bracket? Say mine went up 5% but theres went up 10%? We could just take money from the top bracket and burn it. That would make things more equal. Would anyone benefit?

The two links provided in the last sentence are intersting. The 2nd one is a link to a book coming out in December that claims it has lots of data to support making the distribution of income more equal which will make everyone happier. I am skeptical.

The first link is an article by economist Angus Deaton. I just read it and I don't claim to understand all of it. It is quite interesting and thoughtful while reviewing alot of literature. It says, among other things (IMO), that the issue is very complex regarding how socioeconomic status, education, income and inequality affect health and life expectancy. This passage calls into question the need for redistribution policies:

"The argument is that high levels of income inequality are associated with low levels of social support and cohesion and so sicken everyone, rich and poor alike. If so, income redistribution toward the poor, which narrows income inequality, will have a direct positive affect on population health. The hypothesis was originally supported by comparisons of life expectancy and inequality across wealthy countries and more recently by comparisons of mortality and income inequality across U.S. states and cities. However, the best recent data support none of the original international correlations, and the U.S. evidence is spurious: There is no relationship between income inequality and mortality once we control for the racial composition of American states and cities."


Bob Simons

The poverty-obesity link gets a lot of press and scholarship. I wonder if its actually a rational decision from a life cycle utility-maximizing perspective. The poor are likely not saving anything towards retirement. They may never really be able to afford to stop working. Thus their golden years hold no lure of idle time and relaxation. On the off chance they beat the actuarial life expectancy, they might just end up eating catfood and being a burden on their children. Might as well enjoy the pleasurable rush of sugar and trans fats (and cigarettes for that matter) in the here and now. When life is brutal, why not make it short?