The Economics of Obesity: A Q&A With the Author of The Fattening of America

The Fattening of America

We’ve blogged about obesity at length here at Freakonomics. The health economist Eric Finkelstein has been studying the subject for years, and, along with co-author Laurie Zuckerman, has just published a book, The Fattening of America, which analyzes the causes and consequences of obesity in the U.S. Finkelstein agreed to answer our questions about the book.

Q: You state that the factors contributing to the dramatic rise in American (and worldwide) obesity, from air conditioning to restaurant portions to modern medications, are all fundamentally economic issues. What are the most significant ways modern society has made it easier to be obese?

A: Modern society is giving Americans many more incentives to gain weight than to lose it. We are, in fact, victims of our success as a nation. The two most obvious factors are: 1) the abundance of cheap, tasty foods; and 2) the new technologies that allow us to be increasingly more productive at work and at home while burning fewer calories. For example, between 1980 and 2005, the price of food fell 14 percent relative to non-food items, so it is thus not surprising that we are eating more food.

And what kind of foods are we eating? Well, consider the French fry. Fries, if made from scratch, take about 40 minutes to prepare, complete with peeling, slicing, and messy, splattering oil. Frozen French fries? Ready to eat in under 14 minutes. And that’s still a lot of work compared to just stopping at a drive-through on the way home from work. To an economist, then, it is no shocker that the average American now consumes almost 60 pounds of frozen potato products per year, more than triple the amount consumed per person in 1965.

And at the same time, we’re burning less calories. No surprise here. We all know that we are spending more time watching TV, but there are also less obvious culprits that are keeping us ensconced in our chairs. One example is that I recently had an inexpensive printer installed in my office. So now I don’t even have to walk the 100 steps to the community printer down the hall a few times a day.

But technology hasn’t just made our jobs and our lives easier; we can also pop some pills or get out clogged arteries cleaned out with relative ease, thus lowering the health costs of obesity. In fact, research by the Center for Disease Control reveals that today’s obese population has better blood pressure and cholesterol values than normal-weight adults did 30 years ago. As any economist worth his weight will tell you, if the costs of being obese go down, and there are people who like to eat and don’t like to exercise, we are bound to see obesity rates go up.

Q: Is obesity really an “epidemic”? If we were to let the current obesity rates continue unchecked, what would the outcome be?

A: Over the past three decades, the number of obese Americans has more than doubled. But whether or not we call obesity an “epidemic” largely depends on how the word is defined. If one defines an epidemic as the rapid increase in the occurrence of something, then yes, obesity is an epidemic. Of course, we also have an epidemic of flat panel TVs. My family was recently afflicted with one of those. If an epidemic requires the spreading of a disease from person to person in a locality where the disease is not permanently prevalent, as defines it, then I would say no, obesity does not qualify as an epidemic.

The reality is that no matter how we label it, as long as there is a demand for labor saving devices and cheap, tasty food, there will be a significant obesity problem. The United States has the most advanced economy in the world, so we saw the obesity spike first, but other nations are quickly catching up. Of course, even in this obesity-inducing environment, many people are finding ways to stay thin and, given the large profit motive, companies are working hard to help people do so. As a result, I find it hard to believe that obesity rates could ever reach the dire levels that some have predicted. In fact, recent evidence suggests that obesity rates may be slowing among adults.

Q: From an economic standpoint, should we be diverting so many resources, public and private, to fighting obesity? Would it make more sense to let obesity rates keep rising, and focus instead on treating and preventing the medical conditions (heart disease, diabetes, etc.) to which obesity contributes?

A: This is the $93 billion question. That is how much obesity is costing the nation every year.

When it comes to the private sector, the market should be allowed to freely determine the optimal amount of resources to invest in obesity prevention and treatment. As noted above, there is a huge demand for products and services aimed at reducing rates of obesity. I am not just talking about drugs and devices, I’m also talking about cool new technologies such as Dance Dance Revolution and the Wii, which use technology to re-engineer physical activity back into our lives. I just bought these for my family.

In The Fattening of America, I make the argument that the government should revisit past policies that may have inadvertently helped promote the rise in obesity rates. I point not only to our agricultural subsidy policies for farmers, but also to zoning laws that discourage pedestrian transportation, subsidies to employers for providing health insurance, and even the existence of the Medicare program. All of these in some way blunt the incentives to invest in prevention, be it for obesity or other conditions.

I do want to point out that the government’s primary motivation is not to reduce costs to Medicare and Medicaid. If it were, they could just stop funding these programs altogether. There may be good reasons to invest in preventive care, but there is little evidence to date that document any long-term savings associated with obesity prevention efforts. If the government funds these and they do not work, they only serve to raise our taxes even more.

Q: A recent Dutch study found that it costs more to provide medical care for healthy people than the obese or smokers, who tend to live shorter lives. What do you make of these results? Are they different from, or similar to studies you address in your book?

A: I am familiar with that analysis. It is well known that smokers tend to subsidize non-smokers because the former pay so much in taxes and die before they can collect their due in social security and Medicare benefits. The researchers’ finding that obese people also cost less is new, and probably not correct for a U.S. population.

It is well established in the U.S. that obese individuals cost more than normal weight individuals at each age of life. I have published several papers showing that result. Recent studies by Fontaine and Flegal also show a relatively small impact of obesity on mortality for BMIs less than 35 (about 70 pounds overweight). As a result, higher age-specific costs and only a slightly shorter life expectancy suggest that the lifetime costs of obesity are indeed positive for most obese adults. The same goes for overweight adults, as they do not seem to have any shorter life expectancy. So I doubt their results for obesity are accurate for the U.S. population.

But let’s suppose they were. Should we give away free Krispy Kreme donuts because obesity saves money? My son would love that, but sorry son, the answer is no. I argue in my book that high costs should motivate employers to address obesity rates, but saving money is not an appropriate reason for government intervention. If it were, then the government should be giving away free cigarettes. Moreover, when it comes to obesity, any effort by the government to encourage people to lose weight, unless it saves more money than it costs, will only raise our taxes even more, regardless of whether or not the measure is effective at getting people to lose weight. Unfortunately, cost-saving obesity interventions have yet to be identified. So until they do, obesity may be taking two significant bites out of the government coffers.

Q: How much should the government really legislate obesity? What programs/efforts would be the most beneficial? Who should they target (e.g., children, low-income adults)?

A: In my book, I talk a lot about my Uncle Al, a smart and successful attorney who also happens, not by accident, to be very overweight. In fact, he’s overweight because instead of spending his time dieting and exercising, he has spent his time building a very successful law firm. I see no reason why the government should get Uncle Al to change his behavior if he does not want to. Even for low-income individuals, any effort to force people to change their behavior will only serve to make them worse off (even if they do become thinner). So no, for adults, I do not think the government can, or even should, legislate obesity away.

In sharp contrast, children are unable to make rational choices, unlike Uncle Al. I think that the government (and parents) have a critical role to minimize the possibility of children growing up to regret the diet and exercise choices they may have made as uninformed youths. Most government interventions are focused on schools, which makes sense given that the food the lunch ladies serve up is too often not that different from the birthday fare my son receives at Chuck E. Cheese. And then, of course, there’s the school vending machines. In my book, we discuss what’s happening in America’s school cafeterias, gymnasiums, and classrooms, and what can be done to help tomorrow’s adults make informed diet and exercise choices.

Q: Can the current obesity trend be summed up as an issue of “personal and immediate benefits” versus “longterm and widespread social costs”? Why or why not?

A: People often like to compare the current obesity “epidemic” with smoking. I think the two are very different. Smokers, by virtue of second-hand smoke, impact non-smokers. As a result, the government has a clear justification for attempting to limit exposure to second-hand smoke (although, in my opinion, some of their policies have gone well beyond resolving market failures).

I see more similarities between obesity and motorcycle helmet laws. If someone wants to ride a motorcycle without a helmet, and take the risk of getting into an accident that would almost surely result in a major trauma, why do we really care? I think the answer is that we don’t want our hard-earned tax dollars to pay for this individual’s “poor” choice. It really boils down to money, and the fact that we live in a society that would not allow this person to bleed out in spite of the fact that he or she knowingly made a choice that made a major injury far more likely. So, to solve this problem, and because those who ride motorcycles are in the minority, we pass mandatory motorcycle helmet laws.

With respect to obesity among adults, I think the issue is one in the same. Nobody wants to pay for my Uncle Al’s excess weight. The primary difference is that with overweight and obese individuals representing two-thirds of the population, passing laws that limit choice, such as we did with the motorcycle helmets, is unlikely to happen any time soon.

Q: Dubner and Levitt recently discussed the unintended consequences that can result from government legislation intended to change behavior or help certain groups — what are the most likely unintended consequences of obesity-prevention legislation?

A: It is very difficult for the government to pass legislation without having unintended consequences. For example, some have suggested that No Child Left Behind may be a factor in rising obesity rates, by helping to eliminate gym class from schools and forcing kids to study harder. Truth or fiction — you get the point. When it comes to obesity legislation, there is no such thing as a free lunch. Getting junky foods out of schools, for example, will not only hurt food companies, but also reduce the revenue for schools to fund other activities. At the end of the day, the choice will be to weigh the costs and benefits to see whether the legislation is better than the status quo.

Q: Is the rise in obesity rates the result of market failures?

A: No. I would say it is just the opposite. The rise in obesity rates is resulting from market forces that are bringing us low-cost products and services that make us more productive at work and at home, and that provide us with highly valued leisure time activities.

For example, consider the microwave. While only 8 percent of American homes had microwaves in 1978, 95 percent currently have them. They make it quick and easy to get food on the table. Then take carbonated beverages. They make up 7 percent of all calories consumed. They would be more expensive without heavy farm subsidies, but not that much more. Also, how many cars today require manually “rolling up” the windows? That term shouldn’t even exist any more. Car windows, along with countless other things, are now automated.

These are a few of the thousands of examples of new products and services that allow us to save a few calories here and there, or consume a few extra calories for not much time or money. In my book, I compare our modern lifestyle to that of the Amish. We could all eschew technology and choose to live like the Amish, but who would want to? That’s a pretty high price to pay to be thin.

In my opinion, obesity is more the result of the success — not the failure — of the market. This is not to say that market failures do not exist, or should not be addressed. My only point is that were we to address them all, obesity rates would still be dramatically higher (although perhaps not quite as high) today than they were a few decades back. But on net, we are still better off.

Q: Is being obese more, less, or equally costly for individuals now than it was twenty years ago?

A: We’ve already discussed how it’s cheaper and easier to be overweight today than it was a few decades back. In addition, thanks to advances in medical technology, the health costs of obesity continue to decline. Among today’s obese population, the prevalence of high cholesterol and high blood pressure are now 21 and 18 percentage points lower, respectively, than they were among obese individuals 30 to 40 years ago. In fact, obese individuals today have better cardiovascular disease risk factor profiles than normal-weight individuals had 30 years ago.

What is driving this surge in improved health profiles for obese individuals? The answer, as you might have guessed, is a dramatic improvement in drugs and devices. Many drugs have been introduced over the past 40 years that effectively treat cholesterol, blood pressure, and other risk factors and diseases that obesity promotes. One million operations were performed in the U.S. last year to unclog clogged arteries. In the past, diet, exercise, and weight loss might have been the primary treatment to help control risk factors resulting from excess weight; today, one has the option of taking a pill or having surgery. Many individuals, including my Uncle Al, feel that diet and exercise are consequently optional.

Mr. Winston

And all this time John Edwards has led me to believe that Americans are dying from starvation. I feel cheated.


Obesity is a sign of market success? This seems unlikely since the wealthy who can afford nutritious and tasty food have low rates of obesity.


Demand-side: we can create a microchip that gets implanted into the chin and detects the number of chews - sort of a toll road for the pie-hole. We can make it cost fifty bucks in special taxes to eat a whopper.

We can do the same thing on the supply side with the combo toilet/centrifuge invention of mine that separates and reverse engineers your deposits and bills you accordingly. Add a little toilet duck and sand, and it removes tough stains as well. All bills would of course be public record, and be published in the hometown newspaper. Illegal substances like salt and cheese would prompt stiff fines.
I'm sorry I'm a personal responsibility sort of person. Read/Learn, walk, lift, run, repeat.


(( Obesity, like smoking, is indeed chosen ))

No, monolithic explanations are chosen.

Obesity, like many other biological phenomena, has multiple causes. Sometimes, it's gluttony or lack of exercise, but not nearly as often as naturally-thin people suppose. Sometimes, it's genetics.

And who knows what subtle ill effects we're all suffering from food additives and plastic containers? In Beethoven's time, "scientific authorities" considered lead drinking cups to be safe, and lead poisoning killed him.

"Obesity is chosen" is just another variation on the ever popular tactic of blaming the victim.


Adam Smith would be appalled by the simplicity of the obesity argument made by Eric Finkelstein. Big Mac's get subsidies from the government for corn fed beef in their burgers from farm subsidies. When will he he start to fully allocate these farm subsidies to the cost/price of the burger? Like many other corporate subsidies (e.g, oil companies are not fully allocating the cost/benefits of US Armies in the Middle East to extract oil and they do not show up in the prices at the pump.No proportional allocated costs seem to be even thought by these discussions. When that happens, then we can start having a serious discussion on free markets.


Sounds like another witchhunt to me. Who can we blame now for higher cost? Fatties. We already make it more difficult for them to get jobs, deprive them of their dignity by designing smaller and smaller seats in planes and movie theaters, and now endless articles are published blaming them for incorrectly raising their children or driving up the cost of healthcare. Why are obese people the new terrorists? They do nothing but live with the shame a self-righteous society lays on them daily. We know its genetic - fat parents equal fat children. Cheap food and sedentary jobs equal fat adults. Its easy math. And as has been said before, one can be healthy AND overweight. Why not focus on teaching society to accept everyone's differences instead of shunning a group of people because they're different? I guess that doesn't sell books...

Keith Wheelock

Encouraging smoking more 'cost effective' than encouraging obesity

Prabhu Ponkshe

Yes, we are eating more fries and more cheeseburgers than we need to. Thanks for pointing that out, while your website shows us a picture of the McDonald's contest on the same page. And you are surprised about obesity because...?


The cost differential of vegetables compared to fast food is not as much a function of price as it is of preparation time. A fast food burger might cost twice as much as a comparable home-cooked meal, but the latter takes four times as long to prepare. As wages increase, the value of our time increases, making the "fast" in fast food that much more valuable.

Lola Granola

I think people need to be careful not to let casual observation cloud the facts. The article here immplies that Americans are more sedentary than they used to be and that this is a significant contributor to weight gain. Researchers David Cutler, Ed Glaeser and Jesse Shapiro, in their paper "Why Have Americans Become More Obese?" show:

Americans have become considerably more obese over the past 25 years. This increase is primarily the result of consuming more calories. The increase in food consumption is itself the result of technological innovations which made it possible for food to be mass prepared far from the point of consumption, and consumed with lower time costs of preparation and cleaning. Price changes are normally beneficial, but may not be if people have self-control problems.

The paper goes on to show that, despite common perceptions about lazy people surfing the web rather than a wave, a decreased level of activity is not a large driver of this epidemic.


Colin Chaudhuri

(much of what I have to say was already touched on by Adam B., please re-read his comments for they are worth reading)

While the author makes some very useful points regarding the rise in obesity (technoligical advances requiring less exercise, cheapness of processed food, lack of time needed to make said processed food), I have to take issue with some of the conclusions.

First, the scenario he lays out with his hypothetical "Uncle Al" illustrates in a nutshell the most basic problem I have with libertarianism. The author indicates the life "Uncle Al" leads as an adult was the result of rational decision making earlier in his life. In order to build up a sucessful law career, he had to sacrifice other aspects of his life, including persumably exercise and healthy eating. However, the idea that the fictitious Uncle Al has no reservations about his decision is ridiculous. First, it makes the assumption that Al made a cost-benefit analysis of the situation. Like most of us, Al stumbled upon his path in life due to unforseen circumstances, peer preasure, family obligations in addition to rational decision making. Uncle Al may or may not have wanted to be on this path. More to the point, a succesful career and thinness did not have to be an either or choice. Due to the perverse incentives the author correctly points out exist in the marketplace, Uncle Al could get a five minute lunch at McDonalds, followed by easy delivery of Chinese Food for dinner. But more importantly, the assumption is Al was happy to make these culinary decisions. Many people want to lose weight as adults but can not seem to do so. Eating badly can be an addiction (especially when you consider the addictive qualities of sugar and caffeine). Furthermore, the marketplace mechanisms that exist to help people are often diet schemes that don't keep the weight off, not true lifestyle guides that will keep someone be thin. More broadly, throughout the Q & A, the authoer assumes the government will only make things worse at higher cost. This is related to most libertarian's assumption that government is merely a form of dependency that harms true freedom. This example should show the false pretense of this assumption. In this case, Uncle Al's dependency is to food (and McDonald's), not government. The farm bill, taxation of high fat food, wider education of healthy lifestyle are effective means of government intervention (to be fair, the auther does point to ways government policy can help, like more pedestrian walkways). I DO NOT suggest we should FORCE Uncle Al to eat better, just merely change the incentives. Too many libertarians assume when people call for government intervention, it is an invitation to government control and therefore a step towards "Big Brother". I acknowledge Libertarians' efforts in being vigilant against this government control and dependency. But in pointing out that government is often the problem, they forget the government has at least a role in the solution. Often our dependency is to corporations, lifestyles, abusive family and friends, not governtment. For example, a woman dependent upon an abusive husband can seek freedom from this dependency at a government funded shelter.
Although I have alluded to this earlier in the post, the assumption by the authoer that the marketplace will take care of this is dicey. The marketplace is reacting; but through get thin quick schemes that often don't lead to lasting weight loss. Furthermore, even effective market reactions, like the proliferation of gyms, are often out of reach for the poor. The marketplace is reacting, but only to the well off. As noted, the poor are disproportionately overweight and nutritionally deficient. It is often the poor who don't have proper education about eating, nor do they have enough effective access to gyms.

Lastly, the injection of the debate over Medicare and Medicaid is a bit off. I understand that the author is trying to indicate that two big government programs are directly effected by obesity. But these two programs are not PRIMARILY about obesity, but rather overall health care for the elderly and the poor. To be frank, the arguement that the government would just stop paying for these two programs if they cost too much doesn't make much sense. Yes, reducing obesity may not reduce costs, but even if it did, it would not be enough to cover the shortfalls of two popular (and needed) services.

Lastly, nobody mentions that obesity is a problem because of our current obsession with beauty. I acknowledge for many girls/women, the pressure to be thin is immense. Particular trends seem to be especially loathesome (heroin chic anyone?). I recognize that combatting the unrealistic expecations for thinnes on women (and an increasing number of men) is related to this debate. The self-esteem of young girls and women undoubtedly suffers due to unrealistic expecations of beauty. However, it is also true that both men and women have certain biological expecations for what we consider attractive (I know, there are tribes and cultures that like women with "curves", however I don't think many worship outright obese women or men). Lets face it, we are attracted to healthy men and women and that generally means at least being somewhat thinner. We face an uphill task meeting those expectations of our partners or potential partners with cheap fatty foods out there.



Right. Medicare causes obesity. Heavens no, don't regulate the crap put into our food by massive, corporate food suppliers. Oh, but wait - yes, let's regulate school lunches. Oh, but wait, government has no role - let the market decide. See, it's all because of the success of the free market. No wait, it's because the government is subsidizing the farmers. Oh, wait.

What an idiot.


I think a very important contributor to higher obesity in America are cheap gasoline prices. Nobody walks anymore. People in urban areas who walk daily are healthier than suburban found people.
Also the dominance of the automobile prevents or discourages biking and walking in the U.S.

A gas tax of $2/gallon and pedestrian/bicyclist friendly cities would do a lot to improve fitness

Robert W.

I was most struck by the author's remarks on children's obesity in this country. I'm often amazed at the callous marketing of poison to children on television, namely McDonald's commercials.

Isn't Ronald McDonald just another Joe Camel in a grotesque clown suit?

If you can't eat at a restaurant every day and not be dead in 3 months of kidney failure then I'm sorry, it's much closer to "poison" than it is "food." Surely many here have seen the film Super Size Me to wit.

I have believed for years that fast food pushers should be forced to carry a Surgeon General's Warning just like cigarettes are forced to do. Also, they shouldn't be allowed to market to children, especially on TV, just like cigarettes cannot.

The article states that obesity costs us $93 billion a year-- how much does smoking cost I have to wonder? And how much of this apparent cost is offset by the disproportionate taxes (more than 50% their retail price) placed on tobacco products?

It seems to me that justly taxed for the fast food industry's ultimate effect on society, that "99 cent menu" would be more like $1.99 or maybe more.


Graffiti Grammarian

...and then there are the synthetic hormones (ie parabens) that are in most of the potions and lotions in our bathrooms, which are thought to interfere with human metabolism and so might significantly contribute to the country's weight problems.

Most of the stuff that goes in or on our bodies -- both food and grooming products like shampoo and hand lotion -- is full of chemicals, most of which are bad for us and some of which are making us fat.

Our personal environment, like our global environment, is badly degraded (and getting worse every day).


There is only mandatory helmet laws in 2 states, so the comparison for motorcycle riders to obesity analogy doesn't really work


I smell a cheap, tasty fallacy of confusing cause and effect. Come on, we could just as easily say that the increasing numbers of overweight individuals are creating the market for unhealthy food and technology. There are better explanations for the so-called obesity epidemic.

In conjunction with the availability of food we must also consider:

(1) The increasing number of low birth-weight infants who are genetically predisposed toward obesity (see Fetal Matrix, Gluckman/Hanson). The genetic switch to preserve calories is set in the womb and sticks for life;

(2) The habit of "emotional eating" that results from low moods and increased tension in everyday life. When feeling down, people consume high calorie foods for quick energy and feel lethargic toward exercise (see Calm Energy, Thayer).

The rampant stress and depression in American and other industrialized cultures can be associated with mood disorders as well as reproductive problems. Low moods explain consumption and poor fetal development can help explain the problem many have with loosing the weight they gain.

The causes of the stress and depression are no secret. It is globalization and the enormous pressures placed on individuals to make decisions about their lives without the traditional supports of custom, family, country, etc. Government policies should address the source of the problem (stress and depression) as well as the symptoms (availability of unhealthy food and technology).



I realize that some obese people have genetic factors or legitimate health issues that impact their weight. However, the vast majority of Americans who are severely overweight are that way because of the garbage they eat and the sedentary lifestyle they lead.

A good example: I was recently in the airport waiting for my flight to board. A family of three came over and sat next to me. Each was moderately to severely obese. The dad got up and said he needed to get lunch before the flight, so he left. Two minutes later, he came back with a large bag of Twizzlers licorice and a 32 oz. Coke. That was lunch. And, it was also the explanation for his 50 inch waistline.

We have choices for this stuff. I choose to go to my gym at least 5 times a week and to work with a nutritionist to eat healthier. I still eat things that are not perfect - pizza, burgers, etc. - but not as often and in moderation.

Overweight Americans, stop making excuses. You make your own choices to become overweight and then you complain that you might be discriminated against because of it? Last time I checked, many people who currently do little to no physical exercise are capable of it but choose not to. Laziness doesn't buy you the right to complain. And, you don't need to spend money on a gym or a nutritionist. Get up and walk each day. Set aside time to do aerobics or mild exercise at home. Just stop whining about how this country made you fat. For many of you without medical conditions that drive obesity, YOU made you fat. Period.



#8 - Dance Dance Revolution can indeed be an intense cardiovascular workout (except on the beginner levels, obviously). Most modern variants include continuous modes with no break between songs - it's no less "real" exercise than running on a treadmill, and lots of people consider it more enjoyable. Anyone looking for a piece of home cardio equipment could do a lot worse than a games console and one or two high-quality dance pads.

An common term is "DDR diet" - you can Google that to see some people's (impressive!) weight loss results.


Great, great piece. I especially like the take on the motorcycle helmet laws, which is a huge debate among all biker forums out there. Steve, not sure how it "doesn't work". Last I checked, there's obesity laws in 0 states, so that sort of supports her argument I think. But as a MA resident (which has helmet laws), I didn't realize those laws were so limited geographically.

"deprive them of their dignity by designing smaller and smaller seats in planes and movie theaters"

Jack, come on. I'm paraphrasing from Meet the Parents... but do you honestly think that airlines and theater operators want to deprive overweight folks of their dignity... or do think, perhaps, in some crazy scheme to make a profit, they realized that smaller seats = more seats = more money?