By Public Health Expert 18/04/2016


Dr Robyn Toomath

Editorial note: In this blog-perspective, obesity expert Dr Robyn Toomath outlines the dogmas and arguments for the ‘individual-responsibility’ explanation and (lack of) solution to the obesity epidemic. She then points to the market failures that render (non-regulated) free-market solutions as doomed to fail. The views in this blog are expanded in greater depth in a book Dr Toomath is launching in Auckland and Wellington this month, Fat Science (Auckland University Press).

If you stop and ask people on the street, nine out of ten (including the overweight ones) will say that you get fat from over-eating and its no-one’s fault but your own. This is not just due to imperfect understanding of geno-environmental interactions, but because the notions of autonomy and self-control are deeply held (1). So when nihilistic biologists such as myself suggest there is no such thing as free will, it’s not just the libertarians but liberal intellectuals who are offended.

I need to remind myself of this tension between free will and socially determined arguments when I feel frustrated at the persistent framing of obesity as an issue of personal responsibility. But no matter how appealing the idea that we can change our body size if we choose to, the reality is that we can’t. At least, not most of us, and not permanently. Professor Sir Peter Gluckman, the Prime Minister’s Chief Science Advisor (and obesity expert), said in a recent speech that over his life time he has lost about 100kg in weight, and put about 95kg back on (2). If motivation and education were the keys to staying slim Sir Peter should be as thin as a rake (he’s not).

It’s all very well maintaining a fantasy if it makes us feel better but the personal responsibility myth causes great harm.

Stigmatisation and shame

The most obvious harm is the stigmatisation and shame experienced by an overweight person. The impact of this can be quantified by looking at wages earned by fat and slim people, corrected for other factors. In a study of 25,800 people in the US, a woman weighing 30kg above ideal weight earned on average 9% less, equivalent to 3 years of work experience or a year and a half of education compared to a normal weight woman. The penalty for severely obese men was a 20% lower salary (3). Prejudice develops at a very young age and psychologist Andy Hill has documented marked aversion to obesity by children as young as nine and this appears to be getting worse with time despite increasing numbers of fat children (4). In the absence of effective treatments for obesity in children (despite Minister of Health Coleman’s assertions to the contrary), I share Children’s Commissioner Dr Russell Wills’ view that identifying obesity in the B4 school check will likely do more harm than good (5).

That is, a targeted individual-level approach to tackling obesity, which requires identifying overweight and obese people to start with, can perhaps do more harm (stigmatisation) than good.

A claimed feature of the current New Zealand Government is pragmatism. Surely the failure of a ‘personal responsibility’ approach to obesity would persuade a Government with its citizens’ best interests at heart (and future health budgets) to change tack? Most of the adult population is overweight (6), we have the fourth highest rate of childhood obesity in the world, we are the 3rd fattest of the OECD countries and there is no sign that obesity rates are flattening off (7). Britain is following Mexico and many States in the US with a tax on sugary drinks, but our Government is holding to a largely personal responsibility and free market ideology and remains resistant to what they see as ‘nanny state intervention’ (8,9).

Economic theory points to way out

The good news is that economic theory itself points to a way out. Governments need to intervene if one of four criteria of ‘market failure’ is met. The first criterion is skewing of the market by ‘externalities’. This refers, for example, to an individual making a decision which results in a cost which is borne by someone else. If you want to sky-dive or climb mountains, the risks associated with dying fall on you (though being injured and rescued is another matter). With obesity a person may choose to eat an unhealthy diet but if they develop obesity-related disease the costs of this are borne by society as well as that individual, and if the financial costs are too high, the government would have grounds to intervene. It is easy to make this case, e.g., in 2012 the annual cost to the New Zealand health system of obesity was estimated at NZ$624 million (10).

The second version of market failure occurs when ‘imperfect information’ perverts our ability to make a reasoned decision. Imperfect information certainly applies to confusing food labelling on processed foods. How do we decide if these products made from artificial ingredients are healthy? Governments seem interested in tackling food labels but the fact that the food industry has lobbied so hard to avoid these suggests that imperfect information works in their favour and may well be skewing the supply and demand equation (11).

The third category is ‘time-inconsistent preferences’, which often result in satisfying short-term goals over longer term ones (or what is sometimes referred to as a high discount rate). This could refer to planning to cook a healthy meal but succumbing to the temptation to eat from the junk food outlets that you pass on the way home. A way of partially correcting for this would be to ensure that healthy food was available in all places where unhealthy food is sold.

I’m most interested in the fourth category, ‘demerit goods’, meaning products like alcohol and tobacco and activities such as gambling which are dangerous or unhealthy. Governments should be bound to protect vulnerable individuals from the market forces of supply and demand for these things. With regard to obesity, foods which are energy dense and without nutritional value (apart from calories) are demerit goods. In terms of a vulnerable individual, it’s not just children but anyone with an inherited predisposition towards obesity that deserves protection.

With regard to obesity the unfettered free market in processed food has failed us and is costing our health system dearly. Individuals are largely unable to overcome their genetic predisposition (to eat more) and a highly obesogenic environment (that supports eating more and exercising less). If we want to fix this problem governments need, and are mandated, to apply smart regulation to the processed food market.

References

(1) Colin Bos, et al. ‘Understanding consumer acceptance of intervention strategies for healthy food choices: a qualitative study’. Biomed Central Public Health 3, 2013, p. 1073.

(2) https://www.eventbrite.co.nz/e/childhood-obesity-the-challenge-of-policy -development-in-areas-of-post-normal-science-tickets-21441661587.

(3) John Cawley. ‘The impact of obesity on wages.’ Journal of Human Resources 39, 2004, pp.451-74.

(4) Andrew J. Hill and E.K. Silver. ‘Fat, friendless and unhealthy: 9-year old children’s perception of body shape stereotypes’. International Journal of Obesity and Related Metabolic Disorders 19, 1995, pp. 423-40.

(5) http://www.stuff.co.nz/national/politics/73137937/Government-targets-overweight-mums-toddlers-to-combat-childhood-obesity

(6) http://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/obesity-data-and-stats

(7) http://www.health.govt.nz/our-work/diseases-and-conditions/obesity

(8) https://blogs.otago.ac.nz/pubhealthexpert/2016/03/22/the-uk-government-shows-leadership-with-a-soft-drink-tax-announcement/

(9) http://i.stuff.co.nz/dominion-post/news/politics/507322/Nanny-state-fears-on-health-bill

(10) Anita Lal, et al. ‘Health care and lost productivity costs of overweight and obesity in New Zealand.’ Aust NZ J Public Health. 36, 2012; pp.550-6.

(11) Brussels Sunshine. ‘High time for CIAA to come clean on its lobbying.’ Brussels Sunshine, 23 June 2010, blog.brusselssunshine.eu/2010/06/high-time-for-ciaa-to-come-clean-on-its.html 


0 Responses to “Who is responsible for stopping NZ’s obesity epidemic?”

  • Is the govt job is not to regulate individuals choice to over ingest and not to exercise? 1984.
    If the govt gave a crap (which it doesn’t ) why is it showcasing the govts morbidly obese MP’s .

    The govt does not “protect” anyone that is a myth., The Crown protects its $ interests.A suggested sugar tax is for their gain= a poor tax. Regulation for control over what people eat and increased $ for this pointless “regulation” .
    You can’t “protect” people from themselves from overeating and not exercising by ” regulating” them you have to change their mind this cannot be done by more govt regulation.
    The desire for “more” needs to be looked at as the food will never provide the physiological fulfillment of self knowledge.
    Far better to teach them about the mind conditioning/programming they are being subjected so their mindfulness/awareness can block their minds from being programmed with thoughts while watching TV.
    .

  • Why is what I eat not my personal responsibility”
    Should I blame you or the govt for what I choose to eat or if I chose to exercise?
    Dear God! here is the extreme radicalized “nanny state” (and yes it does sound like 1984- a state that again needed people to support a ” smart” grid and state regulation of every personal act).

  • It is good to see acknowledgement of the environmental factors that drive obesity. It is not however, simply the availability of food that is part of our environment. It is an environment that encourages physical inactivity. We know that physical activity by adults in NZ is low and is one of the worst globally. (Lancet, 2012 doi:10.1016/S0140-6736(12)60646-1). We also know physical activity in adults is worse in urban environments. The rate of car-ownership in NZ per household over-time is a correlate to obesity levels (and inactivity).

    Nonetheless, I balk at some of the claims made here. We don’t have an unfettered market in processed food. The sale of food is subject to a plethora of regulations over ingredients, claims, locations, quality etc.

    I also don’t think the Government’s rationale for not implementing a sugar tax is free-market ideology. There is still a widely-held perception that policies should be evidence-based. It has been very difficult to discover evidence that such taxes reduce obesity. (The best-evidence, Mexico’s ‘soda tax’, shows taxes can reduce consumption of sodas, not that overall calories intake is reduced).

  • Unfortunately the fact is Govt policies are not evidence based.

    Why would this govt “concerned with health” add GST( a healthy food tax) to already over priced fresh fruit and vegetables and then talk of increasing existing food regulation and taxes . Which addresses none of the many factors that contribute to obesity.
    Reading this article tells me that the people supporting increasing govt food regulation have no understanding of the cause(s)of obesity and ignorantly think soda causes it (and more “poor taxes” will fatten up the Crown’s already obese coffers).

  • But ‘this government’ did not add GST to fruit and vegetables? GST was applied by the 4th Labour Govt in 1986. The goal of GST is not to manipulate people’s buying patterns but raise tax revenue, as efficiently as possible. That’s why it’s broadly applied.

  • Yes the govt’s #1 priority is to increase revenue.
    And it did not remove GST from fruit and vegs at the beginning of it’s campaign for ” increased food regulation”. , “obesity as an epidemic” and sugar taxes.

    Meanwhile with the govts austerity program many people in NZ are without medical care, disabled people are having their supported living payments stopped for no reason,having to beg in the street ( which the govt wants to ban) the govt are talking about closing birthing units and yet still overeating becomes a news priority.

    I also suggest the Crown NZ govt is the same govt no matter which party/color is said to be in front. .National/the govt sells profitable public assets to the Crown’s corporations cheaply the govt/Labour buys them back for more , national/the govt privatizes .Its all the Crown NZ govt…

    The GST on fruits and vegetables, the govt that was not focused on money and revenue (cared about healthy eating ) would have long since removed GST tax from veg and fruit and would not have let the commerce commissioner allow a retail food monopoly.

  • @Troy K.

    1 – Governments #1 priority is to govern. It needs money to do this.

    2- GST is an efficient (if not entirely fair) revenue collection method. It is efficient in large part because of its universal application. To start identifying different exempt items because it meets some non-revenue imperative would significantly increase the cost of operating GST without necessarily driving any different behaviour.

    3 – At worst, we have a retail duopoly. The reality is that there is a significant number of non-aligned food retail businesses with real choice being offered, especially in the metropolitan areas. For instance, in Auckland there are growing asian (Tai Ping etc) and boutique (Nosh etc) supermarket sectors, as well as independent and chain butcheries and fruit and vegetable retailers. In short there is a wide choice in terms of quality, price and styles of grocery items.

    None of which is to say that government should do nothing, but its best to start from a position of fact when considering these things imo.

    • The taking over of self regulating food intake which is not govt function or “governing” it is a neocon extremist role ..

      Money is created from nothing( debt) and the govt budget is borrowed money from private bankers with interest. Not from taxes.
      The govt could create its own money without interest to govern.It does not. The Crown NZ govt is not concerned with governing( sic) it is interested in control of the empire and building the Crown corporations wealth.
      All taxes are taken by and for a private debt collection agent( ird) using the force of govt yes an ” efficient” form of money theft.
      The commerce commissioner has allowed a retail food monopoly.

  • Anabel has a better understanding of money and the fact the Crown NZ govt borrows money with interest from private banking cabal (and does not create it) nor does it have a mandate.
    (There is no written constitution allowing the foreign directed Crown “governance” /rule of NZ.)

  • The reason for obesity overeating needs to be understood.
    The ego ( a mind based sense of self) looks for more and has a deep need for more for fulfillment.
    Overeating is a psychical expression of the need for more, its a psychological need that cannot be fulled by food.
    Other people try to do it with possession, knowledge, achievements, entertainment but its all the same a deep need for more.
    As it is based on a false sense of self, a mind construct, it can never be fulfilled by consuming any of these things .
    Only the true knowledge of SELF, beyond the mind, can bring true and lasting fulfillment.

  • @Annabel – at the risk of going way off topic:

    While the NZ Govt has a cost in the management of the health effects of obesity, it is a govt issue to manage the cause. .

    Money is not created from nothing – debt has a real value. If it didn’t you wouldn’t trust it and so no one would lend anything to anyone. The govt budget includes income from a range of sources. Raising debt, even at govt level, is not income – its a balance sheet transaction.

    Many govts have tried to raise income by “creating” money. They fail, without exception because inflation is a thing.

    @Troy, NZ has a series of documents that collectively legitimise the constitutional arrangements of the country. You could always challenge their legitimacy if you do feel strongly about it. I wouldn’t rate your chance of success.

  • You are incorrect, the central banking system is in place in every nation, govts don’t create their own money or have any control over their currency all is left to private bankers. Lending is done for profit not on trust.
    Inflation is denied in govt official reported figures, when food prices steadily go up we are told they are not. Zimbabwe did not create its own money, it had a central banking system when they went into hyperinflation. “From 1991 to 1996, the Zimbabwean Zanu-PF government of president Robert Mugabe embarked on an Economic Structural Adjustment Programme (ESAP), designed by the IMF and the World Bank, that had serious negative effects on Zimbabwe’s economy” . The central banking system caused the hyperinflation not the govt creating its own money as it did not. The USA has had unprecedented waves of QE without hyperinflation.

    The “cost” argument to remove the responsibility of self regulation doesn’t work.
    Govt does not even meet the obligation of healthcare costs of the people of NZ , medical treatments are routinely denied (due to the budget cuts) but the govt can spend an extra $11 billion in war/defense spending.
    The Crown govt are using the people of NZ as debt slaves, it borrows the money ( budget) in their name so it doesn’t have any “costs” as the debt is placed on the people of NZ. The taxes ( ird private debt agent)go to the private banking cabal for interest. Debt does not have a value except to the moneylender who deal in fiction, , money is created out of nothing it is the biggest ponzi fraud ever. But people do not understand money.
    The people of NZ should understand the argument for the Crown’s desire for more taxes and increased food regulation and that it is not needed and could not reduce obesity as it does not address the cause.

    So why spend all this money and energy on a campaign that ignores the aspect of the psychological dysfunction of overeating . If they ignore the reason why people overeat, they clearly have no understanding then they are just going to make another mess to create even more useless regulation and a “poor/sugar tax” .

  • @ Ashton I did challenge it and found out they have no written constitution or lawful mandate to govern. (It was really funny argument where they started talking about NSW granting them the right to govern the settlers of NZ).
    Ask them for the evidence / document that gives the Crown the lawful right to govern NZ and its people and you will get nothing but mumbo jumbo.
    No written constitution.

  • @Anabel. Sorry, but without some substantiation of your claims I’m not inclined to accept your position.

    @ Troy – case reference please?