Insights (Essays)

Insights (Essays) January 2011

Sarah Palin is (Half) Right about Obesity Policy

Neil Seeman

Obesity prevention was a major part of President Obama’s vision during his election campaign:

“Childhood obesity is nearly epidemic, particularly among minority populations, and school systems can play an important role in tackling this issue.”

On this observation, most politicians agree. But there is a line beyond which a conservative-minded, limited-government philosophy will not cross. Mrs. Palin paid homage to this sentiment – with protestations against a “nanny state gone amok” – in her recent criticism of the First Lady’s “Let’s Move” initiative, which aims to spur children toward healthier eating and living.

I salute Mrs. Obama for encouraging parents to be better role models for their children, yet she is wrong if she thinks that the epidemic of childhood obesity in America is solvable using the lectern of the White House alone. On this matter, Mrs. Palin is right. America – and the rest of the world – keep getting fatter despite “get moving” or “eat your fruits and vegetables” platitudes.

For several decades, prominent conservatives such as Mrs. Palin have eschewed heavy state regulation to promote healthy lifestyles. Remember the Snack tax? The “Twinkie tax” proposal from Kelly Brownell at Yale encountered hostile conservative criticism in the early 1990s for being regressive. The most ardent enemies of the Twinkie tax were Reaganite conservatives who recoiled at the suggestion of a “nanny state.” Conservative radio host Rush Limbaugh helped kill the Twinkie tax by mobilizing his listeners against it.

Rush Limbaugh may have been right: the costs of a “nanny state” may outweigh the marginal benefits of higher tax on fast food – a policy solution that carries adverse financial consequences for poor and marginalized communities; it may also contribute to the stigmatization of those bound for psychological reasons to an unhealthy diet. So what is the role of the “nanny state”?

One option is to confine the role of the state to that of an impartial educator: advising parents and children, using mild messaging campaigns, that overeating and lack of exercise is unhealthy. Meanwhile, private initiatives – in the form of insurance policies or employer-based programs – can reward people and providers and employees for promoting healthy lifestyles. In the United States, there have been conservative-minded proposals that create incentives for employers to offer their workers fitness subsidies – such as paying part of their gym memberships.

Drawing the distinction between “conservative” proposals and “liberal” proposals is not to suggest they are mutually exclusive. Obesity is a deeply complex bio-social-cultural, political and genetic phenomenon.  This is where Mrs. Palin is wrong: dividing the world up into “right wing” policy ideas and “left wing” policy ideas is to ignore scientific reality. The science of obesity is in an evolving state. For example, it is only recently that researchers have agreed that waist size, not body mass index, is the more significant driver of obesity-related chronic illness.

What, then, do we do about the obesity crisis gripping America and other nations? First, we be humble. More is unknown about obesity than known. Second, we must engage industry in this debate – something the public health community has historically been averse to doing. Third, we must recognize that weight loss is deeply individual and requires an intimate patient-provider relationship to address it. To change behavior I think we need to reward individuals financially for sustained attempts to manage their weight loss, aided by their primary care provider. We need to reward primary care providers financially for creating individualized weight management plans.

President Obama is the ‘nudger-in-chief’ when it comes to urging children to step away from video games and cut down on junk food. Michelle Obama has called obesity a “national-security threat”. But one of the White House’s chief advisers, Cass Sunstein, with whom Mr. Obama worked closely at the University of Chicago, takes a different route that steers government away from the bully pulpit. Mr. Sunstein champions behavioral economics, the economic school of thought that values incentives over penalties. And incentives work best when tailored to individual desires and predilections. On this, Mrs. Palin and Mr. Obama should agree.

About the Author(s)

Longwoods essayist Neil Seeman is Director of the Health Strategy Innovation Cell at Massey College. His next book is XXL: Obesity and the Limits of Shame.

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