There has long been a major difference of opinion about whether obesity is a serious health problem/risk factor/productivity impairment factor that should be the target of a major cooperative effort to eradicate, or merely a lifestyle choice that many people knowingly make, who should be left alone. The latest salvo in this “war” over the issue appears to be a book by health economists Eric Finkelstein and Laurie Zuckerman called “The Fattening of America” (Wiley Jan 2008).

The authors comes down hard on manufacturers, retailers and parents who push unhealthy and fattening food and drink on children, since they lack the knowledge and judgment needed to make a choice between obesity and normal weight, and will suffer a lifetime for even early obesity. But he also notes that “…the nasty side effects of obesity aren’t as nasty as they used to be. When you have a first-rate medical system that can cure the diseases that obesity promotes, you no longer need to worry so much about being obese.” [K. ZeitVogel “Obesity Now a ‘Lfestyle Choice’ for Americans, Expert Says” Yahoo! News Jan 10, 2008 (news.yahoo,com)]

It is clear that there are many to whom obesity is a kind of lifestyle choice, and there are a host of gurus, oversize clothing retailers, and champions of the oppressed who support the idea. On the other hand, there is also a growing body of evidence indicating that many of the causes of obesity are genetic, and people with genetic pre-disposition, “lazy metabolism”, and food “addictions” can’t make a choice, at all, in the free sense this usually entails.

On the one hand, an epidemic of healthy weight would cause serious problems for may sectors of the economy, such as sugary-drink and fattening/hyper-caloried/oversized portion food manufacturers and purveyors. But the American economy as a whole would be far better off, since obesity is a major cause or at least promoter of sickness care costs, worker absences and impairment at work. And like many lifestyle choices that are arguably “constitutional rights” of people to make, obesity forces healthy people to subsidize those who choose obesity, in both labor performance and sickness care costs.

Obesity is perhaps most hard on those who actually do choose it, as well as those with less than full choice in the matter. It creates early social problems as fat kids either tend to become bullies in order to turn their weight problem into a power advantage, or become ostracized because they don’t look right. Fat kids also tend to become fat adults, and the latter suffer handicaps in getting jobs and getting paid enough for them, as well as in penalties being imposed on them by employers or difficulties and penalties in trying to get individual insurance.

Still, the “issue” of whether it is a lifestyle choice or a problem is not really an issue. It is clearly both. There are many who have no choice, but the majority of those of us who are overweight/obese, including me, become burdened by excess weight because they enjoy the process of the eating/drinking and low exercise habits that promotes it, even if they are less than thrilled about the outcomes thereof. Fortunately, there is good evidence that when offered sufficient incentives, they can often lose weight and keep it off, though it is usually keeping it off that represents the greater challenge.

As long as obesity is a major promoter of significantly higher sickness care costs, it will inevitably be the target of all stakeholders in the “healthcare” system, at least, for “reform”, “prevention”, and similar efforts to reduce its incidence and prevalence, as if it were a disease. On the other hand, it is also clear that it is not a disease in the sense that it has to seek a medical or surgical solution, even though medications and bariatric surgery have proven to be effective. Even bariatric surgery, for example, requires lifetime lifestyle changes in order to keep its benefit continuous rather than transitory.

As long as it is economically advantageous for food and drink sellers to market their fattening products to consumers, they will no doubt continue to do so – as their “constitutional right”. And as long as people continue to prefer the lifestyle “strategies” that lead to obesity over those that lead to healthy weight, there will continue to be a market for these sellers. But as long as obesity functions as significantly as it does to promote chronic diseases and risk condtions, as well as productivity and performance impairment and higher costs of workforces, there will be plenty of stakeholders who will strive to prevent, reform, and otherwise reduce (pardon the pun) the incidence and prevalence.

The fact that a “philosopher” or even “economist” argument can be made about how we value and treat people who are obese does not alter the essential facts about the problem of obesity. Even if people knowingly and willingly choose to be obese, the effects of that choice create so much damage to others, as well as to those who choose, themselves, that like smoking and violence, the fact that many choose it will not cause it to be a generally accepted option. It will be treated as an economic problem, even if we manage to reduce the social stigma associated with it, for those who truly do not have a choice. Ideally, as more of us seek to eradicate or at least minimize the problem, already a major economy of its own, we will get a lot better at it.