Paul Campos on “10% of US Health Costs Are Due To Obesity”
Thursday, July 30th, 2009 by Barry DeutschPaul Campos is interviewed over at Megan McArdle’s blog. There’s a lot there worth reading, but I’ll highlight this bit in particular, since the study he’s discussing has been much in the news:
Consider the methodology of this study. It tried to calculate changes in health costs if everybody with a BMI over 30 had a BMI under 25. But leaving aside the preposterous assumption that all increased health risks associated with a level of body mass are caused by that level of body mass, the idea that somehow we could make fat people into thin people is bizarre.
A study like this isn’t talking about turning 180 pound women into 165 pound women, which at least in theory might actually be possible. It’s talking about turning 200 pound women into 130 pound women, on statistical average. The success rate for such attempts is about .1% Even stomach amputation does not turn fat people into thin people.
So even if it were true that we knew it would be beneficial to turn fat people into thin people (which we don’t) it’s not something we have any idea how to do. The statements in the study indicating that there are known methods for doing this are simply lies of the most egregious sort.
Now lets talk about excess health care costs. if you look at the study, nearly half of the excess health care costs associated with being fat are from higher rates of drug prescription. But why are fat people being prescribed more drugs than thin ones? Largely, because they have the “disease” of being fat, which is then treated directly and indirectly by prescription drugs!
For instance, statins. Statins are a multi-billion dollar business, but there’s very little statistical evidence that they benefit the vast majority of people to whom they’re prescribed. Basically the only people who have lower CVD [cardiovascular disease] mortality after taking statins are middle-aged men with a history of CVD.
But the heavier than average are prescribed statins at higher rates simply because they’re heavier than average, even though there’s no evidence this is beneficial for them. And of course this doesn’t touch on the costs of all the treatments for “obesity” itself, which are uniformly ineffective. [...]
I mean, there’s no better established empirical proposition in medical science that we don’t know how to make people thinner. But apparently this proposition is too disturbing to consider, even though it’s about as well established as that cigarettes cause lung cancer. So all these proposals about improving public health by making people thinner are completely crazy. They are as non-sensical as anything being proposed by public officials in our culture right now, which is saying something.
It’s conceivable that through some massive policy interventions you might be able to reduce the population’s average BMI from 27 to 25 or something like that. But what would be the point? There aren’t any health differences to speak of for people between BMIs of about 20 and 35, so undertaking the public health equivalent of the Apollo program to reduce the populace’s average BMI by a unit or two (and again I will emphasize that we don’t actually know if we could do even that) is an incredible waste of public health resources.
Also well worth your reading time is Megan’s followup post, in which she refutes the usual objections people posted in her comments. (Thanks, Sebastian!)
