If Americans were paid to eat less and exercise more they might be motivated to lose some weight—and save us a bundle on health care—says Dr. Barry M. Popkin, director of University of North Carolina-Chapel Hill's Interdisciplinary Center for Obesity.
According to a report released by the Center for Disease Control this month, 26.7% Americans are obese and they're only getting fatter. "The statistics have become rote, but consider that people in their 50s are about 20 pounds heavier on average than 50-somethings were in the late 1970s," wrote economics journalist David Leonhardt in a 2009 New York Times article, "As a convenient point of reference, a typical car tire weighs 20 pounds."
Obesity is defined by having a Body Mass Index (BMI) of over 30. You can calculate your BMI by dividing your weight (in kilograms) by your height (in meters) squared. By state, obesity prevalence ranges from 18.6% in Colorado to 34.4% in Mississippi. Colorado and the District of Columbia (19.7%) are the only two states with prevalences under 20%, while nine states, predominantly in the South and the Midwest, have prevalences of over 30%. To make matters worse, these rates rely on self-reported height and weight data, which likely produces underestimates because both men and women tend to overestimate their height and women tend to underestimate their weight.
"From a societal standpoint, if a third to a half of Americans weren't so fat, the idea of the government providing tax incentives for the obese to eat less and exercise more wouldn't be so controversial," Dr. Popkin told Big Think, "In 1955, if you'd thought about taxing cigarettes you would have been run off the planet. The only difference is we have a smaller population that is healthy and thin, so we have more people who take offense because it's affecting them. But we had the same issue with cigarettes."
Popkin proposes two possible ways of using taxes to motivate people to lose weight. His first policy suggestion is to demand that anyone with a BMI greater than 30 who receives Medicare, Medicaid or government administered health care pay a fee if they are unwilling to prove they've undertaken a few predetermined exercise activities or show that they are consciously watching what they consume. Popkin admits that taxing bad behavior is different and more challenging than placing a tax on consumers products like cigarettes and alcohol, but he says there are technologies available that could enable the government to monitor obese people's diets and exercise.
"We have devices that we could put on your throat that could measure your swallows," Popkin explains. "We have devices now to measure how much you move, so we can see when people are engaged in activity like walking or jogging. He even suggests that obese people could wear ankle bracelets or collars similar to those used to monitor DUI felons and people on probation to prove that despite their high BMI, they're active and eating properly. "If Americans are going to be serious about losing weight," says Popkin, "then they need something that's serious."
If the idea of asking obese people to prove that they're exercising and eating well, or else face a tax, sounds far too Orwellian, Popkin's second suggestion is to make all Americans pay an additional flat-tax of, say, $100 a person per year, to build a pool of money which is then returned to people who either have a BMI lower than 30 or have somehow proven that they're dieting and exercising. Popkin points to corporate weight-loss programs, in which employees are rewarded with cash for partaking in exercising, dieting, and smoking-cessation programs, as an example of how there are already versions of what might be considered a "fat tax" being administered not just in America, but around the globe.
"You could definitely look at a federally administered program like large corporate program," says Pat Sukhum, co-Founder of RedBrick Health, a company that works with Fortune 1000 companies to create cost-neutral programs for giving employees cash incentives to lose weight. Sukhum says the right combination of extrinsic rewards (like cash) and intrinsic motivation—prodding by co-employees, friends, and perhaps government-funded publicity campaign—might even result in a return on the government's investment. "In the long-run many of our companies more than reclaim the cost of their incentive programs," says Sukhum.
Approximately 72.5 million U.S. adults are obese. It is an indisputable fact that, on average, Americans need to lose weight. As a factor contributing to several leading causes of death, including heart disease, stroke, diabetes, and cancer, obesity must be met head-on by a government-administered tax rebate program that motivates the obese to eat less unhealthy food and engage in more exercise.
Why We Should Reject This
"We don't tax people based on physical characteristics for a whole host of reasons," says Dr. Henry Aaron, Senior Fellow of Economic Studies at the Brookings Institute.
"The first order of importance when in comes to any tax policy, is how much it costs to administer them," says Aaron, "you're talking about an expense that would approximate the value of the rebate. Furthermore, the medical relationship between BMI and health status is very much in dispute. Instituting incentives for improved behaviors can certainly be helpful, but in the case of obesity the causes and cures are too diffuse."
Dr. Aaron also rejects any parallels drawn between the "sin tax" placed on alcohol and cigarettes and a "fat tax" levied to fight obesity. "Tobacco and alcohol used as recommended in any form are poison," he says. "Qualitatively there is no doubt that higher taxes have reduced smoking, but with that said, it's very difficult from a statistical standpoint to figure out what caused the real reduction. There were also the Surgeon General's warnings that smoking was bad for your health, labels were put on products, people were told they couldn't smoke indoors. It became distinctly uncool to smoke and the masses acquired a new norm."
-- A New Weight-Loss Plan: Getting Paid to Shed Pounds; Time magazine article says dieters who have a financial incentive to lose weight are nearly five times as likely to meet their goals when compared with dieters who had no potential for a financial reward.
-- Germany Weighs Tax on the Obese; Marco Wanderwitz, a conservative member of parliament for the German state of Saxony, says it is unfair and unsustainable for taxpayers to carry the entire cost of treating obesity-related illnesses in the public health system.
-- Big Brother Is Watching Your Weight; Your tax dollars may be at work, penalizing fat people, says Slate journalist William Saletan.
-- Alabama To Place "Fat Tax" On Obese State Employees; Alabama's State Employees' Insurance Board requires all Alabama state employees to receive medication screenings for several conditions, including body mass index.
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