I really love that logic. They'll get fat if we give them benefits because they know they can afford to actually see a doctor! If we just made sure they didn't have those benefits, they'd go exercise! And if we took away unemployment benefits and social security, they'd work really hard not to lose their job and make sound long-term financial decisions! (Logic may not apply in any country other than the US)
Are people really this dumb? I just assume anyone making arguments like this is being disingenuous because they want to argue for a specific political philosophy. Tell me nobody actually takes this seriously.
I agree, this is really stupid. The study actually found that low education and minority status were most correlated with obesity. Oh, and that's the same group that has public health insurance. Thanks for telling us something we didn't already know.
I think the question is: Did the study control for those external correlations.
If they properly controlled for things like age, race, education, and other factors and found the sole (known) factor to be insurance, then it's potentially valid.
One of my favorite arguments in Pharma is that diet and exercise only decrease the blood pressure, on average, by about 4mm hg on both systolic and diastolic....but if you applied that to the overall population, you'd see the rate of high blood pressure drop in half.
In other words: What looks small in one context can be major in another.
I haven't read this article (clicked on the wrong comments section!), however, I can answer from my personal experience that the logic is sound. I almost never go to the dentist. For a while it was covered under my insurance and so I went twice a year. But now it is out of pocket and I rarely go. The longer I'm away from the dentist I start to worry a bit and I think "crap, I hope my teeth are okay." It gets in my head. I start brushing at lunch. I start flossing. And I keep that up for maybe another year until I get to the point that I decide perhaps I really should go to the dentist. So i go. He says everything is great. I relax, and I don't worry about brushing at lunch or flossing so much. But two years down the road...
Now that might sound really "stupid," but I thought I'd just pass on my experience on the matter.
Our plan utilizes a provision in the 1996 Health Insurance Portability and Accountability Act that permits employers to differentiate premiums based on behaviors. Currently we are focused on tobacco usage, healthy weight, blood pressure and cholesterol levels.
Safeway's Healthy Measures program is completely voluntary and currently covers 74% of the insured nonunion work force. Employees are tested for the four measures cited above and receive premium discounts off a "base level" premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families. Should they fail any or all tests, they can be tested again in 12 months. If they pass or have made appropriate progress on something like obesity, the company provides a refund equal to the premium differences established at the beginning of the plan year.
At Safeway, we are building a culture of health and fitness. The numbers speak for themselves. Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant. When surveyed, 78% of our employees rated our plan good, very good or excellent. In addition, 76% asked for more financial incentives to reward healthy behaviors. We have heard from dozens of employees who lost weight, lowered their blood-pressure and cholesterol levels, and are enjoying better health because of this program. Many discovered for the first time that they have high blood pressure, and others have been told by their doctor that they have added years to their life.
At Safeway, we are building a culture of health and fitness. The numbers speak for themselves. Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant.
Because people are losing weight, or because fat people are quitting the company? I imagine you could solve many problems this way as well--the black problem and Jewish problem come to mind.
So let me get this straight. Changing healthcare incentives will achieve what our entire culture's obsession with thinness, outright moral judgements on fat people, self-esteem killing public perceptions and a multi-billion dollar weight loss industry hasn't?
These are the types of ideas that only Autistic People can really take seriously. Most fat people desperately do not want to be fat, they have tried lots of methods of not being fat, have probably spent more money and effort than any government program would encourage to no avail.
Yes David, most fat people don't want to be fat and have tried lots of methods to not being fat, but most of them don't have an incentive to STAY non-fat and fall back into old routines.
One recent study showed strong success by paying individuals just $7 a pound to lose the weight. It's definitely possible.
The trick is CONTINUING incentives. Otherwise you get yo-yoing.
Oh, and please call me autistic. I'd love it.
My credentials include being formally fat, packing on weight easily, and doing metabolic research on the overweight and obese at the most prestigious medical research facility in the U.S.
But I guess I'm just silly to say that people need external incentives to lose and keep off weight. And that they need the immediate gratification of those incentives, and not long-term things like "you'll live longer".
Both are forms are continued incentive. Don't run a red light, don't get an expensive ticket.
I understand your point, but different mindsets require different incentives. However, to your point, it's the exact same thing if you simply charge people much higher premiums for living unhealthy lifestyles.
I think the point is, it's much harder to (en masse) prove someone is living an unhealthy lifestyle, versus making them achieve certain healthy lifestyle markers and re-imbursing them for those practices (i.e. 120 visits to a paid healthcare facility per year).
If I remember my Psychology 101 courses, people respond to rewards and punishments. But those rewards and punishments have to be proximal (near in time, and directly related to your actions). If you weren't seeing the doctor while eating unhealthily, insurance isn't going to change your behavior one way or the other. Now if the insurance company had some way to spy on you and charged you directly (as opposed to a third party) different rates based on diet, then yes, I could see that having an effect.
Moreover, it's pretty obvious that being sick and fat and getting relatively cheap health care is not enough of a "reward," vs. the "punishment" of being sick and fat and getting relatively expensive health care, that normal human beings would adjust their behavior accordingly when, say, confronted with a bag of potato chips.
Under ObamaCare, it would be illegal to "discriminate" against someone in their health insurance premium because of age or pre-existing conditions. So young healthy people will pay the exact same premium as old sick people. I'm sure they're going to love that.
Lol, I didn't realize it even when I re-read it. I meant formerly :)
My body weight was ~25% fat. I was overweight. I still, to do this day (though I'm pretty much thin and fit now) don't like it when clothes cling to my stomach (i.e. if the wind blows I pull my shirt away from my stomach).
And I still gain fat readily, though I replaced it pound for pound with about 20-25 pounds of muscle since I started losing way back when.
The relevance of this article, I think, is that it is part of the proof against the argument that if we just give everybody health insurance, they will become healthier and healthcare costs will go down.
Now Obama is calilng it "ConsumerCare", touting all the wonderful benefits and no one will be excluded for pre-existing conditions. He just can't explain how he will pay for it without doubling the national debt in 10 years.
Haha. Excuse me while I stop snorting my beer all over my screen. I trust CBO or OMB numbers as much as you trust the GOP flowchart. So padre, how are we going to resolve this Mexican standoff?
When I was in retail, I didn't have insurance but I was on my feet all day and in much better shape.
Now I have an administrative job in an office. They pay me to sit at a desk eight hours a day but the health insurance is pretty good. On the other hand, eight hours a day at a desk means 1) not much exercise at work and 2) not a lot of energy for exercise after work.
Following Mickey Kaus' first rule of journalism - always wildly overgeneralize from personal experience! - I'd rephrase thus:
Situations offering health insurance correlate with work environments and lifestyle choices conducive to obesity.
Mark T, I agree. There's got to be something tangibly at stake for people to change lifestyle habits. But what? Is it better to offer incentive or punishment or a combination of the two?
Either way,the US government is not likely to offer incentive/punishment (I'm thinking something like a luxury tax for unhealthy foods, but then that would only be effective in conjunction with offering cheaper, healthy foods) for chaning health habits. Even if they did, the feds wouldn't do it wisely. Not that I'm saying I know the wisest path to take in order to get people living healthier lifestyles.
As far as incentives not making a difference, that's bunk.
Here is a quote from a Fox News article about North Carolina paying at-risk girls $1 a day for not getting pregnant.
"Dr. Hazel Brown, co-director of the program, said six girls of the 125 who have been enrolled for six months or longer have gotten pregnant or otherwise dropped out since it began in 1997. "
Read the full article here: http://www.foxnews.com/story/0,2933,529037,00.html
Just goes to show they don't understand the basic psychology of at-risk girls. No amount of money will stop them from "living in the moment" which is what being a teenager is all about, except for a few bookish nerds.
There are no magic bullets, but taxing things that are known causes of medical utilization seems the most efficient to me. It both funds the insurance expansion and deters the activity. Far better to tax that than to tax either health insurance or medical utilization or to tax unrelated activities).
Thing is, many of those activities have a substantial upside. For every rock climber who falls and breaks something expensive, there are many more who live healthier on account of the exercise.
As far as I know, obesity has no upside other than improved famine resistance.
My son is is certified in outdoor emergency care; people get seriously hurt doing the most healthy activities. They break legs, their necks, their arms, have heart attacks from elevation gain and poor circulation, have stokes, get bit by spiders and have allergic reactions, get caught in avalanches, get dehydrated. They're equipment wears out and fails.
My own pre-existing condition happened on a bike; and I've got a rather large chunk of jaw missing and seriously damaged cervical vertebrae to show for it.
In many states, I would be denied insurance.
And I have never met the $5,000 deductible of my current plan. It's never paid a cent for my health care.
It's not just about a single incident of breaking something expensive. The long-term costs of such an accident can easily outstrip the costs associated with something like obesity, and accidents are hardly uncommon.
Skiing accidents are the ones I happen to know about, because that's how I tore my knee up at age 17. I'm 32 now, and I've already had four surgeries and plenty of associated costs like physical therapy and doctor visits. I now have osteoarthritis and expect to have two knee replacements -- we're trying to stave off the first one until I'm in my 40s so that I won't need three. The lifetime bills will run well into the hundreds of thousands, not to mention that I'm crippled for life. I liked skiing, but I wasn't a fanatic or an elite athlete, and an insurance hike would have deterred me and saved my knee.
I've also been fat, although I am not now. There aren't many upsides to being fat, but there are significant positives to not doing the work required to lose the weight. I lost 80 lbs a few years back, and I spent an average of two hours a day directly engaged in diet-related activities like working out and cooking. I then gained 35 lbs back, partly due to major health conditions, but also because I simply didn't have the time or the energy to continue working that hard for the rest of my life. I'm currently at the top end of "normal" BMI, still carrying a little more fat than I'd like, but it's doubtful I'll ever make it back into tip-top shape. For many people, it takes a whole lot more than 30 minutes of walking a day and skipping the mayo on your sandwich. Most "normal" people wouldn't be able to direct that kind of effort into any endeavor, so why do we expect all fat people to do so, and call them lazy slobs if they don't?
I really don't have a clue how we deal with obesity in this country and still believe that most initiatives, either punitive or rewarding, will be neutral at best and more likely counter productive (see. margarine, low-fat, olestra, fake sugar, calorie counting etc...)
Talk to people who carry excess fat and they'll talk about the intense negative societal pressures that they perceive on a daily basis. They will talk about the petty humiliations they endure while going about normal life, the lack of attention from the opposite sex, feeling prematurely aged from excess weight etc. Will government incentives make the tipping point on top of these petty daily trials?
I really think that what is missing from the weight loss discussion is any mention of peer groups.
If you are part of a social circle that has many people who carry excess bodyfat (overweight is too crude a term) than a successful attempt to actually rid yourself of that excess fat could be extremely challenging to your friends, or your spouse, or your family.
You're basically telling them "I'm disgusted with the way I am, and they way that all of you are, to the point that I will make drastic life changes to be not like you anymore." Real body transformation involves changing some fundamental aspects of your personality and this may be why real fat loss can be such a daunting challenge. Your old relationships will feel threatened by your transformation.
This is why reformed alcoholics give up their old drinking buddies or why people who quit smoking are more successful if smoking partners aren't always lighting up around them.
If you are a metaphorical fat sheep - the only thing that makes you fatter is the "ok" from the majority. In the case of obesity and being overweight - we are talking about 2/3s of all people supporting you. It really is hard to change anything about yourself when 2 out of 3 people you know are doing it? It is even harder when the government supports it with money incentives? But sure - let's blame health insurance for it! I take it that most of our mirrors are broken already?
I wish more doctors were holistic about treating healthy weight. D-Chiro-inositol is proving to be pretty helpful in treating PCOS in both females (and the equivalent metabolic disorder in males.)
PCOS is present in about 5% of the population and is a widespread cause of obesity which is resistant to exercise. D-Chiro-Inositol helps the body to use Insulin more effectively. It's found in chickpeas, carob and really expensive pills. Myo-inositol or other forms of inositol are not substitutes.
If we do have to have national healthcare, couldn't we also have national gym memberships? And ban hydrogenated oils? These seem like they'd yeild some good benefits relative to cost.
I really love that logic. They'll get fat if we give them benefits because they know they can afford to actually see a doctor! If we just made sure they didn't have those benefits, they'd go exercise! And if we took away unemployment benefits and social security, they'd work really hard not to lose their job and make sound long-term financial decisions! (Logic may not apply in any country other than the US)
Are people really this dumb? I just assume anyone making arguments like this is being disingenuous because they want to argue for a specific political philosophy. Tell me nobody actually takes this seriously.
I agree, this is really stupid. The study actually found that low education and minority status were most correlated with obesity. Oh, and that's the same group that has public health insurance. Thanks for telling us something we didn't already know.
I think the question is: Did the study control for those external correlations.
If they properly controlled for things like age, race, education, and other factors and found the sole (known) factor to be insurance, then it's potentially valid.
One of my favorite arguments in Pharma is that diet and exercise only decrease the blood pressure, on average, by about 4mm hg on both systolic and diastolic....but if you applied that to the overall population, you'd see the rate of high blood pressure drop in half.
In other words: What looks small in one context can be major in another.
TreeJoe,
This effect could be real but given the information that the originalarticle gives us we have no clue if it is or isn't.
And that makes me a sad panda(with a slowly expanding insured wasitline.)
I haven't read this article (clicked on the wrong comments section!), however, I can answer from my personal experience that the logic is sound. I almost never go to the dentist. For a while it was covered under my insurance and so I went twice a year. But now it is out of pocket and I rarely go. The longer I'm away from the dentist I start to worry a bit and I think "crap, I hope my teeth are okay." It gets in my head. I start brushing at lunch. I start flossing. And I keep that up for maybe another year until I get to the point that I decide perhaps I really should go to the dentist. So i go. He says everything is great. I relax, and I don't worry about brushing at lunch or flossing so much. But two years down the road...
Now that might sound really "stupid," but I thought I'd just pass on my experience on the matter.
Safeway employees have financial incentives to lose weight -- and they do:
http://online.wsj.com/article/SB124476804026308603.html
Our plan utilizes a provision in the 1996 Health Insurance Portability and Accountability Act that permits employers to differentiate premiums based on behaviors. Currently we are focused on tobacco usage, healthy weight, blood pressure and cholesterol levels.
Safeway's Healthy Measures program is completely voluntary and currently covers 74% of the insured nonunion work force. Employees are tested for the four measures cited above and receive premium discounts off a "base level" premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families. Should they fail any or all tests, they can be tested again in 12 months. If they pass or have made appropriate progress on something like obesity, the company provides a refund equal to the premium differences established at the beginning of the plan year.
At Safeway, we are building a culture of health and fitness. The numbers speak for themselves. Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant. When surveyed, 78% of our employees rated our plan good, very good or excellent. In addition, 76% asked for more financial incentives to reward healthy behaviors. We have heard from dozens of employees who lost weight, lowered their blood-pressure and cholesterol levels, and are enjoying better health because of this program. Many discovered for the first time that they have high blood pressure, and others have been told by their doctor that they have added years to their life.
At Safeway, we are building a culture of health and fitness. The numbers speak for themselves. Our obesity and smoking rates are roughly 70% of the national average and our health-care costs for four years have been held constant.
Because people are losing weight, or because fat people are quitting the company? I imagine you could solve many problems this way as well--the black problem and Jewish problem come to mind.
So let me get this straight. Changing healthcare incentives will achieve what our entire culture's obsession with thinness, outright moral judgements on fat people, self-esteem killing public perceptions and a multi-billion dollar weight loss industry hasn't?
These are the types of ideas that only Autistic People can really take seriously. Most fat people desperately do not want to be fat, they have tried lots of methods of not being fat, have probably spent more money and effort than any government program would encourage to no avail.
Yes David, most fat people don't want to be fat and have tried lots of methods to not being fat, but most of them don't have an incentive to STAY non-fat and fall back into old routines.
One recent study showed strong success by paying individuals just $7 a pound to lose the weight. It's definitely possible.
The trick is CONTINUING incentives. Otherwise you get yo-yoing.
Oh, and please call me autistic. I'd love it.
My credentials include being formally fat, packing on weight easily, and doing metabolic research on the overweight and obese at the most prestigious medical research facility in the U.S.
But I guess I'm just silly to say that people need external incentives to lose and keep off weight. And that they need the immediate gratification of those incentives, and not long-term things like "you'll live longer".
Joe
Continued incentives are stupid and inefficient. Punishments for bad behavior are much better (or at least cheaper) for long term corrections.
Could you imagine paying people every time they didn't break the law but had the opportunity to do so (stopping at a red light for instance)?
Nelson,
Both are forms are continued incentive. Don't run a red light, don't get an expensive ticket.
I understand your point, but different mindsets require different incentives. However, to your point, it's the exact same thing if you simply charge people much higher premiums for living unhealthy lifestyles.
I think the point is, it's much harder to (en masse) prove someone is living an unhealthy lifestyle, versus making them achieve certain healthy lifestyle markers and re-imbursing them for those practices (i.e. 120 visits to a paid healthcare facility per year).
Joe
Are you just testing your readers reading comprehension skills?
Sitting in front of a computer and blogging instead of exercising makes you fatter.
Are bloggers more likely to have health insurance?
How do you know bloggers don't go the gym? You can't exercise more then 45 minutes a day without causing injuries anyway.
"You can't exercise more then 45 minutes a day without causing injuries anyway."
Ex-squeeze me? Care to cite that ridiculous statement?
Well, he did use the "you" pronoun, so maybe he's trying to make an insulting observation about zic's stamina?
Did not read the paper, but it sounds amazingly like the disproven arguments that seat belts cost lives.
If I remember my Psychology 101 courses, people respond to rewards and punishments. But those rewards and punishments have to be proximal (near in time, and directly related to your actions). If you weren't seeing the doctor while eating unhealthily, insurance isn't going to change your behavior one way or the other. Now if the insurance company had some way to spy on you and charged you directly (as opposed to a third party) different rates based on diet, then yes, I could see that having an effect.
Moreover, it's pretty obvious that being sick and fat and getting relatively cheap health care is not enough of a "reward," vs. the "punishment" of being sick and fat and getting relatively expensive health care, that normal human beings would adjust their behavior accordingly when, say, confronted with a bag of potato chips.
Incentives don't matter, which is why the LBJ welfare state was such a smashing success!
Under ObamaCare, it would be illegal to "discriminate" against someone in their health insurance premium because of age or pre-existing conditions. So young healthy people will pay the exact same premium as old sick people. I'm sure they're going to love that.
Joe, what is formally fat? Fat, wearing a tuxedo?
Lol, I didn't realize it even when I re-read it. I meant formerly :)
My body weight was ~25% fat. I was overweight. I still, to do this day (though I'm pretty much thin and fit now) don't like it when clothes cling to my stomach (i.e. if the wind blows I pull my shirt away from my stomach).
And I still gain fat readily, though I replaced it pound for pound with about 20-25 pounds of muscle since I started losing way back when.
So I think of myself as formerly fat :)
The relevance of this article, I think, is that it is part of the proof against the argument that if we just give everybody health insurance, they will become healthier and healthcare costs will go down.
Now Obama is calilng it "ConsumerCare", touting all the wonderful benefits and no one will be excluded for pre-existing conditions. He just can't explain how he will pay for it without doubling the national debt in 10 years.
All health care bills under consideration are deficit-neutral or very close to it. Please stop lying.
Haha. Excuse me while I stop snorting my beer all over my screen. I trust CBO or OMB numbers as much as you trust the GOP flowchart. So padre, how are we going to resolve this Mexican standoff?
When I was in retail, I didn't have insurance but I was on my feet all day and in much better shape.
Now I have an administrative job in an office. They pay me to sit at a desk eight hours a day but the health insurance is pretty good. On the other hand, eight hours a day at a desk means 1) not much exercise at work and 2) not a lot of energy for exercise after work.
Following Mickey Kaus' first rule of journalism - always wildly overgeneralize from personal experience! - I'd rephrase thus:
Situations offering health insurance correlate with work environments and lifestyle choices conducive to obesity.
Mark T, I agree. There's got to be something tangibly at stake for people to change lifestyle habits. But what? Is it better to offer incentive or punishment or a combination of the two?
Either way,the US government is not likely to offer incentive/punishment (I'm thinking something like a luxury tax for unhealthy foods, but then that would only be effective in conjunction with offering cheaper, healthy foods) for chaning health habits. Even if they did, the feds wouldn't do it wisely. Not that I'm saying I know the wisest path to take in order to get people living healthier lifestyles.
As far as incentives not making a difference, that's bunk.
Here is a quote from a Fox News article about North Carolina paying at-risk girls $1 a day for not getting pregnant.
"Dr. Hazel Brown, co-director of the program, said six girls of the 125 who have been enrolled for six months or longer have gotten pregnant or otherwise dropped out since it began in 1997. "
Read the full article here: http://www.foxnews.com/story/0,2933,529037,00.html
Just goes to show they don't understand the basic psychology of at-risk girls. No amount of money will stop them from "living in the moment" which is what being a teenager is all about, except for a few bookish nerds.
There are no magic bullets, but taxing things that are known causes of medical utilization seems the most efficient to me. It both funds the insurance expansion and deters the activity. Far better to tax that than to tax either health insurance or medical utilization or to tax unrelated activities).
I'm wondering about other risky behaviors.
Like mountain biking.
Rock climbing.
back-country hiking.
Swimming.
Kayaking.
White-water canoeing.
ski/ride
hang glide.
Hiking the Appalachian Trail.
Should they pay an extra premium for their risky behavior?
Thing is, many of those activities have a substantial upside. For every rock climber who falls and breaks something expensive, there are many more who live healthier on account of the exercise.
As far as I know, obesity has no upside other than improved famine resistance.
How observant of you.
My son is is certified in outdoor emergency care; people get seriously hurt doing the most healthy activities. They break legs, their necks, their arms, have heart attacks from elevation gain and poor circulation, have stokes, get bit by spiders and have allergic reactions, get caught in avalanches, get dehydrated. They're equipment wears out and fails.
My own pre-existing condition happened on a bike; and I've got a rather large chunk of jaw missing and seriously damaged cervical vertebrae to show for it.
In many states, I would be denied insurance.
And I have never met the $5,000 deductible of my current plan. It's never paid a cent for my health care.
It's not just about a single incident of breaking something expensive. The long-term costs of such an accident can easily outstrip the costs associated with something like obesity, and accidents are hardly uncommon.
Skiing accidents are the ones I happen to know about, because that's how I tore my knee up at age 17. I'm 32 now, and I've already had four surgeries and plenty of associated costs like physical therapy and doctor visits. I now have osteoarthritis and expect to have two knee replacements -- we're trying to stave off the first one until I'm in my 40s so that I won't need three. The lifetime bills will run well into the hundreds of thousands, not to mention that I'm crippled for life. I liked skiing, but I wasn't a fanatic or an elite athlete, and an insurance hike would have deterred me and saved my knee.
I've also been fat, although I am not now. There aren't many upsides to being fat, but there are significant positives to not doing the work required to lose the weight. I lost 80 lbs a few years back, and I spent an average of two hours a day directly engaged in diet-related activities like working out and cooking. I then gained 35 lbs back, partly due to major health conditions, but also because I simply didn't have the time or the energy to continue working that hard for the rest of my life. I'm currently at the top end of "normal" BMI, still carrying a little more fat than I'd like, but it's doubtful I'll ever make it back into tip-top shape. For many people, it takes a whole lot more than 30 minutes of walking a day and skipping the mayo on your sandwich. Most "normal" people wouldn't be able to direct that kind of effort into any endeavor, so why do we expect all fat people to do so, and call them lazy slobs if they don't?
And if they are required to pay an extra premium, and they are required to keep insurance, does that not seem like intrusion into personal freedoms?
My point exactly.
So which is more important to you, personal freedom or affordable, universal health insurance?
So is the issue the requirement to hold insurance, or that the insurance company is watching out for the rest of the risk pool (and the bottom line)?
What an interesting question. Because anyone who partakes of one of those activities regularly is likely to be fit and trim, and hence, a lower risk.
So which would be watching out for the risk pool: limiting the risky behaviors or encouraging them?
A question for those heroes of the slide rule: the Actuaries, perhaps.
What controls did they use to filter out differences in the amount of physical activity, average age of the people with and without health insurance?
Without that information we have no way to know if the study means anything.
That leaves us with nothing to do but approach the issue with our preconceived notions and the urge to flame.
I really don't have a clue how we deal with obesity in this country and still believe that most initiatives, either punitive or rewarding, will be neutral at best and more likely counter productive (see. margarine, low-fat, olestra, fake sugar, calorie counting etc...)
Talk to people who carry excess fat and they'll talk about the intense negative societal pressures that they perceive on a daily basis. They will talk about the petty humiliations they endure while going about normal life, the lack of attention from the opposite sex, feeling prematurely aged from excess weight etc. Will government incentives make the tipping point on top of these petty daily trials?
I really think that what is missing from the weight loss discussion is any mention of peer groups.
If you are part of a social circle that has many people who carry excess bodyfat (overweight is too crude a term) than a successful attempt to actually rid yourself of that excess fat could be extremely challenging to your friends, or your spouse, or your family.
You're basically telling them "I'm disgusted with the way I am, and they way that all of you are, to the point that I will make drastic life changes to be not like you anymore." Real body transformation involves changing some fundamental aspects of your personality and this may be why real fat loss can be such a daunting challenge. Your old relationships will feel threatened by your transformation.
This is why reformed alcoholics give up their old drinking buddies or why people who quit smoking are more successful if smoking partners aren't always lighting up around them.
Megan,
It depends on who "you" are, and on whether or not you sucked your thumb enough as a child.
Cheers.
If you are a metaphorical fat sheep - the only thing that makes you fatter is the "ok" from the majority. In the case of obesity and being overweight - we are talking about 2/3s of all people supporting you. It really is hard to change anything about yourself when 2 out of 3 people you know are doing it? It is even harder when the government supports it with money incentives? But sure - let's blame health insurance for it! I take it that most of our mirrors are broken already?
On a sidenote;
I wish more doctors were holistic about treating healthy weight. D-Chiro-inositol is proving to be pretty helpful in treating PCOS in both females (and the equivalent metabolic disorder in males.)
PCOS is present in about 5% of the population and is a widespread cause of obesity which is resistant to exercise. D-Chiro-Inositol helps the body to use Insulin more effectively. It's found in chickpeas, carob and really expensive pills. Myo-inositol or other forms of inositol are not substitutes.
If we do have to have national healthcare, couldn't we also have national gym memberships? And ban hydrogenated oils? These seem like they'd yeild some good benefits relative to cost.