Archive for February, 2013

February 26, 2013

the HAES® files: Opportunity Costs

by Health At Every Size® Blog

by Fall Ferguson, JD, MA

There are a number of very real direct “costs” to individuals, communities, and societies resulting from the current “war on obesity.” The direct consequences of this “war” include disordered eating practices, weight cycling, body dissatisfaction, bullying, weight stigma, bariatric surgery, insurance exclusions, and a general reinforcement of fat-phobic, weight-centric health ideas that don’t really serve to improve anyone’s health or wellbeing, regardless of their weight or size. These consequences are costly indeed in both economic and human terms, and collectively have a profound impact on health.

But what about the opportunity costs? Opportunity cost is a term of art from the field of economics, and may be defined as:

“A benefit, profit, or value of something that must be given up to acquire or achieve something else. Since every resource (land, money, time, etc.) can be put to alternative uses, every action, choice, or decision has an associated opportunity cost.”

A key feature of opportunity costs is that they do not appear on any balance sheet. However, according to economic theory, they should be taken into account in any sound decision-making process.

It’s high time we started to account for the opportunity costs of our culture’s declared war on obesity. In other words, what do we forego as a society when we allocate precious social, economic, cognitive, emotional, and physiological resources toward pursuing and maintaining our weight-based paradigm of health?

Here are a few opportunity costs I can think of:

Public health resources. Imagine how much real health promotion and useful health research we could be doing if we weren’t allocating our public health resources toward obesity-focused endeavors. For example, in 2010, the U.S. National Institutes of Health (NIH) spent $971 million (almost a billion) on research on obesity. I can certainly think of at least few better ways to spend that kind of dough!

I wasn’t able to track down any data on what we spend nationally or globally on health promotion campaigns focused on obesity, but given how much health programming is devoted to obesity-related themes, my guess is that the amount is high indeed. It’s widely recognized that spending money on health promotion can result in a net cost savings to a given health care system. However, we have to spend that money on actually promoting health, not promoting a misguided weight-based approach that is not supported by any long-term evidence of effectiveness. In an era when we don’t have enough money to fund state public health agencies and needed community health initiatives, it seems doubly sad that we waste resources this way.

Proper health care for many thin and fat people. The war on obesity has generated a kind of “tunnel vision” among many health professionals, who often make assumptions about people’s health based on their size. When the patient is thin, doctors sometimes overlook signs and symptoms of certain disease states (those typically associated with “obesity”). Conversely, doctors overtreat fat people based on the assumption that they have diseases that they don’t have. And perhaps even more often, health professionals assume that certain signs and symptoms of disease states are due to a patient’s weight rather than actually diagnosing and treating based on those signs and symptoms. All too often, a doctor can’t see past a patient’s size, whether thin or fat, and thus fails to treat the patient, rather than the patient’s size. (Is this not malpractice? – but there’s a topic for another day.) The resulting human suffering represents an opportunity cost of this “war”: we are missing out on the possibility of providing proper health care.

The numbers are fairly staggering. According to Dr. Deb Burgard’s analysis of data from a research study on BMI and cardiometabolic health, we either undertreat or overtreat a combined 35.7% of patients with respect to cardiovascular disease alone. In other words, as a result of BMI-based assumptions, almost 72 million people in the U.S. are either receiving treatment for heart conditions they don’t have or are not receiving treatment for heart conditions that they do have. All this misdiagnosis has financial consequences as well. By missing out on the opportunity to prevent and treat disease effectively, we are costing the system a lot of money.

Productivity. I don’t even know how to begin calculating the opportunity costs of dieting in terms of productivity. It’s beyond argument that dieting can result in “foggy brain” and mood disruption. Hungry people have a hard time concentrating. If we could assemble figures around the lost productivity caused by dieting, I’m guessing that employers would never again pay for a weight loss program and schools districts would never again justify another school health initiative in terms of obesity.

Fun and creativity. Even if we manage to keep up with our jobs and schoolwork, dieting and obsessing over our bodies and appearance take time. All that obsessing means that we forego the chance to paint, sing, laugh, hike, go to the movies, stand on our heads, write poetry, play with our dogs, and generally chase whatever rainbows we want to chase.

Self-esteem and self-confidence. How many of us have been undermined by cultural messages about the relative value of fat and thin bodies and by our doctors’, teachers’, parents’, coaches’, spouses’, and others’ insistence that we didn’t measure up? Far too many of us have spent countless days, months, years, or decades in anguish over our perceived failures to be thin enough, fit enough, buff enough, etc. How do we measure that suffering in terms of opportunity costs?

Joy and happiness. I don’t think it’s an exaggeration that our collective fear of fat and pursuit of the thin ideal has made millions of people miserable worldwide.

These are some of the opportunity costs I can think of – and I am sure there are more. Please write in to the comments below and add to the list.

ben steinMy final thought (for now) on this: the concept of opportunity costs assumes that there is a benefit obtained. What have we gotten of value for all that we have given up? As Ben Stein said in Ferris Bueller’s Day Off, “Anyone? Anyone?”

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