Minding the Obesity Epidemic

supersize.jpgJeanne Whalen at the WSJ has a fascinating piece on a slew of new obesity drugs now in clinical trials. There’s a lot to comment on, but I was struck by a chart on the front page, giving the following rates of obesity (BMI > 30) in different countries in 2005:

US: 39%

UK: 23%

France: 7%

China: 2%

Japan: 2%

These are pretty shocking figures. The chart mentions that the obesity rate in the US was 35% in 2002….so the percentage by which obesity increased in the US in three years is double the overall percentage in the Asian countries mentioned. How is it that twenty times as many Americans are obese than Chinese or Japanese nationals?

I plan to look for answers in Avner Offer’s The Challenge of Affluence: Self-Control and Well-Being in the United States and Britain Since 1950. The book is a masterpiece of meta-analysis, reportage, and Jon Elster-style explication of the microfoundations of social action. Offer’s thesis is (inadequately) summarized below:

Resources and cravings do not map precisely on to well-being. . . .Over the last two decades, a new understanding began to emerge, especially from psychology and economics, that what we want and choose can often fail to deliver, and can even be counter-productive. . . . This understanding is the work of many inquiries and disciplines. My effort here is to extrapolate it to the personal dynamics of affluence during the last six decades. . . .

Offer has a whole chapter explaining the ways in which high levels of competition, stress, and inequality in American and British society contribute to compulsive, mindless, or otherwise unhealthy eating.

Kudos also to Cass Sunstein for exploring the issue in his review of Brian Wansink’s diet book Mindless Eating . Bottom line:

Wansink has concluded that much eating is mindless. Americans are fat not because they have made a rational calculation that French fries are so yummy that they are worth the costs in health and svelte. Nor are French fries essentially irresistible. Often Americans eat because of contextual cues, or “hidden persuaders,” to which they are blind, but which greatly affect their behavior. . . . Wansink’s real subject is choosing, not eating, so even thin people should read it.

Philosophers ranging from Aristotle to Dewey recognized the ultimate importance of habit, and Wansink brings their insights into a world of diet fads sorely in need of philosophical perspectives.

So what’s the bottom line for law? Well, given the insights of Offer and Wansink, the agenda for regulation currently pushed at The Situationist makes a lot more sense.

The new obesity control drugs may also have some interesting implications for medical marijuana laws. Consider the mechanism of action of Acomplia:

Acomplia, known by the generic name rimonabant, attacks obesity in a new way, by blocking receptors in the brain and in fat cells that help regulate appetite and metabolism. Cannabis, the active ingredient in marijuana, acts on the same receptors, which is believed to explain why marijuana users often get hungry.

I suppose this makes Acomplia something of an anti-marijuana, but the larger parallel may help support the thesis of Richard Grandpre’s provocative Cult of Pharmacology: that legal and illegal drugs have mechanisms of action that sometimes are strikingly similar. (For the opposite view, see the Peter Kramer review on the Amazon page.)

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