Slim logic for the "fat tax"

An editorial in Forbes examined the wisdom in the proposal of a "fat tax" in the US to finance the out-of-control healthcare spending in the country.

The logic is this: since fat people supposedly require more health care, they should pay an extra tax to finance the spending.

Because shame and blame is such a great motivator of health and positive behavior change.

The problem that most people don't seem to grasp is that people can't control what they weigh. It's like charging tall people more because they have more serious falls, or pale-skinned people more because they're more likely to get skin cancer. Or people with other skin tones more because of some other reasons. Maybe the links are legit- I don't know. In the end it doesn't matter. We know that people can't permanently change their height or their skin tones. But despite evidence to the contrary, we still persist in thinking that people are in charge of what they weigh.

I don't know any person, fat, thin, or anything in between, who hasn't tried to lose weight at one point or another in their life. People aren't fat because they refuse to be thin. They're fat for any number of reasons, some of which might be able to be altered, others not. It's tremendously presumptuous to assume that anyone with excess adipose tissue is simply too lazy to do anything about it and that their appearance is their fault.

And fault-finding seems to be the key issue with this type of proposal. I'm all for taking responsibility for your health and well-being. I'm all for preventing a disease rather than treating it later. It's just that prevention campaigns seem to morph into victim-blaming. "Hey, we tried to prevent obesity, so if you're still fat, it's all your fault." You can substitute any disease or thing-that-might-be-prevented in there. Except that no matter what we do or how hard we try, people will be fat, people will get sick, and people will die. Such is life. Not much can be totally prevented, even if we funnel boatloads of cash into the effort. Life's a bitch, and then it has puppies.

The irony is that most people can recognize that charging people more taxes because of race or ethnicity is pretty discriminatory. That thinking hasn't trickled down to weight-based discrimination. It's the last acceptible discrimination. Not only is it acceptible, most people who are subject to this discrimination believe they deserve it. Which is pretty messed-up, if you ask me.

Weight isn't a behavior. People can change behaviors. But since weight isn't a behavior, you can't always change it.

Health is complicated. I don't have all the answers, and I don't know anyone who does. Anyone who is fat can tell you horror stories about how they were shamed about their weight (and yes, charging you more because you have a fat ass does count as shame), and most of them are still fat. Not because they have no willpower or they don't care about their health or they just couldn't be bothered to un-Velcro themselves from the couch and stop shoving Twinkies into their mouths, but because body weight is really complicated and we don't get to pick our weight any more than we can pick our height, shoe size, or skin tone.

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hm said...

Who would be the one to get to draw the line, anyway? The whole idea is logically preposterous, shame and blame aside. Weight is not like income- you cannot put it into a "bracket"- I know women whose weight fluctuates by 10 pounds or more just because they're on their period.

And, of course, to be fair they'd also have to tax the anorexics for being UNDERweight and costing more. Preposterous. Sounds a bit like Hitler, looking to select and reward the perfect human and punish and eliminate the rest.

Anonymous said...

What about the anorexics who are in hospital a lot? Do we get charged a skinny tax? I hate to think how much my illness has cost the government but I'm willing to bet it's a lot more than most overweight people.

C-Girl said...

I think you are SO, SO right in saying that at some point or another we are ALL unhappy with our weight and try to alter it…. yes, even ashamed of it. No matter the size, no matter the weight. It is just gravity. Would we be happier living on the moon with a different number? Weight is just gravity but what you put into your body is health. And health…. health has meaning. I hate that we even have to have a tax on something so vital, but now that we do… God help us make the right decisions! Decisions like not taxing a number on the scale!

Anonymous said...

This is especially insane considering the link between obesity and low socio-economic status.Not to bring another major policy issue into the mix, but how are they supposed to pay this tax after they already earn less money and have to spend more on, for example, larger clothes? This makes absolutely no sense.This weight discrimination is even seen in the workforce. White obese women make significantly less than all of their counterparts. How is any of this fair?

CarsMa said...

We would never charge someone that has say cancer extra because they didn't ask for cancer. UGH People overweight or underweight don't ask for it either. It's a disease. Let's try doing to someone in a wheelchair and see how far we get. UGH - Stupid. Maybe everyone should just go on the new wildly popular Bride Diet (NG tube). Again - stupid.

Annoyed said...

I fully agree with all the above. The "fat tax' is a form of discrimination. Who are we to say that only certain race, weight, height, physical or mental condition are more worthy than others. Let's not become Hitler again, discriminating against the "preconceived" imperfect people.


Anonymous said...

While a "fat tax" would be discriminatory, I don't think it comes anywhere near the acts of a Hitler. Please, let's avoid such hyperbole - it only takes away from your argument.

Also, while I recognize that there are people who have a physical condition that may limit their ability to go below, or above, a certain weight, I do think a statement such as "people cannot control what they weigh" is a bit broad. I know it may not be PC to say so but I do believe that some people could control it, to a certain extent of course, if it mattered to them to do so.

Anonymous said...

Love this. I've been reading a lot lately about fat discrimination, (I especially recommend reading Health at Every Size by Linda Bacon, Rethinking Thin by Gina Kolata or The Obesity Myth by Paul Campos) and this echoes exactly what the majority of research indicates. You cannot look at a person and assume anything about his or her lifestyle choices by looking at weight.

Research actually indicates people at an "overweight" BMI live longer than those at a "healthy" BMI. Active fat people are far healthier than inactive sedentary people in the "ideal" weight range. Many of the diseases associated with obesity are actually caused by weight cycling/dieting habits, an inactive lifestyle, or other factors like stress and discrimination from the health care system. Whenever physical activity levels are controlled for, weight is in no way correlated with health (except in extreme cases). People who are underweight, even when terminal diseases are controlled for, actually exhibit more health problems and die younger than those classified as obese. I could go on and on and on. I am super passionate about this issue.

The body's control mechanisms, in the form of hormones and metabolic processes, are a tightly regulated machine. All people have a set-weight range and it will be very difficult to deviate much above or below this range in the long term. People who are fat who go on a diet experience intense metabolic slow downs, and their body's produce hormones that increase hunger and lethargy (thus eat more and stop moving). The body's of fat people who go on a diet and lose weight actually behave more like a thin person who is starving, not a thin person who is naturally thin. The body fights to regain the lost weight, and then to protect from future famine (aka dieting) ratchets up the set-point. Dieting makes you fatter!!! Also, when research has looked at the diets of both fat and thin people, the diets do not differ significantly (again except in extreme cases). Likewise, time spent exercising does not differ significantly.

We live in a society where the dieting industry profit immensely from us believing that weight is always within our control and if we are fat it is our fault. Much obesity research is directly funded by the pharmaceutical companies making diet drugs or by weight loss programs. Studies funded by these sources, as opposed to government grants, are significantly more likely to find results indicating fat is bad. Hmmm... that's a bit suspicious, no? The dieting industry wants you to believe being fat is a moral issue, thus justifying it as a basis for discrimination. It's interesting to note that more minorities and those in lower socioeconomic statuses are ofter fatter and thus receive more discrimination. In a world where it is no longer acceptable to discriminate based on skin color or social status, fat is still safe to mock and judge. It's safe to say, "I don't like you because your fat." It's not safe to say. "I don't like you because your a middle-aged black woman."

In the end, even if fat was actually bad and weight loss was the answer, 95% of dieters return to their pre-diet weights within a couple years (and often higher). Why push a "cure" that is ineffective and not sustainable. What does work? Promote healthy lifestyle choices (a moderate diet guided by internal hunger cues and food preferences and moderate activity that is enjoyable). When people are encouraged to be healthy and NOT focus on losing weight, they actually show the greatest improvements overall in key indicators of health.

I hope you talk more about these issues in your blog. You have a much wider readership than me, not to mention you are a freelance writer (possible query/proposal to popular fitness magazines??) who could help dispel the myths that are out there.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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