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Which of the following should keep you awake at night counting the minutes until the clock strikes Doomsday: Terrorism? Climate change? SARS? AIDS? Well, according to public-health expert Lawrence Gostin of Georgetown University, your answer should be "none of the above." In a burst of impassioned rhetoric, he told a summit run by the Oxford Health Alliance (OxHA) in Sydney earlier this year that although global terrorism is "a real threat," it's just a teddy bear next to the 800-pound gorilla of obesity.
"Ever since September 11, we've been lurching from one crisis to the next, which has really frightened the public," Gostin said. "While we've been focusing so much attention on that, we've had this silent epidemic of obesity that's killing millions of people around the world, and we're devoting very little attention to it and a negligible amount of money."
Purblind politicians, it seems, are averting their gaze from the horrors to come. "In the current US Presidential campaign, prevention of obesity and the effect it is having on the poor has so far registered barely a blip on the Democratic side of politics and zero on the Republican side," said Gostin in the summit's official press release.
These rhetorical fireworks seem to signal an audacious tilt by obesitarians at knocking the global warming industry from its pole position. "It is true that new and re-emerging health threats such as SARS, avian flu, HIV/AIDS, terrorism, bio-terrorism, and climate change are dramatic and emotive," adds Professor Stig Pramming, an Oxford don who is OxHA's executive director. "However, it is preventable chronic disease that will send health systems and economies to the wall."
Scary stuff. And just a bit cheeky, too. Al Gore won an Oscar and a Nobel Prize for terrifying us about global warming. Is Professor Gostin saying that he didn't deserve it?
Anyhow, obesity is just one of many threats to national finances in the year 2030. What about oil shortages, depression, aging populations, Ebola, mass migration, internet meltdown, and nuclear warfare&38212;to say nothing of all those known unknowns and unknown unknowns? Although the prospect of millions of avoidable deaths from heart disease, diabetes, and cancer is dismaying, why should the Oscar for moral panic (and the lion's share of research funding) go to global obesity rather than to global terrorism or global warming?
At work here is not only a cynical public-relations campaign by the chronic-disease lobby, but also a profound moral confusion. The obesity epidemic is unlike its rivals, which are beyond any single individual's control. Sure, a host of other factors are at work in the obesity epidemic: faulty genes, obesogenic working environments, prosperity, advertising, poverty, family break-up, and so on. But in addition to all of these factors, obesity represents a crisis of freedom and personal responsibility.
In the worst cases, the obese have sold their birthright of a trim physique for a mess of pottage—a lounge in front of the television and a Mars bar. Framing a lifestyle disease as a calamity as unavoidable as a collision with an asteroid helps no one because it leaves out the crucial ingredient of free will. Some research suggests that excessive materialism and individualism, as well as the decline in religious belief, are important factors in the rise of obesity. More funding, more government regulations, more hectoring from public-health authorities will not have an impact on these.
There are other fallacies in the obesity narrative. The politics, to begin with. Gostin got this wrong. Obesity is an issue in the US presidential campaign. Onetime Republican hopeful Mike Huckabee is the most famous ex-obese man in America. His triumphant loss of 110 pounds and his book Quit Digging Your Grave with a Knife and Fork help explain an electoral appeal that baffled foreigners. Since he clearly had the upper hand in the obesity stakes, it's little wonder that the other candidates ignored it.
Second, and more seriously, there is the assumed moral equivalence between death by terrorism and death by gobbling. Terrorism rends the fabric of civic life, striking at the law and order that underpin a workable democratic society. A suicide bomber killing dozens in a Baghdad food market is simply not the same as a grocery shopper sloooowly killing himself in a supermarket with yet another super-size Coke and a roast chicken. The former, if unchecked, will destroy a democratic state and human rights. But a democracy of obese voters is still a democracy. It is indecent to equate the two.
Third, in any case, Gostin's foreboding calculations may be completely wrong. They do not appear to account for the savings that public-health systems will achieve through a decline in the average life-span. Ghoulish as it may sound, a study in The New England Journal of Medicine (NEJM) has forecast that obesity will rescue the American social security system from bankruptcy. Which will cost more: death from obesity at 65 or death at 85 after 20 years with Alzheimer's? The idea that for the first time since 1900, the average lifespan of a generation could be shorter than that of its parents is dismaying. But the impact on the bottom line should not be ignored'if OxHA is interested in the truth rather than playing Chicken Little.
The problem with calculating the economic impact of obesity is that its victims would have died anyway. The relevant issue is by how much their life expectancy will be reduced. The authors of the NEJM study estimate that it will only be by "one-third to three-fourths of a year." This is not negligible when spread over millions of Americans. But lethal childhood diseases in the developing world deprive millions of victims of decades of life. Pro-life supporters could even trump this by multiplying the millions of annual abortions by the world-average life expectancy. Statistics is a game that two can play.
Finally, pooh-poohing the danger of terrorism is bound to be a damp squib. OxHA wants to enlist youth, activists, and environmentalists in a "coalition of the committed" who will build a world of weight-watchers. Sorry, guys, but it's impossible to get starry-eyed about calorie-counting and regular exercise. Fighting terror—even fighting global warming, for that matter—has a social-justice dimension that obesity lacks. Ultimately, death by obesity is a lifestyle choice. Death by terror isn't. •
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