General Medicine Health Care Healthy Living

Medical innovation cannot cure fatness…

Possessing great intelligence is not a guarantee for being right.

Judges and professors are surely smart, but the quagmire that is the obesity epidemic can fell the smartest of the smart.  So it is when a professor of public policy and a famous federal circuit judge, author and senior lecturer at the University of Chicago wax prophetically on the topic of obesity in America.

In an opinion piece in Saturday’s WSJ, these two academics correctly point out many important truisms on the obesity problem.  As they eloquently say, society has advanced to the point that regular life burns fewer calories.  That’s obvious.  Not only do people burn fewer calories at work, as they argue, but more importantly, except in health oases like Boulder Co or Bend Or, suburbia makes it challenging to safely commute anywhere without an automobile.  In my representative middle American city it would be unsafe for me to ride or walk to work.  Likewise, my child could not walk or ride safely to school.

On the other side of the obesity equation (the calorie intake side), they also correctly point to the decreasing costs of high calorie food.  Correct again.  The middle of the grocery store–that portion of the store with the highest amount of high fructose corn syrup and inflammatory trans-fat–is increasingly less expensive.  The dollar/calorie ratio is clearly decreasing.

Furthermore, in pointing out the obvious observation: as education on the importance of diet and exercise in controlling obesity has increased, so has the weight of Americans, they argue correctly that lack of knowledge is not the problem.  America knows about obesity.

They also debunk the simplistic myth that taxing junk food will help; as taxing over-indulgence in calories is impossible.

So far, so good.  The professor and the judge are three for three.  But in the last inning of the close game, where it really matters, they strike out with the bases loaded.  I had to read their conclusions numerous times, as it was with great disbelief that such a cogent piece from incredible minds could conclude in such wrongness.

After all their rightness, the professor and the judge conclude that medical innovation may be the most promising solution to the obesity problem.  They make two outrageous conclusions.  (Not counting the false analogy that obesity-related behavior is like HIV-related behavior.)  
  • They argue that medical research will devise a way to minimize the effects of obesity.  Their words speak for themselves.
  • True, if R&D led to better treatment or even prevention of the diseases that obesity gives rise to or exacerbates, including heart disease, joint problems, surgical complications, and especially diabetes, this would reduce the incentive to lose weight. But if most of the adverse health consequences of obesity were eliminated, obesity would cease to be an issue, except perhaps from an aesthetic or emotional standpoint.

  • To illustrate medical innovation, they cite the example of Vivus’s obesity wonder-pill, Qnexa (they misspelled it ‘Onexa’).  Yet, two weeks ago, an FDA panel of experts recommended against approving this pill.   It seems “instant willpower” in a pill comes with the potential for depression, arrhythmias and birth defects.  Such adverse effects were cited as the primary reason for recommending against approval.

At the risk of being considered myopic, it is impossible for me to imagine that we can medically innovate our way out of the obesity problem.  Carrying excessive body fat will always be detrimental to our organs and joints.  Saying that modern medicine can some day eliminate the adverse effects of obesity is simply ludicrous. Any judge or professor who would like to know more about the obesity problem should spend a week or so in a cardiologist’s office.  The wrongness of their present notion would quickly become evident.

Stapling the stomach or taking pills to change brain chemistry are not now, nor never will be the answer to fatness. The solution to obesity is not in medical innovation, but rather in a complete societal paradigm shift.

In solving our fat crisis, a Mom is substantially closer to the treasure than two powerful academics.


5 replies on “Medical innovation cannot cure fatness…”

John, excellent post. I agree with everything except your assertion that taxation has no effect on lifestyle choices. There is a direct correlation between cigarette taxes and consumption (see for example, in Europe where gas prices are twice what they are here people drive smaller, fuel efficient cars, and looking at food specifically, here is a study showing soda taxes cut consumption ( In the fattest country in the world, where a hamburger is cheaper than a head of broccoli, I think there is a role for economic incentives to control obesity.

Most people are surprised to learn that energy expenditure via physical activity has increased in Europe and North America since the 1980s, not decreased.

We're getting fatter because we eat to much.

I suggest that excessive consumption of refined, over-processed carbohydrates (sugars and starches) are the main culprit.


Reference: Westerterp, K.R., and Speakman, J.R. Physical activity energy expenditure has not declined since the 1980s and matches energy expenditures of wild mammals. International Journal of Obesity, 32 (2008): 1256-1263. Published online May 27, 2008. doi: 10.1038/ijo2008.74

It has been my observation, from having been in the counseling profession and from taking note of the lives of friends and others, that overweight to the point of qualifying for bariatric surgery is always or nearly always caused by having been abused or neglected as a young person. The person learns to comfort with food, and their thoughts are never very far from it. Thus, they overdo, eat too much, and it shows. But bariatric surgery doesn't fix the comfort need, so usually the person gains again. Unless there is a transfer away from food as the primary comfort or addiction, or a healing, the person will likely always deal with the issues of overintake and overweight caused by inappropriately satisfied emotional needs, regardless of taxes, prices, knowledge or advice to exercise.


Thanks for relating your observation. I am not a counselor, but I know that pills and surgery have significant limitations as a widespread solution. Your observations are congruent with that notion.


Comments are closed.