Fat is an economic issue

Written by Piers Cawley on

Terry Pratchett once observed that a character of his was anorexic because every time they looked in a mirror, they saw a fat person. By that measure, I’m anorexic, though I tend to avoid mirrors. By more objective measures, I’m morbidly obese - 6' tall, 346 pounds; the Body Mass Index calculation is never going to give a good number.

To listen to some sections of the press, I might as well be public enemy number one. A drain on the public purse, a morally bankrupt insult to the eye of the right thinking, Daily Mail reading healthy public. Apparently, I have the self control of an incontinent puppy and spend my time sat on my arse in front of the TV or looking at child porn on the internet, constantly stuffing my face with lard and chocolate.

Mmm… lard and chocolate…

Now, everyone’s entitled to their opinions of the morality of others. Catch me on another day, and I can rant for ages about the ugliness of the way diet and beauty industries stoke insecurities to sell product. Today I want to talk about the cost issue.

Fat people aren’t cheap to keep - we tend to die younger, and in the process of our dying we cost a lot of money. But dying can be an expensive business and however we go, we all do sooner or later. Fat people’s healthcare costs may well be higher than those of healthy people of the same age, but those healthy people could end up waiting ‘til they are 80 before dying of something horribly expensive like cancer, or Alzheimer’s.

When you add up the net lifetime healthcare costs of the average healthy person, and those of the average obese person, the healthy person costs more.

This is analogous to the “Long Tail” idea - the idea that the long tail of low sales of ‘specialist’ books/records/services adds up to being of greater value than the total sales of the top 100 or whatever. Obvious when you think about it, but running counter to traditional thinking in this area.

We’re really good at spotting the big things, but rather less good at spotting the slow accretion of small things. Each drop of water that falls from a stalactite to a stalagmite doesn’t appear to contribute anything. Nevertheless, the stalactite and stalagmite got there somehow.

I find this knowledge rather heartening. Okay, so as a fat git with diabetes, I’m likely to die young, but that’s my business. The pernicious idea that the broader population of tax payers is somehow suffering because of me and that because of that I should be denied access to health care isn’t just morally repugnant, it’s economically illiterate.


Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure from PLoS medicine. The paper describes a mathematical model rather than something which does the arithmetic on a real population, so it’s only as good as the assumptions, but it does seem compelling that the driver for high total healthcare costs over a lifetime is the length of that life. But, as I fat git, I might be expected to say that. Ho hum.