Time to cut the fat: the case for government anti-obesity legislation.

• Author: McGuinness, Stephen A.

1. INTRODUCTION II. THE NATURE AND CAUSES OF THE AMERICAN OBESITY EPIDEMIC A. Rates of Obesity and Overweight Have Reached Crisis Proportions B. The Obesity Epidemic Is Responsible for Severe Social Harms C. The Causes of the Crisis III. WHAT CAN BE DONE TO ADDRESS THE OBESITY CRISIS A. The Government, Not the Individual, Is the Best Place to Address the Problem B. Potentially Effective Anti-Obesity Policies C. There Is a Strong Prima Facie Case for Government Intervention IV. THE PATERNALISM OBJECTION TO GOVERNMENT ANTIOBESITY LEGISLATION A. The Basic Anti-Paternalism Argument Against Government Intervention in the Food Industry B. Some Legislation Can Be Justified Entirely on Non-Paternalistic Grounds C. Can Anti-Obesity Legislation Be Justified on Paternalistic Grounds? 1. The Case for Paternalistic Anti-Obesity Legislation Depends Crucially on the Extent to Which the Food Choices of Americans Are Voluntary i. Whether an Extemal Agent Should Respect the Choice of an Adult Depends Importantly on the Extent to Which That Choice Is Voluntary ii. Are the Food Choices of Americans Wholly Voluntary? 2. If the Unhealthy Food Choices of Americans Are to a Significant Extent Non-Voluntary, Does this Sanction Paternalistic Interference? 3. What Kinds of Anti-Obesity Policies Would Be Justified on Paternalistic Grounds? 4. Can More Heavy-Handed Anti-Obesity Policies Be Justified on Hard Paternalism Grounds? i. Is Hard Paternalism Ever Justified? ii. Can Hard Paternalism Justify More Aggressive Anti-Obesity Policies Such as Product Bans? V. THE SLIPPERY SLOPE OBJECTION TO GOVERNMENT ANTIOBESITY REGULATION VI. CONCLUSION I. INTRODUCTION

   Rates of obesity and overweight in America have increased dramatically in recent decades, with no end to the increase in sight. (1) The obesity epidemic has brought with it severe social costs. Obesity is a known cause of numerous fatal diseases and is responsible for tens of thousands of preventable deaths every year. (2) It is also a contributing factor to the development of numerous non-fatal health and psychological conditions. (3) Moreover, obesity significantly drains the public purse as a result of the billions of dollars it annually adds in increased government health care costs. (4)

   Given the seriousness of the American obesity problem, there would appear to be good reasons for the government to implement aggressive new policies designed to curb, and even reverse, the national rate of obesity. For example, "full disclosure" laws requiring the conspicuous posting of nutritional information, and/or health risks, restrictions on the advertising of unhealthy foods, government subsidies for the production of nutritional staples, and the institution of a "fat tax" on particularly unhealthy foods. (5)

   While there appears to be a prima facie case for the institution of such policies--based on the seriousness of the obesity epidemic--critics have repeatedly objected to these potentially effective policies on the grounds that government interference with the food industry would amount to government "big brother" forcing its vision of the good down Americans' collective throats. (6) Such critics argue that food choices are an entirely private matter, and that obesity is simply a matter of personal responsibility. In short, they conclude that the American obesity crisis is simply none of the government's business. (7)

   This Article examines--and ultimately rejects--this anti-paternalism argument against government anti-obesity policies. It argues that government intervention in the food industry for the purpose of stemming the American obesity epidemic is justified and survives paternalistic objections to the contrary.

   This Article begins by briefly outlining the nature, severity, and causes of the obesity epidemic. It considers what can be done about the problem, finding that only government intervention is capable of effectively combating the crisis. It also outlines several types of potentially successful government anti-obesity strategies. Finally, it considers the primary topic of this Article: whether government antiobesity policies constitute unjustified government paternalism.

   In response to this anti-paternalism objection, this Article first notes that several anti-obesity policies can be justified entirely on non-paternalistic grounds. It then proceeds to confront the paternalism objection head-on, finding that whether Americans' unhealthy food choices should be respected depends crucially on the extent to which such choices are voluntary.

   If such food choices are to a significant extent less than voluntary, there is a strong argument for enlisting government aid in the fight against obesity. Finding that, contrary to common opinion, the unhealthy food choices of Americans fall significantly short of being fully voluntary, this Article concludes that there is a strong argument in favor of government intervention. This "soft" or "weak" paternalism strategy, which sanctions government interference only to the extent necessary to ensure the voluntariness of choices, supports government intervention into the food industry only to the extent necessary to mitigate the various factors that make the unhealthy food choices of persons less than fully their own. It acts in defense of gastronomical autonomy.

   Having concluded that many anti-obesity policies are justified on both non-paternalism and soft paternalism grounds, this Article considers whether more aggressive anti-obesity policies that would override the voluntary choices of Americans (such as product bans) can be justified. To the extent that unhealthy food choices are voluntary, this paper finds that Americans can be said to have fully accepted the risks of their perhaps imprudent choices. In such cases, there are strong arguments in favor of respecting the choices made by competent adults, allowing individuals to bear the risks of their own choices for the greater good of individual freedom. Thus, this paper finds that anti-obesity polices supported by a hard paternalism rationale are generally unjustified, subject only to a narrow "defense of integrity" exception. (8) In short, although the paternalism objection cannot be thought to prohibit government anti-obesity policies, it does function to limit the intrusiveness of such measures.

   Finally, having found that a compelling case for the introduction of several anti-obesity policies exists, this Article considers a second common objection to their implementation, that of the slippery slope. This objection contends that the adoption of even relatively mild anti-obesity policies will start the government down a slippery slope towards ever more intrusive policies; thus, it is thought that the government should refrain from regulating obesity altogether. Finding this slippery slope argument to be most unconvincing, at least in the case of anti-obesity regulation, this Article concludes that the overall case for government anti-obesity regulation is very strong indeed.

2. THE NATURE AND CAUSES OF THE AMERICAN OBESITY EPIDEMIC

   1. Rates of Obesity and Overweight Have Reached Crisis Proportions

      A study released by the National Center for Health Statistics in 2008 found that 32.7% of American adults were overweight, that an additional 34.3% were obese, and that 5.9% were extremely obese. (9) The figures for children are equally (if not more) alarming. In a recent study, 16.9% of American children were classified as obese, including 19.6% of the 6-11 age bracket. (10) Given these staggering statistics, the Centers for Disease Control and Prevention (CDC) have classified the American obesity problem as an "epidemic." (11)

      Americans have not always been so fat. On the contrary, the explosion of obesity rates has occurred primarily within the past few decades. (12) The percentage of obese adults has increased from 13.4% in the early 1960s, to 15.0% in the late 1970s, to 23.2% in the late 1980s and early 1990s, to 30.9% at the turn of the millennium, to 35.1% in the most recent estimate. (13) For children, obesity rates have increased from 5.0% in the early 1970s, to 10.0% in the late 1980s and early 1990s, to 13.9% at the turn of the millennium, to 16.9% in the most recent estimate. (14)

      The current rates of obesity in the United States are certainly unnerving, and there is no sign that the situation will improve any time soon.

   2. The Obesity Epidemic Is Responsible for Severe Social Harms

      The American obesity crisis has staggering social costs. A high body fat content significantly increases the likelihood of developing numerous health conditions, including type-2 diabetes, coronary heart disease, high LDL ("bad") cholesterol, hypertension, stroke, nonalcoholic fatty liver disease, gallbladder disease, osteoarthritis, sleep apnea and other breathing problems, several forms of cancer, and menstrual irregularities. (15)

      Because the obese and overweight are at a much greater risk of developing the various conditions outlined above, they also have a significantly greater risk of early death. Every year, at least 112,000 cardiovascular deaths, 15,000 cancer deaths, and over 35,000 non-cardiovascular, non-cancer deaths are attributed to obesity and overweight. (16) In sum, obesity and overweight are jointly responsible for at least 160, 000 preventable deaths per year.

      The obese and overweight suffer from a variety of psychological problems as well, including depression, anxiety, low self-esteem, poor body image, and suicidal tendencies, with many of these stemming from widespread societal bias against the obese. (17)

      Finally, obesity and overweight add billions of dollars to annual government health care spending at a time when government debt is steadily increasing. Currently, $86-147 billion dollars per year in increased health care costs are attributed to the obesity crisis, with the government picking up approximately half of this inflated bill. (18) Moreover, there are...