Obesity Law: Rushing into the Void Edward P. Richards Director, Program in Law, Science, and Public Health Harvey A. Peltier Professor of Law LSU Law Center

Key Policy Questions Why Obesity? Why Now? Is Law the Answer? What Can We Learn From The Past?

Why Obesity? Contributes to diabetes, cardio-vascular disease, and cancer Increasing at a dramatic rate Increasing fastest in children Fatter earlier means sicker earlier, longer, and more expensively A serious health problem that disproportionately affects the poor, blacks, and American Indians

The Most Important Reason COSTS

Costs of Obesity Direct health care costs for the management of diabetes and other secondary diseases Cost of SSI disability payments Costs of disability to the economy Medicaid costs to the states

Why Now? Federal government wants to do something about health care costs Obesity is the “do it yourself” solution Put a little money into regulation and education and the rest is up to individuals Avoids the hard issues: Access to care Drug pricing, etc.

Why do Motives Matter? Reducing obesity will take a very long term Preventing the next generation from being as fat is the important goal Costs will go up before they go down The complications of the already obese The cost of obesity treatment Governmental timeframe is too short

Is Obesity an Unintended Consequence of Past Laws?

Farm Policy Make food more affordable Make a larger variety of food available Make meat affordable for everyone Make more fresh food available Unintended consequences Supersizing as marketing edge Larger portions at home The snack culture

Land Use Separate commercial and residential development to make neighborhoods more healthful Encourage greenspace development to reduce the cost of housing Low density housing requires automobiles, so there is no need to walk

Building Regulations Fire regulations keep stairs closed and at the edge of the building Security regulations often limit routine access to stairs ADA and other regulations require easy access for handicapped persons, but non-discrimination regs also prevent this access from being limited to disabled persons

Vending Machines in Schools Driven by budget cuts Generate important income for many schools Lead to the breakdown of rules against eating in schools, otherwise no income

School Lunches – Why Fast Food? Many schools are overcrowded Lunches are served to many more students than the kitchens and cafeterias are designed for Fast food, especially when it is supplied by third parties, is the only way to serve the crowd

Physical Activity of Students Many schools do not require students to have organized physical activity each day PE was cut as budgets were cut PE was cut to make more room for substantive courses Schools increased homework so students do not have time to play after school

Areas of Future Concern What are the potential unintended consequences of proposed obesity legislation?

Insurance Mandates What do you mandate? Many existing obesity treatments are quackery Even effective ones like surgery are very dangerous and only suitable for a small number of people Some docs are already telling patients to gain weigh to qualify Encouraging bad treatment is worse than obesity

Impact on Schools Healthy snack mandates Is the real problem snacks? Vending machine income What will the schools do to offset the loss? Will banning fast food result in better lunches or just encourage schools to let students leave campus to eat? Give the schools staff for data collection

Impact on Public Health The treatment of obesity is a medical problem The cost savings from reducing obesity are medical care costs, not public health costs Obesity management should be with health care dollars, not public health dollars Health departments do not have the resources to the work they already have

What Should We Learn From Past Mistakes? Think before you legislate - the science does not support a lot of the proposed solutions Look hard at the underlying reasons for current behavior and address those causes directly Analyze the possible unintended consequences of new laws Develop a long term strategy, including money Don’t weaken other health programs