Arizona’s governor Jan Brewer recently proposed a $50 fat fee be imposed by Medicaid as a condition of coverage, from the Wall Street Journal:

Ms. Brewer’s surcharge would apply only to only certain childless adults: Those who are obese or chronically ill, and those who smoke. They would need to work with a primary-care physician to develop a plan to help them lose weight and otherwise improve their health. Patients who don’t meet specified goals would be required to pay the $50, under terms of the proposal.

Of course, this proposal didn’t sit well with some legislators, presumably  those with a constituency heavily (no pun intended) comprised of obese, chronically ill people who smoke:

State Sen. Kyrsten Sinema, a Democrat, said such a fee would unfairly penalize those who can’t control their weight. “If someone is obese because they’re severely disabled or can’t exercise, we shouldn’t be punishing them,” she said. “I mean, it’s not their fault.”

Not their fault?  I understand that a growing (again, no pun intended) number of people looking at their expanding waist lines in the mirror think that through belief they can overcome reason so far as assigning fault for obesity goes.   They can’t accept they could be so slothful and gluttonous as they appear, so rationalize justifications for why their obesity must not be their fault.  Yet the verdict is in.  Unless someone is force-fed, such as is done with a captive goose to transform its otherwise bland liver into foie gras, then the sole culprit in any person’s obesity is themselves.  Weight control is always within the purview of the individual.  Irrationally believing otherwise does not make it so.

The physics are exceedingly simple.  To maintain the energy balance of any system (such as is a human body), energy that the system gains must be balanced by energy the system loses.  Food is energy for living things.  If the system (the body) receives more food, i.e., energy, than it expends, then it must either expel it as waste or store it.  Some excess energy is expelled as waste (which is part of why even obese people can suffer nutritional deficiencies).  Most gets stored as fat.

If the excess energy consumption continues for a chronically long period of time, the body becomes so grossly oversupplied with energy that it become less capable of efficiently making use of the energy being supplied to it, i.e., metabolism slows, contributing to the storing of even more energy in the form of fat, in a vicious cycle that imperils the continued viability of the body.

But make no mistake.  Obesity is not glandular nor genetic nor due to eating particular types of food nor to not eating others.  It is the sole result of years of consuming more calories (calorie is the unit of measurement for the amount of energy available in food) than are used or expelled.  No matter what fad diet proponents claim, the only way to reduce body fat is to consume fewer calories than are expended or expelled such that the body needs to burn some of its fat stores.  It’s as simple as that. 

So far as a policy measure, this strategy of making people pay, if only just a bit, for their unhealthy lifestyles should be applauded.   But likely won’t.  It seems cruel to make poor fat people pay more for their health care in a manner that benefits relatively rich people (given that government programs such as Medicaid are funded by taxes, and the poor pay little to nothing in tax).  In fact, it is cruel to allow fat people to eat with impunity and expect the rest of us to pick up the tab for treating the health issues that predictably accrue from their gluttony.  Food is the most heavily-abused drug in America.  In a society that increasingly views health care as an individual right, the costs of which should be borne by the state, at least some of the cost society bears when people abuse food should be charged back to them.  With every right, as my Baptist preacher proclaims nearly every Sunday from the pulpit, comes responsibilities.

America is a gluttonous society.  From food to cars to housing, etc., over-consumption is encouraged; even celebrated.  But gluttony is not a sin for nothing.  It destroys from within, ravaging our bodies and souls as it weakens the fabric of society.  Gluttonous over-consumption reflects our rampant worship of false gods;  our love for temporal things that either don’t matter in the long-term quest for survival, or actually impair our ability to survive.  Gluttony’s individual effects can be seen in our waist lines and in the gargantuan cars and houses in which we drive and live.  Its collective effects can be seen, inter alia, in the several trillions of dollars and several thousands of lives spent to ensure a steady flow of the world’s energy resources to our shores.  Gluttony impairs our freedom, both individually, when we become slaves to our appetites, and collectively, when we must make bargains with international demons to slake our thirst for more, more, more of everything.  When the obituary for America is one day written, it will surely conclude that gluttony played an integral part in her demise. 

So I’d say $50 is hardly enough to pay for a lifetime of abusing food.  But it’s a start.

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