A taboo is an unspoken social rule of omission: things you may not talk about. You have every right to say it, but people agree that the speaker will come off badly if they do. Obesity is one of these, where telling a fat person they are fat means the speaker comes off worse than anyone else; being skinny is not a taboo. Obesity is even a taboo when smoking is not. The way we think about obesity, as a right, is warped. It is the result of self-entitlement.
I probably have a low-level body-image dysmorphia, so my decision to isolate obesity as the taboo that has social cost could well be an externalisation of personal concerns (i.e. my fixation on my body image). I understand that bias from the outset. However, I do not think that bias undermines the fact that as a society we are all paying a cost for other people’s obesity.
Obesity is seen as a right: the right to freedom of food and the right to freedom to exercise. A right like this, when upheld, always extends to abstinence and indulgence. The right to be obese is not upheld by other people’s recognition that an obese person has the right to be obese. The right to obesity, like all rights, is upheld by the public’s acceptance that they have responsibilities relating to the right to obesity. In a country with healthcare free at the point of use, which the UK is, the public recognises its responsibility to pay for the people who have indulged in the right to eat and not the right to exercise. Doctors recognise that although that recommend a new diet plan, if the obese person refuses, the doctor still is responsible to treat that person for long-term illnesses and weight-related operations.
A list of publications available from the Million Women Study outlines some of the weight-related health concerns they have researched since 1996. Whether the female-only investigation can be extrapolated to men as well is debatable, but the summary is, that for women at least, 1 in 8 hospital admissions are weight related. Weight alone is responsible for 2 million extra patient days in hospital every year. This is important when you consider that every bed costs £1,000 ($1,651) per day to keep a patient in (and that’s before the medical care).
According to David King, writing for the Lancet, between 50 and 60% of people in the UK could be obese by 2050. The cost of this is not just beared by the NHS. Weight-related sickness costs companies money. If half of people need an increase in the number of sick days they take, that will cost money in lost productivity. Already failing companies will be under increasing strain. Small businesses may fail just because of unreliable staffing. There is also the motivation concern: as a company becomes increasingly dependent on its healthy staff, the healthy staff become overworked and demotivated. Both stress and demotivation can lead to diminishing productivity and further health concerns. King’s report, titled The Future Challenge of Obesity, estimates the cost to the economy to be about £45.5 billion ($75.12 billion).
At the point of care, doctors can’t mitigate risk. This is another right/responsibilities issue. A doctor can recommend a low-calorie, healthy diet with light exercise. But a patient assumes the right ignore all advice, compound existing issues and still expect health care.
The parallels between this and smoking are quite clear. Smoking severely damages your health putting strain on the NHS and small companies that depend on reliable staff. The difference is that few people perceive being informed about smoking to be a taboo. It can be seen as concern or even encouragement to stop. From what I have observed, it seems people default to the assumption that people want to quit smoking. Such a position on eating habits is considered rude and obnoxious. The effects of smoking on the economy are slowly being lightened by stigmatising smokers. This is a freedom social norms have permitted. But social norms aren’t ready to put down the donut. And the taboo costs money.
(If you want to guest post here, writing about the cost of taboos about both drugs and sex will be well received.)
Related reading (including a little less doom and gloom)
The linked references.