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
richards@lsu.edu
http://biotech.law.lsu.edu
Key Policy Questions
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Why Obesity?
Why Now?
Is Law the Answer?
What Can We Learn From The Past?
Why Obesity?
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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
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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?
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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?
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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
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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
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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
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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
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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?
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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
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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
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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
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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
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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?
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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