When personal choice becomes a public health problem

“Elective” afflictions like obesity affect us all; can we dictate what we pay for?

Quynh Nguyen

The ’80s generation is the first to be raised in a commercially and materialistically saturated environment, glutted with television and artificial foods.

Our generation is the first to see the decline of slow food and the rise of fast and packaged food. We were the first to receive the onslaught of food ads on TV for increasingly artificial and unhealthy foods.

We were also the first to be raised with television, computers, Nintendo and the Internet as household commodities. Under our watch, and with support of our parents’ disposable income, these electronics have become a mainstay of our lives.

It hardly comes as any surprise that our generation and the ones after are going to be hit hard by obesity. One report, published in the January issue of the International Journal for Pediatric Obesity, suggests that nearly half of all children in North and South America will be obese in four years.

Obesity? So what, right? I used to be of the opinion that if people wanted to be obese, they had the choice and freedom and easy access to cheap food to do so. And far be it from me, a nonobese person, to dictate what they should or should not eat.

Then I met my current fiancé. He has Type 1 diabetes, which means he injects himself with insulin at least four times a day to control his blood sugar levels. If he doesn’t take care of his blood sugar levels, his feet will eventually rot off, his eyes will develop cataracts, he will go blind and his heart will fail.

The obese face a similar fate – Type 2 diabetes. While Type 1 diabetes strikes without notice, Type 2 diabetes assaults those who have a choice – with proper food moderation, Type 2 diabetes can be avoided or even cured.

It costs a boatload of money to care for diabetes. Glucose meters, test strips, syringes, biannual exams and insulin amount to thousands of dollars in care. So do hospitalizations for foot infections, heart attacks, dementia or hyperglycemia.

People, insurance companies and the government shoulder these costs. However, the ability of the individuals and their employers to handle the cost of health care is declining. The costs of health care are rising much faster than inflation or job growth, leading employers to stop offering health insurance as part of their benefits package. Now we have more people going uninsured than before, so the costs of health care are being shifted to the government.

Since the government provides significant money to health research, hospitals and health care, should they be allowed to control costs through risk management? Does the government have a right to impose on the freedom of the individual to eat as they want to eat, to do what they want to do and be the size they want to be? Even doctors don’t have that right.

The government does have a duty to protect its citizens. The government has enacted laws for wearing seatbelts and helmets, for enriching grain products and for immunizing babies and children. After sitting around and watching people die from preventable auto-related deaths, neural tube defects, tuberculosis and polio, the government made obvious decisions compulsory. As a result, the number of neural tube defects in fetuses has decreased dramatically and the incidence of polio in the United States is zero. The overall effects and benefits of compulsory helmet and seatbelt laws are not yet determined, but a report from the National Highway Traffic Safety Administration states that 12,000 lives are saved every year with seatbelt use. All in all, it’s hard to complain about these “imposing” laws when there are some obvious benefits to them.

In contrast, the government cannot make exercise, something so obviously good for you, compulsory. They can’t make healthier eating compulsory, they can’t limit time spent watching TV or playing games, and they can’t force people to take a nutrition class to be able to understand the relationship between food and health. So what can they do to limit obesity?

One way is to affect the supplier – the food industry. With government intervention, food labeling has been made compulsory for all packaged foods, and is now more readable. Trans fats are now listed along with polyunsaturated, monounsaturated and saturated fats to help consumers make a choice on what to eat. The New York City Department of Health and Mental Hygiene decided to take that a step further and make those choices available to people eating food from restaurants. It is banning trans fats from restaurants and proposing to make calorie lists available to restaurant patrons.

The ban on trans fats may seem cruel, unusual and unprecedented, but the fact is, trans fats are a “frankenfat” concocted in a lab and have no use whatsoever in the human body. Trans fats contribute to heart disease and have no real benefit except as a cheap source of hard grease to the food industry.

Calorie listings and the elimination of trans fats to less than 0.5 grams a serving will allow people more of a choice than allowing the unquestioned use of trans fats and having no calorie listings at all. The city of New York is making a step in the right direction and I hope it continues. Instead of a culture of fear or laziness, we should strive to foster a culture of health.

Quynh Nguyen welcomes comments at

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