June 17 (Bloomberg) -- When I read an article last week called ``The Effects of Obesity, Smoking, and Drinking On Medical Problems and Costs,'' I thought it was the creepiest thing I'd read in a long time.

Roland Sturm, senior economist at the RAND research group, published the study last year in the journal Health Affairs, and since then it's been making the rounds of the public health lobby.

These days everybody -- even chain-smoking drunks -- knows that smoking and undue drinking is bad for you and, by extension, bad for other people, too, who pay for the consequences through higher health insurance premiums or some other mechanism of the social compact.

Sturm's article, however, aims to prove that no matter how costly you think smoking and drinking are, obesity is worse. Thus federal and local government, having heavily regulated the bad habits of smokers and drinkers, better do the same with fat people: their health, along with the health of our economy and of our federal budget, requires nothing less.

The Lobby's Logic

If you think like a public health lobbyist -- not something I'd recommend -- the logic is inescapable.

First the danger: ``Obesity increases health care costs 36 percent and medications costs 77 percent, compared with being in a normal weight range.'' Almost 10 percent of all national medical costs are related to obesity, and half of these are paid for by taxpayers through Medicare or Medicaid.

Next the problem: More than 20 percent of Americans are obese. Another 33 percent are overweight.

Then the urgency: Unlike smoking and drinking, obesity is on the rise.

And then the solution -- yet here Sturm gets cagey, declining to propose specific remedies. He does mention that simply ``exhorting individuals'' to adopt healthier habits rarely ``achieves lasting behavioral change.''

On the other hand, he adds helpfully, ``taxation and access control'' have done wonders in reducing smoking and drinking. Might they do the same for obesity?

Social Menace

For the public health lobby, Sturm's paper performs the essential intellectual task: it redefines overeating from a private, personal failing into a social menace that affects us all, thus clearing the way for state intervention.

This task has been greatly advanced as well by a sly shift in language among public health professionals, who have begun applying what they call the ``disease paradigm'' to overeating.

In the popular press and elsewhere, they routinely dub obesity a ``disease'' that has become an ``epidemic,'' the cause of which is traceable not to individuals but to a ``toxic food environment.'' It is a collective rather than individual problem, in other words, requiring a collectivist, and not a private, response.

The phrase ``toxic food environment,'' or TFE, is an especially brilliant touch. A coinage of Kelly Brownell, director of the Yale Center for Eating and Weight Disorders, it subtly recasts free citizens as helpless victims of an impersonal force.

``Unhealthy food, and advertising for unhealthy food, is everywhere,'' Brownell said last week, at a conference on obesity at the Washington-based American Enterprise Institute.

``It's in our schools, in convenience stores. Who would have thought you could go get food at a gas station?'' (This reverses the time-honored American tradition of getting gas at restaurants.)

``Until the toxic food environment has changed,'' he said, ``nothing will happen.''

`Taxation, Access Control'

Brownell and his colleagues in the public health lobby share Sturm's preference for ``taxation and access control.'' Regulating TV ads -- banning Ronald McDonald, for example, as we banned Joe Camel -- might cleanse our minds of unhealthful yearnings for sugar and fat. A ``fat tax'' at the point of sale would raise the price of bad foods; interventions at other stages of food production, from harvest to market, would further purify the TFE.

A regulatory regime of taxes and subsidies might indeed undo one trend that many economists now see as a primary cause of obesity in the U.S.: the ease, in both time and money, with which food can be obtained.

A recent study by two Harvard economists, David Cutler and Edward Glaeser, suggests that increased obesity is primarily a consequence of eating more rather than exercising less.

Obese

For this we have technology to thank: the mass production of food -- freeze-dried and microwaveable, artificially flavored and preserved, highly tasty and highly caloric -- has vastly decreased both its price and the time required to eat a filling meal. In 1970, a homemaker would spend, on average, two hours a day cooking meals and cleaning up afterward. Now with the availability of prepared foods, the same activity takes less than half the time.

One unintended consequence has been the increase in obesity rates, but on the whole this radical decline in ``time costs'' for the most basic of human needs should be hailed as a triumph of civilization, a major advance in the human condition. Brownell, Sturm and the professional party poopers of public health think otherwise, of course, which is why they seek to reverse the trend.

Will they succeed with bad eating habits, as they did with smoking and drinking?

``I'll quote Gandhi,'' Brownell said last week. ``He said: `First they ignore you. Then they laugh at you. Then they fight you. And then you win.'''

Last Updated: June 17, 2003 00:12 EDT