The Fattening of America - mini review and a critique of another study

I recently finished reading The Fattening of America by health economist Eric A. Finkelstein and Laurie Zuckerman. The basic premise of the book is that obesity rates in the U.S. have skyrocketed in the last 20 years due to advances that make food cheaper and make activity more expensive in terms of opportunity cost. If you look at the cost to buy a certain number of calories, you can buy more calories for less money if you purchase snack foods and soda rather than healthy items like fruits and vegetables. Additionally, advances in technology result in the automation of many jobs, creating far more sedentary workers in office jobs.

I've read several studies published in recent weeks that suggest the U.S. is over-reacting to the high rates of obesity and that since the obese will have shorter expected lifespans, the cost of obesity is negligible, if not positive. I disagree with the findings of Pieter van Baal at the Netherlands' National Institute of Public Health. The study estimated, using models and not actual subjects, the lifespan and health care costs for three groups: thin non-smokers, obese non-smokers and smokers. The following table are their estimates for lifespan and health care costs from the age of 20 forward:

	Lifespan	Health care cost	Incremental cost for final years	Average Cost
Thin non-smoker	84	$ 417,000	$ 11,500	$ 6,516
Obese non-smoker	80	$ 371,000	$ 15,000	$ 6,183
Smoker	77	$ 326,000		$ 5,719

Essentially, this analysis suggests that the obese non-smoker will live four fewer years than their non-obese peers, and save $11,500 per year in medical costs. As people in their 80's are also receiving Social Security from the government, there would be additional savings.

The study was again based solely on models and not actual data. Additionally, a lifespan of 80 or 84 years is longer than the average lifespan observed today. Also, the costs in the final years of life are high enough to drive the average health costs per year up nearly $800 for a 60 year period. My final critique is that there was no estimate for lost productivity or a decrease in quality of life between the groups.

This would be very interesting analysis to see, however, I feel the van Baal study has enough holes to draw the findings into question. If anyone is aware of a study with normalized data from actual subjects, please let me know.

Thank you.