Let's apply that logic to everything, then, and see how it works out. You're fat or obese and have health outcomes stemming from those choices? Enjoy your heart attack, fatty. You get injured doing something "non-essential?" Your mountain bike accident sounds like your problem. You're a smoker and get lung cancer? Sorry, no treatment is available for you.
You don't get to dictate the health choices of others. And if we're going down that road (which you seem to embrace) a vaccine against a disease with such a low death rate hardly seems a logical place to start. But that's presuming logic is the starting point, a conclusion lacking evidence.
A lot of health risks, including at least the top 6 causes of death worldwide (heart disease, stroke, lung infections, COPD, respiratory cancers, diabetes) can be substantially mitigated by personal choices such as diet and exercise
That's true, but genetics is literally the opposite: it's the one thing you definitively can't choose to change. So your argument doesn't work in the case being discussed.
If you had to pay an extra $200/mo to your insurance company because you were morbidly obese, one would expect that this would encourage a lot of people to start eating better.
One would expect that all the existing drawbacks of being morbidly obese would encourage a lot of people to start eating better. Why would this specific drawback work when others haven't?
I disagree wholeheartedly. So many diseases today are preventable when you consider that most people take no action to improve their health through any kind of diet or exercise. Its a probabilities game. If you eat fast food frequently, drink/smoke too much, and don't exercise you cannot expect to have the same odds of a long life as someone who is doing those things.
Now if we accept the above argument, even if only to a small degree, than we can conclude that individual decisions have should result in a widespread increase in demand for chronic healthcare needs, such as heart disease. This in turn causes insurance rates to go up for those individuals taking care of their health. Furthermore it funnels more and more human capital away from the rest of the economy by raising demand for doctors, nurses, and all other kinds of medical staffing/machinery.
Its inconvenient to believe that your health has a larger effect on the world you live in, but it does.
> most people are overweight, so health is unimportant
I would say, yes, health is unimportant to the average person because of their actions. I don't think that's good or fair, but it is the current state of the world.
If you want to continue the analogy: my argument is akin to telling someone trying to lose weight to research the most bioavailable supplements -- despite the fact they still eat a Snickers bar every afternoon. It's a micro-optimization that has been elevated to "table-stakes".
Attempts to solve obesity are met with the same objections around freedom of choice. And honestly any attempt to do anything about it would be so much more complicated than saying "get this shot", which is already fairly complicated to begin with.
With that kind of logic, most discussions would be meaningless. Basically we are all dying from a disease called "life". The point is how you want to die: either miserably from chronic illnesses brought by long years of bad habits or gracefully from old age. However, there are no guarantees, but if you don't buy a ticket, you have zero chances of winning. Anyway, eating "healthy" does not beat exercise.
What you call lifestyle changes I call “need to make a decision”. Patients make terrible healthcare choices all the time. If we’re going to hammer them on vaccines let’s go all in, huh?
Obesity causes massive costs and burden on our healthcare system yet I don’t see people calling them idiots.
What I meant is that heart disease is largely avoidable for most people through relatively simple / nearly free solutions like good diet and exercise, yet it’s still pervasive as OC pointed out.
I guess “poor decision making” was a misleading phrase on my part because I think I get your point that individuals could put greater value on enjoying the present, future be damned, and who’s to tell them that’s not the best way to live life. Life on average will be shorter, but I guess that’s not fair to project that as a success metric onto other people who might not care as much about their projected lifespan as they do about enjoying some more indulgent foods.
And further to your point, there’s a very reasonable debate about the value of the individual vs. the value of the community in decision making that isn’t universal. So yeah I take back that earlier comment.
My stance might be very different if the state and the mainstream decided to encourage the public to not only get vaccinated but also do things to be healthy. Losing weight, restricting calories, choosing to eat lentils instead of Macaroni and Cheese, going on daily/nightly walks, getting sun exposure, all shouldn't be ignored or treated as obsolete. What exactly is the reason, other than keeping the junk food industry afloat, that we not all be encouraging ourselves? Do we really need a bunch of studies to be performed to conclude that being generally healthy is either helpful against infection or at least won't make infection worse?
If we had a campaign of "do your part, eat right, get some walking in, and help the fight against COVID", I'd be like "Hell yeah! Now's our chance to see if we can beat this thing! Get the vaccines, get healthy, and join the fight!"
I've come across some data supposedly contesting the idea that obesity is a big driver in hospitalizations, but I'm not sure how much I buy it yet, and it certainly doesn't seem like a good reason to just do nothing at all.
The point is that you have a lot of influence over outcomes. There are mountains of evidence to support that fact, with comparatively easy and accessible interventions ranging from abstaining from smoking, to eating healthy food, to getting exercise. As with everything else in life, though, what you are doing by living healthily is turning the probabilities in your favor. That means that someone with unlucky genetic predispositions, or with an undiagnosed infection/deficiency/toxin exposure etc, might develop cancer despite doing everything in their power to avoid it, while a lucky bon-vivant smoker/drinker/junk foodie might just roll those dice favorably enough times to die of other causes. The point is that you should live your life based on the expected outcome of your actions, rather than on specific example cases, which may be outliers not representative of what you might expect if you follow their lead.
"Lose weight, get in shape" is good advice that would lower all cause mortality if it reliably resulted in such a change. The advice that we ought be perfect to avoid mortality doesn't take into account reality.
I agree with your statement in the small (yes, get fit, try to motivate friends and family to do the same), but it's not useful to moralize about what-if on a population level in my opinion, and it is tantamount to blaming the victims of the pandemic for bad outcomes. Especially before the vaccines, many young and healthy people died or experienced very bad outcomes, and it still happens, though the vaccines have helped a ton in this regard.
I'm not sure why you persist in arguing against a point that I never made. It is well known that the majority of cases of some of the most expensive diseases such as type 2 diabetes or COPD are primarily caused by poor lifestyle choices. Whether effective lifestyle interventions can be found is an entirely separate issue.
This is kinda an extremist straw man, though. I don't think anyone is claiming that the fields of nutrition and physical fitness are settled and that we know everything about what people need to do to be healthy.
But if you're obese and eat junk food all day, or if you just sit around on your couch and never get any exercise, and then end up with (for example) heart disease, that is something that was likely preventable, and we have a pretty good idea why and what could have been done differently. I'm force to subsidize these people's health care to some extent, and I think that's unfair.
The whole autonomy thing is tricky. We live in a society where we "care" for each other in collective ways (taxes etc.). People who want to live in that society lose some autonomy as a part of the bargain. I don't think this means we should legally force people not to eat or drink certain things. But I do think that (for example) denying people liver transplants when they won't stop drinking excess amounts of alcohol is fine. They can have their autonomy, but then they have to live with the consequences of their choices.
Viewing things like exercise and diet as a non choice is insanely dis-empowering. I want to know that I can choose to change if its important to me, I don't want to feel powerless to genetics or the society in which I was born.
It's not that I think people are destined to eat junk food, it's that describing what you eat as a choice is shallow and useless.
A choice is only meaningful if you are able to implement it. Only with knowledge, training, and technology can you overcome the deficit. Combining that by changing the structure and incentives of society will amplify that effect.
If people are continuously trying and failing to implement exercise and weight loss programs, it suggests that our knowledge and tools are incomplete. If we reach the point that obesity and 'lifestyle' related issues are a non-problem or can be overcome successfully long term, only then it becomes a meaningful choice.
This is why I emphasized knowledge and skills, cause and effect over freedom of choices. Obesity is not just a problem on an individual level, but also on a societal level. If you want to solve them, you must manipulate all the levels of causality.
Don't a large number of people have health problems as a result of poor diet and lack of exercise? I think that would qualify as a choice. I know I could probably lower my cholesterol with more discipline. If I choose not to, it's reasonable for me to pay higher insurance premiums.
What you are really saying is that we should held people accountable for their own choices and, as a society, attempt to help those who cannot make those choices.
I agree, to an extend, but the reality is that there are a series of factors, besides the moral or 'self-evident' reasons, that make companies/governments fund these projects.
Moreover, forget about these factors for a second. The bottom line is that very few people would care if you found the cure for a very rare and destructive disease. Lots of people would pay a lot of money to avoid being fat.
And by the way, why exactly do you think that those lifestyle choices are easy to change?
Very few people want to have diabetes (I assume). So there must be something else besides pure will that we should take into account when thinking about this issue.
> Charging people more who are intentionally harming themselves with poor diet and bad exercise habits is both ethical and fair
0) Heart disease, not obesity, is the number one killer in america. There is not a particularly strong correlation (certainly not = 1.0) between heart disease and obesity, diet, or even exercise.
1) There is very, very little correlation between exercise and obesity.
2) The systemic origins of obesity are not well understood, certainly not well enough to declare "ethical and fair" any kind of punitive mechanisms.
3) Your argument appears to be steeped in Puritan ethics which are unsupportable given modern science and medicine about the nature of free will, how the biology and physiology of the mind affects heath outcomes, and even the effectiveness of punishment as a generator of "good" behavior.
You don't get to dictate the health choices of others. And if we're going down that road (which you seem to embrace) a vaccine against a disease with such a low death rate hardly seems a logical place to start. But that's presuming logic is the starting point, a conclusion lacking evidence.
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