Obesity, regulations and donuts

Last month the new director of the South Carolina Department of Health and Environmental Control (DHEC) stirred up the debate on healthcare in the Palmetto State.  Catherine Templeton said that she had a “hallelujah moment” in talking with health experts when she realized that obesity was an important contributor to numerous health problems like heart disease, high blood pressure and diabetes.

If we could prevent obesity, she reasoned, we could make South Carolinians healthier and reduce the state’s spending on Medicaid. 

No one disputes her conclusion and the healthcare professionals, who have worked on the obesity problem for decades, appreciate the attention Ms. Templeton has given the issue.  The business community also appreciates efforts to make our workforce healthier and more productive.

There aren’t too many states (actually only 3—“thank God for” Mississippi, West Virginia and Alabama) that have a higher adult obesity rate than South Carolina’s 31.5 percent. 

But Ms. Templeton’s characterization of how she thinks the state should attack obesity caused some concern.  “If we could paratrooper in—sort of the obesity SWAT team—just focus on those areas with a surgical approach…And if you knock out the most critical areas, you’ve made a difference for the whole state.” 

The “SWAT team” analogy gives the impression that the obesity problem can be quickly corrected with a concentrated effort in a specific geographic area in a relatively short period of time.  No one in the healthcare community believes that.  Obesity is a systemic problem with numerous determinants not likely to be corrected with some one-time surgery.

Many of us are also concerned that fighting obesity will take the place of improving the health of all low income South Carolinians.  In his opposition to our state expanding Medicaid under Obamacare, the director of our Department of Health and Human Services Tony Keck has said that South Carolina could better spend the relatively small state match for a Medicaid expansion on focusing on “hot spots” where “there are profound health problems.”

With Ms. Templeton’s newly found interest in obesity within hot spots around the state, I can see Governor Nikki Haley’s administration coalescing around obesity SWAT teams as a more effective and less costly approach to improving health than expanding Medicaid to make healthcare available to 500,000 working poor throughout our state.

However, there is no disagreement that obesity is a driving force in rising healthcare costs.  And one component of the remedy is to encourage personal responsibility.  To the degree that it is possibly, people who need or want to lose weight should make better choices in their diet.  Both Governor Haley and Mr. Keck have pointed out the need for personal responsibility in one’s health.   DHEC board member Kenyon Wells is quoted as saying in regard to obesity, “It is hard to get people to change.  We can throw as much as we can at it, but it stills gets down to personal values and personal responsibilities.” 

But for people to take more responsibility for their weight, the public needs more information about the food from which they are making eating decisions.  If you can’t compare the nutritional values, especially calories, of your choices, how can you make better decisions? 

One of the provisions of Obamacare addresses this issue.

Section 4205 of the Affordable Care Act amends Section 403 of the Food Drug and Cosmetic Act of 1938. This amendment requires restaurants and similar retail food establishments with 20 or more locations nationwide to provide calorie information for menu items, food on display and self-service food and additional written nutritional information for menu items. Additionally vending machine operators that own 20 or more machines are to disclose calories for foods.

Governor Haley, Ms. Templeton and Mr. Keck should welcome this new nutritional transparency to encourage more personal responsibility in fighting obesity.  But they apparently will need to work on at least one member of our Congressional delegation.

In May Representative Tim Scott formed a bipartisan Congressional Regulatory Review Caucus along with Representative Loretta Sanchez of California.  Yesterday was the first briefing for this caucus and the topic was the nutritional labeling requirements in Obamacare. 

Naturally since this calorie transparency was associated with the President, Mr. Scott was against it.  Freedom to eat what you want without concern for nutrition appeared to be Mr. Scott’s philosophy. 

“I don’t want to know how many calories are on my pizza,” Scott is reported to have said.  Addressing the Dunkin’ Donuts representative at the briefing Scott said, “I had five of your powdered donuts the other day, and I did not look at the calorie count.”

But Mr. Scott is doing himself (and his body) a disservice by not checking out the calories.  Instead of the five powdered donuts at 1700 calories, he could have had 5 glazed donuts at only 1300 calories or 6 ½ glazed for the same 1700 calories.  And we all know that glazed taste better than powdered.

But my suggestion is that Mr. Scott should have gone with my favorite, chocolate kreme filled.  Yum!  Four of these (if a person can actually eat four at one sitting) would be only 1480 calories. 

If Mr. Scott would look at nutritional information as the way to make better tasty calorie choices instead of a tool to fight obesity, maybe we can win his stomach if not his brain.

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