Block That Metaphor – and Marbled Fat

Yesterday on Fresh Air Maggie Mahar told Terri Gross of NPR that there was 30% waste in the health care system. She went on to say that the waste was not just “fat hanging out of the sides of the meat…. It is marbled in, so we’ll need a scalpel” to remove the waste.

I don’t know any carnivorous surgeons who can use a scalpel to carve out marbled fat. While at first I thought the metaphor was awful – perhaps it’s very apt. Cutting out some waste might appear easy – but since waste is always someone’s income, removing it might be akin to removing the marbled fat in a steak.

Speaking of marbled fat- Health Affairs had a timely web release yesterday pointing out the cost of obesity n the American health care budget. This article assigned $147 billion to excess costs from obesity in 2006 – and pointed out that obese people cost 13% more than matched nonobese people in the working population under 65 (with private insurance).

This number will be quoted a lot – and it should be. We pay a huge societal price for being sedentary and eating too many calories. Individuals with high BMIs(body mass index) pay a high personal price, too.

Let’s remember, though, that identifying obesity as a cause of excess costs is not equivalent to solving the health care cost crisis. In the medical world, there aren’t many wildly successful approaches to weight loss aside from bariatric surgery – which is serious enough that it is restricted to those with morbid (severe) obesity. There are things we can do outside of the medical world – like building bike lanes and walkable cities, opening up the stairway doors and discouraging elevator use, and putting calorie counts on menus. None of these has been definitely proven to cause weight loss – but at least all of these public-health oriented measures are inexpensive. They are also a great example of “choice architecture, making it easy for people to make more personally and socially beneficial choices.