Fine Dining
07 March 2014

Fine Dining

You have to laugh. The State of Arizona in the USA is proposing to start fining the good people of Arizona for being overweight. Specifically they’re going to slap them with a fine of $50 (£31) if they don’t follow their doctor’s advice to diet. “Fine dining” takes on a new meaning when there’s not enough money left to buy your next meal. That’s not what I mean by portion control! Being overweight is no laughing matter, but it can be when you read silly ideas like this. I’d previously read of a Police Department, I think it was in Detroit, that decided to stop paying bonuses to policemen who had a weight problem, presumably because they couldn’t run fast enough to catch the bad guys and so fail to hit their productivity targets? Anyway, Arizona has decided that the best way of keeping down state healthcare costs (Medicare) that result from treating the complications of obesity is to fine people who don’t comply with medical advice. Smokers and people with diabetes who don’t comply will be fined too. In my opinion this is daft.

Firstly, there’s no evidence that such an approach will work. Secondly, it will be too complicated to enforce…..those who have a weight problem for medical reasons will be excluded – define “medical” if you can – and those who have children will be excluded too. The third reason why I think it’s nonsense is that it deliberately targets those who are least able to pay. It is, if you like, an indirect fat tax. And there’s no evidence that that works either. The whole plan is doomed to an embarrassing failure.

No-one loses weight because they’re being punished. It might be a sudden shock that starts you off. Being told you have high blood pressure or early diabetes might provoke you into action. But what keeps you going is not the “stick” approach, it’s the “carrot”. Feeling better when your diet improves, feeling more energetic as your activity levels increase, feeling more self-confident as your waistline starts to reduce and you get a positive comment from a friend or colleague…..”Have you lost weight? You look great!”…. ..That’s what keeps us going! And that’s what makes it worthwhile.

So, their intention may be good, but their idea is ill-founded and in my experience of working with patients, very destructive. There’s no evidence that it will work. A far better approach would be to improve facilities and opportunities for residents to adopt a healthier lifestyle; because they want to. There is growing evidence that people will change their lifestyle for positive rewards. And until someone else offers you one, I suggest you make one up for yourself. Decide what you want to achieve, plan how you will do it, set a timescale and agree with yourself what reward you will have when you reach your target. That’s not self-indulgent, it’s positive thinking. And that really is “fine”.