COMMENTARY

Kick Out Fat People to Lower Healthcare Costs?

Arthur L. Caplan, PhD

Disclosures

October 22, 2013

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Hi. I'm Art Caplan from the Division of Medical Ethics at the NYU Langone Medical Center. Nobody likes fat people anymore. In medicine, we sure don't. We know that obesity is responsible for all manners of chronic illnesses that are causing problems for patients and driving up the healthcare bill. It is probably the biggest epidemic of disease that American doctors and many in Europe have to deal with.

It has become very popular to try to figure out ways to penalize people who eat too much. At one point, the Mayor of New York City thought that maybe we should reduce the size of drinks and sugary beverages that you could buy. A lot of places are insisting that they post calories. Of course, if you're showing up at McDonald's every day, it probably doesn't matter that you're reading the calorie chart; it's probably not a good behavior to begin with. But we are trying to take steps. Certainly, doctors talk to their patients and try to counsel them about ways to lose weight.

But what if, as a matter of public policy, the government started saying, "You know what? We're not dealing with fat people anymore. We're throwing them out of here." If you think that that's fantasy, New Zealand just had a situation with 2 people who had migrated there 7 years ago from South Africa, a chef and his wife. The chef, when he arrived in New Zealand, weighed about 360 pounds. That was packed onto a 5'6" frame. His wife was not obese. After about 6 years, they applied for a renewal of their right to stay and work and run their restaurant in New Zealand, but they were told that they had to leave. He was too fat.

The government said that he is going to be a burden on their healthcare system. They didn't want him there. He and his wife, who isn't fat, had to get out of there. He has been there for 7 years and no one had said anything. And I have to add something else: He had lost about 50 pounds, so he was moving in the right direction. Still, the New Zealand government said, "No. We are deporting you because you're fat."

There are many ways to wage war on obesity. Deporting people is not one of them. I think we have to take a lesson here. It's important to say that there are all kinds of weaknesses and temptations that have led to our obesity epidemic. We took a long time to eat ourselves into the problem. It will take a long time to work our way out of the problem. But I don't think citizens should have to worry that they are not going to get benefits, that they are going to be penalized or, at the far extreme, thrown out of the country because they have a medical problem.

At the end of the day, I don't see obesity as different from many other bad habits and behaviors that people have. We're not telling the people who don't wear motorcycle helmets to go home, and we're not telling people who have dangerous occupations or play tackle football that they better leave our shores because they are going to drive up our healthcare bill. In fact, the fastest way to lower our healthcare bill is to get rid of everybody who is a sinner because then the hospitals will be empty.

The game of medicine is to try to figure out how to make people behave better, how to pursue their health, and not threaten them, penalize them, or make them pariahs.

I'm Art Caplan from the Division of Medical Ethics at NYU. Thanks for watching.

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