Majority of US Healthcare Costs Are Caused by Bad Eating Habits | Hacker News Reader

Majority of US Healthcare Costs Are Caused by Bad Eating Habits

nytimes.com

48 pointsjyu59 comments

There’s lots of money to be made selling fast food and then treating the diseases that fast food causes.

All the more reason for each of us to take more personal responsibility for our food and our health. I wouldn't count on anyone else helping me much with either any time soon.

Most health care spending in the US is caused by aging. Most heath care spending is paid for by the state, local, or federal government (50%+). Most heath care spending is caused by people living longer. Most heath care spending is caused by better and more expensive treatments that we did not have 100 years ago. Smokers have shorter lives and spend less on heath care over their lifetime. Smokers cause a huge short term spike in heath care costs.

PS: There are plenty of ways of slicing it, but excluding sudden death we are all going to spend a lot of money on heath care and we are all going to die.

I work in healthcare and this is my understanding from the responses of patients that I encounter - fast food is cheap. One of the families I work with, both parents are diabetic and the children are all overweight. I asked them about their eating habit and the answer was : McDonalds for breakfast, lunch, and dinner. Why? Because it's cheap to eat at McDonalds for a family of 4 than it is to buy vegetables at the market....for 3 bucks, you get a whole meal for one person. $3 at Safeway, you only get..a cabbage and some tomatoes?

They didn't understand that their eating habit is going to cost them much more in health expenses

The big problem is farm subsidies for corn and soybeans. If they transferred those subsidies to produce we could make it significantly cheaper to eat healthy.

However, if you are smart it's possible to eat much cheaper than McDonalds and almost infinitely healthier. The secret is just eat like they do in poor countries. Start with bulk quantities of some basic staples. I'm Brazilian, so for me it's rice and beans. Then buy veggies and meat that are on sale. Of course if you want it to taste good you have to learn to season and cook it properly, which takes time.

I admit that corn syrup drinks, processed carbs and extremely fatty/salty/msg-y food tastes great and can be quite addictive. I sympathize with people who are stuck in that cycle. However I've found that how I feel from eating healthy and getting a reasonable amount of exercise is far more significant to me than something that tastes good for 5 mins while I eat it. I'm convinced if people were more in touch with their own bodies it wouldn't be hard to convince them to eat healthier. Unfortunately American culture itself is a huge impediment to this, which is why I'm so happy to see Michelle Obama planting a garden. Cultural change is what we need.

(OT, but your profile info does not have an email.)

From reading that, it seems that you are living in the US for quite some time. As a Brazilian living in Cambridge, MA, may I ask you where do you live now? There are lots of Brazilians in Mass, but I'm yet to find a fellow Brazilian hacker.

Actually only half-brazilian. Born and raised here in Minneapolis, MN then moved to Santa Fe, NM and now Mountain View, CA, mas também passo bastante tempo em Brasília.

I've heard this before, but it isn't true. I make one cup of Quaker oatmeal most mornings - cost is around 11 cents. I buy tea and coffee in bulk - another 11 to 25 cents or so. My entire breakfast costs less than 50 cents, and all it requires is boiling water or 3 minutes in the microwave. It's faster than a drivethrough.

Rice and beans are practically free they're so cheap. I buy turkey or chicken cold cuts, again very cheap. I buy "turkey dogs" (hot dogs, but made of turkey) when they're on sale for something like $2 per six. 3 of them is 210 calories, almost all protein, for about $1. I buy whatever fruit is on sale, fruit isn't so expensive either. I don't like bread, but wheat bread is cheap. My girlfriend sometimes cooks a huge pot of stew that sits on the stove for 3-4 days and serves 10+ meals for under $10.

I'm not sure how much eggs are per dozen - maybe a dollar or two?

It's possible to eat very quickly and inexpensively. The problem isn't cost, it's a mix of education and being willing to forsake convenience/delay gratification. Our culture is decent at the former, but quite bad at the latter.

I agree, I find that going to the grocery store and paying upfront for my meals to come is more cost effective than constantly buying fast food. Fast food is not very cheap at all actually. Unless you're buying from the dollar menu, in which case it's $3... for your kids. It's hard to get full on 99c fries and a mini burger.

To provide a single anecdote, I am able to get full on two dollar menu items. You don't have to stick to what they define as a "meal" (i.e. burger, fries, soda). If I'm short on time or cash, I can get two double cheeseburgers, or a chicken sandwich plus a salad, for less than $3, drink a glass and a half of water with it, and be full until the next meal. Whether just anyone can do that is another question.

I agree. Though with your stew boiling for 3 days you should begin to factor in energy costs.

You probably should add some more vegetables by the sounds of it.

Part of the problem is likely that some menu items are simply far worse for you than you'd guess, if you don't check the nutrition information.

As an example, I was on the road recently and I stopped by a Burger King drive-thru to get a quick lunch. I knew that a Spicy Chicken Sandwich is 450 calories, which isn't wholly unreasonable.

Sadly, they were out of those, but they asked if I'd like an "angry tendercrisp sandwich' instead. It sounded similar, so I said yes.

The angry tendercrisp sandwich: 1030 calories, 61g of fat, 15g of fat, and 2670mg of sodium.

But I'm sure there are some people who order them, thinking they're healthier than a burger.

My suspicion is that their struggle is more about the perceived cost and time. My wife and I are able to eat most of our meals at $2-3 per person. We have found that to get the cost low, you need to seek out cheaper produce (usually not safeway) and cut way back on meat consumption. Making your own cereal also helps as well as only buying things on sale. You also need a little more time to prepare the raw ingredients.

This seems to come up every couple of weeks, and is invariably followed with a whole bunch of recipes for rice and beans.

But the thing is that eating at McDonald's for three meals a day is both dumb and expensive. It isn't just expensive compared to rice and beans, it's expensive compared to regular-person food. A meal at McDonald's doesn't cost $3, it generally winds up more like $6... but even if you could find a way to eat at McDonald's for $9 per person per day, that's still a helluva lot of money compared to a sensible diet of breakfast cereal for breakfast, sandwiches for lunch, and meat + veges + rice/whatever for dinner.

Don't agree! I've cracked down on eating out for a month and lived off pasta and vegetables. You can't get a meal for $3 at McD. but you can eat for $ 1 for the day making your own food. It's an interesting experiment!

This excludes meat and dairy products though.

> both parents are diabetic and the children are all overweight

As an interesting factoid:

Pre-late 1800s per-capita Sugar consumption: 1 lb/person

Today: 150+ lb/person

The paradigm-busting, pivotal event in the late 1800s: the invention and introduction of Coca-Cola. Once Coca-Cola started putting sugar into American diets, the door was opened for sweeteners.

"According to health officials at this ancient pueblo, where the Zuni have hunted and farmed for perhaps 800 years, diabetes is now the single leading reason for Indians to seek hospital treatment."

http://www.nytimes.com/1986/02/18/us/surge-in-indians-diabet...

exactly. The true costs of each burger are deferred from the McDonald's counter and amortized over a lifetime and a population in the form of Medicare deductions on your paycheck. This article is timely as I had written this blog post last week suggesting a fast food tax: http://www.scrollinondubs.com/2009/09/01/fast-food-tax/

It wasn't an optimal solution but it at least attempted to redirect the costs of poor eating choices to the people who make the bad decisions. The proposal from the NYT article is way simpler and more effective:

yank the "preexisting condition" defense from insurance companies and they become instantly incented to encourage healthy eating. Current advocates of proper eating habits gain a powerful ally at that point.

sean

The headline "Majority US Healthcare Costs Are Caused by Bad Eating Habits" is not the headline of the article, nor is this supposed fact stated anywhere in the article.

I very much doubt it's true, and I don't think it's well-defined enough to even be false.

(...) the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained, as a study released last month says, by our being fatter. Even the most efficient health care system that the administration could hope to devise would still confront a rising tide of chronic disease linked to diet.

This is a key argument in the article and the headline seems like a reasonable paraphrase of that.

At the minimum, a lack of physical activity has to be included as a factor in this along side diet.

Haven't you heard? The new wisdom is that exercise makes you even fatter. Well, I exaggerate, but I'm referring to a recent Time story saying 'exercise won't make you thin' (the idea being that you still need to eat less or you'll just get hungrier and never lose weight).

You are quite right, but 'pin the tail on the donkey' seems to sell better :-/

It's not actually new wisdom.

We are just going back to what we knew 40 years ago.

Basically, between 1960 and 2009 we thought exercise will make you thinner.

Outside those times exercise was thought to increase appetite.

The somewhat confusing thing is that people focus so much on "losing weight". Even if exercise makes you hungrier, it's been shown quite conclusively to make you healthier.

If you really want to lose weight without regard to any other factors then take up smoking as it reduces your appetite. Or just cut off your legs. Certainly don't build up any muscle mass as that will only make you heavier.

Also, lack of exercise is correlated with weight gain in larger population and consequent lack of health.

People confuse this the statement that later exercise make up for a person's lack of exercise at a given period. This might or might not be true but it doesn't follow from the first statement. Lack of exercise over longer periods might screw people in ways that we have no idea how to fix.

> ... the fact that the United States spends twice as much per person as most European countries ....

Is actually explained by the fact that we pay our doctors twice as much as they do.

We have the same number of doctors per person as they do. And unless our doctors are way more efficient, that means we get sick at about the same rate.

But we spend twice as much, because we pay twice as much. Not because we get sick twice as much.

And see this: http://news.ycombinator.com/item?id=816589 which was just posted.

Yea, I couldn't think of a better way to describe this article. Surely I think it's an improvement over "Big Food vs. Big Insurance" which doesn't give you any idea of what the article is really about. Do you have a better suggestion?

Are American eating habits really that significantly different from Canadian eating habits to explain the fact that the US spends twice as much per capita as Canada spends - notwithstanding the 50 million Americans without coverage?

Comparing Canada vs USA obesity rates shows that YES indeed eating habits seem to be very different:

http://eaves.ca/2008/07/08/fatness-index-canada-vs-united-st...

If you look at the comments below the post, though, the comparison doesn't seem to be valid, due to different measurement methodologies.

WOW. That's just astonishing - thanks for the link! I think it's definitely worth studying how two very similar societies can have such radically different obesity indicators.

As a Canadian living in the USA I have to say, we don't eat that differently in Canada, the big difference is we eat less.

Canada is just as full of greasy, nutrtionless, processed-to-hell food as America is, but we simply do not consume as much of it, from my observations.

When I moved to the USA I immediately (over 4 months) gained a buttload of weight (both figuratively and literally...). This is due to my bad habit of finishing everything on my plate. I've since fixed this and my weight is rapidly decreasing. Yay. Serving sizes in the USA are simply ludicrous and completely out of step with reality.

Before talking about high-fiber, low-fat diets, Americans need to do one simple (but difficult) thing: eat less. Eat way less.

A friend and I (both Canadian) paid a visit to the Cheesecake Factory this last weekend - when our plates landed on our table our eyes bugged out. There was enough food to feed 4 people in a standard Canadian restaurant. I'm not even exaggerating :S The table next to ours polished their food single-handedly and then ordered dessert. We were shocked. How any single person can consume that much food in one sitting is unimaginable, and somewhat disgusting.

Well, the Cheesecake Factory is a bit of an outlying case -- those portions are ridiculous even by American standards. But as an Australian living in the US I agree with you -- I find it hard just to get a normally-sized meal for breakfast or lunch.

In Australia, if you order a ham and cheese sandwich, you get ham and cheese. In America if you order a ham and cheese sandwich you get a huge stack of ham, a bit of cheese, lettuce, tomato, pickles (!?), maybe some sprouts, mayo and a bright yellow mustard-like substance. If I tell them I just want ham and cheese they look at me like I'm crazy (and I am, cuz I'll be paying about six bucks for this sandwich anyway).

On the other hand, last I heard Australian rates of obesity have overtaken US rates. On the other other hand, Australia probably has more of the slightly-fat people (ordinary folks with big beer guts) and fewer of the ridiculously-fat people (acres of waddling flesh or too-fat-to-walk electric wheelchair folks).

I've also found that Americans like to lather sauce over everything, which begs the question of if they'd realize if we replaced all their meat with soy protein. This may be part of the diet problem.

In Canada we have ranch sauce, we have mayo, but it wasn't until I got to the US that I started seeing these things going on everything under the sun, in gigantic quantities.

Why have the ham sandwich if all you'll be tasting is the mayo?

"Well, the Cheesecake Factory is a bit of an outlying case ..."

I'm not sure about that. Cheesecake Factory, Claim Jumper, you name it.

Even the fast casual restaurants like Chipotle. They tout the "freshness" of their ingredients–despite the fact their burritos weight as much as my laptop.

Of course, every restaurant now is on the "hamburger slider" craze ... even though the slider is probably the size a normal hamburger should be.

Don't even get me started on the Midwest. When I first started visiting Oklahoma regularly, I was a little shocked. You'd almost think there was a state law that every restaurant had to be a buffet.

Restaurant meals have grown so large that I only order an entree if I'm planning to take home a doggie-bag.

If I want to actually eat all I order, I usually get two appetizers, or an appetizer and a salad.

My wife and I pretty much always split an entree in restaurants in the US, with maybe a side dish to go with it. Every time we get two, it ends up being way too much food.

I agree completely. I am shocked by the amount of food they serve here in the US. I went out with a customer recently to one of those Mexican chain restaurants. Basically I was "done" at the appetizer stage. They proceeded to have the main course, and ordered dessert!

There are many times when my (petite) wife and I go out, and we share ONE meal and sometimes even have some left-over!

Among reasonably thin people in the U.S, it's common knowledge that if you go out to eat, you will bring food home. Most of the time when I go to restaurants with family or friends, we at least end up with lunch for the next day, and sometimes another full dinner. Occasionally, if it's a really good restaurant and my dad orders way too many dishes, we end up with leftovers for the next week.

This reminds me of the story a Japanese girl once told me of her visit to Disneyland. At one of the restaurants she ordered the steak and salad. The salad came first and by the end of it she was so full she couldn't even think about eating the steak.

Funny thing is that I remember complaining about exactly this 20 years ago!! I wanted smaller meals at lower prices. My friend pointed out to me that the reason restaurants were raising portion sizes was to price at what the market will bear. Most people feel they get their money's worth with the huge amounts of food, so there is really no incentive for the restaurant to offer a lower-priced option. So for those of us who don't feel the need to stuff ourselves, the option is to take the rest home if possible.

As a Canadian who visits the United States often, I can definitely say the portion sizes are a lot larger in the United States. Every time I go to the US I go into a state of shock when I see the portion sizes.

You would think that after 20-30 trips to US I would have learned to adjust my expectations by now, but it is still amazing to me to witness how much food Americans eat no matter how many times I see it.

I once offered to pick up some "Chinese food" for some colleagues visiting the US from China. They didn't recognize anything on the menu, and ended up ordering the "house special", with grilled chicken, vegetables, and rice. Reasonably healthy, from the looks of it.

About an hour after getting our food, I remarked that they had not finished what they ordered.

"This is too much food for us; we can't eat it all!" they explained.

"It's too much for us too," I assured them, "but we eat it all anyway."

For the most part, "Chinese food" (served outside china) is an attempt by Chinese resturaunters to cater to the tastes of locals. So a better description of what you had was "American Chinese Food".

If you ever have the opportunity, try Indian Chinese Food. It's fantastic.

Doesn't everyone die? If so, isn't the question what diseases take the longest time to cause death, and thus require the most medical expenditure? Wouldn't medical expenses be lower if everyone died of a heart attack at 55? That would certainly be cheaper than living till 70 and treating cancer, bone loss issues, bladder issues, and cholesterol issues over a period of several years.

If so, isn't the question what diseases take the longest time to cause death, and thus require the most medical expenditure

Not exactly. You're missing two variables. The rate of infection in the population as a whole, and the rate of expenditure to treat the disease.

How so? The argument is that eventually everybody dies of something, so avoiding one fatal disease only shifts your death to another disease at some point in the future.

I really think it's quite likely that fat people, on average, cost less in health care over their lives than thin people. I don't have any numbers to back this up, but every person who dies suddenly of a heart attack saves an awful lot of money by not dying of cancer, or worse still some degenerative disease.

Nothing wrong with the basic gist, but read closely the statement I quoted. Just because something takes a long time to kill you doesn't mean its treatment is expensive. Similarly, just because something is expensive to treat doesn't mean enough people have it to make it worth targetting from an overall cost perspective. That's all I was saying.

And if you get less deaths per person-years, you might also save money (per person-year).

Diabetes - blindness, circulation problems, infections, amputations. It's not at all clear that health care for fat people would be less than for thin people.

Well, when a lot of people are obese hospitals need to be able to accommodate them even before they die. Consider the cost of beds, wheelchairs, examination and operating tables, and so on. All that equipment has to be reliable for intensive long-term use; if patient's hospital bed collapses underneath them they would sue and almost certainly win.

Now, bearing in mind that this basic-but-necessary equipment is not cheap to start with, making sure that it can handle the weight of an obese person gets quite pricey.

* and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet. *

Cancer and heart disease are fundamentally diseases of age. Everyone will die of one or the other eventually. The links to certain dietary elements are almost all a result of a data mining.

We are digging our graves with our teeth.

Caring for diabetes and related conditions consumes about 1/7 of all US healthcare spending (could be a little more or less depending on how you count). http://www.diabetes.org/diabetes-statistics/cost-of-diabetes... The vast majority of type-2 diabetes cases could be prevented with better eating habits. If the incidence of preventable chronic diseases was greatly reduced, healthcare costs would be so low that we wouldn't be arguing over how to pay for it.

Yes, but before advocating any diet please read Gary Taubes' "Good Calories, Bad Calories".

Please. The government already amplified a terrible mistake to colossal dimensions and could do it again.

Why is there no mention of the artificially restricted supply of doctors? This fact plainly accounts for a large portion (if not the majority) of US health care costs.

A retired gastroenterologist once told me his personal theory: Every human can consume a finite amount of sugar in his/her lifetime - once you exceed that limit, you die. The theory is a bit flimsy but it makes you think about cumulative nutritional choices.

Isn't it the same everywhere (assuming there is no war or natural calamity etc like situation)?

Not necessarily. For example: http://library.thinkquest.org/16665/causes.htm <- leading causes of mortality in ~20 countries. Look at how big the variations between different countries can be even for coarsely-grained statistics.

This is a poor headline. I'd say a better one would be. "Majority of US Healthcare Costs are Cause by Not Exercising enough to burn calories from Bad Eating Habits"

Well, there is something slightly perverse about eating more food than you need, and then doing useless physical work to balance out the equation.

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