Sunday, November 6, 2011



I began to think about this topic after watching Ken Burns’ special “Prohibition”.  In some ways, my being able to succeed (so far) in watching what I’m eating is because I decided MYSELF, to make the changes from my previous diet to the new one.  If I had been TOLD that I couldn’t have chocolate or other foods I like, I likely would have rebelled and gone out of my way to get some.  As it is, I have a little bit of less healthy foods, but self regulate my portions. 

It’s human nature to rebel against prohibitions.  At least in America, it is.  When people were told they COULDN’T drink at all, suddenly all sorts of criminal enterprises came about to supply the sudden increased desire for alcohol. 

Lately, it seems like our government is legislating a lot of things which deny people the things they think they want.  I think, in some cases, they’ve learned lessons from prohibitions’ failures.  Instead of outlawing cigarettes, they’ve regulated them to death.  You CAN smoke, but only in proscribed places.  No one has said you’re not ALLOWED to smoke.  I think if that happened, we’d see a boom in smoking and in bootlegging of cigarettes.  Already bootlegging from lower taxed states (and Indian reservations) is a problem.  But, this strategy has mostly succeeded and the rate of smoking has overall decreased. 

Dieting is sort of like that.  If I were told I wasn’t allowed to eat certain foods, I would crave them.   People have proposed to put higher taxes on junk food like soda and chips and cookies and such.  I think that people would self regulate if they had to pay more to eat at a fast food restaurant, or to buy soda or chips.  Part of their allure presently is that they’re cheaper than healthier foods.  Would we be able to subsidize farmers better with taxes on junk food and fast food so that healthier foods could be cheaper? 

I like high fat and high sugar foods as much as the next person.  I am not a food evangelist who goes out and says that these foods should be outlawed.  People would find a way to get them somehow if they were.  I do recognize the value of moderation though.  It turns out that after the repeal of prohibition, fewer people drank because there were laws with age limits, closing times for bars and restaurants, and laws about public drinking.  People moderated themselves because if they didn’t, they’d pay for it. 

I wonder if some of the plans larger corporations have started, with gyms at work, nutrition counseling and rewards for weight loss like better costs on health care are working?   They’ve made healthier foods at their cafeterias less expensive than less healthy foods. 

Would punishing people who have lifestyle related diseases with higher costs for health insurance work?  I kind of doubt it.  By that point, it’s too late.  The damage is done.  If you don’t cover those people with health insurance, someone will be paying for it, eventually.  Uninsured or poorly insured people delay care and then come in to the hospital unable to pay for the very expensive care they need. 

I think the trick is to make it seem like it’s not a prohibition against bad lifestyle choices, but to regulate those bad choices.  Making bad choices should be more expensive, and making better choices should be less so.  My husband has noted that our grocery bill has gone up a good bit since we’re shopping to a menu which includes a lot of fresh vegetables.  That’s okay for us, but I know it’s not okay for many people that I take care of in my practice.  They make choices between paying for food, medicine, rent, and utilities.  Cheaper food is often the only choice available.  Supermarkets are unable to survive in poor neighborhoods because their products are too expensive.  Subsidize the costs of healthy food with taxes on less healthy foods and I wonder if that would make a difference?  Has this experiment been done anywhere? 

I really hope they never outlaw chocolate.  I’d have to become a criminal. 

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