Human Limits

Exploring performance and health with Michael J. Joyner, M.D.

Photo of Michael J. Joyner, M.D.

Obesity: Who is Responsible?

On a recent plane ride I had a window seat with a trim lady in the aisle seat.  The middle seat was then occupied by a short but large man who sat down and immediately fell asleep and started to snore.   When he woke up just prior to takeoff he apologized and commented “the Drs. tell me there is nothing they can do about it…….” This man pretty obviously has obstructive sleep apnea (OSA) and he also told me that he does not bring his CPAP device while traveling due to inconvenience.   Obesity is a major cause of cardiovascular problems, diabetes and early death.  It is also the major cause of sleep apnea which is a dangerous condition associated with all sorts of medical problems including hypertension, diabetes, cognitive impairment, and heart disease to name a few.   The issue of large (fat) people on planes is very controversial and some airlines have policies requiring people to buy two seats.   However, I want to talk about the “they” concept noted above.


Nothing “They” Can Do About It?

When the gentleman next to me said “there is nothing they can do about it,” my internal response was something like, “You are right, Drs. don’t have much to offer you, but there is something you can do about it, namely lose weight.”  I held my tongue and went back to my book.   However, this experience got me thinking about who is responsible for what, especially when it concerns their own health.   This brief conversation also raises issues about how things like insurance premiums should be set for people with controllable diseases, conditions, and/or lifestyle choices.


Is Obesity Contagious?

Losing weight and keeping it off is hard but possible in our obesogenic world.  One emerging argument is that obesity is “contagious” and that it travels in social networks with the behavior of friends and families having a major influence on body weight and things like physical activity.  This idea is not uniformly accepted, but it is an interesting concept that might stimulate new ideas about how to address the obesity epidemic.  Here is a link to an interesting paper on Facebook preferences and body weight; can social networks be used to turn the obesity epidemic around?


Should Insurance Premiums be Adjusted?

One concern is that as long as health insurance premiums don’t consider lifestyle related diseases and risk factors, people that make unhealthy choices are economically shielded from the costs of their behavior.   This is also one of the main arguments for sin taxes, and this topic has been in the news recently based on proposals in California to limit the ability of Obamacare to charge higher health insurance premiums for smokers.  It is hard to understand the rationale for this move in California.  We should also remember that most other forms of insurance are risk adjusted based on our behavior and choices.  Why should health insurance be different?



The U.S. is having major and prolonged discussions about health care costs, outcomes, and payment schemes.    To some extent this is also going on in the rest of the world.  What strikes me in this whole collection of discussions is how little attention is being paid to policies that promote increased personal responsibility, and the extent to which any of us should pay for “bad behavior and choices” by others.  Where do we draw the line?  As a society we are all in it together….. up to a point.



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