A Question of Scale

The bad news: Massachusetts is facing an obesity crisis. The good news? There’s a way to fix it.


I’d sit around and guzzle soda and take down whole pizzas by myself. Other times, I’d eat dinner, then sit around and guzzle soda and take down whole pizzas by myself. My parents implored me to eat better, to go outside, to be more active. But cookies don’t grow in the wild, you know. Back then, eating was easier than being healthy, and I preferred the comforts of my kitchen.

There were consequences. By middle school, I was racing to the locker room so I could change before the older guys arrived, what with their fondness for poking and mocking shirtless fat kids. Once I was safely into my gym clothes, the scariest words on earth were “shirts versus skins.”

Were I back in seventh grade now, I doubt I would feel any less self-conscious, but I certainly wouldn’t be alone. According to a 2009 study by the Massachusetts Department of Public Health, one-quarter of the state’s adolescents weigh too much, about three times more than 20 years ago. And the people who are supposed to be feeding them properly aren’t doing any better: More than half the adults here are overweight, too.

Of course, the “obesity epidemic” is America’s cause célèbre right now. Everyone from Michelle Obama to that annoying British chef on ABC has stepped forward to address the issue. Here in the commonwealth, Governor Deval Patrick put forth a plan last year to deal with the problem. He called for restaurant chains to begin prominently displaying nutrition information, as in New York City. He directed grants to cities and towns so they can come up with local health initiatives. And, in a controversial move, he called for schools to measure the weight and height of first, fourth, seventh, and 10th graders; calculate their body mass index; and send a letter home to their parents explaining the implications.

The whole idea, says state Public Health Commissioner John Auerbach, is to change the way we think about what we put into our bodies. Yet the underlying premise of the governor’s push seems to be that fat people do not know they are fat — and do not understand that the foods they eat make them that way.

As a fat-kid emeritus, I’ll bet you all the Munchkins from here to Hopkinton that Patrick’s plan will not work. The reason is simple: Obesity is not a matter of ignorance. Does anyone really believe there is one overweight kid in Massachusetts who is not acutely aware of how overweight he or she is? No, the challenge isn’t bridging a knowledge gap; it’s closing a behavioral one. And there is only one sure-fire way of getting people to change their behavior: pay them.

  • Ashley

    I like the idea of incentivizing behavior (in general, not just this context) and I wonder in this context if it could be applied more proactively. For example health plans offer $150 reimbursements

  • Ashley

    for members who attend the gym. What about adding something like that for people who maintain a healthy weight?