Often repeated diet and health recommendations from the public health community are to increase consumption of fruits and dark green leafy vegetables, reduce intake of added sugars, trans-fats, saturated fats, cholesterol, salt, and alcohol while maintaining bodyweight by aligning caloric intake with one’s level of physical activity. The impetus for such advice is that scientific evidence suggests obesity leads to an increased risk of premature death, type II diabetes, heart disease, stroke, hypertension, gallbladder disease, osteoarthritis, and many other maladies (U.S. Department of Health and Human Services, 2001). Regardless, recent statistics on obesity and dietary intake show that the majority of Americans are far from complying with this advice: the majority of Americans are overweight; approximately one third are obese; and the average diet is too high in calories, added sugars and saturated fat. To meet the 2005 Dietary Guidelines, the typical American would need to more than double their current intake of vegetables and whole grain foods while halving their intake of solid fats and added sugars (Hedley, et al., 2004; United States Department of Health and Human Services and United States Department of Agriculture, 2005).
This increasing prevalence of obesity and iet-related illnesses begs the question why so many people are putting themselves at risk of such serious illnesses. There must be something that compensates for accepting such risks a tradeoff that makes the risks worth accepting. Clearly, many Americans still eat too much food and choose those that are too high in fat, salt refined grains and added sugar. Given these strong preferences, the task the public health community has set for it self changing American’s diets is extremely difficult. Here, we offer a quantitative perspective on just how difficult it will be to realize a substantial improvement. We focus attention on the subset of consumers who have strong incentives to choose a healthful diet, those who have been diagnosed with diabetes, and show that they embrace opportunities to resist any change.
In this paper, we first provide some background on diabetes in the United States, indicating how diet and risk preferences could lead to a variety of behavioral adjustments and concomitant health (or health risk) outcomes. We offer a theoretical model that shows that if consumers treat diet and medication as substitutes in producing good health, consumers are unlikely to realize all the health benefits possible from diet and medication. In fact, consumers may choose diets that pose health risks even larger than those incurred in undiagnosed states: diet quality for those on medication may be worse than those who do not have diet related chronic diseases. This study uses the most recent data sets from the National Health and Nutrition Examination Survey 1999-2000 and 2001-2002 (for simplicity NHANES 1999-2002), which contain detailed information on dietary intake, medical conditions and whether an individual takes medication for such conditions. We estimate how differences in dietary quality correlate with whether or not an individual has been diagnosed with diabetes, and whether or not an individual uses medication to manage his or her health condition. By examining diet quality for those having a diet-related disease, we show that the threat of severe adverse health consequences (premature death, blindness, loss of limbs, kidney failure) can induce major improvements in diet quality (improvements from the perspective of the public health community, not consumers). But the availability of medications that can also forestall the adverse health consequences of chronic diet related disease means that most consumers will compromise diet quality. We examine the overshooting that occurs as people with diabetes rely on medication, compromising diet quality. We conclude with suggestions for new guidance for information policy.
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Estimating the Impact of Medication on Diabetics’ Diet and Lifestyle Choices
