Obesity PDF
Obesity PDF
Obesity PDF
Obese?
David M. Cutler, Edward L. Glaeser and
Jesse M. Shapiro
I
n the early 1960s, the average American adult male weighed 168 pounds.
Today, he weighs nearly 180 pounds. Over the same time period, the average
female adult weight rose from 143 pounds to over 155 pounds (U.S. Depart-
ment of Health and Human Services, 1977, 1996). In the early 1970s, 14 percent of
the population was classied as medically obese. Today, obesity rates are two times
higher (Centers for Disease Control, 2003).
Weights have been rising in the United States throughout the twentieth
century, but the rise in obesity since 1980 is fundamentally different from past
changes. For most of the twentieth century, weights were below levels recom-
mended for maximum longevity (Fogel, 1994), and the increase in weight repre-
sented an increase in health, not a decrease. Today, Americans are fatter than
medical science recommends, and weights are still increasing. While many other
countries have experienced signicant increases in obesity, no other developed
country is quite as heavy as the United States.
What explains this growth in obesity? Why is obesity higher in the United States
than in any other developed country? The available evidence suggests that calories
expended have not changed signicantly since 1980, while calories consumed have
risen markedly. But these facts just push the puzzle back a step: why has there been
an increase in calories consumed? We propose a theory based on the division of
labor in food preparation. In the 1960s, the bulk of food preparation was done by
families that cooked their own food and ate it at home. Since then, there has been
a revolution in the mass preparation of food that is roughly comparable to the mass
y
David M. Cutler is Professor of Economics, Edward L. Glaeser is Professor of Economics,
and Jesse M. Shapiro is a Ph.D. student in economics, all at Harvard University, Cambridge,
Massachusetts. Cutler and Glaeser are also Research Associates, National Bureau of Economic
Research, Cambridge, Massachusetts.
Journal of Economic PerspectivesVolume 17, Number 3Summer 2003Pages 93118
production revolution in manufactured goods that happened a century ago. Tech-
nological innovationsincluding vacuum packing, improved preservatives, deep
freezing, articial avors and microwaveshave enabled food manufacturers to
cook food centrally and ship it to consumers for rapid consumption. In 1965, a
married women who didnt work spent over two hours per day cooking and
cleaning up from meals. In 1995, the same tasks take less than half the time. The
switch from individual to mass preparation lowered the time price of food con-
sumption and led to increased quantity and variety of foods consumed.
Our theory is nicely illustrated by the potato. Before World War II, Americans
ate massive amounts of potatoes, largely baked, boiled or mashed. They were
generally consumed at home. French fries were rare, both at home and in restau-
rants, because the preparation of French fries requires signicant peeling, cutting
and cooking. Without expensive machinery, these activities take a lot of time. In the
postwar period, a number of innovations allowed the centralization of French fry
production. French fries are now typically peeled, cut and cooked in a few central
locations using sophisticated new technologies. They are then frozen at 40 de-
grees and shipped to the point of consumption, where they are quickly reheated
either in a deep fryer (in a fast food restaurant), in an oven or even a microwave
(at home). Today, the French fry is the dominant form of potato and Americas
favorite vegetable. This change shows up in consumption data. From 1977 to 1995,
total potato consumption increased by about 30 percent, accounted for almost
exclusively by increased consumption of potato chips and French fries.
The technical change theory has several implications, which we test empiri-
cally. First, increased caloric intake is largely a result of consuming more meals
rather than more calories per meal. This is consistent with lower xed costs of food
preparation. Second, consumption of mass produced food has increased the most
in the past two decades. Third, groups in the population that have had the most
ability to take advantage of the technological changes have had the biggest in-
creases in weight. Married women spent a large amount of time preparing food in
1970, while single men spent little. Obesity increased much more among married
women. Finally, we show that obesity across countries is correlated with access to
new food technologies and to processed food. Food and its delivery systems are
among the most regulated areas of the economy. Some regulations are explicit; for
example, the European Union has taken a strong stance against genetically engi-
neered food, and Germany for many years had a Beer Purity Law. Other regula-
tions are cultural, like Jose Boves crusade against McDonalds in France. Coun-
tries with a greater degree of regulation that support traditional agriculture and
delivery systems have lower rates of obesity.
While the medical profession deplores the increase in obesity, the standard
economic view is that lower prices for any goodeither monetary or time costs
expand the budget set and make people better off. But self-control issues compli-
cate this interpretation. If people have difculty controlling how much they eat,
lowering the time costs of food consumption may exacerbate these problems.
Certainly, the $40$100 billion spent annually on diets testies to the self-control
94 Journal of Economic Perspectives
problems that many people face. In the last part of the paper, we consider the
welfare implication of lower food production costs when individuals have self-
control problems. We will argue that for the vast majority of people, the price
reductions in food preparation have led to welfare increases.
Trends in Obesity
We make extensive use of the health and weight data from the National Health
and Nutrition Examination Surveys (NHANES) that were conducted in 19591962,
19711975, 19761980, 19881994 and 19992001. We present data through 1999
where we can, but conduct most of our detailed analysis using data through 1994.
The NHANES data measure height and weight directly, using mobile research vans,
so obesity calculations are exact. This method is increasingly important as more
people are overweight and embarrassed to admit it. The available, if somewhat
sporadic, historical data on heights and weights has been compiled by Costa and
Steckel (1997).
The primary measure of obesity is Body Mass Index, or BMI, which allows
comparisons of weight holding height constant. BMI is measured as weight in
kilograms divided by height in meters squared. Optimal BMI levels are generally
believed to lie between 20 and 25. BMI below 20 is considered thin, BMI between
25 and 30 is overweight, and BMI above 30 is obese. A six-foot-tall man would
therefore be overweight at 184 pounds and obese at 221 pounds. The medical
evidence shows increasingly high rates of disease and death as BMI increases above
25 (World Health Organization, 2000; Sturm, 2002).
1
Early in the twentieth century, Body Mass Index was either optimal medically
or too low, depending on the country (Costa and Steckel, 1997; Fogel, 1994).
Between 1894 and 1961, average BMI for men in their 40s increased from 23.6 to
26.0, with a somewhat smaller, but comparable, increase for men in their 30s. The
increase for men in their 40s corresponds to roughly 16 pounds for a typical
American male (ve feet, nine inches tall). Fogel (1994) shows that increases in
BMI over the past few centuries were a major source of improved health. However,
since 1960, BMI has increased by another 0.7. The weight increases in the more
recent period are substantially less healthy than in the earlier time period. An
average BMI above 25 places a large share of people in the medically overweight
category. Over the past four decades, the share of the population that is either
overweight or obese increased from 45 to 61 percent. The share of people that are
obese increased from 13 percent to 27 percent. Obesity has increased for both men
and women. For both men and women, most of this increase is in the 1980s and
1990s, and our analysis will focus on this period, as well.
1
But see Campos (2003) for a reevaluation of this evidence.
David M. Cutler, Edward L. Glaeser and Jesse M. Shapiro 95
The Demographics of U.S. Obesity
Not only is average weight increasing, but the right tail of the distribution is
expanding particularly rapidly. Figure 1 shows the distribution of the Body Mass
Index between the 19711975 and 19881994 surveys. Over this time, median BMI
increased by 0.9; the 75
th
percentile increased by 1.5; and the 95
th
percentile
increased by 2.7. While eating disorders, such as anorexia nervosa, are believed to
have increased over the past 30 years (Hsu, 1996), the prevalence of this disease is
still very low. We do not nd a signicant increase in the population with very low
weight even among younger women. The U.S. Surgeon General estimates that
Figure 1
Distribution of BMI, 19711975 and 19881994
Males, age 2055
10
0
.05
.1
20
197175
198894
30
BMI (kg/m
2
)
40 50
Females, age 2055
10
0
.05
.1
20
197175
198894
30
BMI (kg/m
2
)
40 50
Source: National Health and Nutrition Examination Surveys.
96 Journal of Economic Perspectives
around 0.1 percent, or 300,000 people, suffer from anorexia nervosa (U.S. Depart-
ment of Health and Human Services, 1999).
Table 1 shows data on obesity for adults. The left columns report average BMI;
the right columns report the share of the population that is obese. The average
increase in BMI between the 1970s and the 1990s, shown in the rst row, is 1.9.
There are some differential increases in obesity by demographic group, which we
examine later in the paper. As a preview of these later arguments, married women
and women with exactly 12 years of schooling have had the largest increases in
average BMI. These groups traditionally spent a lot of time preparing meals at
home, and they spend less time now. However, Table 1 also provides some rst
evidence that increased obesity is not a result of women working. Holding constant
obesity within demographic groups, the shift to more households with women
working can account for no more than 10 percent of increased obesity (Cutler,
Glaeser and Shapiro, 2003).
2
2
But see Chou, Grossman and Saffer (2002), who argue that increased labor market attachment has
played an important role in the rise of obesity in the United States.
Table 1
Increase in Weight by Population Group
Average BMI
(kg/m
2
)
Percentage Obese
(BM 30)
197175 198894 197175 198894
Average 25.4 27.3 16% 30%
Adults
All 25.0 27.1 15 28
Single male 24.4 25.5 9 18
Married male, nonworking spouse 25.6 27.1 13 26
Married male, working spouse 25.7 27.3 11 24
Single female 24.9 27.4 18 32
Married female, working 24.3 27.4 13 33
Married female, not working 24.9 28.0 16 36
Elderly
All 26.1 27.6 19 32
Male 25.4 27.0 13 28
Female 26.7 28.2 25 36
Women aged 20, by education group
High school 26.3 28.4 24 38
High school 24.2 27.5 13 33
College or more 22.8 25.4 7 20
Men aged 20, by education group
High school 25.6 26.5 15 23
High school 25.7 26.7 13 24
College or more 25.2 26.4 8 21
Notes: Data are from the National Health and Nutrition Examination Survey (NHANES). BMI is
measured in kg/m
2
.
Why Have Americans Become More Obese? 97
The bottom rows of Table 1 show changes in obesity by education group,
separately for men and women. Obesity for women is strongly negatively associated
with education. This was true in the early 1970s and continues to be true today. But
obesity has increased for all education groups. For men, obesity is relatively inde-
pendent of education and has been for the past few decades. These trends belie an
obvious income-based explanation for increasing obesity. Higher incomes, at least
as reected in increased education, would actually lower obesity. In Cutler, Glaeser
and Shapiro (2003), we conrm in a regression framework that trends in educa-
tion, age, race, marital status, employment, occupation and the employment status
of the spouse of the head of the household explain at most 10 percent of the
increase in BMI and obesity over this time period. Demographic change is not the
explanation here.
International Evidence on Obesity
Figure 2 puts the U.S. experience in international perspective, showing data on
obesity in OECD countries. The United States is a clear outlier, but other countries
are heavy, as well. Obesity levels in several former Warsaw Pact countries are nearly
as high as they are in the United States. Obesity in England is also extremely high.
France, Italy and Sweden rank much lower in their obesity levels, and the Japanese
are quite thin.
Data on changes in obesity across countries are harder to nd. Some countries
have scattered information, discussed in Cutler, Glaeser and Shapiro (2003). The
increase in obesity in the United Kingdom is similar to that of the United States,
although it starts from a lower level. Australia has also seen a rise in obesity,
although not as large. Canada, a country that one might think would parallel the
U.S. experience, had much more modest increases in obesity for men and a
decrease in obesity for women between 1978 and 1988, although obesity has
increased since then (Katzmarzyk, 2002). A good theory of the changes in obesity
should be able to explain why obesity has risen so much in some countries and so
little in others.
Calories In versus Calories Out
Arithmetically, people get heavier if they consume more calories or expend
fewer calories. On average, about 3,500 calories is one pound. There are differ-
ences in metabolisms across human beings, and it is also possible that different
caloric expenditures may have different impacts on the amount of weight gained or
lost. But for a typical person, an increase in calorie consumption of 3,500 calories
or a reduction in caloric expenditure of that amount increases weight by one
98 Journal of Economic Perspectives
pound.
3
In this section, we evaluate which of these factors explains changes in
obesity.
We start with some basic energy accounting. People burn calories in three
ways. The rst is through basal metabolismthe energy cost associated with keep-
ing the body alive and at rest. Basal metabolism represents about 60 percent of
energy utilization for most people. The energy cost of basal metabolism depends on
weight: BMR Weight. The more a person weighs, the more energy is
required to sustain basic bodily functions. Schoeld, Schoeld and James (1985)
estimate values of of 879 for men and 829 for women, and of 11.6 for men and
8.7 for women (ages 3060). Different age groups are associated with different
values of these parameters, and the parameters may also vary somewhat with
conditions. However, the substance of our conclusions is unchanged under
reasonable alternative assumptions. A 70 kilogram (155 pound) man burns on
average about 1,800 calories before he does any activity. A 60 kilogram woman
(132 pounds) burns about 1,400 calories.
The second source of energy expenditure is that processing food requires
energy. This thermic effect is about 10 percent of total energy expenditures
during a day and comes from the thermic effect of food.
Finally, calories are burned by physical activity. The caloric needs of a given
amount of physical activity is proportional to weight: Energy
a
a
Weight
3
There has been controversy in recent years over whether other variables, such as the fat or carbohy-
drate composition of food, may also inuence weight patterns (Atkins, 2000). Given the lack of scientic
consensus on the importance of energy composition (Bhargava and Guthrie, 2002; Fumento, 2003), we
ignore these issues in this paper.
Figure 2
Obesity in International Perspective
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David M. Cutler, Edward L. Glaeser and Jesse M. Shapiro 99
Time
a
, where
a
varies with the activity done, a. The units of
a
are calories per
kilogram-minute, so
a
gives a translation between the weight of the individual and
the duration of activity and the total caloric expenditure associated with the activity.
In this literature,
a
is typically grouped into categories such as light activity, such
as walking or light housework, moderate activity, such as fast walking and garden-
ing, and heavy activity, like strenuous exercise or farm work (Ainsworth et al.,
1993). Summing across activities, we denote an exercise index E
a
a
Time
a
,
reecting total physical activity in a period of time.
In steady-state, calories in equal calories out. Denoting K as daily calories
consumed, this implies a weight equation of the form
K E Weight .1 K.
Using estimates of and E from the literature (Schoeld, Schoeld and James,
1985; Whitney and Cataldo, 1983), this equation can be used to estimate that the
10- to 12-pound increase in median weight we observe in the past two decades
requires a net caloric imbalance of about 100 to 150 calories per day.
These calorie numbers are strikingly small. One hundred and fty calories per
day is three Oreo cookies or one can of Pepsi. It is about a mile and a half of
walking. Given the small size of this change, it is obviously difcult, if not impos-
sible, to determine exactly what explains it. The detailed data on dietary habits and
activities that would be needed to examine this question do not exist. Accordingly,
we use more indirect measures to infer the causes of rising weight. We discuss
evidence on changing intake rst and then turn to energy expenditure.
Evidence on Caloric Intake
There are two sources of data on food intake: food recall studies and agricul-
tural sales data. Detailed food recall data are available for 19771978 and 1994
1996 from the Continuing Surveys of Food Intake by Individuals, conducted by the
U.S. Department of Agriculture.
4
In a food recall study, respondents detail every-
thing they ate in the previous 24-hour period. In principle, all food consumption
is recorded. In practice, consumption is surely understated, as people do not record
everything they eat. For example, the average male in 19941996 reports consum-
ing 2,347 calories, and the average female reports consuming 1,658 calories. These
imply steady-state weights considerably below those measured for the same popu-
4
In food recall studies, respondents are contacted and asked to recall all food eaten in the previous
two-hour period. Respondents are then asked to keep detailed food diaries for the next one or two days.
Consistent with other researchers, we use consumption information from only the rst day, although
these too are believed to be underreported (Enns, Goldman and Cook, 1997).
100 Journal of Economic Perspectives
lation. Underreporting is not necessarily a problem for our analysis, if the extent of
underreporting is constant over time, but as surveys have improved, underreport-
ing has likely fallen.
Table 2 shows changes in food consumption between the mid-1970s and the
mid-1990s for males and females. The top row in each panel reports overall caloric
intake. Reported consumption increased by 268 calories for men and 143 calories
for women between the two surveys. This increase is more than enough to explain
the increase in steady-state weight.
The rows of the table show the distribution of those calories by meal. Some-
what surprisingly, most of the increase in calories is from calories consumed during
snacks. Dinnertime calories have actually fallen somewhat. The increase in caloric
intake is because of greater frequency of eating, not eating more at any one sitting.
In calculations not shown in the table, we nd that the number of snacks in the
typical day increased dramatically over this period. Whereas only about 28 percent
of people in 19771978 reported two or more snacks per day, 45 percent reported
two or more snacks in 19941996. The average number of snacks per day increased
by 60 percent over this period, thus more snacks per dayrather than more
calories per snackaccount for the majority of the increase in calories from snacks.
The nding that increased caloric intake is from more snacks rules out two
obvious accounting explanations for increased obesity. The rst is that obesity is a
result of increased portion sizes in restaurants (Young and Nestle, 2002). If this
theory were true, calories at main meals, particularly dinner, would have increased.
Similarly, the evidence also rules out the view that fattening meals at fast food
Table 2
Changes in Food Consumption, 19771978 to 19941996
Meal
Calories
a
Change
Percentage
of Total
Change 19771978 19941996
Male TOTAL 2080 2347 268 100%
Breakfast 384 420 36 13
Lunch 517 567 50 19
Dinner 918 859 59 22
Snacks 261 501 241 90
Calories per meal 573 566 7
Meals per day 3.92 4.53 .61
Female TOTAL 1515 1658 143 100%
Breakfast 286 312 26 18
Lunch 368 398 31 22
Dinner 676 602 74 52
Snacks 186 346 160 112
Calories per meal 422 408 14
Meals per day 3.86 4.44 .58
Note: Data are from the Continuing Survey of Food Intake 19771978 and 19941996.
a
Average calories except for the row reporting average meals per day.
Why Have Americans Become More Obese? 101
restaurants have made America obese. The food diaries also present evidence on
where calories are consumed. Fast food has certainly increased, from about 60 cal-
ories per day to over 200 calories per day. But this increase is largely at formal
meals, where it has been offset by reduced home consumption. The increase in
snacks, in contrast, is largely concentrated in snacks consumed at home and, to a
lesser extent, in snacks purchased in stores and restaurants.
We also examine data on food sales, taken from total production and adjusted
for exports, imports and feed stock (U.S. Department of Agriculture, 2000). In
recent years, the data have also been adjusted for wastage, although this adjustment
is imprecise. Food supply declined relatively steadily between 1909 and 1950. There
were signicant downturns during World War I and the Great Depression and
moderate declines in other periods. This decline is almost certainly related to
reduced need for food, as people moved off of farms and into cities. The decline
in food consumption helps to explain why obesity increased only mildly during this
earlier time period, despite a large reduction in energy expenditures. Since 1965,
however, food supply has increased markedly, particularly in the last two decades.
In 1978, food supply was 3,200 calories per person. By 1999, food supply was 3,900
calories per person, 700 calories higher. Adjusted for wastage, the increase is
418 calories. This change is three to four times the increase that is needed to
explain the increase in average obesity over the time period.
Evidence on Energy Expenditure
We examine two components of energy expenditure: voluntary exercise and
involuntary energy expenditure associated with employment. Data on voluntary
exercise come from time diary studies. As with food diaries, the very act of keeping
the diaries induces some people to alter their behavior. Moreover, some of the data
is retrospective, and there are natural memory problems. People may lie, as well.
Still, these problems may not bias trends in time allocation, which is our concern.
Table 3 displays information on time usage in 1965, 1975, 1985 and 1995. Time
use has been remarkably stable over time. The biggest change occurred between
1965 and 1975, when television watching increased by 40 minutes. Some of the
increase in TV time appears to have come out of other forms of socializing
(Putnam, 2000) and a decline in meal cleanup activities. Using our energy expen-
diture equation above, we calculate that a 40-minute change from light household
activity to sedentary activity would lead to a four-pound increase in steady-state
weight for the average male.
5
However, since 1975, television viewing has increased
by 22 minutes, half of the increase in the previous decade. Furthermore, this rise
in TV viewing has been offset by a decline in other passive categories, such as
sleeping, and an increase in more active categories, such as sports or walking. At the
bottom of Table 3, we calculate values of Ethe energy expenditure indexfor the
5
Forty minutes of sedentary activity burns about 50 kilocalories for a 70 kg man (Ainsworth et al., 1993).
Light household activity uses about 7090 kilocalories for the same person (Ainsworth et al., 1993),
corresponding to a difference of about 2040 kilocalories, or 24 pounds, in steady state.
102 Journal of Economic Perspectives
different time periods. The estimated value of E fell between 1965 and 1975, but
has been quite stable since then. We cannot explain changes in obesity in the past
two decades on that basis.
The second component of energy expenditure is energy spent on the job and
commuting to work. Philipson and Posner (1999) stress this hypothesis in explain-
ing the increase in obesity over time. This view is certainly true over the longer run.
Between 1910 and 1970, the share of people employed in jobs that are highly active
like farm workers and laborers fell from 68 to 49 percent. Since then, the change
has been more modest. Between 1980 and 1990, the share of the population in
highly active occupations declined by a mere 3 percent, from 45 to 42 percent.
Occupation changes are not a major cause of the recent increase in obesity.
Changes in transportation to work are another possible source of reduced
energy expendituredriving a car instead of walking or using public transporta-
tion. Over the longer time period, cars have replaced walking and public transpor-
tation as means of commuting. But this change had largely run its course by 1980.
Table 3
Time Use, 19651995
(Minutes per day, age 1864)
Activity 1965 1975 1985 1995
Paid work 290 258 259 266
Eating on the job 11 8 8
Breaks 8 4 3 1
Household work 146 128 124 102
Food preparation 44 41 39 27
Meal cleanup 21 12 10 4
Child care 37 31 31 18
Obtaining goods and services 51 45 53 49
Personal needs and care 622 644 634 632
Meals at home 58 54 50 65
Meals out 11 19 19 (meals at
home & out)
Sleeping/napping 473 496 479 495
Education and training 12 16 18 23
Organizational activities 20 24 18 17
Entertainment/social 78 65 65 72
Recreation 27 37 43 47
Active sports 5 4 10 13
Outdoor 1 7 5 6
Walking/hiking/exercise 1 2 4 5
Communication 158 191 195 212
TV 89 129 129 151
TOTAL 1440 1440 1440 1440
Kcal per minute per kilogram 1.69 1.57 1.62 1.53
E for 70 kilogram man 16.4 13.5 14.7 12.6
E for 60 kilogram woman 15.1 12.3 13.5 11.3
Notes: Time use data from Robinson and Godbey (1997) and authors calculations from 1995 time diary.
Energy expenditure data from authors calculations based on Compendium of Physical Activities.
David M. Cutler, Edward L. Glaeser and Jesse M. Shapiro 103
In 1980, 84 percent of people drove to work, 6 percent walked and 6 percent used
public transportation. In 2000, 87 percent drove to work, 3 percent walked and
5 percent used public transportation (U.S. Department of Commerce, 2000).
Changes of this minor magnitude are much too small to explain the trend in
obesity: for a 70 kilogram man with a typical commute time of around 22 minutes,
this change would lead to an increase of less than 0.4 pounds in steady state.
A nal piece of evidence on energy expenditure comes from examining
population subgroups. Children and the elderly do not work now, and they did not
work in 1980. However, the data show large increases in obesity among children
and adolescents.
6
Further, the elderly may be more active now than in 1980, yet
they are also more obese now than in 1980.
In sum, our results suggest that the most plausible explanation for the rise in
obesity involves increased caloric intake, not reduced caloric expenditure. Given
the limitations of the evidence, we cannot be certain that this completely explains
the rise in obesity. However, we will accept this conclusion and turn next to theories
of why caloric consumption has increased so greatly.
Technology, the Division of Labor and Obesity
Several theories could potentially explain the increase in caloric intake over
the past 25 years. Price and income changes are one explanation. As people get
richer, they will demand more food. But income changes seem unlikely to explain
our results. Income and obesity are negatively associated today, at least for women.
Furthermore, for much of the period, real incomes were not increasing greatly at
the bottom of the income distribution, but obesity for those groups still increased.
Relative price declines for food could also explain increased consumption. How-
ever, from 1970 to 1999, the Consumer Price Index for food items increased only
3 percent slower than the CPI for nonfood items.
We also reject a theory of obesity that the increased numbers of women at work
have increased the demand for eating outand for eating less healthy food. As we
argued above, increased female labor force participation does not appear linked to
rising obesity. Furthermore, it is not clear that eating out should increase caloric
intake. Restaurants can cook low-calorie food just as easily as high-calorie food.
Indeed, substitution of dinners from home cooked to eaten out seems not to have
increased caloric intake at dinner.
Here, we propose a new theory of increased obesity based on reductions in the
time cost of food, which in turn has allowed more frequent food consumption of
greater variety and, thus, led to higher weights.
6
Anderson, Butcher and Levine (2002) offer evidence that children of working mothers are more likely
to be overweight than children of nonworking mothers, although this effect explains only a small
portion of the total increase in child overweight in the last 30 years.
104 Journal of Economic Perspectives
The Rise of Mass Preparation
Traditionally, consumers took raw agricultural products and transformed
them into edible food. This preparation involved signicant amounts of time. As
late as the 1960s, a majority of the total costs of food were preparation and cleanup
time. In 1965, the average family spent $15 per day on purchased food (in 1990
dollars) and about 130 minutes on preparation and cleanup (Robinson and
Godbey, 1997). At an average wage for women, this time cost perhaps $20, or
57 percent of total food expenditures. Over the past 30 years, the time involved in
preparing food has fallen in half.
People could always make almost any form of food that is currently available,
if they were willing to spend the time to do so. For example, ambitious cooks could
make snack-size cream-lled cakes, for example, but it took time. Technological
innovations since 1970 mean that preparation can now be done in restaurants and
factories, exploiting technology and returns to scale. Snack-size cream-lled cakes
are now widely available for less than a dollar.
To produce food in one location that will be nearly ready for consumption in
another location, one must surmount ve main technological obstacles (Kelsey,
1989): controlling the atmosphere; preventing spoilage due to microorganisms;
preserving avor; preserving moisture; and controlling temperature. Innovations in
food processing and packaging over the last three decades have improved food
manufacturers ability to address each of these issues.
Controlled atmosphere processing and, more recently, modied atmo-
sphere processing, allow food manufacturers to control the gaseous environment
in which their foods are stored. In the case of fruits, vegetables and other foods with
living cells, these technologies slow down ripening and prevent spoilage. For
recently introduced packaged goods such as fresh pasta, prepared salads and
cooked chicken, control of the atmosphere inside the package can greatly lengthen
shelf life (Testin, 1995).
Hydrogen-peroxide sterilization (approved for use in 1981) and stretch-wrap
lms (introduced in 1976) have improved food producers ability to kill and seal
out harmful microorganisms. Since the 1970s, food irradiation has made signicant
advances, although the diffusion of this technology has been slowed by public
concern and the Food and Drug Administration.
A persistent problem in food processing is that packaging can adversely affect
food avor. The 1980s saw huge advances in avor barrier technology, which
involves materials specially tailored to the food that prevent migration of avor-
related chemicals to and from the food. In addition, the food industry has increas-
ingly made use of chemists as avor specialists to design food avors to suit
consumers tastes (Schlosser, 2002). These chemists hone in on what makes certain
foods desirable and synthesize it in the laboratory. These articial avors can then
be added to make pre-prepared food more appealing.
Temperature and moisture pose a particular problem in the case of frozen
foods. If moisture builds up in the package, ice crystals can form, which separate
ingredients and alter the foods texture (Kelsey, 1989). In addition, moisture can
Why Have Americans Become More Obese? 105
lead to dehydration of food in the freezer and freezer burn. Advances in poly-
ethylene plastics and other materials have improved control over the internal
moisture of food packages, thus extending the freezer/shelf life of many foods and
improving avor.
Other technologies are available at the user end. Microwaves were developed
in the 1940s as an outgrowth of radar technology and became widely available in
the 1970s. As late as 1978, only 8 percent of American households had microwaves.
By 1999, 83 percent of American households had microwave ovens (Energy Infor-
mation Administration, 2003, provides more details). Other kitchen appliances,
such as refrigerators, have also improved.
These technologies did not affect all foods or all places equally. Generally,
foods that are consumed in more or less the same form that they leave the farm, like
fresh fruit, stand to gain less from advances in packaging and processing. Foods that
involve signicant amounts of preparation benet most from the new technologies.
American technological leadership and the large size of the American market
meant that many of the most important innovations were rst developed in the
United States. Other countries have often limited the incursions of American food
products or food retailers (such as fast food outlets). Moreover, food is often one
of the most regulated areas of any the economy, and many economies have put
substantial roadblocks to the incorporation of new food technologies.
Perhaps the most telling evidence for the revolution in time costs of food
production has been the reduction in the time spent cooking and cleaning. Table 4
shows food preparation times for different subgroups of the population in 1965
and 1995. The food preparation and clean-up times for both working and non-
working women fell by about 50 percent. These changes hold work status constant.
They reect technology, not labor force participation.
The trend toward increased levels of commercial preparation also appears in
data on the distribution of food payments. In 1972, 44 percent of the cost of food
went to farmers. By 1997, only 23 percent of the cost of food represented the input
of farmers. The rest is input from the retail sector. This statement does not just
apply to the restaurant sector. Eighty percent of the cost of food eaten at home is
now spent on nonfarm related expenses. Labor in the supermarket and the factory
has replaced labor in the home, and this shift has been associated with dramatic
time savings within the home.
Implications of Technological Change
Food preparation involves both xed and variable costs. For example, peeling
and cutting French fries is a marginal time cost, while deep frying is generally a
xed cost (up to the point where the fryer is full). Mass preparation means that the
xed time component can be shared over a wide range of consumers. In addition,
mass preparation reduces the marginal cost of preparing food by substituting
capital for labor. Finally, mass preparation exploits the division of labor. Food
professionals instead of everyday people now prepare food, reducing both xed
and marginal costs.
106 Journal of Economic Perspectives
Reductions in the time cost of food preparation should lead to an increase in
the amount of food consumed, just as reductions in any goods price should lead
to increased consumption of that good. Based on a standard quantity-quality model
of food consumption, as in Becker and Lewis (1973), this increase can occur
through several channels: 1) increased variety of foods consumed; 2) increased
frequency of food consumption; 3) a switch to high-calorie/high-avor prepared
foods that had previously been unavailable; or 4) an increase in the overall
consumption of each individual food item. As xed costs decline, we would expect
most of the increase in calories to come from increased variety of foods and
frequency of food consumption, rather than more food during each meal. Indeed,
reductions in time costs have an ambiguous effect on calories per food item. If the
quantity of meals and food at each meal are substitutes (for example, as people
become sated), the calories at any given meal will decline.
Testing the Implications of the Theory
The mass preparation theory suggests four empirical implications. First, the
lower costs of food preparation mean that individuals should consume a wider
range of products at more times during the day. Second, the increase in food
consumption should come mostly in foods that had an improvement in mass
preparation technology (and complements to those foods). Third, individuals who
have taken the most advantage of the new technologies should have had the biggest
increase in obesity. Finally, obesity rates should be higher in countries with greater
Table 4
Time Costs by Demographic Group
(minutes)
1965 1995
Meal
Prep.
Meal Prep.
Cleanup
Meal
Prep.
Meal Prep.
Cleanup
Adults
Single male 13.6 18.1 15.5 17.3
Married male, nonworking spouse 6.5 9.4 13.2 14.4
Married male, working spouse 8.1 11.9 13.2 14.4
Single female 38.1 60.1 28.9 33.1
Married female, working 58.3 84.8 35.7 41.4
Married female, not working 94.2 137.7 57.7 68.8
Elderly
Male 16.6 26.3 18.5 20.2
Female 65.9 10.4 50.1 60.3
Source: Authors calculations from Americans Use of Time Survey Archives, 1965 and 1995.
David M. Cutler, Edward L. Glaeser and Jesse M. Shapiro 107
access to technological changes in food consumption. In this section, we test these
implications.
Implication 1: Changes in Food Type, Composition and Timing
A reduction in the time costs of food preparation should cause people to
consume a greater variety of foods now than in the past and at more times during
the day. We already noted the evidence for this point in Table 2. Snacks are where
a signicant portion of the changes in food production have occurred. Snacks are
also largely pre-prepared.
Implication 2: Calories from Different Food Products
Consumption should have increased most for food items that have experi-
enced the most time-saving technological change. The best measure of the degree
of mass preparation is the U.S. Department of Agricultures measure of the share
of costs going to farmers instead of other food preparers, called the farm value
share. Food items with a great deal of mass preparation have low farm values. The
USDA has calculated the farm value share for some food categories: it varies greatly,
from over 60 percent for eggs to near 10 percent for grains. Figure 3 shows the
relationship between farm value share and caloric growth across 13 food categories.
There is a relatively large and statistically signicant negative correlation of .68
between the two: food items with large amounts of commercial preparation have
increased in consumption, and food items with less commercial preparation have
fallen.
Figure 3
Food Preparation and Changes in Intake
0
.4
.2
0
.2
.4
20
meat
potato
veggie greens misc
noncitrus
grains
fats
sugars
legumes citrus
dairy
eggs
60 40
Farm Share of Value, 1990
P
e
r
c
e
n
t
C
h
a
n
g
e
i
n
C
a
l
o
r
i
e
s
,
1
9
7
0
1
9
9
9
80
Notes: Data on calories for each food group are from the Per Capita Food Consumption Data System
(2002). Data on farm share of value were obtained by personal correspondence with Howard Elitzak
of the United States Department of Agriculture, Economic Research Service. The regression equation is
ln(cals, 19701999) 0.185 (.075) 0.008 (.003) farm share of value, 1990; N 13, Adj.
R
2
0.409
108 Journal of Economic Perspectives
Implication 3: Changes in Obesity Across Demographic Groups
Obesity should increase the most among groups for whom the costs of food
production fell the most. Thus, the theory predicts that obesity should increase the
most among groups who formerly made most of their food in the house and should
have increased the least among groups that already ate out more.
To test this prediction, we relate changes in obesity across demographic groups
to the amount of time spent preparing food in 1965 and to changes in the amount
of time spent preparing food between 1965 and 1995. We divide the adult popu-
lation into the eight demographic groups shown earlier in Table 4. An important
issue is whether the time costs should be for the person or the family. Under the
assumption of joint household decision making, it is the total time usage that
matters, not the individual time spent. In other models, the time that each person
spends in food preparation would matter. For example, if men eat at work in ways
their wives cannot control, we would not expect reduced time costs for wives to have
much effect on weight of married men.
Table 5 shows the relationship between the initial time spent preparing food
and the change in BMI. In each column, we regress the change in BMI for each of
the groups in Table 4 on the level or change in average time use for that group
from 1965 to 1995. Column 1 shows the relationship where time spent in food
preparation is calculated for the average individual in the group. In column 2, the
time is calculated for the average household of individuals in the group. There is
a positive relationship between time costs and obesity changes in column 1, but less
so in column 2. Women spend less time preparing food now than they used to, and
they are much more obese than they used to be. The difference between men and
women may be related to the fact that variety has increased the most for women
(men already ate out more) or to lack of joint decision making. The results in
Table 5
Time Costs and Changes in BMI
(Dependent variable: change in BMI, 19711975 to 19881994)
Independent Variable (1) (2) (3)
Sex-specic time cost (min.), 1965 0.0155
(0.0027)
Household-specic time cost (min.), 1965 0.0078
(0.0055)
Change in sex-specic time cost, 196595 0.0182
(0.0050)
Constant 1.3043 1.3774 1.7983
(0.1712) (0.5134) (0.1768)
Observations 8 8 8
Adjusted R-squared 0.8156 0.1223 0.6336
Notes: Standard errors are in parentheses. Data on the change in BMI are from the NHANES surveys of
19711975 to 19881994. The initial time cost is from 1965, computed as minutes spent preparing and
cleaning up after meals. The data are from the Americans Use of Time Survey Archive.
Why Have Americans Become More Obese? 109
column 1 indicate that each 30 minutes of initial food preparation time is associ-
ated with an increase in BMI of nearly 0.5. This factor does not explain all of the
increase in obesitythe constant is statistically signicantly positivebut it ex-
plains a good share. Column 3 shows the relation between the change in BMI and
the change in the time spent preparing food, using person-specic time costs. The
results are similar: groups that saw a large reduction in the time spent preparing
food also had large increases in BMI.
Implication 4: Obesity Across Countries
Reduced time for preparing food should have a greater effect in countries
where the appropriate technological innovations are encouraged. Many countries
have explicit or implicit restrictions on the ability of food producers or consumers
to have access to such technologies. We examine whether such restrictions are
related to obesity.
Evidence on household appliances certainly suggests that countries differ in
their access to food preparation technology. While over 80 percent of U.S. house-
holds have microwave ovens, in Italy, where obesity is much less common than in
the United States, only 14 percent of households have microwaves (Alberta Agri-
culture, Food, and Rural Development, 2003). By contrast, in the United Kingdom,
which has obesity rates much closer to those of the United States, 66 percent of
households have microwaves. Calculations of the time spent cooking in a typical
day, based on the Multinational Time Use Study (2003) line up similarly. Control-
ling for basic demographics, Italian and French adults spend about 19 more
minutes per day cooking than Americans, whereas those in the United Kingdom
spend almost exactly the same amount of time as Americans.
Our sample, which is determined by the availability of data, is OECD coun-
tries.
7
Table 6 shows the results. In all of our regressions, we control for female
labor force participation rates and GDP per capita, to test these theories of obesity.
The rst column includes just female labor force participation rates and income.
Neither is signicantly related to obesity, nor are they related when other variables
are included. Ideally, we would have data directly on food industry regulation, but
because such data are not always available, we use a number of proxies.
The second column includes the frequency of price controls in the economy
as a whole. This variable is an average of the 1989 and 1994 Economic Freedom of the
World index of price controls (Gwartney, Lawson and Block, 1995). The index
ranges from 0 to 10. We have normalized it to have a mean of 0 and a standard
deviation of 1. People in OECD countries with more price controls are much less
obese than people in countries without price controls. A one standard deviation
increase in price controls is associated with about 3.7 percentage points less obesity.
The third column looks at the relation between producer protectionmea-
sured as the ratio of agricultural prices in the country to and worldwide pricesand
7
The appendix of our working paper, Cutler, Glaeser and Shapiro (2003), shows the countries included
in each regression.
110 Journal of Economic Perspectives
obesity. This variable comes from the OECDs Producer and Consumer Support Esti-
mates 1999 database. The measure captures tariff and nontariff barriers to agricul-
ture, but is only available for nine countries. A one standard deviation increase in
domestic prices above world prices reduces obesity by a statistically signicant
4.5 percentage points. One possible concern is that this relationship is driven by pure
price effectshigher food prices from protectionism would lead to lower consump-
tionbut the strong correlation between our measure of protectionism and our other
measures of regulation suggests that price effects are not the whole story.
The fourth column includes a count of the number of food laws listed in nine
countries from Kellan and Guanino (2000). These laws include packaging and
labeling requirements, preservative tolerances and pesticide regulations. The mean
country for which data are available has 26 food laws. Although we have only nine
observations, the few observations do suggest that countries with more food laws
have lower levels of obesity.
Recent research has highlighted the link between regulation and the structure
of the legal system (La Porta et al., 1999). Countries with a common law legal origin
(the British model) are much less regulated than are countries with a civil law
origin (the French model). The fth column includes a measure of civil law legal
Table 6
International Regressions
(Dependent variable: percentage of adult population that is obese)
Independent Variable (1) (2) (3) (4) (5) (6) (7)
Frequency of price controls
a
3.7
(1.3)
Producer protection
a
4.5
(1.7)
Number of food statutes
a
7.4
(2.2)
Civil law origin 7.5
(2.2)
log(time to open business) 2.6
(1.1)
Cost of a Big Mac (US2000$)
a
4.7
(2.3)
log(GDP per capita), 1998 0.68 4.63 6.78 5.10 1.58 4.72 10.65
(4.57) (4.25) (4.59) (3.76) (3.72) (4.56) (6.80)
% females in labor force, 1992 0.24 0.04 0.81 0.69 0.26 0.15 0.46
(0.31) (0.27) (0.66) (0.41) (0.25) (0.31) (0.47)
Constant 0.35 22.73 42.96 31.42 11.15 39.75 39.30
(19.27) (17.98) (33.38) (22.05) (15.82) (23.15) (31.83)
Observations 22 21 9 9 22 21 13
Adjusted R-squared 0.072 0.204 0.491 0.310 0.557 0.128 0.124
Notes: Standard errors are in parentheses. Appendix Table 3 shows the available countries and source of
data.
a
Data are standardized to have a mean of 0 and standard deviation of 1.
David M. Cutler, Edward L. Glaeser and Jesse M. Shapiro 111
origin to capture the overall prevalence of regulation. More regulated countries are
7 percent less obese than are less regulated countries.
One way that regulation works is to stop new technology. To measure the ease
of technology importation, the sixth column relates obesity to the Djankov et al.
(2002) measure of the time required in days to open a new business (in days).
Countries with greater time delays to opening new businesses are less obese than
countries with shorter times.
The last column relates obesity to the price of a Big Mac, taken from the
Economist. Big Mac prices are an approximate measure of relative food costs in
different countries. Countries in which Big Macs cost more are less obese than
countries in which they cost less. Although Big Mac prices will presumably depend
on demand as well as supply, if demand differences were the sole force behind the
price heterogeneity, we would expect to see the opposite pattern: countries with
higher prices having more obesity (assuming that supply is not perfectly elastic).
The results in Table 6 are not denitive, but they certainly support the theory.
People in more regulated countries, and particularly countries with a more regu-
lated agricultural sector, are less obese. Female labor force participation rates and
real income are unrelated to obesity.
Obesity, Self-Control and Consumer Welfare
Lower time costs of food preparation may affect consumption through two
channels. The rst is a standard price mechanism. The cost of food consumption
includes time and money costs. As time costs fall, one would expect a standard
demand response to price. This effect could be large enough to explain the
increase in consumption we observe. Reductions in the time required to prepare
food reduced the per calorie cost of food by 29 percent from 1965 to 1995. If the
elasticity of caloric intake with respect to price is 0.7, this could explain the
increase in caloric intake. An elasticity of 0.7 is possible, but probably on the high
side. Typical price elasticities for total food consumption are on the order of 0.6
(Blundell, Browning and Meghir, 1994). The elasticity of caloric intake with respect
to price is likely smaller than this, however, since the food spending elasticity
includes increased quality of food in addition to quantity. We do not know how
much smaller, however.
We suspect, however, that this is not the only reason why lower time costs lead
to increased consumption. A second issue is that self-control issues are likely to be
important, as well. The standard model of consumption involves rational individ-
uals who decide how much to consume on the basis of price and income, fully
accounting for the future health consequences of their actions. But at least some
food consumption is almost certainly not fully rational. People overeat, despite
substantial evidence that they want to lose weight. The diet industry has $40$100
billion in annual revenues (Cummings, 2003). Food brings immediate gratication,
while health costs of overconsumption occur only in the future. Maintaining a diet
112 Journal of Economic Perspectives
can be very difcult. People on diets frequently yo-yo; their weight rises and falls as
they start and stop dieting. Survey evidence on the relationship between actual and
self-described optimal weights (from the Behavioral Risk Factor Surveillance Sur-
vey, 2003) conrms this difculty. In general, desired weight rises only slightly with
actual weight, particularly for obese individuals.
As a result, people with self-control problems may nd themselves overcon-
suming food, particularly when the time costs of food preparation fall. In this
situation, lower time costs of food preparation may be a welfare loss.
8
In this
section, we present a framework for self-control problems and evaluate the welfare
implications of technical change in such a situation.
A Model of Self-Control Problems
Consider an individual who discounts all times in the future at a rate higher
than the pure time discount rate, but trades off consumption in future states at the
time discount rate. Such an individual will always want to begin a diet tomorrow,
because the long-term benets justify the lost utility tomorrow, but not today,
because the immediate gratication from food is high. Reductions in the time cost
of food preparation may reduce the welfare of this person, by increasing the
immediate consumption value of food relative to the long-term health costs.
This model produces the following condition for optimal food consumption:
Discount Factor
Marginal Benefit
of Food
Marginal Time and
Cash Cost of Food.
The marginal benet of food is discounted because there is a time delay between
the time at which people decide they want to consume and the time at which they
actually do consume. In standard exponential discounting models, such time delays
of one hour or less are far too small to matter. But for hyperbolic individuals, even
these short time delays may matter. Technological change that shortens this time
delay will make eating much more attractive for hyperbolic discounters. As a result,
a hyperbolic discounter will overconsume relative to the consumers long-run
interests. In the past, time delays due to food preparation limited the tendency to
overeat. After all, hyperbolic consumers had to wait an hour before satisfying their
desires. Today, mass preparation means that individuals can satiate their desires
immediately, and as a result, the impatient eat more.
The intuition behind this argument can be illustrated by thinking about a
hungry worker and a vending machine lled with cookies. If the vending machine
is 10 feet away, a person might eat mid-afternoon cookies, even if the worker is on
a diet (the diet can always start tomorrow). The same person, however, might not
be willing to walk 10 minutes to and from the store to get cookies or to spend a
8
Increased food consumption might be a welfare loss for another reason as wellthe external costs of
individual weight for medical and disability programs. As with smoking, however, we suspect that such
external costs are relatively small compared to the internal costs (Gruber and Koszegi, 2001).
Why Have Americans Become More Obese? 113
half-hour baking cookies (if at home). The benets of eating cookies that are
10 minutes or one-half hour down the road are too far away. Many behavioral
change programslike those involved with smoking and drinking cessation as well
as weight lossencourage keeping the offending items as far away as possible.
Raising time costs is believed to reduce consumption.
9
In this kind of model, food consumption carries two costs: the value of
foregone consumption of nonfood items and the health and social costs of in-
creased weight. In equilibrium, the consumer will choose caloric intake so that the
marginal benet of additional food consumption is equal to the costs of foregone
consumption and lower health. Technological innovation that allows mass prepa-
ration of food will impact consumption in two ways: rst, through a decline in price
of food (where price is understood as including preparation and clean-up time),
and second, in reducing the delay before consumption. The price reduction will
affect all; the reduced time delay is likely particularly to affect people with self-
control problems. The essence of self-control problems is that people have dif-
culty passing up current pleasure for future benets. Anything that decreases the
delay of benets exacerbates this problem.
This result helps to explain one of the most striking facts about the recent rise
in obesitythe dramatic increase at the upper tail of the weight distribution.
People with self-control problems are more likely to have high initial weight levels
and are more likely to gain more weight with further improvements in food
technology. This result also helps to explain why reductions in the time cost of food
might have a much larger impact on the level of obesity than reductions in the
monetary cost of food. Because reduced time costs affect both the price of the food
and the delay before consumption, hyperbolic consumers will be very sensitive to
changes in time delay, even if they are not very price sensitive.
Welfare Implications of Lower Time Costs
Changes in the time costs of food preparation have two opposing effects on
welfare. The direct impact is that reduced time costs lower total prices of food
consumption and thus raise consumption. This reduces other consumption and
may harm health, but a rational consumer takes these into account. For a rational
consumer, when prices fall, welfare increases. A consumer with self-control prob-
lems may well spend more than is optimal on food, however. There are two possible
welfare costs from this behavior. The rst cost is the reduction in consumption of
other goods beyond what a rational person would do. We suspect that this term is
small; after all, the chief harm from people overconsuming food is not that they are
immiserized by additional food spending, but the health costs of increased weight.
That health cost of overconsuming is the product of the weight gained and the
9
This situation can be modeled formally using the hyperbolic discounting framework of Laibson (1997)
and Harris and Laibson (2001). We sketch the analysis here and refer readers interested in a formal
treatment to our working paper, Cutler, Glaeser and Shapiro (2003). ODonohue and Rabin (1999)
discuss the effects of immediate versus delayed rewards in a hyperbolic discounting model.
114 Journal of Economic Perspectives
health costs of additional weight, weighted by the degree of nonrational discount-
ing. People are worse off if this health cost is greater than the welfare gain from
lower costs of food preparation. Thus, people are worse off if
Difference between
Standard and
Hyperbolic
Discount Rates
Change
in Weight
Cost of
Weight
Change in
Costs of Food.
If preferences were rational, the difference between standard and hyperbolic
discounting would be zero, and the left-hand side of this equation would be zero.
The health effect would be fully internalized, and welfare would necessarily in-
crease. With nonrational discounting, weight may increase too much, and people
may be worse off.
To compare these terms, we need to express everything in the same units. It is
easiest to evaluate them in units of time. We do not know the monetary willingness
to pay for lower weight, but we can use exercise technology to gure out a rough
estimate of the time cost. In time units, people are worse off if
Difference between
Standard and
Hyperbolic
Discount Rates