2015.02.06 好市多 COSTCO 让我们变胖了吗？

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HEALTH
Is Costco Making Us Fat?
A recent analysis of all the possible causes of skyrocketing obesity rates reveals two big culprits: wholesalers and restaurants.

By Olga Khazan

Damian Dovarganes/AP
FEBRUARY 6, 2015
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Here's a fact that shows just how quickly obesity has taken over America: In 1990, no state had an obesity prevalence of 15 percent or more. By 2010, no state was less than 20 percent obese.

Adult Obesity Prevalence in 1990 and 2010


CDC
But what's driving the epidemic? We have no answers, only theories. Some studies say it's food deserts; others say it's desk jobs. Some even claim that it's the decline in smoking, since tobacco suppresses appetite.


Along with three other researchers, Charles Courtemanche, an assistant professor of economics at Georgia State University, analyzed a number of these theories for a recent study.

Courtemanche realized that a lot of past studies came to conclusions like, "the increasing popularity of driving to work is correlated with the rise of obesity." But he wasn't sure what, specifically, was having the greatest effect on obesity's rise.

He gathered 27 things he thought might be contributing to obesity—everything from working hours to exercise trends to gas prices—and put them in what he calls a "statistical horserace." Essentially, he took all the studies that associated some factor with obesity and saw what would happen if he held everything else constant, like demographic or economic changes. (For example, he told me, "If you're just looking at cigarette prices, was it really cigarette prices, or is it just that they're related to food prices and gas prices? It's controlling for everything together.)

Only two of the factors ended up being meaningful drivers of obesity: 1) the proliferation of restaurants and 2) the rise of warehouse clubs, like Costco, and super-centers, like those Walmarts that have grocery stores in them.


As you can see from the chart, both restaurants and super-centers saw a remarkable growth since 1990, and together they explain about half the rise in class II and class III obesity—the worst varieties.

Changes in Food Store Numbers

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Interestingly, regular supermarkets actually had a slight negative effect on obesity rates, so it's not just that food has become more accessible. Instead, Courtemanche said, it's that it's become much, much cheaper. At a place like Costco, you can save big bucks by buying pounds upon pounds of peanut butter all at once. Meanwhile, "Walmart super-centers undercut their competitors by 10 to 30 percent," he said. "They're really telling the truth when they talk about 'always low prices.'"

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Restaurants, meanwhile, save customers a different kind of cost: time.
"You're talking about switching from seeing a restaurant as an occasion, to an environment where restaurants are everywhere, and you're always driving by one, so there's no time cost anymore," he said. "It's very easy to get restaurant food."

This doesn't mean that food should become more expensive, and Courtemanche admitted that his wife still does most of their food shopping at a Walmart. But the government could use this information—the fact that we love cheap, easy food ... maybe a little too much—and use it to regulate menu labels and calorie counts. (It's already doing this a little bit.) Or it could subsidize healthy food and tax junk food, so that peoples' overall grocery bills are still low, but they get nudged toward the carrots and away from the Oreos.

It is kind of a depressing finding, though, that obesity, which costs our healthcare system so much money, is happening because we're getting the food we love for so little.

"We'd all like something to be all good or all bad," Courtemanche said, "and the reality is that often there are things that are mostly good but have some adverse consequences."

Olga Khazan is a staff writer at The Atlantic.



健康
好市多让我们变胖了吗？
最近对肥胖率飙升的所有可能原因的分析显示了两个大罪魁祸首：批发商和餐馆。

奥尔加-卡赞报道

Damian Dovarganes/AP
2015年2月6日
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这里有一个事实表明，肥胖症已经迅速占领了美国：1990年，没有一个州的肥胖症发病率达到或超过15%。到2010年，没有一个州的肥胖率低于20%。

1990年和2010年的成人肥胖症流行率


中国疾病预防控制中心
但是，是什么在推动这一流行病呢？我们没有答案，只有理论。一些研究说这是食物沙漠；另一些研究说这是办公桌上的工作。有些人甚至声称是吸烟的减少，因为烟草会抑制食欲。


佐治亚州立大学经济学助理教授查尔斯-考特曼奇（Charles Courtemanche）与其他三位研究人员一起，为最近的一项研究分析了其中一些理论。

Courtemanche意识到，过去的很多研究得出了这样的结论："开车上班的日益普及与肥胖症的增加有关"。但他并不确定具体是什么对肥胖症的上升产生了最大的影响。

他收集了27个他认为可能导致肥胖的东西--从工作时间到锻炼趋势到汽油价格的所有东西，并把它们放在他称之为 "统计赛马 "的地方。基本上，他把所有与肥胖有关的因素的研究，看看如果他保持其他一切不变，如人口或经济变化，会发生什么。(例如，他告诉我，"如果你只看香烟价格，那真的是香烟价格，还是只是因为它们与食品价格和汽油价格有关？这是把所有的东西都控制在一起）。

最后只有两个因素是有意义的肥胖驱动因素：1）餐馆的激增和2）仓库俱乐部的兴起，如好市多，和超级中心，如那些有杂货店的沃尔玛。


从图表中可以看出，自1990年以来，餐馆和超级中心都有了明显的增长，它们共同解释了二类和三类肥胖症--最糟糕的品种--的一半增长。

食品店数量的变化

NBER
有趣的是，普通超市实际上对肥胖率有轻微的负面影响，所以这不仅仅是食物变得更容易获得。Courtemanche说，相反，是食物变得更便宜了。在好市多这样的地方，你可以通过一次性购买数磅的花生酱来节省大笔费用。同时，"沃尔玛的超级中心将其竞争对手的价格压低10%到30%，"他说。"当他们谈论'永远的低价'时，他们真的在说实话。"

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与此同时，餐厅为顾客节省了另一种成本：时间。
"他说："你正在谈论从把餐厅看作是一个场合，转换到一个餐厅随处可见的环境，你总是开车经过一个餐厅，所以没有时间成本了。"获得餐厅的食物非常容易"。

这并不意味着食物应该变得更加昂贵，Courtemanche承认，他的妻子仍然在沃尔玛超市购买大部分食物。但政府可以利用这一信息--我们喜欢便宜、容易的食物......也许有点太多，并利用它来规范菜单标签和卡路里计数。(它已经在做这件事了。)或者它可以补贴健康食品，对垃圾食品征税，这样人们的总体杂货账单仍然很低，但他们会被引导到胡萝卜上，远离奥利奥饼干。

不过，这是一个令人沮丧的发现，花费我们的医疗系统这么多钱的肥胖症之所以发生，是因为我们用这么少的钱获得了我们喜欢的食物。

"我们都希望有些东西是全好的或全坏的，"考特曼奇说，"而现实是，经常有一些东西大部分是好的，但有一些不良后果。"

奥尔加-卡赞是《大西洋》杂志的一名职员作家。