As for the spending thing (and then I'm off the soapbox for the day, I promise)-
Yes, I agree there is a huge amount of PR (personal responsibility) involved in spending habits. But I think it's easy to dismiss the pervasiveness of advertising and the thousands of small and large ways we're pressured to buy buy buy as having no effect, when in fact, I think they are hugely influential on our natures, especially when we're young.
I was a (pardon the pun) a huge fattist for quite a while- I considered obesity the height of personal weakness. As a small female, I got fed up with fat people spotting the empty seat next to me on the bus, plane, whatever and taking advantage of the extra space my small frame afforded them, so I spent many a ride jammed up against someone else's sweaty, smelly excess abdomen. I feel the trade-off for me not being able to reach things on high shelves is that I don't fill up the entire seat on a bus and I never have problems with "leg room," whatever that is.

And so I found it unfair to be squished because someone else can't keep her hands out of the Ding-Dong box.
But you know what? Obesity ain't that simple. Admittedly, I don't buy the "genetics' argument because obesity rates have tripled in the past 30 years and we just don't evolve that quickly. But we are surrounded by food. Surrounded. And it's pushed at us relentlessly. And we don't evolve that fast and our bodies and brains are, I think, hard-wired to remember a time when we spent most of our lives starving (heck, obesity was once the height of beauty because it was rare). And I think advertising, etc., takes advantage of that and eventually most people give in. And once fat, I think it's really hard, a lifelong struggle, in fact, to address it. I think losing a large amount of weight is harder than quitting smoking (you still have to eat, after all) and props to those who manage to take off a large amount of weight and keep it off- that's a war they never stop fighting, and in a society where they are surrounded by images and messages saying "eat this! eat this! eat this!"
So yes, body health is a personal responsibility, but I think our culture makes it as difficult as possible to stay healthy- little access to exercise in our car-dominated culture, sedentary jobs and endless push push push of foods that have little nutritional value. Hell, I just had chocolate and wheat thins for breakfast. Mmm! Healthy! Well, I did have a glass of milk, too...
And that carries over to our consumerism. It's a high to buy something. I remember sitting in front of the TV as a kid, listing the things I wanted for Christmas-- in June. I lost that acquisitiveness somewhere in the wake of my mom's death, since you can't buy anything to make THAT feel better, but you know, a lot of kids aren't as lucky as I was to have their mom die. (said with sarcasm. I can't believe I feel it necesary to explain that, but again, people can surprise you with what they don't understand)
Personal responsibility is all well and good and essential, but it's not the entire answer when your entire society is built on a system (advertising) designed to keep you spending more than you have. Is there an easy solution? Gads, no. I'm a believer in regulated capitalism, and a business has to advertise a product. But I think now, in our negative-savings society, we're seeing the effects of unregulated advertising and the thing is, when it comes crashing down, all of us, even those who are saving what they can, will feel it. Just as we had to be the ones to bail out the Savings & Loan crooks. And I think, in a society dominated with a command to buybuybuy it's wrong to permit unregulated lending. It's wrong. It allows wealthy corporations to take advantage of the weak and the poor and that's as close to evil as I can find.
Oh- I forgot- my friends didn't move from Buffalo because my friend's husband's mother was (still is, I think) quite ill and he is her entire support system. Though I imagine your response would be that he shouldn't have had a mom who got sick, right?

Or she should have been tough enough to take life without any family around her, right?
I'm also not sure where they would have found the money to move. It's expensive, moving!
Done, promise. I have a play to get written today (not on economics; on aging. With zombies! And cupcakes!) and actors to rehearse. Carry on with your unkind comments without me, hi_Im_god. My heart breaks to think of your low opinion. I'm cut. Really I am. You too, STS. Can you see the virtual tears spilling on my keyboard?
And STS- I worked three jobs in college, along with full-time classes. Nothing like an 8:30AM to 11PM day five days a week and an 8:30-6PM on the other two to really make a girl depressed. So yeah, I know from hard work. Did your wife work, too, while you were working two jobs? What did she do? In my friends' case, he had to limit his search to a night job, because she worked full-time (which was six days' a week, by the way) during the day and they had no money for day care, duh). What did you do with your kids while your wife was (I assume from your tone) working, too? Or wasn't she?
It was a happy ending at the end, though- she was able to switch jobs and found one that also included health insurance, but it took a few years of looking. He's working now, too. But it took time; it's not a magic solution. You have to find the d*mn job.