New federal regulations issued this week stipulate that the electronic health records–that all Americans are supposed to have by 2014 under the terms of the stimulus law that President Barack Obama signed last year–must record not only the traditional measures of height and weight, but also the Body Mass Index: a measure of obesity.
Obviously this is both an affront to freedom in general and the liberty of those with ‘unacceptable’ BMIs (mostly fat people, though some very thin people) more specifically. This isn’t about releasing any more information than would have been released before — heights and weights were already set to be included in the electronic health records — but rather being specifically classified by some health index number that can be used as a justification to grant you different treatment than others.
A couple things are clear to me here:
- When others believe they have the power to make health decisions for you (for instance, they control your access to healthcare) then you lose your body autonomy. Full stop.
- A government is going to act like any other self-interested body with a lot of power—it will exert its political will on the populace in order to remain in power. Right now it is popular to blame certain groups of people (including fat people) for willfully using more scarce health resources than ‘normal’ people. So classifying people into groups that would allow such a body to ‘punish’ those groups in the name of the ‘normal’ people is politically expedient (in that it will likely do no political harm and might even scrape together a few extra votes).
What do you think of this? Do you think it will happen? Besides refusing to be weighed, how can you personally combat the threat of potential classification based on BMI? What do you think the implications including BMIs on everyone’s electronic health records will be?
Big Liberty 
I just want to say, first, that I love your blog, even though I don’t agree with all of the political stuff. Your fat acceptance material is spot-on, as well as the material on universal health care and the concept of privilege and those damn checklists.
With regard to your post, I’m fairly leftist in my politics, but I am truly terrified by this and I deeply regret ever supporting Barack Obama, more so than I can express in words. (Why I supported him at all is a long story that I am too embarassed to confess at this time.)
I supported universal health care at one point when I was younger and more naive. I thought, how wonderful if everyone could get great health care at little to no cost. It was Sandy’s Junk Food Science that opened me up to the abuses that occur under this system, and it took a couple of months, but I couldn’t deny the obvious any longer.
This is what gets me. Mainstream medical professionals and health educators have admitted, up, down, and sideways, the weaknesses of the BMI. So why are they still using it?!?!?!
It ultimately doesn’t matter, because neither my body nor my health are anyone’s business, but the fact that they use a tool that they know is flawed in order to justify their moral panic just adds insult to injury.
I can’t, for the life of me, why so many of my fellow leftists support universal health care, banning “junk” food from schools “for the health of the children,” and make comments like “This is so unfair, because thin people are unhealthy too! Even though I’m fat, I eat organic!” Why are they allowing the government to judge anyone on the basis of their (perceived) health, knowing, as fat people, the implications?
I wonder how many of these people that believe that fat people are costing them money would make athletes pay for their overuse injuries. Or pregnant women for any complications that arise during pregnancy? Those are self-inflicted after all!
More and more medical professionals, and the public, are standing up to this, and I can only hope that they will wake the hell up before it’s too late.
As a lefty who’s lived in the UK, where there’s universal public healthcare as well as a thriving private system, a lot of the anti-universal healthcare rhetoric in this country is wildly overblown. Most Brits, if told what the US system is like, blanch in horror and ask why in the world Americans permit corporations to dictate their healthcare. They ask why it is that we don’t care enough to take care of our poor and our sick.
In the NHS, I was never once told by a GP that I should lose weight, particularly not if I went into the appointment noting in advance that I preferred not to discuss dieting. I actually was never weighed by my GP either, except when I first became pregnant (and the midwives in the specialist endocrine maternity clinic never bothered to look at that number or weigh me again). The one time I was asked for a weight was when I was being given a steroid treatment that was weight-based. If anything, GPs in the UK were more relaxed about weight than my doctors here in the US.
What universal healthcare does guarantee is that if you need to see a GP before you’re on your deathbed, you can see one. If you do need an ER visit for your child because his arm is broken, you won’t be arguing with an insurance company and hospital eight months later about a $1,000 bill WHEN YOU HAVE INSURANCE AND THE HOSPITAL IS IN-NETWORK BUT TOO LAZY TO CHECK THAT OUT. (ask me if I’m bitter about that still).
So, yes, the British government probably knows my BMI. Funnily enough, that never stopped me from getting the best possible care regardless of my weight. A token of how much more hassle and anguish I’ve gone through with the American insurance system is that, as a naturalized British citizen, I’m getting myself the heck back across the Atlantic to England the first chance I get 🙂
With all due respect, England is a very different country than the U.S. For one, it’s much smaller, so universal health care is more sustainable there than over here. So what works in the UK isn’t necessarily going to work in the U.S. Furthermore, the NHS has been in financial crisis more than once, from what I understand. It may have its virtues, but it’s not the cure-all for what ails the U.S.
I don’t see how recording BMI is different from recording height and weight. If you know height and weight, figuring out BMI is easy.
Y’know, when I balance that out against the state of health care for poor (and even middle class) people in this country and the fact that there was no regulation against health insurance companies discriminating against fat people prior to the recent reforms, I can’t help but go, “So? They’re going to track our BMIs?”
I mean, one of the problems I have with libertarianism is that I don’t see a lot of practical solutions to something like this. The anti-government stance means that we’re left with corporate self-interest, which is basically where we’ve been with health care up until these latest reforms. And that’s worked very poorly for anyone who hasn’t had the money to pay out the wazoo for health care.
As a matter of my own ethics, I would totally and without protest accept the government tracking my BMI if, in exchange for that, the poor people down the block (both fat and thin) actually got to visit a doctor *before* they were deathly ill.
I am not a libertarian, but I see BL’s point here. I support government aid to the poor to pay for health care, and I do accept some regulation of business. However, to have a completel government takeover of health care is, to say the least, highly problematic. At least when medical practice is controlled privately, you can opt out. Doctors can choose to practice as they wish rather than obey the dictates of insurance companies or the government. The government will not allow you to opt out, because if you develop a more serious disease, why, you’ll cost all those good compliant people money! And if they see your injuries or illnesses as self-inflicted, they can refuse to treat you. Elected officials also have a tendency to pander to those who elect them, and where most of the population is fat, phobic, that’s a huge problem. Lastly, while it’s frustrating to have to shop around for a good provider, they cannot use the force of law to compell you to comply with their dictates. You actually have the luxury of shopping around. The government can punish you for not buying insurance, not following lifestyle recommendations, etc.
You seem to think that people able to pay for care is the same as being able to access it, and that’s unfortunately not the case. What good is being able to pay for care if you cannot find a doctor that accepts new patients or have to wait six months for urgent medical problems?
Yes, poor people would be able to pay for health care if we had universal health care. Again, though, with the current state of affairs where so many people believe that most illnesses can be prevented by living the right lifestyle, and where fat people are the first on the chopping block in this regard, it wouldn’t be quality care. If anything, they are more at risk from this measure because they are more likely to have various illnesses, stress-related conditions like high blood pressure, be fat, and to follow so-called unhealthy lifestyles. They may be able to go to a doctor before they become deathly ill, but after that, they stand a good chance of being subjected to treatments that will make them just as, if not more, deathly ill, i.e. WLS.
It’s not letting me reply to the above comment, so I’ll reply here – my point was not to say that the UK’s system would be immediately applicable to the US, by any means. I was pointing out that my BMI, in the UK system, was entirely irrelevant, so there’s no reason to immediately jump to the conclusion that, if BMIs are known (and they’re known by your insurance company anyway, unless you refuse to be weighed), it will make any difference at all to your level of care.
In point of fact, in a system where care is guaranteed to everyone, you are far more likely to receive good treatment even if you are fat than you are if you’re in a system, like the US version, where denial of service can occur for any number of reasons, valid or not.
I agree with Living400lbs, what is the difference between tracking height/weight and BMI? The only difference is that the latter involves more math.
Besides, can they really MAKE everyone get weighed and measured? The laws in the U.S. are pretty much firmly on the side that no adult can be forced to go to a doctor or to take their children to one, or accept any kind of treatment or testing, except in rare instances like a danger-to-self-or-others temporary psych hold or getting kids required immunizations for school. That pretty much means we can refuse to be weighed or have our children weighed. Maybe there are a lot of people who don’t know that they are allowed to refuse, but I have seen enough medical records to know it happens all the time. (And when someone is over about 400 pounds or so, a general practitioner doctor’s office is unlikely to have the right equipment to weigh them; even a lot of hospitals don’t have it.)
Besides, we’ll never, ever have complete government control of health care in America. The corporations would never allow it. Furthermore, the major corporate interests involved in health care — Big Pharma and the insurance companies — are at direct odds with one another. The former wants people to have as many prescriptions and surgeries as possible; the latter wants us to never set foot in a doctor’s office or hospital, ever.
But the “fatties use up too much health care” blame game is just as much a tool of the insurance companies as it is of any government body — and it’s not like anyone actually has a shot at better coverage unless they are young, thin, and in perfect health, and carry their own private policy as opposed to their (or their partner’s or parent’s) employer’s. The HCR exchanges might enable you to carry a different company’s card if you’re unemployed, but they all pull the same shenanigans.
“Besides, can they really MAKE everyone get weighed and measured? The laws in the U.S. are pretty much firmly on the side that no adult can be forced to go to a doctor or to take their children to one, or accept any kind of treatment or testing, except in rare instances like a danger-to-self-or-others temporary psych hold or getting kids required immunizations for school. That pretty much means we can refuse to be weighed or have our children weighed. Maybe there are a lot of people who don’t know that they are allowed to refuse, but I have seen enough medical records to know it happens all the time. (And when someone is over about 400 pounds or so, a general practitioner doctor’s office is unlikely to have the right equipment to weigh them; even a lot of hospitals don’t have it.)”
Yes, we have the right to refuse care *now,* but do you really, honestly think it will stay like that? Do you really think that people, who are paying for your healthcare with their tax dollars, are going to care much about your rights if you develop a disease that’s *allegedly* lifestyle-related?
“Besides, we’ll never, ever have complete government control of health care in America. The corporations would never allow it. Furthermore, the major corporate interests involved in health care — Big Pharma and the insurance companies — are at direct odds with one another. The former wants people to have as many prescriptions and surgeries as possible; the latter wants us to never set foot in a doctor’s office or hospital, ever. ”
Which, as far as I’m concerned, is a good thing. I feel a lot less anxious knowing that that is the case, even though it’s not a whole lot of comfort to me.
“But the “fatties use up too much health care” blame game is just as much a tool of the insurance companies as it is of any government body — and it’s not like anyone actually has a shot at better coverage unless they are young, thin, and in perfect health, and carry their own private policy as opposed to their (or their partner’s or parent’s) employer’s. The HCR exchanges might enable you to carry a different company’s card if you’re unemployed, but they all pull the same shenanigans.”
Really? Why, I had no idea.:)
You’re missing a crucial point, though. First, while you are right in that corporate America is hardly blameless in its abuse of fat people, you have yet to establish how government control of healthcare would solve this problem. Governments can be ruthless in their seeking of money, power, and prestige just like corporations, especially when acting at the behest of such a fat-phobic voting bloc. And, just like corporations that choose not to hire fat people or insurance companies that charge higher premiums, governments can fine, imprison, force medical treatment on, or refuse to cover noncompliant people. With corporations, at least, you have more options and a legal recourse. The government is a true monpoly. And what legal recourse do you have when your government is the oppressor?
BL is arguing from a libertartian point of view and, as such, she will advocate deregulation of the health care industry. I’m not arguing for that, necessarily, but I AM arguing that government-run healthcare won’t be any better. Really, we are trading one set of problems for another.
What about doctors? Like it or not, doctors need to make money in order to practice medicine. How much are they really going to be paid under government healthcare? The people only have so much money to pay in taxes, and third-party payments may or may not be allowed. Trust me. I’ve been on Medicaid, and it’s next to impossible to find doctors that accept new patients on Medicaid. Why? Because they are reimbursed by the government, which doesn’t pay nearly as much as private insurance. Don’t get me started on the weight lists and their “managed care” plans.
Sorry, it’s wait lists…Freudian slip, maybe?
No, I honestly don’t think they will ever make every person in the U.S. have yearly doctor visits, labs, studies, take medications, or any of that. It would not only take a wholesale changing of the law to be able to do that, but it would be expensive. (And are there actually countries with UHC who force people to accept care? I once put out a query to non-U.S.-based readers about that on my blog, and nobody came forward to tell me that was the case in any place they had lived. If you have different information, I’d be interested in having it.)
A lot of people don’t go to doctors, ever, regardless of what might be “wrong” with them. Sometimes the reasons for this are financial; they can’t afford to miss work to go see a doctor, or they can’t afford the deductibles or co-pays for visits or medications. Sometimes they are so headless-chicken busy that they don’t think they can spare the time. Sometimes they don’t want to catch a bunch of shit from their doctors for weight, smoking, drinking, drug use, or whatever else doctors like to nag people about. Sometimes they just don’t like doctors, period, and don’t feel comfortable discussing their health with anyone, or at least not with allopathic practitioners. Or they don’t believe any doctor has anything to offer them for their particular condition (possibly on the basis of prior bad experiences).
Often these people die without ever being hospitalized, and without the coroner being able to put a cause of death on their death certificates without a postmortem exam, because so little health information about them is available. But many, if not most, of these folks do have some sort of coverage, even if it stinks, and they keep paying premiums; they just don’t ever use them. Insurance companies are not about to look that particular gift horse in the mouth — and frankly, if they ever do, they don’t understand their own best interests.
Wow, this thread got a lot of comments while I was sleeping! 😉 Thanks for the input, everyone.
I’m not going to address the issue of libertarianism and its stand on universal healthcare, because I’ve talked about it elsewhere (and it’s really not the topic of this post). (besides, the straw argument of ‘libertarians don’t have solutions to X’ is usually unanswerable, since the idea that there are ultimately perfect solutions to poverty, for instance, is a myth)
So, “access” — does not mean whether one can afford it. It means whether one is impeded by another from getting it. I know some social activists claim those are the same things. I don’t. True that some oppression results in poverty, but it’s the oppression, not the poverty, which impedes access. Then there are the systems of delivery which can be talked about, and the myth of ‘free’ government healthcare (which Joanna aptly points out does not necessarily mean increased access to healthcare or better quality healthcare for everyone).
I think there’s something missing here for those who wrongly conflate governments and corporations (while oddly seeming to hate the latter and cheer on the former): this is *mandated*. In that you can’t avoid it if you plan on ever going to any doctor anywhere. That kind of power is only ever available to a *government*, or an entity protected from competition by the *government* (like many health insurance companies).
As for trying to suggest that this is no different from tracking heights and weights, then why are they specifically calculating these numbers and putting them on medical records? Sure, to a public health researcher this doesn’t make a difference, but who do you think this *will* make a difference to? Doctors, nurses, clinicians, all the medical and insurance staff who pull your record and don’t have a calculator handy, etc. It is still labeling you, classifying you by some health index. I’m a bit shocked that so many commenters here are just sweeping this fact under the rug, or twisting themselves into pretzels in order to obscure the very simple reality of what’s going on.
The government (in the form of Sebelius and the HHS) is saying: BMIs are important. Obese BMIs are bad. We’re going to put that number in an obvious place right on your file! Whenever that file is pulled there’s that BMI, right there. It’s such an important number that we’re going to make sure it’s something that’s there, right there, right on your file.
And this is okay, how? You know, other than it’s just another drop in a bucketful of fat hate? Does that mean we shouldn’t get pissed off, because the bucket’s already pretty fracking full? Sorry, I’m going to get pissed off that they’re choosing to highlight this bullshit number and make sure that it is on all of our files, regardless of whether our personal doctors, or whether we as health individuals, think that it is a number that matters. It’s the PRINCIPLE of the thing.
Regardless of how you feel about universal healthcare (which isn’t really being debated here), the idea that a body with ultimate power has mandated that the BMI is important enough to be specifically calculated ahead of time and put in your records — doesn’t that strongly hint at a future public health campaign, or at the least a desire by and belief of those currently in political power that this is a number that is important? I would love to dig up some post from a long time ago, before Obamacare was voted in, where I claimed this kind of thing would be one of the first steps towards it being codified that fatties are second-class citizens, courtesy of the obesity epipanic and some immovable political force. I might do this when I have a few extra minutes, at some point.
I’m sorry if I derailed the thread. It’s just that this post made me think of UHC as well as electronic medical records right away and my thoughts were going in all those directions at once. So I’ll focus on the point now.
I’m not sure there is a whole lot that can be done, because if you refuse to be weighed, you could be labeled non-compliant, which only looks worse. And I’m 99.9% positive that BMI won’t be used just as a descriptor either. The possibility of being denied care or employment is very real, and since EMRs are not known for their security features, your private information can be known by just about everyone.
People with the wrong BMIs will also, I’m sure, be targeted for diet and exercise interventions.
If it does happen, I hope enough people around the country will either refuse to take part in workplace wellness programs, get new jobs, or do something to send the message, “I don’t approve of this.” Parents can speak out against bogus health ed in school and opt out of BMI screening. More and more people are waking up to fat acceptance, or if they don’t go that far, at least to the reality that the obesity epidemic is a sham.
I’ve written about this from my own little corner of the world as a home care RN, but I believe it’s worth repeating here. The U.S. federal government requires that EVERY home care patient, regardless of their insurer, must have data collected and then sent, with an identifying SSN, to federal bureaucrats. You know what is included in the 20+ pages of data (known as OASIS-C) they require? You guessed it—whether or not you are obese. It is included under question M1036–Risk Factors–past or present. (Yes, even if you were fat in the past, and it is “likely” to affect your current health status, it will be recorded.) No BMI or height/weight measurements are required for the obese box to be checked: only the judgment of the RN or therapist performing the assessment. If they think you’re obese, then you are.
The original purpose of the OASIS data set was to develop quality measurements and to aid in determining reimbursement for Medicare patients. Perhaps someone could explain to me how these goals are achieved by collecting this data on hundreds of thousands of privately insured home care patients? Will the Medicare program become more efficient if they know that a 30-year-old Blue Cross patient is obese? (A great deal of home health patients’ private health information is transmitted to the fed gov’t–including aspects of one’s mental health, living conditions, etc. Go here: http://tinyurl.com/2wbmbc8 for the entire list of questions.)
I realize this isn’t the time/place to argue for/against universal health insurance. But I think it’s important to know that the same people who are urging the government fight a “war on obesity” are also requiring the collection of personal health data about fat people.
They’ll have to use an old weight to calculate my BMI since I don’t let them weigh me at the doctor’s office any more. And no, I don’t want them putting my BMI on my medical record – mainly because it’s a number that doesn’t mean anything, really. The number itself doesn’t tell anything about my health – it’s not a code for what my blood pressure/cholesterol/blood glucose/etc numbers are so it has no meaning, other than to say I’m OMGDEATHFATZ (and have been for 30 years and it hasn’t killed me yet, who’d have thought?). My BMI doesn’t tell them how much or how little I exercise or what kind of food I eat or how much, it doesn’t tell them what my mental health or spiritual health is like, so why the hell does the government need to know what it is? They don’t, unless they have nefarious plans for all fatties over a certain BMI, and with the rampant fat-phobia in our government, I wouldn’t put it past them to have those plans on the back burner (why yes, I am a cynic, how could you tell?). I said this a long time ago and was shouted down by other bloggers as being close to paranoid (not Big Liberty), but even paranoid people are right sometimes………………….
You know what really sucks? When you have Cushings Disease and have had your pituitary tumor removed and losing weight is a sign that the surgery worked and your disease is gone (or at least in remission) and gaining weight is a sign that the surgery didn’t work or that it wasn’t the full answer to your illness so you don’t have the option of refusing to be weighed.
In re-reading my comment, it sounds a bit like whining, it was meant as a “thinking out loud” type of comment. I just wanted it to be clear, I wasn’t looking for pity!
This policy endangers fat people’s lives in numerous ways.
1. Fat people will be targeted for denial of access to healthcare at all.
2. Fat people will be surcharged based on our weight if we do attempt to access healthcare.
3. Fat people will be denied access to diagnostic and treatment services based on our weight.
4. Fat people will be targeted with dangerous efforts to make us lose weight.
5. Fat people who refuse to submit to weight-loss treatments or who fail to lose weight or who regain will then be denied access to healthcare, denied treatments, etc.
6. Fat people’s healthcare providers will feel their bias and prejudice and outright hate for fat people is justified — it’s government-sanctioned!!!
7. Fat people who refuse to be weighed or to have BMI information included in electronic records will be denied access to healthcare.
And these likely outcomes are just the first few I can think of.
I anticipate *nothing* good coming from this fat-hating, eugenics-minded policy.