Other reasons why fat person cost calculations are bogus

Ragen has a great article out today, please take a look if you haven’t seen it already:

The True Cost of Fatties

In her post, Ragen talks about how the back of the envelope ‘study’ done a couple of years ago that suggests fat people are killing the planet with all the extra gas we consume, and the usual shady numbers we see about how much extra healthcare dollars fat people consume. Apparently fat fatties eat money just like they eat Twinkies — in excess, and uncaring as to how it effects anyone else in their lives. We’re truly terrible people, a costly evil scourge that must be eradicated…at all costs.

Which leads me to my first additional point to Ragen’s post:

When we hear fat person cost calculations, there’s an ever-present underlying assumption that if fatties were thinnies or normals, we wouldn’t consume those extra resources. However, overwhelming evidence shows that in order to maintain a significant amount of weight loss down from a natural setpoint of significantly higher, individuals need to dedicate something like a part-time job to it: exercising for several hours a day, paying for expensive diet plans or special meals or therapies, measuring and weighing and planning and special shopping trips and scribbling in a journal–you get the picture. There’s a $60 billion dollar diet industry that derives most of its income from people going on and off temporary diets. If fat people were to do what the above ‘experts’ claim and go on mandatory, permanent, life-long diets, imagine how that number would explode. It would likely eclipse the (shady) amount (badly) estimated spent on fatty healthcare ($147 billion in 2008).

The next part of the fat person cost calculation has to do with absenteeism and the murkily-defined and -exampled presenteeism. Presenteeism is, as defined, when workers show up to work but have much lower levels of productivity than a coworker doing the same job.

…presenteeism was measured and monetized as the lost time between arriving at work and starting work on days when the employee is not feeling well, and the average frequency of losing concentration, repeating a job, working more slowly than usual, feeling fatigued at work, and doing nothing at work. [2]

From what I’ve seen, fat people are accused of presenteeism because they’re assumed to have greater health-related obstructions to doing their job. This would be most pronounced in markets that rely on physical labor. However, the studies I’ve seen that show a ‘significant’ (1% difference! Le gasp!) increase in presenteeism as defined don’t correct for age, which is strongly positively associated with both fatness and decreased productivity in manual jobs.

Fatty presenteeism and absenteeism is estimated to cost employers $73.1 billion annually. My question is, naturally: how much more productive is a starving person? (dieting is indistinguishable from a famine state) How much more productive is someone who spends a part-time job in addition to their full time job keeping off weight? How much would it cost the economy as a whole if we estimated the lost productivity of fat people due to the fact that in order to maintain a thinner state, they would have to dedicate something like 15 – 20 hours a week they could have spent working additional hours, raising up a new generation of workers, or supporting their community and the productivity of others? Methinks that would be a hella more than $73.1 billion a year.

Now for the second point I wanted to add to, or rather stress, in Ragen’s analysis:

You can single out practically any group of people you want and find additional ‘costs’ associated to their ‘lifestyles’ or genetic differences. Thin people are the awesome du jour, but they’ve got their own set of associated costs (if you believe the hype that they’re more active and so on): cost of gas getting back and forth to the gym, athletic injuries, diet plans, they live longer and hoo boy is that expensive, they take more vacations, they tend to be richer and hence de facto consume more resources, and so on. Let’s add that up.

Or parents, as mentioned by Ragen and by me in another forum: parents, especially of unfashionably large families, consume mountains more resources than childless people, have high levels of absenteeism in the workplace, and cost their employers much more in family insurance plans, childcare benefits, and so on. Let’s add that up.

Or people who get tattoos — let’s go after them, shall we? They get sicker more often, as a new tattoo is the same as an open wound. They tend to hang out in edgier clubs, are exposed to the possibility of more violence, and are probably more likely to be drug users (a purely correlative assessment, of course). Let’s add that up. And don’t get me started on people with psychological disorders like depression, bipolar, or those who’ve had traumatic backgrounds, or who are part of prejudicial groups — the extra health costs associated with their therapies and prescriptions and their decreased productivity is nigh-on criminal(big flashing sarcasm meter on all these points, of course)

And so on, and on, and on…

So why fatties? Because we cost so much more than other groups? Nope. Because our costly status is preventable, or cheaper to treat? Nope (see my Truth About Fat: References page). Because:

Fat people are scapegoats.

For what? For a breaking healthcare system, a broken health insurance paradigm, a slowing economy, global warming, hunger in non-Western countries, the declining standard of Western beauty, and pretty much anything else some random person doesn’t like and doesn’t want to either understand or tolerate.

We are in a moral panic, not an epidemic. Fat people ‘cost more’ because we are hated. Fat people destroying the earth, or anything else for that matter, is a proxy for how the moral crusaders believe we are destroying humanity.

References

1. Rising obesity will cost U.S. health care $344 billion a yearUSA TODAY, November 17, 2009.

2. Obese Workers Cost Workplace More Than Medical Expenses, Absenteeism. Duke Global Health Institute, October 7, 2010.

3. Obesity Promotes Global Warming? John Tierney.The New York Times, May 16, 2008, 9:49 AM

4. Wrestling with the ‘Double Burden’: Hunger and ObesityWorld Food Program USA. By Sara Draper-Zivetz  Published on February 18, 2011

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A Bad Day for Fat Liberty

And liberty, everywhere.

In Dundee, Scotland, fat kids from a non-neglectful household are being put up for adoption by the state because their parents failed to ‘slim them down.’

Seriously.

Fuck.

I’ve written a few times about how the loss of the individual right to body autonomy and the moral panic over fat can lead to such an outcome, that it was one of the many steps on the road of divesting fat people of their civil rights — that is, in criminalizing fatness.

For everyone who thinks fat hate and fatphobia is no big deal, and is just a personal health issue, please read this and think again.

On Mother’s Day 2011, Hate for Fat Moms in Abundance

I’ve been tweeting up a storm this Mother’s Day morning, all on the #thingsfatpeoplearetold hashtag. Not about anything particularly new, or some fat-hating piece released this morning, but rather on the messages about fat motherhood and mothering fat children I’ve heard in some context or another during the past few years.

Full disclosure: I’m not a bio mom. I have three stepchildren between the ages of 17 and 21. I’ve been in their lives since the youngest was 12. None of them are fat; all three are quite thin and conventionally attractive. My husband and I can’t have kids the traditional way, since he’s got a 15 year-old vasectomy. A couple years ago (when I was a fledging size activist) I started looking into non-traditional ways of having kids. I quickly learned there were two huge barriers: sizism, and ageism. My husband is 24 years older than I am, turning 53 this year after I turn 29. Adoption agencies, both local and international, discriminate against couples who have at least one member over the age of 50 (sometimes even 40). But also? Couples with at least one ‘obese’ or ‘morbidly obese’ member are discriminated against as well. Given that many private adoption agencies in the US are Christian, and I’m not Christian, there’s another roadblock.

So we considered artificial insemination or some other procedure. They are very expensive, not something we could even dream of affording in the short term. Also? Some fertility clinics put up major obstacles (i.e., charge you much higher fees) if you’re over a BMI of about 33, or just outright disallow it, though there’s no real evidence that the IVF limit is justified in any medical sense (though we can be sure the social engineers have their justifications).

But the final nail in the coffin of my desire to have children (at least, in the short term) was the barrage of negative/othering messages directed at fat moms, moms of fat kids — which my child has a decent chance of becoming, given that body size is 77% heritable.

Some of the messages our enlightened age given in regards to fat motherhood:

Fat children are a symptom of bad parenting.

Didn’t you hear? If you’re a mom who works (like most moms do), you’re making your kids fat. But if you shelter your kids too much and cater too much to their wants and needs? You’re also making your kids fat. And you’re ignorant, too; moms of fat kids don’t understand it’s just calories in/calories out, stupid.

Becoming a mom while fat is irresponsible and dangerous to both you and your child.

Maternal obesity is the plague of the land, didn’t you know? It’s causing the obesity epidemic (which surely exists, am I right?). Fat pregnancies result in fat children. Or maybe it’s being too thin while pregnant. Or maybe it’s dieting while pregnant. Or maybe it’s eating too many fats. Or it could be that you didn’t control your weight gain while both fat and pregnant. But it’s definitely your fault! Couldn’t be that pesky 77% heritability. Certainly not.

Fat moms are a burden to society.

You cost more in hospital resources, fatty! It couldn’t be that C-sections are way over-prescribed for fat pregnancies relative to thinner populations, given that fat pregnancies almost automatically get slapped with the ‘high-risk’ label despite the individual health of the mother (hello, failure of population study research to apply to the individual).

Fat moms are embarrassing to their children and husbands.

Kids can be cruel, can’t they? But is it really the kids, or a combination of their youthful urge to categorize and understand the world, including complex social mores, in the context of what they hear from their parents, see on TV, read in magazines and the internet, and hear from their friends? Children are wonderful, tragic barometers for the bigotries of our age. So is it so surprising when a mother hears that her child is being teased because she has a fat mom? And, moreover, that her child wants to transfer that bigotry to her mother to stop the teasing? Or that her husband doesn’t want her to participate in public activity because he’s embarrassed of her size?

Fat moms are guilty of child abuse, and should have their kids taken away from them.

This one, more than any other, made me change my mind about having kids. Having been abused by other people in my life, the idea of being categorized as one of them — whether justified or not — was too much to bear. There are many other examples of this, please Google it if you’re interested (and have banked the requisite Sanity Watcher’s points).

I want to issue special Mother’s Day good-wishes to fat moms, given the above, and everything else they must put up with to survive in a society who hates and blames them at every turn.

What other messages directed at fat moms have you heard, both from the media and in your own life?

Food Addiction the Next Focus of Obesity Epipanic

In a study posted online that will appear in the August print issue of Archives of General Psychiatry, researchers used functional magnetic resonance imaging (fMRI) to study the response of 48 healthy young women in response to cues signaling impending delivery of a highly palatable food (chocolate milkshake) vs. a tasteless control solution; and consumption of a chocolate milkshake vs. a tasteless solution.

The women ranged from lean to obese and had been recruited for a healthy weight maintenance trial. Their eating behavior was assessed using a food addiction scale developed by lead author Ashley Gearhardt, a doctoral student at Yale University.

“Similar patterns of neural activation are implicated in addictive-like eating behavior and substance abuse and dependence,” Gearhardt noted in the study.”Food and drug use both result in dopamine release in mesolimbic regions [of the brain] and the degree of release correlates with subjective reward from both food and drug use.”

Gearhardt and colleagues found that participants with higher food addiction scores showed more activity in brain areas linked with craving. “These findings support the theory that compulsive food consumption may be driven in part by an enhanced anticipation of the rewarding properties of food,” the authors write. “Similarly, addicted individuals are more likely to be physiologically, psychologically, and behaviorally reactive to substance-related cues.

The researchers said that if certain foods are addictive for some people, that could explain in part why they find it so hard to lose weight and keep it off.

While researchers have speculated that an addictive process may be involved in obesity, the authors said that this is the first study to identify distinctive neural or brain activity in people with addictive eating behavior.

In addition, Gearhardt said, ”If food cues take on enhanced motivational properties in a manner analogous to drug cues, efforts to change the current food environment may be critical to successful weight loss and prevention efforts. Ubiquitous food advertising and the availability of inexpensive palatable foods may make it extremely difficult to adhere to healthier food choices because the omnipresent food cues trigger the reward system. (PsychCentral) (emphasis mine)

First, this is clearly a press release — the article doesn’t even come out in print until August. If I know anything about scientific publishing (and I know a little from my day job), it’s obvious that the ink was barely dry on their paper before they released it online, making sure to alert the major channels as soon as they hit “Upoad Article.”

Here’s the link to the online article. Naturally, the full text is behind a paywall. Any of my Fatosphere buds out there got an Athens login?

So this is what we have to go on without even knowing anything about the methodology beyond the statements released by a co-author.

First of all — 48 women. Not a giant sample size. Second — they weren’t all overweight or obese, and they were recruited from a “healthy weight maintenance trial” (if some were obese, and obesity is considered an ‘unhealthy weight,’ then does that imply the obese and possibly overweight women were dieting?) A natural question to ask is if this is going to be another round of ammunition against obese people in the grand moral crusade, how did these addictive responses correlate with BMI? This wasn’t mentioned in the vast majority of statement press-releases (nor in the article quoted above). I dug around and found one person at Consumer Reports who actually read the damn study (shocking, I know, most science ‘journalists’ can’t be bothered to actually read studies), and she said:

The researchers also found that a high score for food addiction didn’t correlate with having a high BMI. You can be lean, but still have an addictive relationship with food. They speculated that this might put lean individuals at an increased risk of future weight gain, unless they can develop behaviors to compensate and keep control of their food addiction. (emphasis mine)

Naturally, BMI isn’t mentioned in 95% of the articles except to implicate this as some factor in the Obesity! Epidemic!

Third — well, where to start. I’ll sketch my ideas, below, my first and later impressions.

First Impressions

As long as they use this study for what it actually shows — that some women out of a tiny sample with higher “food addiction” scores have higher activity in some brain areas linked to reward — and don’t try to generalize to all fat people or fat women, we’re good.

However, it’s unlikely that will happen, given the sensational nature of the science-illiterate press. Also, the co-author herself makes concluding remarks about how this might shape efforts to make people (excuse me, encourage!) lose weight. I.e., change the “current food environment” and restrict “availability of inexpensive palatable foods.”

Well, that’s a funny thing! How would we restrict availability of inexpensive palatable foods? Oh, by levying unpopular food taxes, you say? And you say that if we create a scare, make people afraid of fatty foods by suggesting the foods themselves are dangerous addictive toxins and — horror of horrors! — these are foods readily sought after by especially children and poor people, they might be more in favor of food taxes?

Yeah. Because it’s not like we can just stand by while poor people are actually able to afford energy-dense food, and might even — gasp! — feed it to their children.

Now onto the issue of ‘food addiction’ as an actual phenomenon parallel to addiction to substances like heroin.

When it comes down to it, an “addiction” to food is a silly idea, since it’s not a foreign substance that we can just quit. If someone exhibits higher pleasure or expectations eating food, then it would seem the real root of the issue is why? That ‘why’ is what needs to be discovered and addressed.

Also, food isn’t inherently addictive because there are people who eat loads of fatty, sugary, salty, etc food without experiencing an attachment beyond that being their regular diet. The issue is much more complex than the drug-addiction model, and simplifying it to that point loses precious information about what’s really going on.

I wonder how many of the women who scored high on the “food addiction” scale were former dieters or were currently dieting? I recall items like milkshakes, pizza, etc holding MUCH more fantastic interest when I was dieting (and I’ve heard many, many other dieters talk about this food-fantasy effect, and Keyes did a study years ago that shows it’s a side effect of one’s body experiencing famine). Could it be their wiring is a bit shot, or sensitive, because they’re restricting or have restricted in the past and a bit of their ‘famine’ mindset is still at work?

Final Impressions

This is why a lot of these studies are little more than junk reinforcing cultural biases against fat people or people who overeat. There are so many obvious questions that go unanswered, because all they want to do is generate a quick correlation for a press release. The medical research looking into body size is rife with these kinds of examples.

I took screenshots of a Google News search to prove this thing was an unabashed press release, intended to be — in a very calculated way, mind you — a seminal work in the war against obese people (excuse me, obesity). Some of the article headlines:

  • Heroin vs. Haagan-Dazs: What food addiction looks like in the brain (healthland.time.com)
  • Freakonomics: Another Obesity Explanation: Food Addiction (freakonomics.com)
  • Craving a milkshake? You might be a junk-food addict (Globe and Mail)
  • Can people be addicted to food? (CBS News, 20 hrs ago)
  • Compulsive Eaters May Have ‘Food Addiction,’ Study Finds (BusinessWeek, 14 hrs ago)
  • For Some, Food ‘Addiction’ Similar to Substance Abuse (PsychCentral, 1 hr ago, complete with pic of Sad Addicted Fatty)
  • For Food Junkies, Brains React to Milkshakes Like Drugs (LiveScience.com, April 4, complete with pic of Bad Woman Inhaling Chocolate)
  • ‘Tempting foods as addictive as cocaine’ (Times of India, 11 hrs ago)

What do you think about this study?

On the 1% increase of obese and overweight in the US

If you haven’t yet seen the article from Reuters: More than 70 million US adults obese, US agency says

And here’s a link to the actual CDC report

Hey look, the obesity level in the US is remaining steady!

Oh wait, the article didn’t say that? The carefully timed flood of press releases on a ‘report’ from the CDC, an agency already over-reporting the levels of ‘overweight and obesity’ as well as stocking their site with all sorts of scare-graphs and claims of an ‘epidemic’ (and not to mention the same folks that claimed 400,000 deaths per/year were ‘attributable’ to obesity when it was found later that the figure was closer to 30,000 deaths/year) seemed to say:

WE’RE IN AN EPIDEMIC FATTIES OMG OMG CHILDREN WILL DIE ETC!

Or, what the CDC actually said:

Over the past decade, obesity has become recognized as a national health threat and a major public health challenge. In 2007–2008, based on measured weights and heights (1), approximately 72.5 million adults in the United States were obese (CDC, unpublished data, 2010). Obese adults are at increased risk for many serious health conditions, including coronary heart disease, hypertension, stroke, type 2 diabetes, certain types of cancer, and premature death (2,3). Adult obesity also is associated with reduced quality of life, social stigmatization, and discrimination (2,3). From 1987 to 2001, diseases associated with obesity accounted for 27% of the increases in U.S. medical costs (4). For 2006, medical costs associated with obesity were estimated at as much as $147 billion (2008 dollars); among all payers, obese persons had estimated medical costs that were $1,429 higher than persons of normal weight (5). In 2001, the Surgeon General called for strong public health action to prevent and decrease overweight and obesity (3). [EMPHASIS MINE]

A few things:

  1. Correlation doesn’t equal causation. The public health dollars scare tactic was calculated by taking the sum of ALL diseases ‘correlated with’ obesity and adding them together. That means there was a crapload of thin people with heart diseases, diabetes type II, certain cancers, and who suffered strokes that have been lumped in with all the fatties to make that percentage look as high as possible. Misleading.
  2. I don’t see a margin of error stated in the report, except a very narrow confidence interval of 0.7 – 1.4 percent. Really that — that — is what’s getting shouted from the rooftops of every science news agency and crappy local evening news station in the country? Really?
  3. Again, it bears repeating: A 1% increase over two years does not an epidemic make. Nor are we currently in an epidemic by any reasonable definition of the term. The fact that the CDC is bearing down on us with these imprecise scare-words means this is about politics and keeping themselves in the green, NOT about the actual fucking health of Americans. Anyone who hasn’t read Greg Bear’s brilliant Darwin’s Radio, please do.
  4. How is obesity a major public health threat again and, if this is true, how in the world has it just ‘become’ so, given that obesity rates have been leveling off for the last few years (isn’t it something like 5 or 6 years now, since 2004)? I smell a press release.

Methinks the CDC is working to ramp up anti-obesity fervor for something. To garner more support for the “Let’s Move” anti-obese kids program? To garner more support for some kind of new, wider initiative (since my guess is that “Let’s Move” hasn’t been generating any real results, surprise surprise)?

And then there was this lovely gem from the NY Times busting open the current HHS anti-obesity funds and focus: Antismoking Efforts Lose Ground to Obesity Fight

Shortly after the first lady kicked off the “Let’s Move” program, the administration awarded more funds to fight obesity than tobacco through two big new money sources for preventive health. The funds, totaling $1.15 billion, came from economic stimulus and health care reform legislation. They still provided more than $200 million for tobacco-use prevention, but much more to grapple with obesity.

Scary. Nice that part of the economic ‘stimulus’ package was funds to stimulate hate! Oh, dearie. It’s so funny I forgot to laugh.

Scarier still: apparently the Robert Wood Johnson Foundation is involved. For extensive analyses of some of their anti-obesity initiatives, check out this link.

What do you think of all of this?

BMI of Every US Citizen to be Tracked

Obesity Rating for Every American Must Be Included in Stimulus-Mandated Electronic Health Records, Says HHS

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:

  1. 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.
  2. 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?

Eugenics Rears Its Ugly Head, Again

When you deliver your body to the State, expect the State to start:

  1. Making you do things
  2. Preventing you from doing things

In other words, if you hand your body over to someone else, that someone else will claim the right to control it.

Today I was rudely reminded that eugenics, one of the nasty platforms of famous fascist/socialist states like Nazi Germany, is alive and well (h/t Elizebeth). Eugenics posits that one can (must) improve the species by allowing some people to have children, and disallowing others. In our modern time, it has also become more selective: couples can choose to have children with certain genetic makeups and not others. All in the name of having the ‘best’ child, who will become the ‘best’ kind of citizen and human, and that these ‘best’ people are superior in general to naturally-born, unselected people.

In this current example, The European Society of Human Reproduction and Embryology (ESHRE)), has recommended practitioners or governments which follow the Society’s recommendations, void the Article 16 of the Universal Declaration of Human Rights for certain classes of people, namely (bolding mine):

1) In view of the risks for the future child, fertility doctors should refuse treatment to women used to more than moderate drinking and who are not willing or able to minimize their alcohol consumption.

2) Treating women with severe or morbid obesity required special justification. The available data suggested that weight loss would incur in a positive reproductive effect, although more data was needed to establish whether assisted reproduction should be made conditional upon prior life-style changes for obese and smoking females.

3) Assisted reproduction should only be conditional upon life style changes, if there was strong evidence that without behavioural modifications there was a risk of serious harm to the child or that the treatment became disproportional in terms of cost-effectiveness or obstetric risks.

4) When making assisted reproduction conditional upon life style modifications, fertility doctors should help patients to achieve the necessary results.

5) More data on obesity, smoking and alcohol consumption as well as other life style factors were necessary to assess reproductive effects. Fertility doctors should continue research in this area.

Article 16 of the Universal Declaration of Human Rights (bolding mine):

Article 16
  1. Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution.
  2. Marriage shall be entered into only with the free and full consent of the intending spouses.
  3. The family is the natural and fundamental group unit of society and is entitled to protection by society and the State.

It is my firm belief that being fat is intertwined with racial status, since fat is preponderantly genetic. Therefore, discriminating against fat people is discriminating against them based on their racial status. Again, fat is not a behavior. Fat is not a disease. Fat is a body type, which is preponderantly genetic.

To understand how ridiculous this is, just consider this one fact: the fear of diabetes is one of the largest health ‘risks’ that anti-obesity crusaders tout when trying to get you into a panicked enough state to agree to their fascist ultimatums. And having diabetes in your immediate family is by far the largest risk factor for having diabetes yourself. Yet, women who already have diabetes — or heart disease, or a history of cancer, or any of the other major ills thrown at the doorstep of fatness — aren’t disallowed from getting reproductive help in the article being discussed here.

This isn’t about the future health of the child (a concept right out of eugenics, by the way), or whatever malarkey they’re concocting to get you to go along with their crusade. Or else women with diseases shown to be genetic wouldn’t be allowed to get reproductive help. No, this is a direct attempt to make formal the second-class status of unpopular groups of people.

As a final note, not only should it be a basic human right for a woman to reproduce if she so chooses. It should also be a basic human right to contract with another individual for services that do not violate other basic human rights. In other words, if there’s a doctor willing to contract with you for IVF services, then you have the right to proceed.