Persons with Obesity Excluded from Nursing Homes

December 15th, 2015 No comments »

The New York Times published yesterday a sobering view of the discrimination faced by persons with severe obesity to access nursing home care. It is a sobering picture and one that is not likely to get better anytime soon.

Employers Promote Fat-Shaming: New Post

December 11th, 2015 No comments »

Fellow blogger Al Lewis has an excellent post on Huff  Post Business on the promotion of fat-shaming in “employer wellness” programs. He points out that (a) these programs do not cause weight loss, (b) they are  often structured to embarrass and harass overweight employees by their colleagues, (c) the penalties for failure to reach an employer goal of a specific BMI or weight loss amount are outrageous. What he might add is that millions  of American workers are affected by these programs,   them the largest human experiments in history. No doubt  the numbers of affected employees dwarfs those in medical or surgical treatment programs. What he does not explain is the absence of outrage in the scientific and medical community over these  scams.

Obesity Stigma Among Dieticians and Nutritionists

October 21st, 2015 No comments »

A systematic review of obesity stigma among dieticians and nutritionists has been published. Six of eight studies showed significant levels of stigmatization although less than among the general population. The results showed dieticians and nutritionists believed in a high level of “internal” factors (read willpower) than genetics or biology.


Fat Bullying Can Kill

November 13th, 2014 No comments »

Want an example? The November 13, 2014 edition of the Washington Post carries a sad story of a talented young man who put on weight, was bullied at school and turned to marijuana to ease the pain of the taunting. The marijuana use brought him into contact with violent drug dealers who are suspected in his shooting. This case will no doubt be listed as a drug-related crime and the shooter or shooters will probably be found and prosecuted. But the bullies at his school, his teachers and administrators, and his classmates who did nothing…they will not shoulder any responsibility but their guilt will be just as great.

Discrimination, Weight, Old Age

May 19th, 2014 No comments »

Avid readers of the Downey Obesity Report may recall interesting research by Angelina Sutin and colleagues on personality aspects and obesity. Now, she has published a new study looking at multiple personal characteristics and their association with physical,emotional and cognitive health in older adults. Participants rated their everyday experiences with discrimination and attributed these experiences to eight personal characteristics (race, ancestry, sex, age, weight, physical disability, appearance, and sexual orientation) at two points in time. The results indicate that discrimination based on age, weight, physical disability and appearance were associated with poor subjective health, greater disease burden, lower life satisfaction and greater loneliness at both time points. Discrimination was generally unrelated to cognitive health. They concluded that the adverse effects of discrimination on physical and emotional health are not limited to young adulthood but continue into old age and are primarily driven but changeable characteristics (age and weight) versus fixed characteristics (race and sex). (One interesting finding was that the most consistent effect for race discrimination was found for cognitive health: White participants who perceived discrimination based on their race scored lower on mental status, while African Americans who perceived race discrimination scored higher.)


Privacy or Neglect?

May 17th, 2014 No comments »

An article by Sheri Fink in the New York Times on May 16, 2014 will raise many questions. The article describes a program of data-mining of Medicare records for use in emergencies, such as hurricanes like Katrina and Sandy. Under the program, vulnerable people are identified who may need help in evacuations or need to help to get to shelters. However, the data are also used to identify those who take frequent ambulance trips or alert primary care physicians when their patients are admitted to hospitals. In emergencies, ‘authorized individuals’ are allowed to access medical records even though they have not been given permission. In an effort to protect privacy, federal officials have decided not to identify “stigmatized groups” including those with mental illnesses, intellectual disabilities and those with obesity. The system is being tested by looking at those on ventilators or using other medical devices who may lose power and have batteries run out of power.

But the issue of not including persons with obesity and those with mental and intellectual disabilities is a challenging one. Are they being left without this safety net? Obviously, not every person with obesity would need this level of attention but those with morbid obesity, in wheelchairs, on insulin surely would. Ask the obesity specialists at Pennington about trying to get insulin to patients after Hurricane Katrina if you want a picture of what a natural disaster can mean. So, is this protection of privacy or leaving the most vulnerable to fare for themselves while others are saved? The debate has only begun.


What Employees with Obesity Cost Employers. Or Do They?

May 17th, 2014 No comments »

A new study in the American Journal of Health Promotion sets out to estimate the costs of obesity to employers, using a database of nearly 30,000 employees from different employers over 3 years. Researchers looked at workdays lost owing to illness and disability, medical, short-term disability and workers’ compensation claims. Not surprisingly, they found the probability of disability, workers’ compensation claims, and number of days missed owing to any cause increase with BMI above 25, as do total employer costs. The probability of a short-term disability claim increases faster for employees with hypertension, hyperlipidemia, or diabetes. Normal weight employees cost on average $3,830 per year in covered medical, sick day, short-term disability, and workers’ compensation claims combined; morbidly obese employees cost more than twice that amount, or $8,067, in 2011 dollars.

Without the benefit of the full text, it appears that the paper may be misleading if it does not address  the Wage Penalty. Economists  have found that employers who offer health insurance pass on the excess costs to obese employees by way of lower wages.

A study by Jay Bhattacharya and M. Kate Bundorf of the Stanford University School of Medicine looked at the issue. They made some startling findings:

  1. Obese workers who receive health insurance through their employers earn lower wages than their non-obese peers.

  2. Obese workers who are uninsured earn about the same as their thinner colleagues.

  3. A substantial part of these wage penalties at firms offering insurance can be explained by the difference between obese and non-obese in expected medical care costs.

  4. The obese with employer-sponsored health coverage bear the full cost of the incremental medical care associated with obesity.

Thus, their study finds that while it is nominally employers who pay for health insurance premiums, it is really employees who bear the cost of employer-sponsored insurance.  Further, the wages of obese workers are lower than those of their normal weight peers, and in the case of white women, the relationship appears to be causal.  It is obese white women who bear the burden of lower wages due in part to the higher costs of insuring these workers. In firms providing employer based health insurance, obese women experience a wage penalty of $2.64 per hour. In firms which do not provide health insurance, there is no significant wage penalty.

Not surprisingly, obese men and women report a higher percentage of common medical conditions, including diabetes, asthma, hypertension, non-specific joint pain and arthritis. Obese women are nearly 10% more likely to have arthritis than their non-obese peers, while for obese men, the differential is only 6%. It is only for arthritis that obese individuals spend more than thin individuals. They state, “For female workers with arthritis, the medical expenditure difference between obese and thin individuals is $1,956; for male workers with arthritis, the difference is $1,224. Clearly, differences between men and women are an important part of the reason why obese female workers spend so much more on medical care than thin female workers, while obese male workers spend about the same as thin male workers.” The authors calculate the yearly wage penalty on obese women employed in firms providing health insurance is $5,784. Bhattacharya J, Bundorf, MK, The incidence of the healthcare costs of obesity, Journal of Health Economics 2009 May;28(3):649-58.

The wage penalty may actually be higher, especially for both men and women at the upper end of the BMI spectrum, Han E, Norton EC, Powell LM, Direct and indirect effects of body weight on adult wages. Economics & Human Biology 2011 Dec;4(11):381-392.

Another recent study of the negative association between BMI and wages found the wage gap is larger in occupations requiring interpersonal skills with presumably more social interactions. This wage penalty increases as employees get older. This study demonstrates that being overweight and obese penalizes the probability of employment across all race and gender groups except for black men and women. Han E, Norton ED, Stearns SC, Weight and Wages: Fat Versus Lean Paychecks, Health Econ 2009; 18:535-548 Weight and wages: fat versus lean paychecks. [Health Econ. 2009] – PubMed Result

Therefore, it is not costs the employer actually pays since they are passed on to the employees. They may also be passing on other costs which have not been studied, such as employee share of disability insurance or life insurance, or reducing the amount of life insurance available to employees with obesity. Additionally, employees with obesity are likely to experience a hostile workplace which may cost overweight and obese employees with obesity promotions and bonuses and impede weight loss efforts. (See also this article.)


Michelle Obama Decries Fat Jokes! NOT.

May 17th, 2014 No comments »

On May 3, 2014, the White House Correspondents Dinner brought together the political-media-Hollywood elite in annual, one-of-a-kind event. The entertainment was provided by Joel McHale who took the opportunity to pepper his act with a number of fat jokes. Targets included New Jersey Governor Chris Christie, Toronto Mayor Rob Ford, and fat Mexican immigrants.

So, given Michelle Obama’s concern about childhood obesity, you think she might have said something. The Obamas  have decried bullying, school lunches, opponents of education of girls, religious intolerance, racial intolerance, homophobia, anti-Semitism, junk food marketing to children, fast food, and too much television viewing. So, it isn’t like they have not used the ‘bully pulpit’ before.

You might think that Michelle would see an opportunity to tell the nation’s poli-media-entertainment elite that fat jokes should go the way of gay jokes, ethnic jokes, racial jokes and religious jokes. How much of obesity does she not get? When the nation’s elites signal that fat people are fair game for stigmatization, they authorize everyone else to stigmatize and discriminate.

A few days later, basketball star Charles Barkley decided that the women of San Antonio were fair game for fat bashing. Kudos to NAAFA and the Obesity Action Coalition for standing up; Michelle Obama sure won’t.