Posts Tagged ‘discrimination’

Employer Wellness, EEOC, Data Warehousing, Predictive Analytics

May 23rd, 2013

Download my comments to the EEOC filed today looking at employer wellness programs and the development of data warehousing and predictive analytics. How new technology can be used to discriminated against persons with obesity. Morgan Downey_EEOC_Employer Wellness Comments

Employer Wellness Issue Heats Up

May 20th, 2013

The Equal Employment Opportunity Commission (EEOC) held a long hearing on May 8, 2013 on employer wellness programs. Opponents made a strong case that there was virtually no way that a mandatory health-contingent wellness plan could not discriminate against protected classes of workers. (See statement of Judith Lichtman) On the other hand, the more pro-business representatives argued that Congress and the Administration supported the changes in the Affordable Care Act and the programs where here to stay. It seems that all parties are urging the EEOC to provide guidances to employers.

The testimony came amid a backdrop of waiting for the final regulations from the Obama Administration. The comment period closed in January and many were expecting we would have final regulations by now. Politico reported that a group of corporate CEOs with the Business Roundtable were in Washington recently to lobby the Administration to avoid further weakening of the regulations.

Forbes magazine was reporting the CVS-Caremark was penalizing workers $600 annually if they failed to complete a health risk assessment. The article noted that most companies did not provide such stiff penalties but many were moving in that direction.

Meanwhile, several research articles provide only lukewarm support for weigh loss employer wellness programs.

A Health Affairs article by Ron Goetzel and colleagues, found only 22 % of employer health care costs could be attributed to 10 modifiable health factors (including obesity). This is actually a drop from 24.9% in 1998, even though rates of obesity have increased and costs related to obesity have gone up. Obesity contributed the most excess costs at $347 per capita. Goetzel, Pei, et al,

Another recent paper was a longitudinal study at the worker productivity in terms of absenteeism, presenteeism and job performance associated with changes in 19 modifiable well-being risks. These included physical health risks, health behavior risks, social and emotional health risks work-related risks and financial health risks.  The researchers found that, “Obesity, high cholesterol, tobacco use and excessive alcohol generally contributed to productivity changes insignificantly or unfavorable, possibly because of its multicolinearity with other risks that are closely correlated.” However, they noted that, “Health-related risk explained only a portion of the total productivity variances. For example, Riedel et al found that health risks accounted for 7.8% of the total variance in productivity impairment and acknowledged that the majority of the variation was left unexplained. Lenneman et al also found only 8.5% of the variance in productivity was contributed by health risks…We found that reductions in work-related well-being risks and financial health risks significantly contributed to improvement in productivity measures especially for measures of presenteeism and job performance that were not attributable solely to the more narrow definition of physical health.” They found modest numbers of workers were able to make improvements: 25% reduced their physical health risks 26% improved their health behaviors 16% improved their social and emotional health, 31% improved their work-related risks and 13% their financial health risks. Improvements in absenteeism, decrease in presenteeism and a modest improvement in job performance accompanied such changes. They calculated these improvements were equivalent to a savings of $468 per person per year. Shi, et al.

Ted Kyle reports in his blog that one program, Healthy Blue Living, requires obese participants to wear a pedometer which uploads their physical activity to the employer wellness program. The employees must meet daily step goals if they want to keep full health benefits. Not doing so could cost them each $2000 a year. Kyle notes (and I strongly agree) that this constitutes human experimentation without the protection of the federal regulation protecting human subjects, 45 Code of Federal Regulations Part 46. In fact, the program is not that successful. Promotional material notes that only 16% who agreed got their weight under a BMI of 30.

Yet another study published in Health Affairs looked at one hospital system’s wellness program. The program provide a substantial incentive/penalty for participation in a health risk assessment (which included automated feedback) signing a health pledge, health fairs and physician referrals. The study found a significant reduction in hospitalizations for conditions related to the conditions covered by the wellness program. However, there was an increase in medication costs. Combined with the costs of the wellness program and incentives, the authors concluded, “It is unlikely that the program saved money.” Gowrisankaran G, et al. A Hospital System’s Wellness Program Linked to Health Plan Enrollment Cut Hospitalizations But Not Overall Costs, Health Affairs 32 (3) 2013; 477-485. Gowrisankaran

A second paper also published in Health Affairs reviewed randomized controlled trials of workplace wellness programs. Their review raises doubts the employees with health risk factors such as obesity and tobacco use spend more money on medical care than others. They concluded that workplace wellness programs show little evidence of saving costs through health improvements without being discriminatory.  To test the assumptions of workplace wellness programs the authors, “reviewed research on the relationships among financial incentives, behavior, health status, and medical spending. We focused on randomized controlled trials involving four conditions- smoking, hypertension, high cholesterol and obesity- that are typically included in health-contingent programs. In our review, we found mixed evidence that employees with these conditions have higher health costs than other employees, which undermines the argument that employees with the conditions are particularly effective targets for incentives. We also found little evidence that working-age people change their behavior as a result of financial incentives, particularly over the long term. These findings suggest that program savings many not, in fact, derive from health improvements. Instead, they may come from making workers with health risks pay more for their health care than workers without health risks do. If true, this conclusion would jeopardize long-standing regulatory efforts, maintained in recently proposed Affordable Care Act regulations to prevent workplace wellness from being “a subterfuge for underwriting or reducing benefits based on health status. (citations omitted) Since low-income workers disproportionately suffer from conditions typically targeted by health-contingent programs, savings arising outside of health improvement may entail hidden, regressive redistributions increasing the burden imposed on low-income workers. “

In effect, they point out, wellness plans shift costs with the most vulnerable employees, those from low income groups with the most health risks probably subsidizing the healthier workers. Horwitz, JR, Kelly, BD, DiNardo, JE, Wellness Incentives in the Workplace: Cost Savings Through Cost Shifting to Unhealthy Workers, Health Affairs, 32 (3), 2013:468-476. Horwitz

The Agency for Healthcare Research and Quality (AHRQ) has issued another independent review. This time they reviewed studies of strategies to prevent weight gain in adults. The reviewers looked at 51 trials involving 555,783 subjects with at least one year of follow-up and a weight outcome. A meaningful difference between groups was considered to be 0.5 kg of weight (1.1 pound) or 1 cm of waist circumference. They found moderate evidence that workplace programs for the prevention of weight gain in adults. One study combining diet, physical activity and environmental components resulted in meaningful and statistically significant prevention of BMI change at 12 months and another that combined internet based diet and physical activity counseling resulted in significant prevention at 24 months. However, a third study found no difference. AHRQ Strategies to Prevent Weight Gain Among Adults, Comparative Effectiveness Review No. 97, AHRQ

Also cited as, Gudzune K et al Strategies to prevent weight gain in workplace and college settings: A systematic review, Prev Med. 2013 Mar 22. Gudzune


Are Pediatricians Doing Their Job?

December 6th, 2011

Amid continuing furor over the removal of the 8 year old boy in Cleveland from his family, come two reports. The first, a study just published in the Archives of Pediatrics and Adolescent Health showing that only a quarter of parents were told by their pediatricians that their child was overweight. Interestingly, more parents who were minority and low income were told than other groups of parents. Arch Pediatr Adolesc Med — Abstract: Parental Recall of Doctor Communication of Weight Status: National Trends From 1999 Through 2008, December 5, 2011, Perrin et al. 0 (2011): archpediatrics.2011.1135v1

Another report has addressed a recurring question in the Cleveland case which is ‘how widespread is the removal of overweight/obese children to foster care?’ There does not appear to a clear picture but there is a picture of the frequency in Great Britain, including the case of a child as young as three. Council ‘put child, 5, into care for being obese’ – Telegraph

Time Magazine blogger calls for abusing persons with obesity

November 15th, 2011

Time magazine blogger, Shannon Brownlee wants us to get serious about obesity with a ‘novel’ idea: 

Shannon Brownlee

insulting,  discriminating and penalizing persons with obesity. Boy, bet that will help. Shannon Brownlee: Let’s Stop Being Passive About Obesity | TIME Ideas |

(Ever notice that the folks who espouse the most mean-spirited attacks on persons with obesity always think it is a novel idea? Why is that?)

Wash Post’s Robinson Joins Christie Fat-Bashing Crowd

September 30th, 2011

Eugene Robinson has a column in today’s Washington Post titled, “Christie’s Hefty Burden.” Chris Christie’s big problem – The Washington Post I cannot recall the last time I disagreed with one of Robinson’s columns but this one is really bad. The middle of the column is a recitation of facts about obesity, seemingly taken of f the NIH website. Robinson’s mistakes are two, one at the beginning and one at the end of his piece and they stigmatize persons with obesity.

 In the first paragraph, Robinson says that whether or not Christie runs for President he needs to lose weight. (I’m sure Christie is grateful for that insight.) But he goes on to state, “Like everyone else, elected officials perform best when they are in optimal health. Christie obviously is not.”

Whoa! Let’s look at this. First, being obese, even having extreme obesity, does not mean that a person cannot perform a given job. They may have a health problem, like diabetes, or joint problems or their weight may aggravate another problem but their weight, per se, does not mean they cannot perform a job. Does one have to be in “optimal” health to perform their best? Tell that to FDR with his polio  or JFK with his back pain. Tell that to tens of thousands of persons with handicapping conditions and diseases who go to work everyday and perform and, often, outperform, their colleagues. Even if Christie has some of the comorbid conditions of obesity, such as hypertension, type 2 diabetes and high cholesterol, many of these are manageable by medicine.

 In the last paragraph, Robinson offers Christie some “sincere advice: Eat a salad and take a walk.” I’d like to suggest Robinson go to anyone of thousands of Weight Watchers meetings this weekend or to the group sessions of bariatric surgery patients and see what reaction such ill-informed and gratuitous advice provokes. If it were so easy, we would not have an obesity problem. If a columnist did some homework, he might learn that even the best, most motivated behavioral interventions produce between 5% – 10% weight loss.

Of course, as most dieters will see, Robinson presumes that Christie is at his highest weight. Maybe?  Or maybe he has lost significant amounts of weight already. Maybe he has sustained that weight loss for a long time. To presume, as Robinson has, that Christie is (a) currently in bad health, (b) cannot perform a position such as governor or President if he is obese, and (c) hasn’t heard the message on eat less exercise more is ludicrous. (Actually, a lot of normal weight persons, in my experience, feel they are just a great person if they tell a fat person to eat better and exercise more.) It is an example (as if we needed another one) that obesity remains the last socially acceptable excuse for discrimination.

 The team on MSNBC’s Morning Joe this morning discussed Robinson’s column and, frankly, had a much more intelligent discussion than Robinson displayed. Hopefully, this will be a moment to educate Americans about the realities of obesity and avoid stigmatizing persons with obesity.

Employment and Wage Discrimination

September 27th, 2009

A starting point for any economic view of obesity is the current state of employment and wage discrimination against persons with obesity. For excellent resources, see:

Economic causes and consequences of obesity. [Annu Rev Public Health. 2005] – PubMed Result

Evidence of discrimination against obese workers Do antifat attitudes predict antifat behaviors? [Obesity (Silver Spring). 2008] – PubMed Result

Bias, discrimination, and obesity. [Obes Res. 2001] – PubMed Result

Recent experiences of weight-based stigmatization …[Obesity (Silver Spring). 2008] – PubMed Result

Racism may increase weight in black women Perceived racism in relation to weight change in t…[Ann Epidemiol. 2009] – PubMed Result

Wage Discrimination

Obesity has significant impact on white women’s wages Obesity, Self-esteem and Wages

Body Composition and Wages

Weight and wages: fat versus lean paychecks. [Health Econ. 2009] – PubMed Result

Why obesity lowers wages:

The wage effects of obesity: a longitudinal study. [Health Econ. 2004] – PubMed Result

Health, obesity, and earnings. [Am J Public Health. 1980] – PubMed Result

Weight Bias

September 26th, 2009

It is difficult to find any area of obesity untouched by issues of bias and discrimination.Is obesity stigmatizing? Body weight, perceived di…[J Health Soc Behav. 2005] – PubMed Result Perhaps the stigmatization associated with obesity is as great as for any human condition. Not only does stigmatization take a terrible toll on individuals’ life in society but it directly affects the health care they do, or do not, receive. The Yale Rudd Center on Food Policy and Obesity is the leading academic center focused on weight bias and discrimination. Rudd Center for Food Policy and Obesity — Home. MD

Weight bias is increasing in the United States without any legal or societal restraints. Changes in perceived weight discrimination among A…[Obesity (Silver Spring). 2008] – PubMed Result

Overweight and obese report stigmatizing encounters across a variety of settings but ones involving personal relationships seem hardest to take. Weight stigmatization and bias reduction: perspect…[Health Educ Res. 2008] – PubMed Result

Weight stigmatization may result in high rates of depression in severe or morbidly obese patients. Depressed mood in class III obesity predicted by w…[Obes Surg. 2007] – PubMed Result

Weight Bias

Weight Discrimination compared to race and gender discrimination

Origins of Weight Bias and ways to reduce bias

Childhood stigmatization see,

Stigmatization of obese children and adolescents, …[Obes Rev. 2008] – PubMed Result

No change in weight-based teasing when school-base…[Arch Pediatr Adolesc Med. 2008] – PubMed Result

Associations of weight-based teasing and emotional…[Arch Pediatr Adolesc Med. 2003] – PubMed Result

Weight-teasing among adolescents: correlations wit…[Int J Obes Relat Metab Disord. 2002] – PubMed Result

Racial/ethnic differences in weight-related teasin…[Obesity (Silver Spring). 2008] – PubMed Result

Effect on provision of health care

Undertreatment of obese women undergoing cancer therapy: Arch Intern Med — Abstract: Undertreatment of Obese Women Receiving Breast Cancer Chemotherapy, June 13, 2005, Griggs et al. 165 (11): 1267

Weight Bias in Health Care Settings,