Showing posts with label Health care. Show all posts
Showing posts with label Health care. Show all posts

Thursday, March 27, 2008

8 - Big Hate

Last week was crazy busy for me, and busy in my world entails a certain amount of fast food. On Monday (the 17th) that fast food was procured at McDonald’s, where I gobbled down two chicken snack wraps, small fries and a small iced tea. As I ate I couldn’t help but think of a comment that my interview subject had made the day prior: “It freaks me out to watch [fat people’s] food choices.” I have the distinct impression he would have been freaking out a whole lot had he been sitting with me that evening.

This week’s post is about the haters—that relatively large (pun intended) group of people who have a problem with other people’s weight whilst not actually carrying it around. A week ago Sunday I sat down with my friend Greg[i] to talk over what it is about bigger folk that gets so far under his skin. I met Greg years ago at a party; we’re Facebook friends and we socialize here and there, so we get along well enough—which is what makes all this so weird. By nature I want to hate anyone who automatically thinks less of me based on my weight, but Greg is a likable guy and thus I don’t. So knowing that I don’t hate Greg and I’m far from out to demonize him in this post, let’s talk about what goes on inside that head of his.

One of the first things that Greg wanted me to know was that, to a point, he was speaking representatively. Representative of what you might ask? Well actually the better question would be “who.” If money makes the world go ‘round, then those that control the money would, by extension, be those that have the most control over the spinning of our fair planet—and those people would be your CEOs. “CEOs are the stereotypical six foot tall, lean, white male” says Greg. Though not a CEO himself, Greg is white, about six feet tall and doing well for himself financially. So he figured (and I agreed) that he could reasonably bring some insight to the table. And with that in mind, we dove in.

We talked definitions for a bit and I found this bit terribly ironic. In my last post, trying to define the term “BBW” in a narrow way proved fruitless despite the fact that the tastes of the men interviewed were quite specific. In contrast, it seemed really easy for Greg to define what overweight meant to him: “Any man whose stomach extends past his chest is overweight. And for women if the belly fat exceeds the belt line by an inch or more, then she’s overweight.” “Cottage cheese thighs” were also mentioned as problematic. I did put up some fight when he mentioned another litmus test: “If you can’t see your junk to know if you need a shave or whatever, there’s a problem.” I parried with the fact that the point when a mirror is needed to help check out the pubes for a woman is far earlier than for a man, but Greg was unsympathetic. I figured maybe I wouldn’t bring up that I’d arrived at the mirror stage some time ago.

Of course definitions--even with someone as unequivocal as Greg--have some fluidity. When asked if a great personality would make an overweight person seem, well, less overweight, he answered in the affirmative. He even mentioned that the term “Rubenesque” evokes the idea of someone with a certain amount of personality as opposed to just the idea of a certain body type. For women Greg named further distinctions as well. For example, there is a definite difference between women whose breasts can be distinguished from/extend past their bellies and women who do not have this kind of body shape. Women who lack such physical definition, and thus a certain amount of femininity, will simply not get the same level of acceptance in Greg’s opinion.

As in many things though, definitions are usually the least of one’s problems; it’s connotation that causes all the trouble. In my last post I listed a number of ideas that many people associate with the word fat, but I figured I might be missing some so I got Greg’s list too: “unhealthy, will die young, lazy, don’t care, low self-esteem, not career-minded, play the victim, feel they are a victim, not in control of their own lives, not getting sex, unkempt, sweaty, frumpy, not well-dressed, will be likely to have food stains on their shirts” (this last one is my personal favourite for sheer funny factor). Now while my list was longer there were some that I had never thought to include and one that we parked on for a bit was “not career-minded.” At this point, we inevitably came back to the issue of who’s running the show. Assuming the world is run by gym-going, low-cholesterol eating, lean, white, male, six-foot CEOs, then the likelihood that an overweight man or woman is going to succeed in an organization run by that guy can decrease dramatically. Now admittedly there are fields where weight may be less of an issue than others, but Greg brought up fields where I wouldn’t have immediately thought that it would be such an issue. “In a law firm someone overweight might not make partner because he or she doesn’t fit the image of what a partner looks like.”

To make his point, Greg told me about a situation that had occurred in his own workplace. During a down-sizing he noticed a manager continually circling back to one overweight employee. It soon became apparent to Greg that his manager had no clue what this employee actually did all day, but the idea of the “lazy, fat guy” had managed to so severely cloud the employer’s thinking on the topic that this employee’s job was on the line. And of course this kind of discrimination grows in proportion to the amount of extra weight a person carries. In fact, Greg agreed that if I wanted to get ahead in many a work place, I’d be better off cutting out an hour at the office and replacing it with an hour at the gym. When, in a session months ago, my therapist told me that my weight would be a factor in my job hunt, I just kind of tuned her out; sitting with Greg that sunny Sunday afternoon, it was pretty hard to ignore.

But Greg doesn’t necessarily have a lot of pity for people in my position, even if he doesn’t think the discrimination is right. Ultimately, in Greg’s opinion, I’ve made my bed and I can’t blame anyone else for only having that bed to lie in. “I think the idea of genetics making people fat is a fallacy. No one forces you to eat what you eat or forces you to eat how much you eat. Genetics are a factor in body shape, but not weight. It’s about activity, lifestyle and discipline.” Greg’s overall feeling is there is a lack of self-respect in allowing oneself to get very overweight and that people simply don’t care. One concession that he did make was in the case of the stereotypical workaholic who doesn’t take care of themselves. “I’ll admit fat people are probably more apt to put someone else’s needs before their own. They end up not taking care of themselves; like people who are overworked and don’t take care of their health. And then I guess there are emotional eaters.”[ii]

Now “health” is one of my favourite buzz words when it comes to talking about weight, so I had to ask, ‘does a thin person who clearly eats a whole lot of unhealthy food freak Greg out as much’—and the answer is no. He figures they must be active enough to offset that choice which somehow makes it more acceptable. To further complicate the health question, Greg doesn’t mind a roll in the hay with someone unequivocally heavy (to a point) as long as they’ve got a cute face; in a weird twist, Greg could have been a survey participant in my last post whilst still being the interview subject for this one. “I couldn’t date someone overweight in the long run. I just couldn’t watch them keep making unhealthy food choices all the time; ‘like no, I don’t want an ice cream, I just ate’”

Some of you are now screaming that Greg is only one person and I need to take his words with a grain of salt (whilst others nod vigorously in agreement with him). Well don’t worry; I’m not buying it all without reservation. But I also don’t think Greg is that much of an anomaly. He’s a country boy who had the kind of active childhood often associated with rural living. He’s never been anything other than slim and agrees that his family ate well (by which I mean healthily). He’s 35, active, and strikes me as thinking harder than the average about his food choices (certainly harder than I do); but being super food conscious is kind of all the rage right now. When asked how long his issue with overweight people has existed, he recollected the fat kids in school. “These kids were different because they didn’t dress like the rest of us. Everyone was wearing jeans except the fat kids who wore stretchy pants because they couldn’t fit into anything else. They seemed to always be fat, lazy kids from ‘town.’ You certainly can’t run around and play sports at recess when you can barely fit into your pants. They were always eating junk food. I guess I teased them too.”

Thinking on Greg’s response makes me say, on the one hand, hurrah for stretchy jeans. But on the other hand I have to wonder if maybe what seems like this complex and involved form of stereotyping and discrimination is as simple as school yard preservation instincts that we haven’t shaken. Is it just a good old case of teasing the fat kid in elementary school; a continuing saga of excluding the person who’s different? I mean, really, the action is the same. The difference seems to lie in rationalizing it. In elementary school protecting our social status is more than enough motive to exclude or malign another person. It’s in adulthood that we have to find reasons to rationalize this behavior. And so we say things like “the burdened health care system” and “type-2 diabetes” and “shorter life spans” when we maybe really just mean “I don’t like fat people.” Ten and fifteen years ago we were all alarmed about smokers being the burden to our health care system, but it was still generally acceptable to discriminate against heavy people even back then. The only thing that seems to have changed from where I’m standing is that now that someone can voice concerns about my health, their discrimination has a good cover. Understand, I’m not denying health issues exist—I’m simply saying that I don’t think every person on the planet who has a problem with my size is really that concerned about my cholesterol or my triglycerides (both of which are great, thanks). Instead, I have to wonder if the man not hiring me is simply engaged in some form of bullying motivated by how he felt on the school yard when he was five and assumptions he’s made about me way in advance of meeting me. I want to think that humans aren’t that base. But time and time again we seem to prove that we are.

Greg has offered to lead me further down this path of non-acceptance, and if he reads this and still wants to hold my hand I may take him up on it. Frankly, I hate thinking too damn hard about what others might think of me; doing so brings up all the insecurities that I have about my body right now. But I’m trying to believe that facing the monster will make it less scary in the long run. You’ll just have to stay tuned and see. In the meantime this post ends on a bit of a downer; but I think the reality is a bit of a downer.



[i] Of course that’s not his real name—we can’t have survey participants from the last post trying to find Greg and beat him down.

[ii] At this point I nearly fell down laughing because emotional eating is like an afterthought to Greg and is an enormous part of my every day existence; as I am fond of saying, another topic for another post.

Thursday, February 14, 2008

5-Vacation and Work -- Mutually Exclusive

So I had these lofty plans to get all this work done on this blog on my week off. Instead I've spent my time watching crap loads of really bad daytime TV whilst sitting around in my pjs refusing to bathe regularly. Yeah, I kinda suck, but that's what vacations are for. Also a couple things that I am working on haven't come together as quickly as I had anticipated so I assure you, there are two potential posts that are not quite ready for public viewing. In the meantime enjoy these articles. Food for thought.



Smokers, fat folks mean health care savings

MARIA CHENG

Associated Press

February 4, 2008 at 10:45 PM EST

LONDON — Preventing obesity and smoking can save lives, but it doesn't save money, researchers reported Monday.

It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.

“It was a small surprise,” said Pieter van Baal, an economist at the Netherlands' National Institute for Public Health and the Environment, who led the study. “But it also makes sense. If you live longer, then you cost the health system more.”

In a paper published online Monday in the Public Library of Science Medicine journal, Dutch researchers found that the health costs of thin and healthy people in adulthood are more expensive than those of either fat people or smokers.

Mr. van Baal and colleagues created a model to simulate lifetime health costs for three groups of 1,000 people: the “healthy-living” group (thin and non-smoking), obese people, and smokers. The model relied on “cost of illness” data and disease prevalence in the Netherlands in 2003.

The researchers found that from age 20 to 56, obese people racked up the most expensive health costs. But because both the smokers and the obese people died sooner than the healthy group, it cost less to treat them in the long run.

On average, healthy people lived 84 years. Smokers lived about 77 years, and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people.

Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.

The cost of care for obese people was $371,000, and for smokers, about $326,000.

The results counter the common perception that preventing obesity will save health systems worldwide millions of dollars.

“This throws a bucket of cold water onto the idea that obesity is going to cost trillions of dollars,” said Patrick Basham, a professor of health politics at Johns Hopkins University who was unconnected to the study. He said that government projections about obesity costs are frequently based on guesswork, political agendas, and changing science.

“If we're going to worry about the future of obesity, we should stop worrying about its financial impact,” he said.

Obesity experts said that fighting the epidemic is about more than just saving money.

“The benefits of obesity prevention may not be seen immediately in terms of cost savings in tomorrow's budget, but there are long-term gains,” said Neville Rigby, spokesman for the International Association for the Study of Obesity. “These are often immeasurable when it comes to people living longer and healthier lives.”

Mr. van Baal described the paper as “a book-keeping exercise,” and said that governments should recognize that successful smoking and obesity prevention programs mean that people will have a higher chance of dying of something more expensive later in life.

“Lung cancer is a cheap disease to treat because people don't survive very long,” Mr. van Baal said. “But if they are old enough to get Alzheimer's one day, they may survive longer and cost more.”

The study, paid for by the Dutch Ministry of Health, Welfare and Sports, did not take into account other potential costs of obesity and smoking, such as lost economic productivity or social costs.

“We are not recommending that governments stop trying to prevent obesity,” Mr. van Baal said. “But they should do it for the right reasons.”





Is the obesity epidemic exaggerated?
(Head to Head: Is the obesity epidemic exaggerated?)

Saturday February 2, 08
Yes: http://www.bmj.com/cgi/content/short/336/7637/244
No: http://www.bmj.com/cgi/content/short/336/7637/245

Last week, the UK health secretary declared that we are in a grip of an obesity epidemic, but does the evidence stack up? Researchers in this week's BMJ debate the issue.

Claims about an obesity epidemic often exceed the scientific evidence and mistakenly suggest an unjustified degree of certainty, argue Patrick Basham and John Luik.

For example, the average population weight gain in the United States in the past 42 years is 10.9kg or 0.26kg a year. Yet, between 1999-2000 and 2001-2002, there were no significant changes in the prevalence of overweight or obesity among US adults or in the prevalence of overweight among children.

Furthermore, they say, the categories of normal, overweight, and obese is entirely arbitrary and at odds with the underlying evidence about the association between body mass index and mortality.

For example, the study on which the bands for overweight and obesity in the US are based found that the death risks for men with a body mass index of 19-21 were the same as those for men who were overweight and obese (29-31). Other studies have shown negligible differences between body mass index and death rates.

The association of overweight and obesity with higher risks of disease is equally unclear, they write. And, despite supposedly abnormal levels of overweight and obesity, life expectancy continues to increase.

They suggest that some public health professionals may have deliberately exaggerated the risks of overweight and obesity, and our capacity to prevent or treat them on a population wide basis, in the interests of health. They warn that this has unwelcome implications for science policy and for evidence based medicine.

But Robert Jeffery and Nancy Sherwood argue that a large body of scientific evidence shows that obesity is a major global health problem.

In the US, the prevalence of obesity in 1976-80 was 6.5% among 6-11 year olds and 5% among 12-17 year olds. In 2003-4 it was 19% and 17% respectively. Europe can also expect to see the numbers of overweight and obese children rising by around 1.3 million a year by 2010.

The risks of obesity on many serious health conditions including high blood pressure, diabetes, heart disease and some forms of cancer, are also serious and well established, they write.

Most health economists and epidemiologists agree that the contribution of obesity to current healthcare costs is high and that it is likely to get much higher. Some have argued that we may even see real falls in life expectancy within a few decades, they add.

In summary, a large body of evidence documents that over-nutrition and obesity are a major global health problem, say the authors. With the continuing rise in obesity and limited treatment efficacy, options for averting a poor public health outcome seem to rest either on the hope that scientists are wrong in their projections or speedy investment in the development of more effective public health measures to deal with it.

They think the second option a more prudent scientific and policy choice.



I hope you enjoyed those two offerings. I hope to have some original content for you soon!