Tag Archives: Blue Cross

Proof Please


So very often these days we hear that the world has deemed to help the portly because they so desperately need help and the world is being nice–and stuff.  Millions upon millions are invested in trying to prove that fat people are unhealthy, and if they would just eat a little less and move a little more, all their problems would be solved, everybody in the world would be healthy, and good, quality health insurance would cost everybody $1.  The fact that despite the millions of dollars spent, nobody has been able to prove these or demonstrate any way to make this magical weight loss happen on all but a fleeting and temporary basis doesn’t seem to deter anybody from testing this hypothesis again and again.

And even when the proof is not available, or indeed the available evidence says that your “weight intervention” causes negative effects and makes people fatter current policy seems to involve simply ignoring those pesky little facts.

Take the current practice of weighing and measuring kids at school and then sending home “BMI report cards”.  Despite showing again, and again and again that shame doesn’t make kids thinner or healthier, showing that shame causes kids to engage in more unhealthy behavior, that shame makes kids fatter, we still do this.  Why?  The National Eating Disorder Information Center issued the following statement regarding BMI testing in schools:

What the American Academy of Pediatrics (AAP) seems to be ignoring in its advocacy of weighing and measuring the height of schoolchildren is the risk it carries not just to increase body-based bullying from student’s teachers and peers, but the risk to children’s developing self-stigma and poor body image.

Body-based bullying continues to be the most common cause of bullying in youth. 29% of girls and 15% of boys are already teased about their weight at home. By grade seven, up to 30% of girls and 25% of boys are teased by other students. Poor body image has been found to stop youth from engaging in social, academic and physical opportunities. It limits willingness to express an opinion. In perpetuating focus on body shapes and sizes rather than on encouraging health providing attitudes and behaviours in children regardless of size, what are our schools (and public health) teaching?

However, it seems that plans to do BMI testing and BMI report cards in schools is continuing throughout North America.

This also reminds me of another recent situation I had recently reported.  Blue Care of Michigan is still touting the positive results of their “enforced march” walking program for fatties despite the fact that there is no evidence at all that those who participated either lost weight, or had any positive health outcomes associated with the program.  They apparently did nothing to track the original fitness level of the plus-sized participants and had no idea whether or not these folks were already active.  They just told these people that unless they wanted to pay an additional $2,000/year they had to participate.  They also forced those who participated to either be a member of Weight Watchers or wear a monitor which counted their steps during the day.  Just like a prisoner, they were forced to wear a physical implement on their bodies that told their insurance overlords what they were doing throughout the day.  Just because their BMI is over 30.  They declared this project a success even though nearly 1/3 of the 12 percent of participants who bothered to respond to the survey said they hated the program and found it coercive.  For more information, you may wish to read this article from my friend and colleague Jon Robison.

Throughout all this rhetoric about making fat people into “healthy thin people”.  Throughout all this spending on proving that fat people can become thin people on more than a very temporary basis and that making fat people into thin people will make them healthy there is one thing continually missing and that thing is proof.

When the available evidence points to the opposite of the fat people can become thin people, or fat people can’t be healthy people or fat kids just have ignorant parents rhetoric, the powers that be either request more money to re-test the hypothesis or simply ignore the inconvenient facts.

You may have heard of iatrogenic effects in medicine.  Dictionary.com defines them as: (of an illness or symptoms) induced in a patient as the result of a physician’s words or actions, esp as a consequence of taking a drug prescribed by the physician.

And good old Dictionary.com also defines iatrogenic as relates to social welfare: “(of a problem) induced by the means of treating a problem but ascribed to the continuing natural development of the problem being treated”.

Some experts have suggested that the “obesity crisis” is a textbook example of iatrogenic effects in both medicine and social welfare.  But I wonder if the “obesity crisis” isn’t responsible for iatrogenic effects in the economy as well.  If the response to the mounting pile of evidence that “diets don’t work” and “shame doesn’t work” and “fat people can be healthy” is always, “let’s pay for more tests” or “let’s do the weight loss junk but try harder this time” the obesity crisis will continue to be very, very expensive.

But I think the treatment for the economic effects of the hysteria surrounding the “obesity crisis” may be as simple as this.  Demand proof.  If your insurance company wants to put you on a walking program without doing an intake of any kind or presenting any data regarding the efficacy of the program, demand proof.  If your kid’s school wants to measure their BMI along with everybody else’s and send home a BMI report card, demand proof that this makes kids happier or healthier.  It’s not easy.  It’s not fun.  But the rights of fat people to enjoy life, liberty and the pursuit of happiness demands that we, the fierce fat folks, demand proof.


The Fat Chick



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Only Fat People Need to Walk: As Indicated by Blue Cross Program

Study showing healthy habits most important for health outcomes.

Study showing healthy habits most important for health outcomes in ALL weight categories.

Oh dear.  I think it’s going to be hard to keep up with all of the discriminatory practices being rolled out by insurance companies to punish those who are fat.  But this new announcement from Blue Cross Network is really above and beyond.

Blue Cross recently announced that its program, offering cash discounts to obese members who agreed to add 5,000 steps a day and be measured via a pedometer was a “success”.  Discounts were significant–representing a cost savings of up to $2,000 per year per family.  Apparently these “discounts” were not offered to anybody who was not obese.  But Blue Cross is claiming success, due to the fact that most of those who enrolled in the program were still walking one year later.

I particularly love the fact that despite the fact that Blue Cross of Minnesota cites this press release as its source, the headline for their online blurb reads, “Money Motivates Weight Loss, One Step at a Time”.  I went back to the original press release.  I read it twice. Not one word is said in that press release about weight loss.  NOT ONE SINGLE WORD.  Holy “make it up as you go” reporting, Batman!  It is possible that there is some mention of the press release in the study announcing the findings.  But there is absolutely no mention of weight loss in the abstract.  And in my experience, were weight loss found in the study, it would be in the title of the study and the first sentence of the abstract.  If anybody has access to the full study, I’d love to know if this holds true.  But in any case, the piece on the Blue Cross webpage did not cite the study but rather the press release as its source.

Now, all of this leaves me with a few key questions.  First and foremost, is walking only beneficial to fat people?  Why in the world are they only offering this incentive to people qualified as “obese”?  There are so many studies that show that modest exercise is beneficial to everybody’s health.  And there’s plenty of evidence showing that healthy habits and not weight loss is what is needed to improve health outcomes?  So why are only fat people singled out for this treatment?  And are these actually “discounts” or are we really talking about being rescued from “fat penalties” not being faced by other insurance network members?

It’s also interesting to note that obese members were allowed to choose between this walking program (created by online biometric site, Walking Spree) or Weight Watchers.  Look, I would clearly pick a walking program over Weight Watchers any day of the week, but I wonder if these “obese persons” were interviewed to see if they had been exercising before this incentive was offered.  Were these people actually sedentary?  What about fit fatties like me who already exercise nearly every day?  Were we offered the same price increases/incentives?  Would I be expected to add this onto my already active exercise program?  Do I have to exercise three times as much as a thin person in order for my exercise incentives to “count” and my discounts to kick in?

I also find it extremely instructive that the first line of the press release reads as follows:

It was a controversial move when a health insurer began requiring people who were obese to literally pay the price of not doing anything about their weight – but it worked, a new study finds.

Okay.  First let’s look at the “not doing anything about their weight” line.  How do we know they weren’t doing anything about their weight?  We know that diet and weight loss attempts fail most of the time in the long term.  Some suggest they fail over 90 percent of the time.  So by “not doing anything about their weight” do we mean that people refused to engage in the dangerous practice of weight cycling? Do we know that people weren’t eating well or exercising before and that they are doing those things now?  Do we know that they were sedentary before and are now active?  Or were some of these people active before and have simply shifted to a less rigorous form of exercise (walking) than before in order to receive a discount on their health insurance?

It’s also interesting to note how the release defines “success”.  Again, nowhere in the release does it state that people lost weight.  Nowhere in the release does it state that there were positive health outcomes or lower healthcare costs.  In fact the final line of the release states:

“Comprehensive evaluations are needed to determine whether participation in these programs translates to meaningful changes in health and costs of health care.”

Overall, I have to state that this press release, issued by the University of Michigan Health System is astonishingly devoid of detail, definition or real facts.  While positively gleeful about the fact that most of the people who elected to participate in this program remained participants for over a year, it really leaves us with more questions than answers.  Did people who didn’t like the coercive nature of the program leave the network for a different insurer?  What were the changes in attitude towards exercise among participants?  Did they grow to like exercise more or see it as a punishment?  What are the long term effects on attitudes towards exercise?  And finally, why are we singling out fat people for this program?  Don’t thin people need to exercise too?


I guess I’m pretty worked up here.  Maybe I’d better go for a walk to blow off some steam.  Because some of us fat people go for walks even without “finger-wagging”, “pedometer-wielding”, “biometric-tracking” moralists telling us to do so.


The Fat Chick

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