Tag Archives: health insurance

Does Eating Margarine Cause Divorce? Correlation is not Causation.

There’s a lot of buzz on the list serves about a new website that just launched called Spurious Correlations. The site reports a new “correlation” each day. For example, the site points out that the correlation in Maine between eating margarine and divorce is over 99 percent. Does this mean that Maine residents who want to maintain their matrimonial bond need to switch right on over to butter? I mean 99 percent seems pretty darn compelling, right? There are lots of other important correlations listed on the site including:

Per capita consumption of mozzarella cheese and civil engineering doctorates awarded–95%

Honey producing bee colonies and the marriage rate in Vermont–93%

US domestic price of uranium with accidental poisoning by alcohol–97%

Spurious Correlations is a wonderful tool for demonstrating that oh so important axiom, “correlation is not causation”. This means that just because two things tend to happen together does not necessarily mean that one causes the other. They might have a third agent which is causing them to happen together or they might have no relationship to one another whatsoever outside of a random statistical similarity.

I think that Spurious Correlations is a fascinating site. I’ve spent way too much time tooling around in there. But I also think it is an important tool for helping us understand our world. Because so many of the people writing and talking about science on websites and blogs, on television, in magazines and newspapers get this relationship between correlation and causation so very wrong. I think in some cases the writers and speakers don’t understand the difference. But in other cases, I think the writers are very clear about the difference and simply report correlation as causation because it makes better headlines or sells more product. Take this blog post for example. I don’t have any proof that buying margarine causes a single divorce in Maine. But I imply that there might be a cause by asking the question in the headline: “Does Eating Margarine Cause Divorce”? It’s easy to see why I did that. “Per Capital Margarine Consumption in Maine Closely Correlates with Divorce Rate” just doesn’t have the same ring to it. But I think most people would agree that even though butter tastes a whole lot better, eating oleo is unlikely to be the cause for divorce. Either something else is going on to connect these two statistics, or they are completely unrelated. So the difference between correlation and causation here is pretty easy to spot.

But what about the correlation between the total number of computer science doctorates awarded and total arcade revenue. These two facts correlate at over 98 percent. And it would be pretty easy to formulate a theory about how these two facts are related. Maybe when there are more computer science students, it means there are more nerds that love to play arcade games. Maybe more computer science doctorates means there are more nerds qualified to design and implement great arcade games. With just the tiniest whiff of a potential relationship, our minds naturally leap to find ways that one of these facts could cause the other. But there remains the very distinct possibility that there is no causal relationship whatsoever between these two statistics.

I find this particularly relevant in our current national hysteria over obesity. It seems every week there is a new study claiming that this thing or that thing causes obesity. And everywhere you look you see “proof” that obesity causes this problem or that problem. But I think it is important for us to keep our wits about us and take a look whether these studies can sufficiently demonstrate that two correlated facts have a causal relationship. For example, people are spending more time in front of computer screens than ever before. Some have suggested that increased screen time causes obesity. But do we know that is true? Or are these things simply happening at the same time. We also have more 24 hour gyms than in the previous century. Is it reasonable to suggest that the increase in 24 hour gyms causes obesity? Maybe dieting causes obesity, or exposure to certain plastics? Heck, based on the correlation, one could easily suggest that talking about obesity increases obesity levels! And how about the rise in medical insurance costs and the rise in obesity. Does a larger number of fat people cause higher insurance rates or is there something else going on? The question of the rise in health insurance rates is detailed and complex but how many people have simply jumped to the conclusion that the fatties are making their monthly premiums higher. How many of us take the time to understand: the only way that we can prove that one thing causes for another is through careful experimentation where as many other variables as possible are ruled out and a causal agent is ultimately found.

So when you come across studies that demonstrate a relationship between say obesity and heart disease or obesity and cognitive function, I urge you not to just jump blindly onto the causation train. Ask yourself a few questions:

Has this study adequately controlled for other causal factors? Has it controlled for diet, physical activity levels, socioeconomic status, access to good healthcare, education, etc.?
Has this study identified a causal link that demonstrates why these two things are happening at the same time?
Is it possible that these two statistics are simply randomly related with no causal relationship whatsoever?

That is not to say that correlation never go together. All causal relationships are also correlations. But not all correlations contain causation. These are important facts to keep in mind the next time you read a headline screaming about the causes of obesity or harm caused by obesity–or the next time you decide to buy margarine in Maine.

Love,

Jeanette (AKA The Fat Chick)

P.S. Want to go on a virtual vacation? Ragen and I over at the Fit Fatties Forum are launching Virtual Vacations that allow you to exercise while virtually visiting some of the world’s most fabulous cities!

Do I owe it to anybody to lose weight?

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Ahhh, the holidays! It’s a time for sharing food, family, friendship and GUILT. I recently shared some thoughts about setting boundaries for the holidays here. (And of course, there’s always this video.) For the most part, I find people can learn to respect the boundaries we set about talking about (or choosing not to talk about) our weight. After all, our bodies are our business, and not anyone else’s. But there are always those few people who find it their “moral obligation” to police our bodies. And those people will usually use one of the following arguments to keep talking about our weight and our bodies even when we ask them to desist:

1. What about your children? Don’t you want to be around to see them grow up, get married, have children of their own, and retire? First of all, let me remind you that you won’t be there to care for your children if you spend the rest of your life in prison. So, put down the butter knife and back away slowly. Seriously, this is like DEFCON 5 in the guilt wars over your body, so I can see how it might make you very upset to hear this, but let’s talk it through, okay? First of all, please remember that weight and health are not the same thing. Most people only have a limited amount of control over how much they weigh. And while there are some things we can do to help increase our odds of having a healthy life, none of us knows how many days we have left on this earth. One of the things that you can do to increase your odds for a long, healthy life is to manage stress. So as much as you want to strangle Aunt Thelma for asking this question over the holiday ham, please remember to take a moment and just breathe. Some other things you may be able to do to increase your odds are to exercise regularly, sleep well, eat a wide variety of healthy foods (especially fruits and vegetables), and engage in some regular activity to help manage stress. Note I said that these are things you may be able to do. Obviously, if you’re working two full-time jobs and taking care of a few children, stuff like stress management classes, regular exercise, or getting any sleep may not be possible for you right now. Not everybody has access to the same opportunities for healthy stuff (more on that in a minute). And maybe if Aunt Thelma is so concerned about your health, maybe she can babysit your little darlings three times per week while you take an exercise class, meditate, or just have fifteen minutes to go to the bathroom all by yourself.

2. But my health insurance rates are higher because of fat people like you. Oh dear. First of all, I strongly recommend assiduously avoiding any discussion of health insurance during holiday gatherings this year. Put it on the list with climate change and which direction the toilet paper roll should go into the holder as points not to be discussed during the holidays. But if your gentle attempts to deflect a discussion about how the size of your hips affects your Cousin Tony’s insurance premiums fall on deaf ears, here’s a few things you should know. First and foremost, there is only a narrow window of things that we have any control over when it comes to health. Fall Ferguson discusses this in a great post on the ASDAH blog here. In particular, she mentions the CDC’s discussion of Social Determinants of Health and references this diagram:

As you can see, health behaviors only account for a relatively small section of the overall determinants regarding whether or not a person is healthy. And notice it says health behaviors. To be very, very clear here, body weight is not a behavior. You cannot tell how healthy somebody is or whether or not they engage in healthy behaviors by looking at them.

Now, back to your Cousin Tony. He seems to think that if you would just lose weight, you would suddenly cost the health insurance companies less and somehow his premiums would magically go down. Well to start with, as a fat person you may be denied access to health insurance altogether. I have a number of fat friends for whom this is the case. So you may not be affecting his premiums at all. Also, if Tony wants to keep his insurance premiums down, then perhaps he can help raise your “social/societal” characteristics or socioeconomic status. After all, that has nearly twice as much effect as the whole healthy behaviors category. All he has to do is, pay you enough money to move you into a different economic bracket. No? Well maybe Tony can pay for child care so you can go to the gym more often, or pay you enough so you can quit your day job and get eight full hours of sleep for once? What’s that you say? Tony isn’t interested in paying for any of this stuff? Well maybe at least Tony can commit to fighting for social justice. Tony can take his pick. He could find for bias free healthcare or reasonable working hours or access to healthy foods or good preventative medicine. No? Well then maybe Tony just needs to shut up. Oh and let me remind you just one more time; Tony cannot tell whether you engage in healthy behaviors just by looking at you. Speaking of which:

3. I don’t like having to look at you because your fat body hurts my delicate aesthetic sensibilities. Most of the time, the answer to this statement is simple. Just. Don’t. Look. If your Dad’s friend Jim finds it uncomfortable to look at your fabulously fleshy frame, he can just look the heck away. You are under no obligation whatsoever to be attractive to anybody’s gaze or be considered as an object of lust. This situation is far less simple however, when you are talking about your spouse or your kids. I am unbelievably privileged to have a husband who thinks my fat body absolutely rocks his stripy socks. But I understand that not all women (or men) have a spouse that thinks this way. I have seen marriages get hopelessly tangled around one spouse helping another to lose weight “for their health” all the while not discussing the real issues around body size and sexual attraction. I have seen kids use weight as a tool to hurt their parents (and vice versa). I have seen kids who ask that the “thin parent” be the one to appear at school functions and do public things with the child in order to “escape embarrassment”. First, let me say that if this is happening to you, I’m sorry. You absolutely do not deserve this, and my heart hurts for you. Second, let me tell you that this situation is far beyond what I can cover in my humble little blog. There are no funny or glib comments that I can make here that will make this problem just go away. Let me suggest that you do whatever is in your power to find help. Maybe you can get some family counseling. A lot of counseling is available on a sliding fee scale based on your income. Perhaps a clergy person can help. If your family is not willing to go to counseling with you, maybe you can at least find some counseling for just yourself. And let me also offer some hope here. I have known people in this situation that were able to find help. And I have known marriages and families that have come through this with relationships intact and stronger than ever. Find some help, and hang in there.

Summary There is so much more I could say about this topic. In terms of my own health practice, I’d really like to get a little bit more sleep. So let me wrap this thing up. Regardless of what you decide to say to your Cousin Tony and your Aunt Thelma, please remember this: you do not owe it to anybody to lose weight. You don’t owe it to yourself, and you certainly don’t owe it to anybody else. Your body is your business. If Aunt Thelma and Cousin Tony are actually concerned about the state of your life and the state of your health, I’ve already suggested some things you can request. They can pay for your meditation classes or do a little free child care (as long as they aren’t expecting weight loss, or any other specific outcome in return). However if Tony and Thelma are just trying to pass a little holiday guilt and judgement along with the gravy boat, they can just step the heck off.

Ho, ho, freaking, ho.

Here’s wishing you a holiday that is peaceful–or at least calm enough to avoid homicide.

Love, Jeanette (AKA The Fat Chick)

P.S. Looking for a little help? How about joining my personal training program? Prices are going to go up in January, so why not lock into some holiday savings right now?

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Workplace Wellness Doesn’t Heal the Bottom Line

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I think we’ve seen lots and lots of press of late concerning workplace wellness. There are a variety of companies charging huge premiums to corporations promising companies healthier employees. And each of these companies, in turn, promises a healthier balance sheet by reducing worker healthcare costs. A lot of c-level employees have spent a fair amount of company cash on these promises. So it’s probably not surprising that when Rand Corporation issued its recent report concerning the effectiveness of workplace wellness programs there was a scramble.

Rand Corporation briefly posted the government-mandated report on its site last Friday. Very shortly after it was posted, it was withdrawn. The following statement was posted in its stead:

“This document was posted in error and has been withdrawn pending completion of contractual obligations to the project sponsor.”

Before the document was pulled, Forbes magazine managed to snag a copy. Forbes didn’t waste any time posting an article about the findings of the report. I’ll summarize the report for you here.

Most workplace wellness programs don’t work.

Yup, you heard it. It seems that most of the millions and even billions of dollars of corporate cash being dumped into workplace wellness programs that don’t offer any statistically significant benefit. In short:

1. Most workplace wellness programs don’t lead to better health among employees.

2. Most workplace wellness programs don’t lead to statistically significant weight loss in employees. On average attendees of the wellness programs lost 1 pound per year for three years. Even those few programs that showed larger weight loss numbers, were not able to sustain the benefits.

3. Most workplace wellness programs don’t lead to better behavior. Even smoking cessation programs generally led only to “short term” improvements.

4. Most workplace wellness programs don’t lead to better health markers. There were no statistically significant improvements in blood pressure, cholesterol, or blood sugar.

5. Most workplace wellness programs were unable to demonstrate lower costs for hospital or emergency care.

The bottom line is that, as a whole, the workplace wellness programs cost the companies money and did not create statistically significant cost savings. In fact, on average, cost savings averaged $2.38/month for year one and $3.46/month for year three.

Not long after Forbes published its article, it seems that the cat was well and truly out of the bag. And the Rand Corporation published the report. You can see the full PDF here.

All of this is especially relevant to us fat folk. For the past few days, I have been at the ASDAH Conference. I’ve been leading fitness classes, speaking about Health At Every Size(R) and hearing a LOT about how workplace wellness programs disproportionally affect people of size.

The fact is, that a lot of workers who don’t have a “government-sanctioned” BMI or waist circumference are required to choose between paying higher premiums and enrolling in company “workplace wellness” programs. Many of these programs violate worker privacy and shame workers in front of co-workers. Imagine if you are required to go to a workplace-sponsored “Weight Watchers” program and are required to step on a scale in the same room with your boss or your co-workers. Just think about the trauma this could cause. Then think about that trauma in light of the fact that these programs simply don’t work. The programs don’t help you lose weight in the long run. These programs don’t help you be healthier. And these programs don’t even save the company money. It’s a lot of personal drama and trauma that provides absolutely no benefit to anyone outside of the company selling the workplace wellness program and Weight Watchers.

It doesn’t benefit the companies. Which isn’t a super big surprise, given the fact that many c-level employees fail to scrutinize or even understand these programs before they are implemented. According to the RAND report, only 44% of companies who used wellness programs have ever evaluated them and only 2% have “detailed information” about how much the company has saved as a result. Uh-oh. There goes that boat you were gonna buy with your annual bonus.

It doesn’t benefit employees. Many employees resent being asked to show up at potentially embarrassing, and decidedly time-consuming programs that don’t work. They don’t like it and it doesn’t improve their health. Um, check please!

As advocates of Health At Every Size, this is a space that will be worth watching. In the meantime, I offer this health advice absolutely free:

1. Manage your stress.

2. Get good quality and quantity sleep.

3. Move around in a way that feels good and joyful to you.

4. Eat a wide variety of foods that taste good to you, and take time to savor and enjoy them.

5. Connect often with people you love and people who love you.

All that stuff is scientifically proven to improve your chances at good health. And you didn’t have to take time off work, step on a scale or tell your boss your intimate health details to get that information. You’re welcome.

Love,

The Fat Chick

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Teenage Boy “Diagnosed Fat”–Infection Missed

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How many times have we heard this same story? A vibrant, active young man goes to the doctor, in this case, with knee pain. The doctor does a routine test and doesn’t see a problem. The doctor does see a young man who fits into an “undesirable” segment of the BMI chart. The solution, the young man is diagnosed as fat, is told that his “extra weight” is probably causing the pain in his knee and sent home. Now Kaleb is an active kid. He plays rugby, and he loves to sail. But once the doctor sees Kaleb’s place on the BMI scale, he just might think something like this: “Aha! I don’t have to say that I don’t know what’s wrong with this kid’s knee. I can write obesity in the kid’s chart and then we have a diagnosis!”

Unfortunately, in Kaleb’s case there was another diagnosis besides “fat” to be found. A short while later, he was taken to the hospital via ambulance after he fell down some steps. At that point, he was referred to a specialist that he saw two weeks later. The specialist ordered an MRI and during the scan they found a serious bone infection. Kaleb was scheduled for emergency surgery the same night. He is recovering well. So thankfully, the story has a happy ending.

But how much pain could have been avoided without the “fat diagnosis”? It appears that had this infection been detected earlier, it could have been treated with antibiotics rather than emergency surgery. Now there’s no guarantee that had Kaleb been thin, they would have found the infection sooner. They might have still sent him home and told him to take some aspirin and take it easy. Thin people are misdiagnosed too. But I’ve heard time and time again about people who are “diagnosed fat” and sent home. Remember this guy who was diagnosed fat, and it turned out to be a brain tumor? Remember his emergency surgery? I wonder if doctors, frustrated by a lack of diagnosis and discouraged from ordering expensive tests don’t lean on the BMI chart as a way to have something to write in their diagnosis box. I imagine in many cases, once patients are “diagnosed fat” and are shamed and blamed, they stop asking annoying questions. They stop demanding that doctors figure out what is wrong with them. In some cases, they stop going to the doctor altogether. This is part of the collateral damage and opportunity costs in the “war on obesity”. This is another example of the casualties that arise from singling out a body type as unacceptable and trying to eradicate it.

And we’re not just dealing with misdiagnosis here. We’re dealing with fat people suffering and dying from the mutilation of otherwise healthy tissue via gastric bypass and banding surgeries. We are seeing the development of more and more new strategies for trying to make fat people “healthy” by making their digestive systems mimic eating disorders and limited blood flow to the gut. We are so focused on helping fat people get healthy by making them thin that we are willing to make them really, really sick to help them get there. And sadly, in so many cases, the fat people who undergo these treatments end up fatter or sicker or less happy than they were in the first place.

There are weapons we can use in this war. One of them is to ask the doctor if thin people also experience the same problem. In Kaleb’s case, he or his mom might have asked, “Do thin people also have knee pain? What tests might you do if I were thin. Can we do those tests please?”

Another weapon is to help make doctors and other medical professionals more aware of the pain and repercussions of fat bias. And it just so happens that we have some terrific tools to do that. The Association for Size Diversity And Health (ASDAH) along with the Size Diversity Task Force are compiling videos about fat bias in healthcare. The project is called RESOLVED. Some folks at ASDAH have informed me that the deadlines are being extended. You can hear more about the project and see my sample video HERE. In addition, the Size Diversity Task Force has a unique opportunity through one of our members to help train medical advocates about fat bias in healthcare. But in order for your video to be used in both places, you need to submit your video by March 18. If you’re interested in participating in the project and/or have any questions or concerns, please leave me a note in the comments below. Or send me an email at jeanette at thefatchick dot com. I’d be glad to help.

Let’s do what we can to limit the number of casualties in the war on fat. Let’s help kids like Kaleb get the attention and care they need at the first doctor’s appointment–not the third. Let’s see what we can do to have “diagnosed as fat” be a thing of the past!

Love,

The Fat Chick

Where there is Hatred, Let’s Sow Love

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Recently my good friend Deb Lemire sent me a link to this amazing Ted talk. Why not go take a look right now? It’s that good. I’ll wait.

It’s clear to me that Lynne is an amazing woman–one I’d love to meet one day. She said many, many true and moving things in her short talk. But one of the things I’d particularly like to talk about today is her discussion of the war on obesity, and her assertion that war is about hate.

I think it’s important to share this business about this war on obesity. There are new people every day who join the ‘righteous’ and march out in this war. The recruits are now younger and younger with indoctrination beginning in kindergarten and even preschool. So what’s wrong with it? Why not fight against this crushing “disease” which is “killing our children”?

In answer, I’d like to begin with two words: collateral damage.

I think many of us have been caught in the “friendly fire” of the war on obesity. Many of us have seen the disapproving looks as we dare to order a roll (maybe even with real butter!) to eat with our salads. We’ve been photographed and filmed with our heads cut off and displayed for the wartime propaganda. We’ve been made scapegoats and blamed for everything from high prices for flying and insurance to global warming. We have been named bad parents and some of us have even had our children torn from our grasp. We are the butt of the joke, the cautionary tale, the perennial ‘before’ photo and the ’cause of the downfall of the human race’.

Except, for one problem. It ain’t necessarily so. There is little evidence that fat people raise health insurance rates to any significant degree. Flying is expensive because of a whole host of reasons including high fuel prices, inept airline management, a complex web of travel taxes and tariffs and poor aircraft upkeep among many other factors. There is little reason to blame fat people for any of the problems the world is facing right now.

And even beyond those issues, there is one other. The war can’t be won this way. You can’t hate fat people thin. For all the marching and the propaganda and the fabulous uniforms and billions of dollars spent, people aren’t getting any thinner. All the money we’re spending and the people being emotionally and physically damaged in the crossfire is for nothing. We are not making people any thinner.

I’d say that perhaps some of this money should be spent on determining what should be done to make the world healthier and happier without causing massive casualties from collateral damage, except we already know what actually works. It’s called Health At Every Size or HAES and it’s for every BODY. There is a lot of evidence that healthy habits are a better determinant of health at all sizes than body size. So HAES simply suggests that we work on making healthy behaviors available and attractive to folks of all sizes, and stop trying to make fat people into thin people.

Why can’t we focus on health irrespective of size? Why can’t we focus on making healthy options like good locally sourced food and safe places to walk and play for people of all sizes, races and economic levels? Why can’t we focus on teaching our children to love and respect their own bodies and those of everyone around them?

We can. As it says in the prayer of St. Francis of Assisi, “where there is hatred let us sow [your] love”. So, let’s do it! Let’s commit to being body pacifists. Let’s throw down our weapons and walk out on the battlefields and bring aid and succor to those who are hurting out there. Let’s find the kids who are wandering around shell shocked and bewildered and show them that there is another way. That making a healthier body is about having a healthier community and a healthier world forged from love and not hate. “Let there be peace on earth, and let it begin with me.”

Love,

The Fat Chick

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