Tag Archives: insurance

Doctors Consult on Fat Profits from Medical Weight Loss Programs

New profits from an old formula

A recent article in the New York Times got my blood boiling this morning. The article cites a few medical professionals (and others) talking about how to fatten profits from offering weight loss products, potions, procedures and magic pills. In particular Dr. Kaplan (touted as a “leader in the medical weight loss industry) talks about his Long Island Weight Loss Institute and the various products and services he offers people to help them lose weight.

In fact, Kaplan is so well known as an expert in the industry that he has started a consulting business to help other doctors. Is he helping other doctors figure out what are the best evidence-based options for helping their clients actually lose weight. Well no. He’s helping doctors figure out how to increase their bottom line by teaching primary care doctors how to bill insurers for obesity treatments.

This is a very big business, at least in part, due to a provision in the federal health care law requiring insurers to pay for nutrition and obesity screening. Marketdata Enterprises Research Director John La Rosa has studied the weight loss industry for more than 20 years. In an interview cited in the Times, La Rosa estimates that medical weight loss programs currently bring in $1 Billion annually–a number he expects to grow 5 percent annually at least through 2019. La Rosa calls the Federal health care provision a “game changer” and mentioned a seminar he recently sponsored advising entrepreneurs to take advantage of the insurance coverage by opening their own weight loss clinics.

While the profits appear to be new, the procedures being sold don’t seem to be new at all. In fact many of the procedures, potions, chants, and magic pills offered have not been proven to be effective or have even been discredited as widely ineffective. Kaplan’s own office offers very low calorie diets, meal replacements, B12 shots and vitamin supplements. None of these techniques have been demonstrated effective for anything but very short term weight loss which typically begins to reverse very shortly after the treatment period (which can be as short as six weeks). What’s more, many of these programs offer little medical supervision. The patients are often actually seen by nurse practitioners or physician’s assistants with little specialized training in the fields of nutrition or bariatric care. One company, Medi-Weightloss (with over 76 locations throughout the country) advertised for a medical director at its Connecticut facility stating that the hours are “not very demanding” stating that files could be reviewed remotely and “there are no set hours or emergency calls”.

Now don’t get me wrong. I think most doctors work very hard in a system that is not very hospitable to good medicine. And I am an entrepreneur. I believe in the power of invention and good business practices. But when you are holding seminars to teach guys in white coats the best way to get insurance companies to reimburse the same snake oil they have been trying to sell us for centuries, I get a bit miffed. I think people are entitled to research-based medicine. And by research-based, I mean medicine that is proven to be effective, not just turn an ever increasing profit.

In this country, not everyone has access to even basic, decent medical care. Medicine is very expensive here. And we are often taught that the reason that medical care is so expensive here is that the fatties are driving up the costs. So the idea that doctors are learning to fatten their profits at the expense of their fat patients has got me more than a little upset. Lets give every BODY access to bias-free, evidence-based, reasonable healthcare. And let’s put the fat-shaming, profit mongering medical weight loss industry on restriction. That would seem to be the healthy thing to do for our bodies and for our economy.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. Want me to come and speak about evidence-based medicine and wellness to your group? Go here. Or just email me at jeanette at thefatchick dot com for more info.

Why BMI stands for “Blatantly Meaningless Information”

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Yup, higher shoe size means higher BMI. Maybe we should re-institute foot binding for better health?

The LA Times has published another awesome article, this time taking aim at BMI. The article headline states “For nearly 1 in 5 Americans, BMI may tell the wrong story”. Although one of the main studies actually places the misdiagnosis statistic closer to 2 in 5 Americans, I have to give the LA Times credit for posting this story which goes on to detail something that many of us in the HAES (R) universe already know: BMI is not a good predictor of individual health. In short:

Having a high BMI does not mean you have poor metabolic health. Having a low BMI does not mean you have good metabolic health.

So why is this important? Well for a lot of reasons. First off, if your doctor is using BMI to determine whether or not you should get further screenings or tests, he or she is using an extremely unreliable metric to make this determination. This means as a fat person you may be exposed to a lot of tests you really don’t need. This means as a thin person, your doctor may miss some stuff that is really important or even life-threatening. I often wonder if a significant proportion of the medical costs associated with fat people are because we have so many more tests done. Or even if higher percentages of certain diagnoses among fat people are in part because we look so much harder for these diagnoses among fat people.

Another reason that BMI bias is such a big problem is that the workplace wellness gurus are using it to coerce or even force us into interventions that may be entirely inappropriate for us. For example, I’ve been talking a lot about this Michigan “walking program” for fatties. BMI was used as the sole determinant as to who had to participate. Those with higher BMIs were told they either had to wear a pedometer that reported their steps to the “home office” or they had to go to Weight Watchers. There was no initial fitness assessment done. There was no assessment of eating behaviors. The program simply assumes that people with higher BMIs don’t engage in fitness and eat very poorly. It’s entirely possible that people in the program had to reduce other, more strenuous and more enjoyable exercise programs in order to comply with the stupid walking rules. It’s entirely possible that people in the program with well-balanced healthy eating habits were encouraged towards more disordered eating habits after their new stint with Weight Watchers. It’s almost certain that people with low BMIs who are also sedentary and eat nothing but junk food were patted on the head and told to “keep up the good work”.

But we’ll never know because they never tested this stuff.

You know what? When company money and government money and my money gets spent on stupid health programs that are just as likely to make people less healthy than before, and nobody bothers to test the hypotheses because “fatties” I get pretty annoyed. In fact I’m crossing right over the line towards enraged.

It’s not like this research is all new. It’s not like the problems inherent in the BMI as a measurement of individual health haven’t been known for decades. But as long as entire industries are set on putting their fingers in their ears and chanting, “La, la, la, I can’t HEAR you!” I’m just gonna have to keep on saying the same things over and over and over. As long as people walk around with misdiagnosed brain injuries because doctors simply think they need to lose weight, as long as thin people miss out on important medical screenings because they are assumed well, and as long as some insurance programs think it’s okay to strap a piece of hardware to my a@@ to track whether I’m moving enough just because of my dress size, I’m gonna keep on talking.

You hear that universe? I’ll keep shaking my chubby fist and you and shouting that your BS. Measuring. Instrument. is not a valid way to understand anything about who I am.

Love,

The Fat Chick

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Boy Scouts, BMI and Managing Risk

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Would the BSOA deem Russell “too fat” to go to camp?

Yesterday, I read Ragen Chastain’s amazing post on the new policies implemented by the Boy Scouts of America regarding participation in events and BMI. In order for any Boy Scout to participate in a “high adventure” activity which includes a duration of over 72 hours and being over 30 minutes drive from emergency medical services, his parents and doctors must fill out a group of forms including Part C which has a whole lot of questions about BMI. In fact questions about height and weight are the first things listed on the form before listing any pre-existing conditions or other information about disease or wellness. Any scout with a BMI over 40 will be forbidden from participating in these high adventure activities (including the Jamboree). And according to the site:

The Jamboree Medical Staff will review all applicants with a BMI of 32.0–39.9 and consider jamboree participation based on 1) health history, 2) submitted health data, and 3) recommendation of the applicant’s personal health care provider. For applicants with a BMI >31.9, a recommendation of “no contraindications for participation” by the applicant’s personal health care provider does not necessarily guarantee full jamboree participation. The jamboree medical staff will have final determination of full jamboree participation.

The Boy Scouts of America (BSOA) site, lists these reasons for the new restrictions:

“Anyone who is obese and has multiple risk factors for cardiovascular/cardiopulmonary disease would be at much greater risk of an acute cardiovascular/cardiopulmonary event imposed on them by the environmental stresses of the Summit. Our goal is to prevent any serious health-related event from occurring, and ensuring that all of our participants and staff are “physically strong.”

And frankly, all of this sent me scrambling for my manuals and training information about exercise in children. One question I had right away was, “Are they using data for all-cause mortality in adults and extrapolating that information for children?” Because, the data I’ve reviewed indicate that mortality among exercising children and teens comes from different sources that that of adults.

According to the Youth Sports Safety Alliance, the number one cause of death among exercising young athletes is Sudden Cardiac Arrest (SCA). During my fitness certification training, I learned that the number one cause for SCA is a heart defect called hypertrophic cardiomyopathy, a thickening of the heart muscle. Hypertrophic cardiomyopathy and other heart conditions likely to lead to SCA are often virtually undetectable from a standard physical exam. This is why many schools are starting to recommend and a few are beginning to require a EKG for participation in strenuous school sports. When SCA occurs, death often follows. Being close to a hospital only helps so much as mortality risk increases by 10 percent for every minute it takes to get to medical care. This is why there is a greater focus on CPR and Automatic External Defibrillators for helping to protect student athletes these days.

I am not aware of any research indicating that SCA is more frequent among overweight or obese young athletes. I am also unaware of any efforts on the part of the BSOA to ask that participants in high adventure activities be screened for hypertrophic cardiomyopathy or be given an EKG as part of the Part C form. Now, I understand that an EKG can be expensive to administer and read, but if the concern is really about the safety of the participants, it would seem that this is a more important test than BMI.

Another important risk for kids and strenuous exercise is heat stroke. And there is some research that indicates that heat illness is more frequent among overweight and obese football players than “normal weight” players. But many experts stress that exertional heat illness is 100 percent preventable. Most experts strongly recommend an acclimation process to help get student athletes ready for physical exertion. The super punishing, first day of practice workouts in full pads and gear is now frowned upon. I wonder if the Jamboree and other “high adventure” scouting activities really do enough to help scouts of all sizes acclimate to higher temperatures and altitudes or if they simply assume that as long as the kids are skinny, they will be safe.

Which makes me wonder. Where is the data? Show me the data that BMI has a serious impact on safety for children and youth who wish to participate in strenuous physical activity. Do not simply show me studies from adults and extrapolate down to kids. And if the health and safety of your scouts is of primary importance, why are you not requiring adequate screening for the leading cause of death among young exercisers? Are you building adequate acclimation days to make the camp safe for participants? Or again, are you assuming skinny = safe and healthy? And why are you making your most important event so strenuous that you have to worry so much about health and safety in the first place?

To borrow from a famous phrase from the film Jerry Maguire, “Show me the data!”

Love,

TFC

Like my posts? You’ll love my stuff!

Buy my book: The Fat Chick Works Out! (Fitness that is Fun and Feasible for Folks of All Ages, Shapes Sizes and Abilities)–available in softcover and e-book versions

Buy my DVD: The Fat Chick Works Out! (A Safe, Easy and Fun Workout for Klutzes, Wimps and Absolute Beginners!)

Buy a book or a DVD for a friend and save $5! Just enter FRIENDBLFT in the discount code box!

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Why I am NOT Shopping at CVS

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Employees of “Gattica” surrender a drop of blood for analysis before starting work each day.

There’s been an awful lot of talk lately about CVS and their recent decisions regarding health care for their workers. It seems that CVS has implemented a policy that states that employees have a choice between submitting to a health screening or paying $600 more per year in health insurance premiums. The screening (paid for by CVS) will measure several “health metrics” including blood pressure, blood glucose levels, cholesterol, height, weight and BMI. Apparently this information will then be turned over to a third party. What we don’t know is what the third party plans to do with this information and how the third party and/or CVS will use this information to help their employees be any healthier. I submit that helping employees be healthier really has nothing to do with it.

Look, if you want to give your employees incentives to see their doctors twice a year–fine. Regular checkups with your doctor make sense. They help employees manage health and catch problems early. But I can think of no reason why handing this information over to anyone other than your own doctor will do anything to improve your health. Not one.

The only reason to hand this information over is so that a company–be it CVS or a mysterious “third party company” can start harassing you for being in a “higher risk” category. That harassment may come in the form of emails or phone calls. That harassment may come in the form of additional payments you need to make as long as you stay in a “higher risk” category. And believe me, the quotation marks are deliberate when I say “higher risk” category.

Every single one of these metrics has a strong, and I mean STRONG genetic component. They are not measures of behavior or lifestyle. They are statistics about bodies. Lifestyle may be a component of having diabetes in some people. Some people are simply born with a very high disposition to diabetes. So you may have two people, one diabetic and one not who engage in extremely similar lifestyles with very different outcomes. The same is true of cholesterol levels and blood pressure. So how is this not a Gattica style punishment of people who were born with less than perfect genes? How much longer before, like in the movie, we will be forced to leave a drop of blood in the scanner before starting work every morning?

And then there’s the question of collecting height, weight and BMI data. Despite the overwhelming evidence that BMI, height and weight do not serve as accurate measures of personal health, we are still collecting this data. Why? I’ll tell you why. Because fat people are discriminated against in this country. Fat people are blamed for everything in the US from rising health care costs to rising prices on airlines. If you have to look to a socially acceptable scapegoat on which to visit higher health insurance prices, you will choose the fatties. Don’t believe me? Just check out the comments section of any news story covering this decision by CVS. They are universally full of righteous thin people talking about how those fatties are driving everybody’s costs up and deserve to be punished “for their own good”.

Some argue that insurance companies already charge smokers more money. But let me be very clear about this. Smoking is a behavior. You can choose to smoke or not to smoke. You don’t need to smoke to survive. Weight and BMI are characteristics. You CAN NOT determine what a person eats, how much they exercise or how healthy they are by looking at their BMI. All you know is the proportion of their height to their weight, and the proportion of extra costs and stigma it is socially acceptable to heap upon that person.

Other risk behaviors are notoriously expensive and difficult to monitor. Behaviors like drinking, not sleeping enough, distracted driving, uncontrolled stress, not looking before you cross the street and skydiving cannot be measured with a 10 second test in a doctor’s office.

So to reiterate, why are we using weight and BMI to measure a persons health risk rather than behaviors?

1. Unless you actually watch a person or test a person all the time, it is difficult to know whether they are telling you the truth about stated behaviors.

2. BMI and weight, while poor proxies for real data about health require only extremely easy and inexpensive tests to determine.

3. It is socially acceptable in our country to blame fat people for anything and everything.

This is why I will no longer shop at CVS. They have chosen to pass insurance costs on to those who may or may not engage in higher risk behavior than their co-workers but are probably less genetically blessed than their co-workers. And they are already passing health care costs on to those of us who are already discriminated against when seeking a job and are already payed less than those of us who are thin. It’s not okay with me.

Love,

The Fat Chick