Tag Archives: obese

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

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?

Aaaaaargh!

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.

Love,

The Fat Chick

P.S. If you’re looking for a form of exercise that doesn’t come with doom and gloom weight loss messages or any finger wagging whatsoever, you might enjoy buying a copy of my DVD. And if you are a member of the Fit Fatties Forum, you’ll receive a special discount. Just click here to order and type FFBL in the discount code box!

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