On Obesity Increasing Health Costs

This is related to the study linked to and commented on by Bri at Fat Lot of Good:

Few things I noticed:

The percentages skew towards the obese:

Of the 11 247 participants examined in the 1999–2000 AusDiab study, data were available in the 2004–2005 follow-up survey for 6140 (54.1% female; mean age, 56.5 years). Based on BMI, 31.6% were normal weight, 41.3% were overweight and 27.0% were obese. The proportions with normal WC, abdominal overweight and abdominal obesity were 32.8%, 26.3%, and 41.0%. When combined definitions (based on BMI and/or WC) were used, 24.7% were normal, 32.4% were overweight and 42.9% were obese.

The 2007–2008 NHS reported similar BMI-based rates for adults aged ≥ 25 years: normal, 34.1%; overweight, 39.1%; and obese, 26.9%.

This seems to be because they included WC obesity, not really something I’ve seen done much so far in these epidemiological studies. It would suggest there are many more ‘obese’ people than the BMI suggests.

Note: no controls for weight-based interventions. That is, costs associated with bariatric surgery (to include these would seem like the dog biting its own tail, as it were). Also, no controls for when fatness is a symptom of a condition in an obvious way, like a side-effect of certain prescription medications or a symptom of PCOS or hypoglycemia. This studies skews fatness as ’cause’ of greater medical costs, when fatness can be a symptom of conditions which would naturally push costs up.

In that same breath, diseases with a symptom of wasting (like some cancers) should be controlled for.

The mean annual payment from government subsidies was $3600 (95% CI, $3446–$3753) per person (Box 1). Based on BMI, government subsidies per person increased from $2948 (95% CI, $2696–$3199) for people of normal weight to $3737 (95% CI, $3496–$3978) for the overweight and $4153 (95% CI, $3840–$4466) for the obese. A similar trend was observed for WC-based weight classification.

This isn’t saying anything new. We’ve known for a while (need a link here) that poorer people in our modern society tend to be fatter than richer people. Poorer people consume more government subsidies. Hence fatter people consume more government subsidies.

I think that this study could have been much more rigorous if they would have done a few things:

  1. Controlled for obesity-related interventions like bariatric surgery and weight-loss interventions
  2. Controlled for costs associated to conditions and medications that clearly have increased (or decreased) weight as a side effect, as that would skew the data
  3. Controlled for income when calculating government subsidies per person

Then again, if those things were done, then I don’t think we’d see such a neat, eye-popping linear relationship between ‘obesity’ and costs, would you?

This ‘study’ is prop for some future political theatrics, nothing more.

More Kevin Smith Flying Fat Fallout

Apparently Kevin Smith was pushed over the edge, and he’s not going to take it anymore.

I outlined a lot of what Smith said during his SModcast on the issue in my last post. There are also great Fatospherian posts on the subject here, here, and here. If you’re signed up, there’s also an interesting Big Fat Blog forum post on the matter.

What a lot of people in FA have noticed is that Kevin Smith isn’t exactly fat positive with respect to how he views himself. Though he says he accepts his fat, he also accepts the common-knowledge-pseudoscience that claims fatter people die sooner or suffer from more health problems. So there’s an inherent tension to some of his argument, in my view.

However, I believe what happened to KS put him over the edge, so to speak, and I don’t mean just his unfair ejection from the first SW flight he took (I think all fat-based ejections are unfair, to be clear, I’m not about to argue the whole policy thing with the armrests). I mean his experience with his fat female row-mate on the second SW flight home. To summarize, she was pulled aside by a flight attendant at the beginning of the flight and apparently told that she was taking up ‘too much space’ and might need to buy another seat. This, despite the fact that the empty seat between she and KS was already bought and paid for by KS (hence, was to remain unoccupied). So they humiliated her, threatened her with a fat fee, and unnecessarily so even taking into account their own policy (again, I think all fat humiliation and fees are unnecessary). This is what KS said himself made him absolutely livid.

It’s my personal opinion that KS is right on the cusp of real fucking fat acceptance, and it might be the experience of another, compounded by his own, that really makes him start looking into size activism in general, or at least turn an ear to it.

There’s more fallout on it today, and I thought I’d quote a few of KS’s tweets from his Twitter feed. (compiled)

(1/2) Hey @GMA: no means no. You called/asked me to come on/were told SModcast 106 covers it. So you SEND SOMEONE TO MY FRONT DOOR INSTEAD? (2/2) Even my sheltered, non-media-savvy kid, when told GMA showed up at the door, offered a look of utter surprise & said “That’s tacky…”

(1/2) @Supernova145 “why no to GMA? would you go on the today show?” 10 minutes to tell this story? To many, I’ll just sound like I’m in fat (2/2) denial. On 1.5hr SModcast, I can tell my whole story as PRELUDE to real story: the poor girl @SouthwestAir shamed on my flight home.

Via @ruminski “did you get details of the girl on your flight home? Are you able to help her in any way?” That’s was the SModcast was for.

But contrary to their claim that I regularly purchase two seats, I wasn’t a regular 2-seat buyer until just this week. They SEIZED on that. In their “apology” blog, they implied (or flat-out wrote) that I regularly purchase 2 seats. Writing that buttresses their lie: 2 Fat 2 Fly. But, by their own guidelines, I was not, in fact, 2 Fat 2 Fly: the arm rests went down & I could buckle my seat belt w/o an extender. So…?

Hey @SouthwestAir: you bring that same row of seats to the DailyShow, and I’ll sit in ‘em for all to see on TV. If I don’t fit, I’ll donate $10k to charity of your choice. But when I do (& buckle the belt as well)? 1) You admit you lied. 2) Change your policy, or at least re-train your staff to be a lot more human & a lot less corporate when they pull a poor girl off the plane & shame her.

Sometimes it baffles me how little people think things through. “Free publicity!” = 200 new articles declaring I’m fat. Yay, me. Epic win.

Via @jmuir16 “justlistened to new smod. My heart’s breakin for that poor girl too. Unreal.” And THAT’S why I’m Tweeting up a storm. Fuck’em.

Via @spidermann “Herb Kelleher, @SouthwestAir founder, would get kicked off their planes: http://tinyurl.com/swafounder ” ARM REST TEST!

Via BierHall “Being heavy is not something to be proud about. I wish more companies would not tolerate the lifestyle of fatness!” Sieg heil!

Via @RavenAtNight “I like how wanting to be treated like more than subhuman is suddenly a call for special treatment.” I’M MAD AS HELL…AND I’M NOT GONNA TAKE IT ANYMORE!

Via @Admiral_Young “Dude…I’m so Kevin Smith Fat.” Deep down inside, aren’t we all just a little bit Kevin Smith Fat?

Via @YoPaulieNJ ” @GMA is running the story w/o u – talking about the safety issues” My safety issue: GMA showing up at my house last night.

Had three seats/whole row for me & Jen. She skipped SF, so I went solo checked in and was given the 2 tix there & return 2 (for that p.m.). Going out, even with 2 tix, I only sat in one seat, sleeping against window, w/empty seat between me and follow passenger. Coming back would have been the same, at 7pm. But I got to the airport early enough to try to bump-up my flight to 5:20 – a practice @SouthwestAir does often. I was told 5:20 flight was packed, but I could go Standby. They sent me to gate. Told lady whole story, and she said there wouldn’t be two seats on that earlier flight. I said I only needed one seat & that I didn’t buy an extra seat because I’m fat (which I am), but because I’m anti-social and didn’t want to sit next to someone & possibly have to make convo (in person, I’m very shy). She said she understood. I was issued the solo ticket. I get on the plane: open seat in the front row. Put my bag away, the sit between two ladies. As I’m about to buckle my extender-less seatbelt, the woman who issued the ticket to me appeared in the doorway of the plane, came over to me and said the Captain said I wasn’t going to be allowed to sit there because I was a safety risk. I asked for clarification and was given none (also asked “Please don’t do this” but that, too, fell on deaf ears. Ladies on either side said I wasn’t a problem. SWA-lady said arm-rests the decider. Arm- rests come down, and voila! I’m legit! I’ve passed the stinkin’ arm-rest-test. And still, the lady asks me to get up and come with her off the plane. I get up without a fuss at all, quietly grab my bag, make eye contact with a fellow Fatty who was praying he’d pass, and leave. You think I wanna fuck around on an airplane? I was right: I fit in that seat. But I can’t risk not complying: I’m more afraid of AirFeds.

Via @bknaust “story about how @SouthwestAir kicked someone else off a plane: http://tinyurl.com/fattyplane ” His Uncle’s funeral?! Fuck SWA.

Via @marfer828 “Listening to the smodcast now. Kinda outraged. @SouthwestAir is effing ridiculous.” Hear the story here: www.smodcast.com

On Kevin Smith and Flying Fat

Okay, so I love you Kevin Smith. There, I said it.

NEW: I have taken down some of what was said during the podcast, if you don’t have time to listen.

Now, on to my comment on Southwest’s pitiful blame-the-victim ‘apology‘:

If this is truly about comfort and safety, then what about:

1) Individuals who put their seats back, encroaching in the ever-diminishing y-axis real estate? That’s not comfortable for most people over 5’10”, and for some of us can be extremely painful.

2) People who drink on flights, or take sleeping pills or other depressive medications? Certainly they might prove an obstacle to a safe exit in an emergency, etc etc.

3) Children who kick the backs of seats? That’s certainly not comfortable for the person sitting in front of them.

4) People with disabilities that may make it more difficult for them to maneuver in an emergency situation?

Additionally, the width of airline seats continues to accommodate less and less of the population. Regardless of your moral views on people who are overweight, have wide hips, broad shoulders, and other encroaching factors in the all-important horizontal direction, you aren’t going to make the population smaller with your policies of humiliation and discrimination. You should just own up to the fact that you don’t accommodate a significant fraction of the population, and have no plans to do so.

And forcing that population to buy two tickets isn’t accommodation, IMHO. It’s a penalty, and you’re only getting away with it because there are enough bigoted fat-haters to keep you in business. Perhaps, not for too much longer….? :)

A girl can dream.

NOTE #1: I haven’t been able to officially post this comment yet, since the site is down right now. FLOODED, people. Most comments are pro-KS. Sweet!

NOTE #2: Here is the cached page of the ‘apology‘ post.

NOTE #3: Kevin Smith and his wife has just put up a podcast about this. Please listen. It’s not all fat-positive, there is a little bit of diet talk, some put-down talk, but it’s a lot more positive than we typically hear out there in the media. Apparently the gate attendant at the customer service desk assumed that he bought 2 seats because he was fat, when the truth was that he buys 2 seats because he just enjoys the space. The customer service rep hems and haws about there only being one seat left, something about ‘safety’ issues. Some interesting/fun quotes from the podcast:

“I live my life fat, and I have to navigate through a thin person’s world all the time.”

“Death before discourtesy is my fucking mantra.” (I agree)

“There’s a little blonde stewardess in the doorway who lights up like Christmas when she sees me.”

“I do the scan to see where the least embarrassing place for a man of my size to plant himself…”

“Right up front of everyone, two women sitting with an empty seat between them.”

“Just as I’m reaching for my fucking seatbelt…I’m going to buckle, and all of a sudden Suzanne from up front leans down and says, ‘Oh hi, we have kind of a problem…’ — first thing comes into my head, oh my god, my mother died? … I did not, for a single second, think what was coming was coming. … So Suzanne leans down, … the Captain says the you can’t sit here. That’s what it dawns on me, and I go, ‘Oh, why?’….and she goes, ‘Oh no, it’s a, it’s a safety issue, a security measure.’ …But ma’am, I’m fine, I’m sitting down. ‘But if you can’t lower the armrests, we’re not, we can’t let you’…what she wanted to say is that you’re too fat, you need to buy two seats, but this flight is too full, so you can’t buy too seats.’ …Where we’re sitting, based on where the galley is, there’s no way the [captain] could see us. … But ma’am, the armrests — and I put the armrests both down. These ladies had them up when I sat down. And Suzanne goes… ‘Yeah, I’m sorry, really, we’ll try to make it up to you outside….’ ….I was not not fitting into the seat. …She wasn’t giving me a choice. …. My guess, it was the dude in the jetway….I think it was that dude. … This was in motion even before I even got into the plane, before a fucking phantom pilot even saw me. …All of the sudden, I was thinking, I’ve got to get up, and everyone’s going to know. Everyone’s going to know I’m too fat, or that I’m the fucking shoe bomber….what’s the safety issue? Am I going to explode like the dude in Monty Python? …Oh, I’m humiliated.”

“This is the moment where I was like, everything is going to be okay, Kevin, because ultimately it’s just going to become a story you’ll tell for the rest of your life.”

“I made perfect eye contact with  a man who was far wider and fatter than me, squeezed in a middle seat…I would never throw a fellow fatty under a bus…but that dude’s eyes locked with mine had a panicked expression…I’m way fatter than him, they’re coming for the fatties, they’re coming for us to take us to Candy Land and kill us….You’re Suzanne, how fucking tripping over yourself are you to make sure I’m not crying at this point? … It was heartbreaking. I go to this desk, and the two people there are like, ‘Is Suzanne dealing with you?’ And I sit there waiting, and waiting, and waiting, for eight minutes…if I insinuated to someone that they’re too fat and eject them from the plane…you’ve got to respect me because I’m a goddamn paying customer. You never treat a paying customer like that.”

[his wife] “I think we bought TEN Southwest tickets this week. Never again.”

“Suzanne was like, ‘Boy, I’m sorry about that.’ What was the name of the pilot who said I was too fat to fly? ‘No one said that.’ Why am I here? ‘No one said you’re too fat to fly. … There’s space allotment for each seat, you took up more space than you’re allotment.’ …. That’s just bullshit PC doublespeak for you’re fat. I’m okay with that. … So I’m standing at the desk, what’s the pilots name? … I need the pilot’s name, you told me he was the dude who wanted me off. ‘That’s what I said, sir?’ …Don’t runaround, simple yes or no.”

“And you know me, I go all lawyer. And when you say something fucking ignorant, I tear it apart.”

“I don’t think the pilot said anything. I think it was the dude in the doorway, and you made a choice.”

“I don’t care. I was justified. I was righteous at this point. … Ma’am, you have to tell me why I was ejected from this flight. ‘There were safety issues.’ What does that mean? Does that mean I’m going to explode on the flight? She left then and went to get the manager…Suzanne’s ID # 84175, Captain Leysath.”

“I got fucked. Somebody fucked me. … We can offer you a $100. That’s it? This is your idea of make-good? … Get me on a helicopter home. Get me a private jet. You got me off a flight you had no right to.”

“I’m going to scorch the Earth…because that’s the only way you can deal with a moment like this. … If I had any less self esteem, I’d be crying in a closet…I’d be starting a diet tomorrow, that’s how upset I’d be. But I won’t be.”

“Fuck that noise. How dare you. You want to embarrass me?  Now you’re embarrassed… if you hire a person in your organization that will do that to someone, fuck you.”

“That dude Erik [the manager] finds me. Everyone’s fucking outraged. Because most of the people in this country? Look like me. … If I’m getting bounced, anyone looks like me, or bigger, I’d be worried.”

“After about an hour of Tweeting, someone got scared shitless. …. Someone found me, and they told me, ‘I just wanted to tell you that they were wrong to take you off of that flight.’ … I’m a fat person, we navigate the world differently than other people. We have to think ten steps in advance…”

“So Erik comes out, ‘we want to make this right,’ but I was like, you can’t make this right. … Honestly, Erik, do you really think my dignity is worth $100?”

“Who sits next to me… a girl, a very, very large girl. Like me. A big girl. A solid one, very stocky. … Oh man, did they create a fat section and put me and that girl in it? …. And I see the stewardess come over to this girl, and lean down, and indicate that she should follow her. I was like, are you shitting me? Is this literally happening to someone else? I’m sitting on the window, she’s on the aisle seat, and there’s the seat between us that is already paid for. There is NO good reason whatsoever to be have the following conversation with the poor fucking sweet girl. I’m looking at this girl’s face, and I saw our daughter. … and if somebody did this to our daughter, I swear to god, I’d beat the fucking shit out of them. ….. We go the whole flight, I’m listening to iPod, going to sleep. I wake up, and at one point we’re sitting there, looking around the cabin, lock eyes, she smiles. Asks me how I’m going. … I had a fucking horrible experience, She goes, they just did something like that to me, kind of. … They pulled this poor girl aside, and they go ‘Uh, you know, you might have to buy another seat, ma’am.’ … That’s the standard operating procedure on Southwest. Build thicker seats motherfucker. This is the United Fucking States. … What fucking Southwest, what clientele are they building a fucking plane for…. they pull her aside, they weren’t nice. She said, ‘They were pretty bitchy.’ … You can tell this chick has been to fat ‘Nam. … She sits down, and the fucking stewardess pulls her out to have a fucking conversation like she was in school. … What woman says that to another woman? …. You know how hard it is to be a fat woman, and you say that to her? … Change your policy. She said, ‘You know, it’s not fair to other passengers who pay for seats, they should get all the space they deserve.’ …. And that that person who said that to her would know the flight isn’t fucking crowded, and that that seat is already paid for. …. She just sat there, and stripped her down and called her fat without ever saying the word. … It’s bullshit, hiding behind fucking language foibles. …. But saying [the girl is too fat] when she knew the flight is not packed, and that the aisle she’s chosen, there’s a seat between us … she’s saying, ‘I can still put the armrest down.’ … My heart broke for her. That’s when I lost it. … Once I talked to that woman, now I’m on a mission. I hope they change their policy. … Something gotta change. But maybe it’s as simple as vote with your wallet, cats. …. Before I met that girl and heard her story, I was just like ‘Fuck ‘em.’ … But that was it. When I heard that fucking story, something happened to somebody else in the span of two fucking hours, I was like fuck ‘em. … Southwest — of course they’re trying to placate me, because I spent an hour dragging their name through the fucking shit. … Fuck you, I don’t want a voucher. I want them to change the goddamn policy… do you know how much it sucks to be fat? For people who don’t have what I have? I can fall back on ‘I can do this,’ … It all probably came from being fat, trying to justify myself, try to make myself be normal. … Don’t feel bad for me. I’m one of the few fat guys sitting on top of it all, going Bwahahah, finally one for us … I remember what it was like being fat before I got famous. You don’t get a second thought. People treat you like fucking shit. You’re barely fucking human to some people….This poor girl, her whole life was printed across her face and my heart fucking broke. … This wasn’t done for this woman’s benefit. …. Societally, I don’t pay much for being fat, the price you pay for being fat …. There’s no reason in this beautiful world to make that person’s burden any worse. …. This was a grown woman pulling another grown woman aside and emasculating her (do you need a dick to be emasculated?).”

Quick Hit – National Review

Here’s someone outside FA that seems to ‘get it’ in many ways. I’ve been seeing many more libertarian-oriented blogs/magazines/papers utilizing some of the language of FA than usual, in commenting on the latest battle in the War on Fat People.

Taking Obesity Too Much to Heart

In the movie The Blind Side, the young Oher is known as “Big Mike,” to his embarrassment. He is big. Massive. One might say obese. Yet, there were no BMI screenings at the Christian school he attended. His teachers gathered to discuss his schoolwork, not to fret about his size. Oher’s size did ultimately matter, but on the football field alone, and there, it was a very good thing.

Put Big Mike in a Massachusetts public school, and this is what transpires. He is weighed, measured and BMIed; an accusatory letter goes home to his parents. Your child, it says, is failing; he is taking up too much space. “What?” his parents exclaim. “We had no idea!” Much healthy living ensues. And in three years, when the next BMI screening rolls around, Big Mike fails the fat test again. Because no matter how much money it spends, the government and its schools cannot make our children lose weight. It can, however, grow quite corpulent itself as it spills into new crannies of our lives.

Quick Hit: Moral Panics and the Obesity Folkdevil

If you do nothing else today, please read Bilt4Cmft’s post “Stepping Forward Looking Back” and the comments which follow. It is a great setup and discussion about fat people as ‘obesity folkdevils’ in the current obesity epipanic moral panic in which we find ourselves.

A quote from my favorite comment, by Miriam Heddy:

We see, again and again, statements like:
“Fat people are draining our economic resources.”
“Fat people are contagious.”
“Fat people corrupt the young.”
“Fat people aren’t as smart as thin people.”
“Fat people are lazy.”

These should seem familiar to anyone who’s looked at antisemitism in Europe, or racism in America.

As for whether there’s violence, already, we’re seeing street harassment, job discrimination, a desire to label fat people and mark them as “other,” studies being done at the genetic label (with a hope of “correcting” fat or eliminating it from the gene pool), a focus on how fat people are stealing money (health care) and space (airplanes) from thin people, fat parents having newborn children seized from them by social services (in Dundee Scotland), propoganda films aimed at kids like “”Wall-E and “Cloudy with a Chance of Meatballs” that link unchecked fat people and the degredation of the human race, and governmental initiatives aimed at looking at the “problem” of fat people.

I wish I had time to write more thoughts on this. But please, zip over and read the post, if you get a chance!

Do you avoid going to the doctor?

There’s a great post over at Fat and Sassy, linking a study which concludes fat people of a certain age are hospitalized far more than their thinner peers. A quote from the study:

Appropriate primary care could have prevented these hospitalizations, Ferraro said. However, those who are overweight or obese may not have sought regular care because of embarrassment or other issues related to their weight.

I was raised in a household where you always went to the doctor if something was even mildly wrong. Throat hurts, persistent dizziness, weird skin thing, etc, you let it go for a few days but no longer than two weeks, and then you go to the doctor.

When I was in elementary school, I was brought to the pediatrician a lot. I don’t really remember all the times I went, but I do remember one particular time: that’s right, it was the time that my doctor made me cry because he suggested I wasn’t getting any exercise and eating tons of junk because I was a chubby kid. The reality was, of course, that my mom didn’t even allow junk food in the house, and nearly every afternoon and evening I would either be riding my bike or playing games with the neighborhood kids (after dark we used to play a great hide and seek game called ‘Bloody Murder.’ Gruesome title that had nothing really to do with the game except that if you got caught, you had to lay down ‘dead’ while your capturer got to scream “Bloody murder!” and run off).

After I passed through middle school, I started actively starving myself, and then my doctor’s visits increased because my ailments increased. However, no longer was I a target for my weight, though once in a while I was still harangued about being ‘overweight’ by the BMI charts. Of course, I told them I was ‘on a diet’ and ‘working on it,’ and they shut up pretty quick. They never dreamed that the ‘diet’ had anything to do with the fact that my blood pressure was always abnormally low, and that I was usually dizzy and pale whenever I was there. They would ask me if I’d had anything to eat that day, and I’d say, “Oh, you know, some carrots. I’m trying to watch my weight,” and that would shut them up. Diet of carrots for the fat girl? Guess that’s okay, though all her indicators show she is STARVING, DEHYDRATED, and in a CONSTANT FOG. But that’s okay. Fat girls don’t deserve to have the ability to use their brains and feel well, right?

I used to visit the doctor perhaps twice or three times a year, for various things. In the past four years, I’ve been once, for some chronic dry skin at the corners of my mouth (that still hasn’t go away, gar). All I needed was a prescription for something stronger than I could get over the counter (nothing was working). I sat in the doctor’s office for 40 minutes before I got seen—no one else was there—and then the nurse briskly led me over to the scale. “Oh, I’m not getting weighed today, I came in for a skin issue,” I explained. She looked at me like I had two heads. “But we need a baseline for your weight, we don’t have one, you’re a new patient.” I smiled at her, and repeated pleasantly. “No, I’m not going to get weighed today. But thanks.”

She made no attempt to hide the disgust on her face as she then led me into the examination room. She angrily started getting the blood pressure equipment together, and I asked, “Do you have an extra-large cuff? I have large upper arms, and the reading won’t be correct unless you have an extra large cuff.” She again looked at me as if I had two heads, or rather, how dare I, the patient, a fat patient no less, make suggestions? She pretended to look for a different-sized cuff, and then without a word as to whether she found one or not, retrieved the original cuff she’d been going for before I said anything (so obviously not a larger cuff). She strapped it around my arm and pumped furiously, breaking several blood vessels on my arm and causing extraordinary pain. Note: I also have painful fat syndrome due to lipedemic fat on my arms, legs, and other areas. So it was doubly painful.

This might sound horrific. But my weight wasn’t mentioned after that, not by the nurse or doctor. I came away from that visit as if it were a win of all things. Though my upper arm was tender the rest of the day. And the prescription my doctor gave me didn’t ultimately work for anything except to temporarily abate the symptoms. Of course, I’m afraid to go back in order to seek a referral to a dermatologist.

I’ve had this likely easily curable skin condition for over a year now. And it’s probably not going to be enough to land me in the hospital for any reason. But how many of us sit on other more serious symptoms, because of the fear of going through humiliation and sometimes real pain and torture because of our fat?