Friday, December 15, 2006

Attitudes toward Overweight and Obese

"Why should the whole population basically pay for the preventable actions which other people choose?"

That was the question posed by Paul Frijters of the Queensland University of Technology as he introduced a "user pays" principle to curb the escalating costs of healthcare associated with the obesity epidemic in Australia.

Professor Frijters urged the Federal Government to lift restrictions on health insurance companies to ask questions about a person's weight and allow them to calculate increased premiums based on body mass index.

Obesity has been linked to a number of life-threatening conditions such as type 2 diabetes, high blood pressure and heart disease.

"There's a much heavier use of medicine and there's much heavier use of hospital care by obese people," Professor Frijters said. "Obesity is so closely related to lifestyle choices and the costs associated with it are becoming so great that it's no longer tenable to simply gloss over it."

In the UK, the media is hot on the warning that obesity could bankrupt the healthcare system in that country.

Professor Sattar, an expert in metabolic medicine, said research had linked obesity to a range of diseases and disorders, including heart disease, cancer, depression, back pain, diabetes and skin problems. He said: "The problem of rising prevalence in obesity may get much worse - rates could climb still further, bankrupting the health system and leading soon to reductions in life expectancy. "So we need to think out of the box, nothing that has been looked at so far seem to have worked."

He said while individuals "clearly have some responsibility for their health", the rest of society should also play more of a role. He said the food industry should own up to the role they play through advertising and schools should be doing more to promote good diets and lifestyles.

Among the ideas put forth to help individuals take some responsibility - warning labels on larger size clothing with a phone number to call a helpline!

I kid you not!

The number should be promoted on the labels of all clothes sold with a waist of more than 40in (102cm) for men, 37in (94cm) for boys, 35in (88cm) for women, and 31in (80cm) for girls.

What's happening here in the states?

Well, from Texas we find this interesting opinion, "Then I stopped and thought — for every person who doesn’t have insurance and spends their time jamming unhealthy foods down their gullet, there’s a cost. When they wheel portly New Yorkers into the hospital with a burrito in one hand and a donut in the other — there’s a cost.

I don’t want the government controlling my life — but I also don’t want it to keep dipping into my pocket because someone else continues to make a stupid mistake that will cost themselves their life and the rest of us millions — if not billions — of dollars."

From Milwaulkee there's this - "None of my columns has elicited the wrath of the masses. I'm about to change that. Because statistically speaking, it's a pretty good bet for me to say that you're fat. And I'm ticked off because you're hurting my wallet.

People often ask how I stay so skinny. It's true; compared to most people I encounter on a typical day, I look like a rail. But according to the chart for body mass index, my current height and weight (6'1, 155 pounds) fits within the ideal BMI parameters.

What's my secret? And why am I ticked off that a big portion of my paycheck goes to treating obesity-related illness? Because my being skinny is not an accident; I have to work at it. During the past 13 years, I've run enough miles - more than 25,000 - to circle the Earth. When that damaged the tendons in my foot, rather than sit and mope, I hit the weight room, took up swimming, bought a bike and, if nothing else, took 60 minutes or more each day to walk. Though I have a weakness for chocolate, a look into my typical grocery cart reveals things like broccoli, spinach, multigrain bread and apples. My alcohol consumption is usually no more than one drink a week. Fast food? Strictly reserved for my few trips a year back home to Minneapolis. In other words, I make the choices necessary to avoid obesity-related illness."

And, a recent survey, reported in Insurance News Net found "more than 25% of Americans are comfortable with charging obese people higher premiums for their benefits."

Clothing with warning labels? Higher premiums based on BMI? Obese people choose to be fat?

What do you think?


  1. In Texas there was great debate on motorcycle helmut laws a few years ago. The law was changed to allow folks to go without one. One of the arguments I heard was that you usually die in an accident w/o one, but if you wear one and live, you cost us greatly with paralysis, rehab, etc. Or with smoking, that those who die of lung cancer or emphysema die relatively quickly, actually costing less, than those with other types of diseases. So let them smoke. It's an interesting angle. I don't have an opinion yet on this, though it does irk me to pay taxes so someone on Medicaid can endulge daily for decades and get free care - and yet who's to blame? The gov't is the one who told them to eat more white flour.

  2. Most of these ideas are barking up the wrong tree. Instead of penalizing the obese, insurance companies should be rewarding the healthy. Insurance companies are experts at managing risk. The problem is they’re managing the wrong risk. They are managing the risk to themselves when they should be managing the risk to their policyholders.

    What would be interesting would be to have premiums tied to health markers. In the world remade by low carb, we would monitor fasting insulin, hba1c (which not only measures glucose levels over time, but also levels of glycation damage overall), triglycerides, HDL levels, anti-oxidant status, and immune system status. If you had all these things under control, which low carbing will do, you would pay a low premium because your risk would be low. People would have an annual checkup to monitor these items which would result in an adjusted premium. The majority of medical practice would be to devise strategies to help people control these items and lower their premiums.

    What would be really interesting would be that if insurance companies balk at subscribing to low carb strategies, people could opt for a low fat strategy. Once the insurance companies see that they’re losing money on the low fat plans, they would eliminate those plans, and the lipid hypothesis would die a faster death than it ever will at the hands of scientists.

  3. Hellistile1:42 PM

    Fat people are being penalized while skinny people still get lots of cancer, diabetes, heart attacks, depression, you name it. If being skinny was a marker for health, all skinny people would be healthy, both physically and mentally. Give me break. However, when it comes to marathoners they should pay the least amount for health premiums. They drop dead with a heart attack while running. Saves lots of healthcare dollars.

  4. and allow them to calculate increased premiums based on body mass index.

    Can't we do better than the notoriously bad BMI?

  5. I'll be honest, one of the reasons I'm trying to loose weight is in case they start charging more for being overweight and/or obese.

    We need to start telling people to eat unprocessed foods. Natural foods, whether they are veggies, fruits, dairy or meats, unprocessed is best. We also need to stop this good carb & bad carb garbage!! Carbs are carbs, and fats aren't bad....and until that information is accepted and promoted, there's little help for anyone trying to "eat healthy".

  6. Why not deny, not just health insurance, but health care entirely, to people whose "health markers" fall outside "established" guidelines? If your cholesterol is to high and you aren't taking your mandatory statins, no health care, period. Not even for injuries sustained in an automobile accident caused by a drunk driver in another vehicle. While we're at it we should implement a program of random, surprise inspections, with fines and other sanctions for any "inappropriate" behavior. It is time to repeal the whole bill of rights and let the government get on with it's vital work with out unnecessary interference from the law.[/RANT]

    Actually, we already have some features of this rationing system operational here in the good old USofA. Try purchasing private health insurance with a preexisting condition, of any kind. If you can find a company willing to cover you, you will face premiums that compare to a house payment. The laws here in the US currently do not allow the denial of health care, but health insurance. This results in the shifting of costs, nothing more than an accounting exercise. Loss of health insurance coverage is a sure-fire path out of the middle class, however. In fact our current system provides a slippery slope straight out of the middle class even with health insurance in the event of catastrophic illness. If you are rich or poor your personal finances are essentially unaffected. If you are middle class, homelessness and financial ruin are just around the corner. Penalizing people for accepting their government’s nutritional advice is cruel and unusual punishment. Oh yea, but we already agreed to throw out that old fashioned bill of rights any way.

  7. Anonymous7:14 PM

    are these ideas actually coming from those who govern us & make our laws??
    .........wait stop the world I want to get off !

  8. "Obese people choose to be fat?"

    Unless you have a metabolic problem you can't control then yes. I'm with Dr. Phil - I alone am responsible for what I put in my mouth and what I do to get in shape.

    Should I pass the blame on my recent 5 pound gain and say I have a slow metabolism? It's true. But I'm the one who shoved all the unneeded calories into my mouth. No one made me buy and eat the ice cream. I made a CHOICE.

  9. Anonymous8:01 PM

    Um Lady Atkins, eating too many white powder foods creates a metabolic problem that you cannot then control, except to futilely manage the symptoms with Yet Another Drug.

    Read up on white powder foods and acquired addiction, plus the whole diabetes and ADA thing.

  10. I know about aquired addiction. I had a major addiction to carbs. I still do - like the alcoholic who makes a choice each day to partake or not. Detoxing is hard work and the cravings can do you in. Everybody who's gone from a high-carb to low-carb lifestyle has had to go through this.

    The fact remains - no one is shoving cupcakes down my throat. I take a medication with a side effect of carb cravings and weight gain, yet I have successfully managed to lose and maintain a healthy weight while on this medication. So believe me - I *know* how hard it can be.

    I know too much about diabetes - my Dad had type 2 (and gets the most horrible information from his doctors) and I was once at very high risk for developing it (overweight, horrible diet, etc.) I have a meter and test my blood sugar so I will know what foods do to it, and I am a member at Dr. Bernstein's diabetes forum. I'm doing all I can to avoid my father's fate.

    The metabolic problems created by "white powder foods" ARE controllable, often with minimal to no medication. The trick is the right diet.

    I'm still with Dr. Phil. I decide what I'm going to eat. Every day I get up and make a decision to eat on plan or off, and what those foods will be.

    Too many people try to blame their problems, weight or otherwise, on others. I believe in personal responsibility - we are each responsible for ourselves.

  11. Anonymous2:25 PM

    I think we're on the same page about being able to fix things with the right diet.

    We can agree to disagree about Dr. Phil. Personally I believe any such behaviorist approach only tells half the story, and can result in people (like yourself it sounds like) who are no longer "using" carbs but have to still take medication.

    If you go a little deeper and learn about the biochemistry of addiction - which would require going beyond behaviorism into the scary area of admitting it changes the brain - you can learn how to eat to actually heal the neurotransmitters that were disrupted by carbs. And maybe get off the meds. I did.

  12. Anonymous6:23 PM

    I just went and read that columnist from Milwaukie and was amazed it was a guy! He totally whines like a girl, so bitter about having to exercise and eat crap so as not to get fat while eating chocolate.

    Mark Twain was right, snicker snicker.

  13. This 'attitude' strikes at the heart of our cultural issue with obesity.

    People who detest the obese, and have bizzare ideas about lifetsyle choice.

    These people are very arrogant, mean and just plain stupid.

    But then again, we are talking about 'power' in socity, and society doesn't require the power wielders to be 'good people'.

    Perhaps we can dust off the old yellow stars of David they used in Germany in the forties.

    Maybe IBM can develop a program to process the obese?