Saturday, February 28, 2009
Public and private fat
After my second cup of coffee this morning I had the opportunity to spend a few leisurely minutes with the latest issue of Business Insurance. The top story ("Firms weigh impact of obesity on comp" -- those B.I. guys are such wacky punsters!) addresses the rising costs of obesity to the workers compensation system, and the difficulties that employers are having dealing with the issue directly. Part of the problem is the usual plague of lawyers:
"As the claims industry (and employers) begin analysis of their data and adverse claims, they are beginning to realize that you can't ignore (issues) that historically have been ignored," including obesity, said Tammy Bradly, director of case management product development for Intracorp in Birmingham, Ala.
Historically, several factors have hampered collection of workers comp data on obesity.
The workers comp industry traditionally focuses on treating specific injured body parts while overlooking so-called co-morbidity factors, such as obesity, that increase claims duration and costs, observers said.
In addition, concerns that inquiries into obesity could spur lawsuits alleging privacy violations have slowed workers comp claims research, said Joe Picone, national director of regional operations in the strategic outcomes practice for Willis HRH in Glen Allen, Va. Because of litigation fears, some predictive models for workers comp claims omitted obesity data, Mr. Picone noted.
It seems to me that since obesity is self-evident, it really ought not be considered a "privacy" issue. What's private about it? It is really a matter of "dignity" or "pride," but since offenses to dignity or pride do not in and of themselves confer a cause of action it is very much in the interests of fat plaintiffs to stretch the cause of action available to them until they can fit into it.
It is not that I am entirely without sympathy; I have battled my desire to eat for ephemeral pleasure my entire life, and even now am thinking about the day-old donut that rests in the Dunkin' box just outside my office. But since we are living in an age where some meaningful percentage of people believe that everybody else ought to pay their mortgage, then it is a short leap to the make your fat my business. Anyway, if President Obama's stated ambition to extract national savings from the health care is going to make any headway at all, everybody's fat will be everybody's business sooner or later regardless of the privacy considerations. Indeed, this obvious conflict between Democratic constituencies (people who want to make one person's health "society's" business and trial lawyers who want to collect a vig for any offense to "privacy" or dignity) will no doubt resolve itself in some way that is more expensive for normally sized taxpayers everywhere.
But I digress. The problem of obesity is real, and its progression since just 1990 is remarkable. Behold this slide from a CDC PowerPoint presentation on the problem (click the image for more res):
My question: Will the trend stop before the percentage of Americans who are grossly overweight degrades our fiscal health as much as it burdens their physical health?
CWCID: Glenn Reynolds, for the mortgage link.
8 Comments:
By 
, at
Sat Feb 28, 11:31:00 AM:
"concerns that inquiries into obesity could spur lawsuits alleging privacy violations have slowed workers comp claims research"
Lawsuits already helped ruin the medical profession and turned it into the medical industry, which will now be phased out as everything is nationalized. This country needs tort reform.
By , at
Sat Feb 28, 11:37:00 AM:
The obesity trend graphic is remarkable only in the sense that it is another example of a government entity gaming the numbers to advance their agenda. What they don't tell you is that they changed the BMI calculation in 1998 so that now even average people are "fat". If Cal Ripkin Jr. is considered overweight, who isn't? http://www.bigfatblog.com/bmi-change-1998
By 
TigerHawk, at
Sat Feb 28, 11:40:00 AM:
I'm well aware of the problems with the BMI index, especially insofar as they relate to people (mostly men) who have a lot of very dense muscle on their bodies (athletes, mostly). I think if you walk around your average Wal-Mart you get the sense that whatever the percentages, most people with high BMI indices are not in spectacular shape, but quite the opposite.
More to the point, if you watch the year-by-year progression in the linked slideshow you see that there was a significant change leading up to 1998 and then in the year-by-year changes since. So the change in method does not explain it all by any means.
By , at
Sat Feb 28, 11:56:00 AM:
TH, before driving too far down this road, take a look at the critique of the CDC study over on this post of mine...
AL
By TigerHawk, at
Sat Feb 28, 12:12:00 PM:
AL, thanks for the link. I get the point, but I also know this: if you are fat (whatever your BMI) and you get sick or injured, virtually all interventions become more expensive and problematic. If you are burned and need a graft, the operation is far less likely to be successful if you are too fat. Same for spine surgery. Same for all sorts of reconstruction. Etc. So whatever the public health data (which I do not doubt has been hideously politicized), if you are fat you really want to stay healthy because if you do not many interventions that work well on average people will not work so well with you. And that is costly for everybody, whether or not we actually socialize medicine.
Now, as I say endlessly on this blog, you can never derive what "ought" from what "is." Perhaps the freedom to be fat is part of what it is to be American, and we should be willing to underwrite that freedom with higher costs. Somehow, I do not see the Obama administration thinking about it that way.
By Elise, at
Sat Feb 28, 02:39:00 PM:
I read the article you linked to and would very much like to see two things. First, the actual statistical work behind the claims about higher workers’ comp claims for the obese. I have to agree with TB and Armed Liberal that data can be tortured to say almost anything the researcher desires.
Second, I’d like to see the intervening factors between obesity and higher comp claims. Is it that obese people heal more slowly? That they are more likely to have other conditions that complicate healing (e.g., Type 2 diabetes)? One study says, “For some ‘smaller claims,’ added treatments related to obesity can balloon cost differences 30 times or more.” I’d like to know exactly what treatments related to obesity we’re talking about.
Beyond that, charging obese people a higher insurance rate is opening a real can of worms. (Although perhaps we opened that can by charging smokers higher rates.) What about people who drink a little too much? Or people who stay thin by eating almost nothing yet never exercise? (Remember the big flap over people who are externally thin but “internally fat” a while back?) Or people whose preferred leisure activity is snowboarding or skydiving or mountain climbing?
As TH has implied, this is the problem with government intervention in any area: providing money buys the right to dictate behavior. I suspect, though, that trying to hang high health care costs on obesity might be a quagmire for the government (and for private insurers for that matter). After all, an awful lot of us are way too fat as far as the statisticians are concerned. More ominously, no one - no one - has come up with a way to lose weight. Yes, I know, close your mouth and exercise more works. But as far as I can tell, no one is willing to follow that prescription which means it’s worthless*. This in turn means that the health industry in the form of the government and/or private insurers is going to be penalizing an awful lot of people for suffering from a condition it can’t cure or even ameliorate.
For a non-mainstream look at a lot of health care issues, I recommend Junkfood Science. The blogger disputes statistics linking obesity to health problems; thinks computerized health care records appear to be medically dangerous; and waxes wroth at what the anti-obesity industry is doing to children. I don’t always agree with her conclusions but she is a nice counterbalance to what virtually everyone else is saying.
*The last time I checked, less than 2% of the people who started any type of organized weight loss program actually lost significant weight and kept it off for more than a year. No other medical treatment that had a 98% failure rate would even have made it to market much less be turning a profit. Maybe someone should talk to Colorado and find out what the they’re doing right.
By , at
Sat Feb 28, 09:47:00 PM:
Elise: You are quite right about the Junkfood Science site. It is a worthwhile place to visit.
By Georg Felis, at
Mon Mar 02, 06:57:00 PM:
Question: Are these numbers adjusted for age? i.e. are 20 year olds in 2007 more overweight by X percent than 20 year olds in 1990? As somebody who *was* 20 in the 90s, and is now fighting the Battle of the Bulge, I am well aware of the human form's tendency to spherical as our ages go up, and as the Boomer generation surge hits old age, I would be *highly* suspicious of any study that did *not* show the American people as a whole fighting weight gain.
