Why are you trolling P/aul Cam/pos, ogged? Why?
I forget who that is. I just feel happy that, I've managed to stay just below obesity without limiting my drinking.
1 -- it's amazing that even the internet law professor who hates other law professors is a terrible, bad professor and blowhard. Worst Profession Ever.
The Paper Chase is already pretty erotic, especially the John Houeseman blowjob scenes.
They were important for character development and not gratuitous.
Barely legal briefs?
I'm not even going to touch 'subpoena' with a 10 foot pole.
The OP is a bit depressing for everybody. Only 2/3rds of the thin, healthy people stayed that way for two decades. The best case isn't very good.
There was a period of time I read fat acceptance blogs, and the health angle was never very convincing. I think HAES and focusing on health not outer appearance makes a lot of sense, but these women would go on about how obesity had no relationship with health whatsoever, and that an obese person who worked out would be healthier than a thin person who didn't, and then...they'd write a post about how they walked up a flight of stairs, and only had to stop once in the middle. Or how they were attending a convention which would require 1+ mile of walking, and they were probably going to need a scooter. I've yet to meet a normal weight person, even a really lazy one, who couldn't handle making it up at least several flights of stairs or handle normal walking distances.
Most obese people, by the BMI definition, can handle stairs and a mile walk. The scooter crowd is mostly morbidly obese.
I've yet to meet a normal weight person, even a really lazy one, who couldn't handle making it up at least several flights of stairs or handle normal walking distances.
Hi! I speak for (even very mildly) disabled thin people everywhere when I suggest that you should get out a bit more.
Have I mentioned my old friend who now makes off-road self-propelled wheelchairs? They run on caterpillar treads.
Is your old friend Johnny 5 from the Short Circuit films?
Ah, Short Circuit came out during my golden age of moviegoing. Anything on a big screen, I loved. My enthusiastic review of Russkies in my middle-school paper included the line, "This film has it all."
15
Well clearly people of all sizes or shapes can be disabled. I was referring to people who don't consider themselves to have health or mobility problems. Being incapable of climbing a flight of stairs or walking a mile is not typical of a healthy non-disabled state.
And just a quick note, if this is going to be a thread where everyone reads what I write in the most hostile way possible, I'm not going to really be interested in engaging.
Thanks.
I'm a bit bothered by the slippage from "developed risk factors for chronic diseases" to "unhealthy".
The original linked story doesn't seem to mention any figures about how many people actually became ill. Hopefully, the paper itself deals with this issue, but I'm too tired to track it down and check.
Yeah, the write-ups are terrible. I read several before settling on the one I linked because it was the only one (!) that even mentioned the outcomes for thin people. I don't know about the original paper, either, but in one interview snippet, the lead author says something like "twenty years isn't a whole life, and these people are trending badly."
Also, Buttercup, stop abusing the disabled.
(That's my job?)
19 is awesome. Russkies was ... Kids help stranded Russian sailor from mean US Navy villain, right? From the brief Gorbachev era of US movies. As Rocky IV said, "if I can change, and you can change, we all can change."
I am always at a loss to see the actual take-home message from these studies, other than "sucks if you're fat, dude." There seems to be some basic denial of mortality lurking below the surface. 80-year-olds with metabolic disorders are a major health crisis? An existential crisis, maybe. I'm mostly trolling here, but it blows my mind to imagine that we've decided, as a society, to hold up perfect health way into the geriatric years as a standard and cudgel.
It can be a serious health crisis for that 80 year old. Could be useful to know which are reducible risks.
The OP is a bit depressing for everybody. Only 2/3rds of the thin, healthy people stayed that way for two decades. The best case isn't very good.
That's pretty encouraging to me. If I don't have any of the risk factors in 20 years I'd be delighted and surprised..
It can be a serious health crisis for that 80 year old.
To quote the 90 year old chairman emeritus of a company I used to work for, "Most sensible people my age are dead."
As an obese person [by BMI], I test really well on most of the standard measures. Blood lipids, cholesterol, liver function, markers of inflammation, and so on.* I'm not quite 'sherpa' levels like I was in my 20s, but I'm still very definitely on the good side of normal.
But ... being fat is still going to stuff me in the end, I'd expect -- joints, if nothing else -- even if physiologically I'm well inside the normal range.
* I have a minor chronic illness that causes me no ill-effects, but which needs monitored, that means I get a full work up of these things every couple of years. So I have a good idea of the trends in my own test results.
My grandfather is 100, though, so the genes can't be all bad.
I was supposed to go see Russkies with a bunch of kids, for my birthday, but it turned out to have an extremely short run in theaters in my area, so I missed it. Checking IMDB, it looks like it did really, really poorly at the box office - $2 million gross - which I guess makes sense if it wasn't around two weeks after it came out.
We had to see Teen Wolf Too instead. One of the disappointments of my young life.
I thought the deal with the health at any size movement/philosophy wasn't so much that health outcomes were expected to be identical for otherwise similar obese/non-obese people, but that for any given obese person, they were a lot likelier to successfully improve their health by increasing their level of physical fitness and activity rather than by losing weight, so that's where it makes sense to direct health-related efforts. (Leaving to one side all of the social/emotional issues about how cruel and intrusive harassing people about their weight is, regardless of its effects on their health.)
I don't see this study contradicting that at all.
I read something about how modern climate control contributes to obesity. They said to be thinner you should expose yourself to varied temperatures. Between the 10 degrees outside and the bus ride while wearing a down parka, I'm set.
Eddie Bauer parkas have become hip again, right?
The one thing that's killing me at the moment is desk-work and driving. Until xelA was in nursery more or less full-time, I'd use public transport more often than not. Which meant a nice substantial walk at each end. Probably not enough to help lose any weight, but enough to keep my back and knees in good order.
27: Hah, CMU has access.
OK, "healthy" is indeed defined in the paper entirely in terms of risk factors. I don't see anywhere in it where they discuss actual illnesses, bad events like heart attacks, or mortality. That said, one of the risk factors is "use of antidiabetic medication", presumably because you've been diagnosed with diabetes, but they don't provide any separate tabulation for the different risk factors. You're "unhealthy" as soon as you have two or more of them.
Driving and modern suburban life are killers. The most precipitous decline in my own health & fitness came when I moved from a downtown public-transit-focused lifestyle to a suburban car-based lifestyle. It sounds really obvious, but to see how dramatically the effects showed my life (as an average weight, moderately active person) really blew my mind. That a majority (?) of North Americans live that way, and then beat themselves up for not being in shape or needing to eat healthier - it's sad.
the health at any size movement/philosophy wasn't so much that health outcomes were expected to be identical for otherwise similar obese/non-obese people, but that for any given obese person, they were a lot likelier to successfully improve their health by increasing their level of physical fitness and activity rather than by losing weight
That might have been what the research said, but I think it veered into what Buttercup, Tormentor of the Handicapped, describes in 13, and this study (assuming it's worth anything) is a good corrective to that, insofar as it says "if you're fat, the odds are against you."
Screech up and stabbed a dude in a bar.
I thought you were a midwesterner. We've known about that for days.
this study (assuming it's worth anything) is a good corrective to that
Good corrective implies that there's some social benefit (presumably, benefit to the fat people in question) in intensifying the message that there are health risks related to being fat. The study itself is fine, but do you really think that fat people will be better off if the message that being fat is bad for them is ratcheted up a notch? There's some optimal level of pressure to be non-fat, and in the absence of this study the pressure wasn't quite high enough?
This seems mistaken to me.
I believe in truth for its own sake, madam.
I think the idea isn't to increase pressure on fat people but to increase political pressure to change things like those mentioned in 41. But these are British people, so maybe it's a step toward Nationalized Death Panels.
That a majority (?) of North Americans live that way, and then beat themselves up for not being in shape or needing to eat healthier - it's sad.
Because I can feel vaguely guilty about pretty much anything, I do have a tendency to beat myself up a bit about having all the advantages of the pedestrian/public transit lifestyle and still being borderline overweight (both by BMI and by my personal sense of what works on me, which are in my individual case pretty much the same). In the alternate universe in which I was stuck driving everyplace, I'd have a hell of a time staying fit.
I have an easy time staying fit, in the 3x/week for 50 minutes sense, but a really hard time holding anything resembling a walking lifestyle. There's a lot of literature saying the walking lifestyle is very important, independent of how many times a week you go to crossfit.
The only thing I can think of is one of those standing desks, and to pretend that teaching counts, and ...the former requires momentum but I'm great at the latter.
40: Sometimes--not often, but sometimes--metformin is prescribed for people at risk of diabetes, because they were prescribed atypical antipsychotics. They are at high-risk of diabetes. Mortality for people with SMI is not great, although I don't really know that the statistics were reliable enough to feel comfortable repeating them. Anecdotally, you see high lipids and diabetes. BUT sometimes they put younger people on the drugs to try to prevent a problem.
""healthy" is indeed defined in the paper entirely in terms of risk factors. I don't see anywhere in it where they discuss actual illnesses, bad events like heart attacks, or mortality. "
reduction of risk factors is all anybody has proven with respect to weight reduction:
http://www.nhlbi.nih.gov/files/docs/guidelines/ob_gdlns.pdf
"there have been no prospective trials to show changes in mortality with weight loss in obese patients"
better than taking statins I guess.
I have an easy time staying fit, in the 3x/week for 50 minutes sense, but a really hard time holding anything resembling a walking lifestyle.
Treadmill powered pick-up truck.
53: That would be a really expensive study. Sustained, significant weight loss is pretty rare, as is death in a given time period for a population that you could enroll in a study to look at mortality rates in general (e.g. after excluding people with terminal illnesses and the elderly).
There's a job that I'm a perfect match for, based on glassdoor ~30% raise, three different people from the company have contacted me to ask if I'm interested. But it's out in the suburbs such that bike commuting probably isn't practical and we'd have to get a second car. I've pretty much written it off because of the commute. Not that biking to my current place has prevented me from gaining weight.
You should probably buy another bike or two.
My current commute actually uses two bikes.
You need a fresh bike for when the first one gets tired.
"53: That would be a really expensive study. Sustained, significant weight loss is pretty rare, as is death in a given time period for a population that you could enroll in a study to look at mortality rates in general (e.g. after excluding people with terminal illnesses and the elderly). "
Plus, the population that does make sustained, significant weight loss is different than the one that doesn't, so, to be fair, you should do an intent to treat study where doctors recommend weight loss to half to their obese patients.
I've done the "two bikes" calculation for a suburban job, should I take one. Hasn't materialized.
I worked from home on a series of projects for about 18 months. At first I tried to get out and exercise but fell back on just working, and my fitness deteriorated and I put on weight. Then that ended and I went back to commuting: 20 minute bike ride, mass transit with plenty of stairs to bound up, walks. Was back to my old fitness and weight within a couple of months, and have held it easily just based on the commute.
That too. Anyway, this makes me think of the best article ever.
I'm mostly with LB, with the caveat that Buttercup's memory of many of the "fat acceptance" blogs matches mine. While "risk factors" isn't a disease, it was pretty common for the bloggers to assert that despite being obese, they had no risk factors: blood pressure was fine, blood glucose and cholesterol fine, etc., so their weight couldn't possibly matter.
I don't understand how a commute could use two bikes.
re: 67
If there's a public transport element in the middle. Bike from home to station 1, catch a train (or bus) to station 2, bike to work.
There couldalso be one portion of a commute that uses a bike optimized for transporting children, and another portion, post--kid-dropoff, that uses a regular bike.
51: Me, too. I have to try to get a standing desk together. Sitting is hell on my back and probably-permanently-screwed-up hip.
That's the normal but I actually do a 1.5 mile loop carrying 4 kids on a bike with an electric assist, dropping at day care or school bus stop. Then when that bike is tired I plug it in at home and take my regular bike to work.
There's no public transportation to the suburb that would save any time relative to just biking the whole way, about an hour.
Re: HAES and whether it's OTT on thetopic of health and weight, the blog Dances With Fat has a FAQ that pretty explicitly denies a causative link between being overweight and unhealthy.
No. Weight and health are two separate things - there are healthy and unhealthy people of all sizes. Health is multi-dimensional, not entirely within our control, and not a barometer of worthiness. The confusion of weight and health does a disservice to fat people because people (often including doctors) think that they can look at us and determine our health, it also does a dangerous disservice to thin people who are told that they are healthy simply because of their weight and that isn't what the evidence shows. In fact, the evidence shows that people's habits are a much better determinant of health than their size is. Body size is not a diagnosis. I call this a Galileo issue - "everybody knew" that the sun revolved around the Earth and so Galileo's statement that the evidence showed that the Earth revolved around the sun was considered heresy. Now "everybody knows" that fat is unhealthy and so statements to the contrary, even though they are fully supported by evidence, are considered heresy. That doesn't make them any less true. Even if fat was unhealthy, there are plenty of things that people do to prioritize their health that we don't police (not getting enough sleep, not looking both ways before crossing the street, extreme sports etc.) The idea that public health means making fat people's health the public's business is just thinly veiled fat bigotry.
In order for an intervention to be medically ethical it must be evidence-based - which means that we have to have a reason to believe that the intervention will work, and that it will not cause more harm than good. Weight loss does not meet these criteria - there is not a single study where more than a tiny fraction of people have succeeded at weight loss long term, and there is no study that shows that people who lose weight live longer or become healthier. Prescribing weight loss for health is like prescribing learning to fly for knee pain. Even though a doctor may honestly believe that flying would take the pressure off the knee, we have not reason to believe that it's possible and therefore it is not an ethical intervention to prescribe. Further, evidence says that most people who lose weight will gain it back and that there are dangers to weight cycling (yo-yo dieting) and so it's possible that the doctor's prescription will do more harm than good.
I think LB's version is a too-sensible summary of HAES. I don't think equating health with virtueis a good thing, nor do I think for a second that we're kind enough (both on apersonal or publicpolicy level) to either overweight or disabled people. I do think that the HAES crowd is very wrong about health risks associated with obesity, to the point of climate change denial or creationists.
Did you really just pwn me in describing my own commute?
Yep, as I mentioned in my comment in 13, I think HAES is a very positive movement. Encouraging people to be as healthy as possible with no predetermined outcome for 'health' and no judgment if you don't meet that goal is a really positive thing. Within the Fat Acceptance Movement though, it's become dogma that weight has absolutely no correlation with health in any way, and things such as knee arthritis or diabetes or immobility are completely coincidental and also as commonly found among slim people as fat people, which is clearly not true.
The way to deal with obesity in Western countries is at the societal level. Make walking easier, stop subsidizing junk food, make fruits and veggies more available, etc. Blaming individuals is counterproductive, and losing and keeping off substantial amounts of weight is quite hard. Given that it's in the interest of the powers that be to maintain the status quo, real change isn't going to happen any time soon.
Also relevant, I was just at a meeting with donuts wherein one flavor was maple glazed with slices of bacon on top.
Or what ydneW said. Also, HAES is actually quite controversial in the FA movement.
My vague understanding was that fat itself causes diabetes, but that otherwise "overweight" people are healthier than "normal" I weight people, and that other than diabetes even obesity in and of itself is not a big deal health wise. I haven't read the link, but does this contradict that understanding?
72: That quote doesn't say there's no statistical link between obesity and markers of ill health. It does say that prescribing weight loss is an ineffective medical intervention, but the reason it gives for calling it ineffective is that prescribing weight loss is unlikely to result in weight loss (which is, as far as I know, absolutely true). I don't actually see anything in that quote that I would call specifically false.
I'm sure there are plenty of people who are way over-the-top wrong about how entirely irrelevant overweight/obesity is as a marker of health, but the presence of people in a movement who are over-the-top wrong about things mostly just marks it as a movement with people in it.
77: I think there are a few things being combined in your comment. There was an older study about BMI and mortality which implied that being slightly overweight was correlated with lower mortality than underweight or even "healthy" weight. I don't remember the details well enough, but the problem in general is the length of the study - folks with cancer or long illness tend to be extremely underweight when they die, and I don't know how that study handled those details - I thought it didn't do much correction for things like that.
Obesity is correlated with quite a few health problems, not just diabetes.
77: I think that's too easy on the association between obesity and ill-health. First, the overweight people are healthier than normal weight people bit I think just means that the BMI categories are somewhat misdefined, and there are some unhealthily underweight people 'misclassified' (from the point of view of their personal best state of health) as of normal weight.
But once you're talking about people who are obese, I'm pretty sure it's not just diabetes, but heart disease as well at least that's strongly associated with excess fat.
And, once you concede 80, the message that exercise/walking/activity alone is a solution goes out the window, because exercise alone doesn't and can't cause weight loss. You need dietary change, which also isn't easy at all (weight loss is really really hard) but possible.
I don't think that follows; that is, while there's certainly a correlation (which seems to almost certainly involve causation) between obesity and markers of ill health, there is separately a similar correlation between inactivity and markers of ill health. An inactive fat person who becomes active but doesn't lose any weight is genuinely going to become healthier than they would have been if they'd stayed inactive; not losing weight doesn't mean the activity didn't do them any good.
Not disputing 82, just saying that there's a separate health* issue for weight alone that kicks in once people have become obese, and that can only be solved by changes in diet.
*even conceding that "bad health" means "risk of getting horrible life-ending or incapacitating problems earlier in life" and not just "where is your body on a continuum of fitness." Being obese has immediate life-capacity-reducing problems outing aside the long term health risks, that suck for people who are obese, and that shouldn't be ignored. Even if it's also simultaneosly fundamentally true that weight is a way way culturally overrated marker for health and that being affirmatively *skinny* is a sign of neither great health nor great virtue.
78: Now "everybody knows" that fat is unhealthy and so statements to the contrary, even though they are fully supported by evidence, are considered heresy. That doesn't make them any less true. Even if fat was unhealthy,
You really don't think this is false? I don't think there are many statements contrary is fat is unhealthy (fat is healthy, right?) that are fully supported by evidence.
For the knee pain thing, a systematic review on the effects of bariatric surgery on knee patients (Obesity Reviews, 2014, doi: 10.1111/obr.12236) summarizes a metaanalysis of multiple studies as finding that bariatric surgery improved knee pain in 73% of patients, and nine included studies that measured function and stiffness all found an improvement. The caveat was that few had a controlled study design (I assume this means that they did not have a group who did not undergo surgery, and was assessed at the same time intervals, just compared the same patient before and after, but it's not clear). I mean, I guess you can split hairs about the studies all day long, but that's the same strategy that's denounced when it comes to other topics.
I think that it is, in fact, incredibly hard to lose weight, but bariatric surgery has let researchers collect significant quantities of data about weight loss and health. I don't think that it's a great option, nor should anyone be encouraged to undergo such an invasive procedure, AND there are lingering questions about how durable the weight loss, but that doesn't mean you can't get cohorts who have lost 25% of their original weight to study.
84: Well, take the study linked in the OP. You start with some obese people with no markers of ill-health, and you end with fewer, but still a reasonable percentage, of obese people who still have markers of ill-health. You could look at that study and say that fifteen percent of obese people studied over a twenty year period remained perfectly 'healthy' by the standards used in the study; a lower percentage than of normal weight people, but still a significant percentage. Is that a statement contrary to 'fat is unhealthy'? You could look at it like that.
I mean, 'fat is unhealthy' is too abbreviated to be able to call it a true or false statement (how much fat? universally, for most people? what's 'unhealthy', specifically), and once you're talking about statements 'to the contrary' of 'fat is unhealthy', you're really getting too non-specific to talk about truth or falsity at all. But where there's something concrete enough to really evaluate, the passage you're quoting seems non-false throughout.
neb, can you write a script that replaces the name of any heavy metal performer in the name field with "[Halford's real name] representing [Halford's firm]?" Thanks.
Hey, LB, have you considered a career in [low blow!]?
But seriously, just about any health study is dealing with probabilities, not clear causal links, and the odds are tipped against being overweight.
I gave in and read the link. Doesn't it say that if you're healthy obese, then it's much easier to stay healthy and obese over the next twenty years than it is to lose weight? So shouldn't the recommendation to obese people be to work at being the almost half who remained healthy and obese rather than trying to get into the 11 percent group who lost weight?
I'm getting really bogged down halfway through Good Calories, Bad Calories. So much science that is all running together into one mushpot in my head.
Sure. But that doesn't mean for any individual patient in a doctor's office that that patient is unhealthy on any particular measure whether or not they're obese, and it also doesn't mean that advising them to lose weight is necessarily the best medical practice (because it's not likely to have much of an effect, and it takes effort away from probably more effective interventions).
I do think that the HAES crowd is very wrong about health risks associated with obesity, to the point of climate change denial or creationists.
Yes. Insanity writ large. When I see a very obese person moving easily and for a long time or distance I'll rethink this, until then, not.
But that doesn't mean for any individual patient in a doctor's office that that patient is unhealthy on any particular measure whether or not they're obese, and it also doesn't mean that advising them to lose weight is necessarily the best medical practice (because it's not likely to have much of an effect, and it takes effort away from probably more effective interventions).
Hi, I have personal experience with this. AISIHMHB when I was at my heaviest (~260-270 lbs. at 5'10"), I went to my GP because my knee hurt so much I couldn't bend it to 90 degrees. My doctor took my blood pressure, which was high, and immediately told me I needed to lose a bunch of weight and put me on blood pressure meds. When I asked about my knee (the whole goddamn point of the appointment in the first place), his only response was literally "Of course your knee hurts. You're fat."
Because of that experience I didn't see a doctor about my knee for another year. When I finally did get in to see an orthopedist, he took one look at it and said "oh, you've got a bunch of fluid in there." Drained almost 100ml, and then magically my knee didn't hurt anymore. (And then it turned out that the reason my knee swelled up was that I had arthritis. Not a goddamn thing to do with my weight.)
When I see a very obese person moving easily and for a long time or distance I'll rethink this, until then, not.
There's morbidly obese and regular obese. What HAES gets right is that there's plenty of people suffering social repercussions of fat who are basically healthy. I think this is especially true of young women, where the range of socially acceptable bodies is much, much narrower than the range as you age.
94 is the sort of story that makes me think I should just refuse to let the nurse take my vitals/other patient history stuff before I see the doctor.
I do think that the HAES crowd is very wrong about health risks associated with obesity, to the point of climate change denial or creationists.
Maybe I'm misunderstand HAES, but does it really matter? From what I know of it, it's all about healthy habits and doing as much as you can, no matter your weight. (E.g., this meetup group just started up in my area and its purpose seems totally sensible to me.)
There's morbidly obese and regular obese.
And overweight. We seem to be going back and forth between overweight and obese a lot in this thread.
94: We have one child who gained a lot of weight quite rapidly and I had some suspicions about the multiple factors involved. Even though her doctor is probably into obese on the BMI chart, the doctor was very dismissive of some of what was going on. Eventually we got a copy of her medical charts from when she was a baby and sure enough, that clarified some of it. She's still going to work with a feeding clinic program unless I feel like it's getting shaming or inappropriate, though I generally trust the hospital where it's housed, but I'm glad we've been able to get a bigger picture. No one just looking at her would see that. (I'm also glad that cropped pants are in; it's easy to buy jeans that fit in the waist and are supposed to fit at mid-calf and have them be full-length for her.)
Maybe I'm misunderstand HAES, but does it really matter?
Yeah, this. Who would be better off if there was less wrongness in the HAES community?
We seem to be going back and forth between overweight and obese a lot in this thread.
As is the case in every single discussion of this issue I've ever seen anywhere on the Internet. Telling fat people they suck seems to be a universal urge.
But that doesn't mean for any individual patient in a doctor's office that that patient is unhealthy on any particular measure whether or not they're obese
In the same way that a person's smoking status doesn't indicate anything about the health of a particular patient. Really, it's like that. The causal link between obesity and diabetes mellitus is just as well established, and the relative increase in lifetime risk is comparable. The major difference is that the population incidence is much higher: an obese young adult will far more likely than not develop diabetes, whereas a smoker has a better than 80% chance of not developing lung cancer.
Telling fat people they suck seems to be a universal urge.
Just like eating.
Telling fat people they suck seems to be a universal urge.
AISIHMHB, in grad school I once saw a nurse practitioner who lectured me on the terrible health effects my weight was going to start causing me any day. Including the admonition, "Just put down the fork, Blume." I still wish I had filed a complaint about her with the student health services.
95 is a good point. Women who are merely overweight can feel as if they're under considerable pressure to be thin, when the extra five or ten pounds doesn't make much a difference to their health or mobility (or at least the marginal improvement might be offset by the annoyance of keeping the weight down.)
Yeah, that's the Campos Shuffle. There are lots of good reasons why overweight isn't a very useful category, and lots of evidence that being a bit overweight doesn't have much health impact, so you use that to prove that obesity is a myth.
In the same way that a person's smoking status doesn't indicate anything about the health of a particular patient. Really, it's like that. The causal link between obesity and diabetes mellitus is just as well established, and the relative increase in lifetime risk is comparable.
What does "obesity" mean in this context?
I'd never heard of HAES until this thread and have no clue what it stands for. My only take is that there is a genuine social crisis of obesity that's hurt a lot of people on a lot of dimensions and that is entirely caused by too much bad food. There's also a massive overrating of the connection between appearing skinny and either long-term health or short-term fitness, that is a big problem for younger women especially. Both are true at once.
102: Sure. But there are still stories like Josh's, where over-focus on weight leads to undertreatment of otherwise treatable ailments, and there's the major stumbling block that prescribing weightloss is really, really ineffective. Losing weight isn't impossible, but it is genuinely very hard, and so focusing on it as the major avenue of attack for improving an obese patient's state of health seems as if it's often going to be ineffective.
And then it turned out that the reason my knee swelled up was that I had arthritis. Not a goddamn thing to do with my weight.
Not that your doctor wasn't an ass, but weight is one of the main risk factors of knee osteoarthritis.
Not that your doctor wasn't an ass, but weight is one of the main risk factors of knee osteoarthritis.
It wasn't osteoarthritis. Which he would have known if he'd looked at the rest of my chart.
That slippage between overweight-obese-morbidly obese is really troubling, and perhaps the very reason for people sliding down that scale. Convincing otherwise healthy happy people who buy clothes marked "L" that they are disgusting sickly timebombs of disease has a way of being pretty fucking depressing.
I look back at pictures of myself in high school, when I was at my thinnest (like a junior's 10, on the near side of L), and I can't remember why everyone was constantly hassling me about my weight. I looked good. The fatter I get, the less anyone seems to notice my size. I don't know if other people experience this, but there seems to be a sweet spot of fatness where no one is telling you you're *almost* an acceptable human, but no one is afraid you're going to die if you run a mile. I'm not at my healthiest or happiest right now, but it is nice that people don't fucking talk about my weight all the time.
97, 100
Yes and no? Politically, there are much bigger problems, including oppressive beauty standards and discrimination towards fat people. But in the liberal bubble, extreme FA activists are like annoying atheists and vegans. Yes, there is far worse out there, but since they're "our" people on some level, it rankles more when they spout bullshit.
Secondly, HAES is actually somewhat controversial in the FA movement, particularly by people who claim that there is no correlation whatsoever between weight and health. The extreme dogma of the movement means there's also no space to talk reasonably about weight and health, or to distinguish between being somewhat fat vs. 500 lbs. Also, former FA members have been raked over the coals for losing weight by following HAES or for legitimate health reasons. (See G/reta Ch/ristina)
http://gretachristina.typepad.com/greta_christinas_weblog/2009/08/open-letter-fat-positive.html
There are lots of good reasons why overweight isn't a very useful category, and lots of evidence that being a bit overweight doesn't have much health impact
I'm of two minds about this. On the one hand, I agree with your read of the evidence. Something similar applies to the designation "pre-diabetic" for elevated plasma glucose. The flip side is that overweight can be a waystation on the way to obese, just as pre-diabetic can be a warning sign of a trend that needs to be stopped. I don't know enough about the science to make claims about the epidemiology of it, but I know the belief is widely shared among people who worry about healthcare costs that these threshold values are significant.
Oh, and of course I have a similar story to Josh's, about getting switched onto some bullshit generic birth control that made me homicidal, and when I tried to talk to the nurse practitioner about the side effects I was experiencing, she began a litany of foods I should cut out of my diet. Would that reduce my urge to KILL, I asked? No, but I might lose weight, which would make everything better.
114: Yeah, I remember that post when she first made it. I'm totally on board with what she says. (And it always cracks me up to see her get linked elsewhere, since I know her as the tenant-in-common/super-close friend of a friend of mine.)
109: Health At Every Size. I do agree that if we could roll back to the food/exercise/lifestyle norms of the first half of the 20th C, people would be healthier and happier, and it would really be a good thing if that happened somehow.
I just watched Breaking Away with Buck and Sally over the weekend, and even just going back to 1979, wow is the difference in body-types obvious. Of four nineteen-year-old boys, you've got one beefcake (a very young Dennis Quaid was really the prettiest thing ever), and three presented as ordinarily healthy and fit, but looking remarkably scrawny by present-day standards.
Or what ajay said. Treating people of any size like a human being is really important. But taking the fact that the BMI categories are fairly bullshit to erase the health differences between being 30 lbs overweight vs. 200 lbs overweight also isn't really in the interests of anyone's health. Doctors being assholes about it isn't the answer either.
108: BMI of 35+ to get you into smoking/lung cancer territory, but there is elevated risk at lower levels.
I was a both cheered and worried that the orthopedist I'm seeing for my ankle-fucked-ness is quite a bit heavier than me.
I felt kind of like I was back in the old days when my doctor would carry his pipe (unlit) with him while doing exams.
The flip side is that overweight can be a waystation on the way to obese, just as pre-diabetic can be a warning sign of a trend that needs to be stopped.
But given that doctors are going to use bullshit BMI measures as their guide, where should they start warning people? Approaching 30? What if someone's weight has held steady at say, 28, for a long time?
Anyone who doubts the extent to which this is about shaming overweight people instead of genuine health concerns need only compare the treatment generally received by the seriously overweight against that generally received by the seriously underweight. They have similarly seriously elevated health risk factors. They do not receive similarly serious levels of public scorn.
Mostly, while I'm sure there's a sizable part of the fat acceptance/health at every size community that's in denial and just wrong about both the connection between obesity and ill-health and about the impossibility of weight loss, I'm also pretty sure that the net effect of HAES is vastly more positive than negative.
124: I did my part making fun of you for being underweight.
126: That you certainly did. I'm sure it was only out of genuine concern for my long-term health.
Anyone who doubts the extent to which this is about shaming overweight people instead of genuine health concerns need only compare the treatment generally received by the seriously overweight against that generally received by the seriously underweight
"Daily Mail editors, start your keyboards!"
124
True. I caught a really terrible disease in my early 20s and lost a bunch of weight. It took me about a year and a half to put the weight back on, and most random people assumed I'd developed an eating disorder, which, to be fair, was a more likely possibility for the American public than the actual cause of my weight loss. Anyways, in that 18 months, I went to various doctors for a bunch of unrelated reasons to the cause of my weight loss, and the only comment I got about my weight was from a male nurse who was pretty positive about my size. I had a BMI of about 16 at the time.
Losing weight isn't impossible, but it is genuinely very hard
Again, the smoking example is instructive. Quitting smoking is really hard. But it's worth doing! And a physician would be remiss if she didn't encourage you to try (even as shaming you would be counterproductive). Just cutting back helps, even if you don't completely succeed.
But at the end of the day, the most effective way to cut down on smoking is to keep young people from taking up the habit in the first place. Some of this involves replacing bad public policies with better ones, and some involves social engineering of various sorts. For the social engineering to be effective, a certain amount of stigmatization is hard to avoid.
For the social engineering to be effective, a certain amount of stigmatization is hard to avoid.
This seems like a really bad analogy. You can, sanely, stigmatize smoking as a behavior. You can't, sanely, stigmatize eating as a behavior.
Quitting smoking is like an analogy ban to short term weightloss, not longterm.
130: telling a poor person with no access to an exercise instructor or produce and without the time to cook is unlikely to be helpful.
Stigmatizing weight as such is terrible and not helpful from a health point of view, because it's not a behavior. If we knew something like snacking was the problem, or drinks with sugar were the problem, those are things you could imagine successfully stigmatizing.
I'm sort of shocked about how asshole-y this comment thread seems to be. What's wrong with you people today?
I lost a lot of weight and a ton of bodyfat while nursing and running a lot, and pretty much only heard praise from everyone, medical or not, except for the sports doc who pointed out that I was probably at risk for post-partum osteoporosis. I'm not sure he's right, because I was lean, not particularly light (BMI 20), but everywhere else was just straight-up praise.
Anyone who doubts the extent to which this is about shaming overweight people instead of genuine health concerns need only compare the treatment generally received by the seriously overweight against that generally received by the seriously underweight. They have similarly seriously elevated health risk factors. They do not receive similarly serious levels of public scorn.
Nonsense. There is no rising epidemic of underweightness in the U.S. Obesity is a top health priority because it is the major risk factor for three of the five most costly conditions in terms of aggregate health spending. A diabetic patient will incur higher than average medical expenses for decades, quite apart from the toll in human suffering. For an individual clinician, sure, it makes sense to be concerned about severely underweight patients - as I wager that most of them are. But from a public health perspective, it's way down the priority list.
124: The difference is causal. Being seriously underweight is usually the result of some condition (anorexia, cancer, etc).
139 before seeing 138, which is also a good point.
For the record, I am not in favor of fat shaming. And I categorically reject the notion that the cause of the obesity epidemic in America is the failure of individual willpower. I'm just saying that any concerted effort to eradicate a behavior (overeating, inactivity) runs an unavoidable risk of stigmatizing the behavior, even if everyone acted in good faith and moral/aesthetic prejudices were not involved, which they assuredly are.
124: I think the people you're perceiving as being asshole-y are focusing on the issue of People Being Wrong On The Internet, rather than about how to make society a better place on issues related to obesity. The post linked in 114 certainly describes people in the fat acceptance community definitely Being Wrong On The Internet, in a way that's both wrong and probably hard on the people they're interacting with.
Netting all the wrongness out, however, I think HAES is less wrong than, e.g., Josh's doctor, and that there's a lot more of Josh's doctor out there than there are overly aggressive fat acceptance advocates. And so spending a lot of effort on the Wrongness of the extremer parts of the fat acceptance community probably isn't an efficient way of making the world a better place, even if they are Wrong.
94/97:That's inexcusably bad doctoring, and I generally agree with LB's summary of HAES. I guess that perhaps, per 76, I've conflated FA and HAES? When I read blogs that have a connection of some sort to HAES, I tend to see a connection between saying, "It's totally OK to be fat/overweight/obese" (which yes, it's both pointless and cruel to assume anything about an individual along the spectrum ranging from "this person must be unhealthy" and "fat people are lazy and stupid") and "fat isn't unhealthy," with no qualifiers. There's no virtue in being thin or in being healthy, mostly dumb luck. I imagine that folks with better function and less pain have a higher quality of life and that some exercise/movement/just getting out of the house is better than none. My mother spent her entire childhood and adult life hating how she looked and struggling with her weight. I think she missed a lot of good things, and I'm sorry she spent so long being unhappy. I think she would have benefitted a lot from HAES, particularly the idea that even small improvement in function is better than none.
However, I think it's simply also incorrect to imply that there are no increased risks associated with being overweight or obese, which is what I was commenting on in terms of flat denial of science. Some health problems linked to overweight or obesity appear to have a direct causative mechanism that is medically fairly well understood, some appear to have a correlation that may or may not be causative. For some conditions, it is just not true that we have no idea whether weight loss helps or that weight loss is so imposible, there's no way a valid study (hence the use of bariatric surgery patients). That doesn't mean that patients shouldn't be properly assessed if they're overweight, nor does it mean they should get substandard care. It also means that a doctor shouldn't hector their patients to lose weight (at any weight, frankly - I think the messaging of everything else around them has probably done a pretty thorough job). It just makes for a bad relationship with a patient, or worse, patients who avoid doctors. What I think is wrong is that a lot of these folks seem to be avoiding the population data entirely, which does have information that is relevant for public health policy. I tried to pick someone I don't think is fringe to quote from, and it seems to me that the quoted section, either for the sake of rhetoric or by being willfully obtuse, doesn't acknowledge that there is data.
(Rereading 142, I find the arch use of capitalization rhetorically bizarre and unpleasant. Pretend I didn't do that, if you would.)
142
I don't think anyone here disagrees with HAES, and I don't think that anyone thinks radical FA activists are worse than or even remotely as bad as a fat hating culture. Part of the issue is that unfogged is possibly one of the only spaces you can disagree with any part of the FA movement and not be either labeled as a troll or co-opted by troll-y types who hate fat people.
I love 116, perfectly captures that the urge to hector a woman re her body size easily trumps even addressing homicidal urges!
UMC right thinking leftish USians are currently emamoured of the idea that turning back the physical environment clock à la LBs approach and somehow reducing the amazing juggernaut of food marketing will magically do it all for us. Particularly the second part of this seems so wildly improbable to me that it verges into magic fairy pixie dust territory outside a fascist health obsessed political environment. Also I think it is very hard to imagine within current US society the massive social pressures in other developed rich nations that keep overall weight down. The social stigma associated with snacking, eating when not at a table or at specific meal times, reading or watching television while eating - all of these pressures have an enormous cumulative effect.
146 was me, oh forgetful phone!
Tumblr has had a profoundly annoying effect on movements I'd otherwise be sympathetic to. Or, in the cases of queer and feminist activism, movements I am actively a part of. I try to remember that when you're new to a idea and it isn't really something you actually believe yet, but want to, sitting in an echo chamber is part of the process, maybe.
I can see where the HAES folks have a legitimate gripe that they end up as psychic collateral damage in the public health campaigns against obesity. The truth is that public health types are not above exploiting moral and aesthetic prejudices in the service of public health goals: one of the first anti-smoking PSAs depicted an old hag with a cigarette asking "Aren't I sexy?". More recently, the fight against skin cancer is being waged by urging young women to prevent wrinkles by wearing sunscreen. There have been examples of anti-obesity PSAs that are straight-up fat-shaming, which strikes me as wrongheaded on several levels. All that said, I think the real villains in stigmatizing obese people are not the public health types, who generally appreciate the social and economic roots of obesity, but rather the Big Food types, who are invested in the myth that individual irresponsibility is to blame for the obesity epidemic.
I didn't read LB's giving an example of how much thinner the country looked a couple of generations back as having any policy recommendations or prescriptions attached, even implicitly. Just noticing that there had been a change.
Super consistently wearing sunscreen is probably the single best way to put off damage to the look of your skin, I don't think that's public health people using vanity I think it's dermatologists just telling the truth.
See if I ever need you for anything.
May I just say "Preach it, sister!" to 148?
150: I did say that if food/exercise norms rolled back to what they were back then, we'd be better off. But I didn't mean to imply that that was any kind of realistic policy goal stated in those terms.
I'm not at all into fat shaming or stigmatizing overweight people (because it's mean and counterproductive, and also because it ends up rebounding on on women with terrible effects) but I'm willing to do my part to stigmatize grains, processed foods and sugary drinks in the name of public health. Fuck you Frito-Lay! Eat shit PepsiCo! Grain free at a hopefully more reasonable size but not too skinny seems like a reasonable social goal. I just need an acronym, like GFAAHMRSBNTS.
The exercise norms modeled in Breaking Away are extremely unhealthy, on balance.
A coworker of mine used to be the only person at work I ever saw smoking. A bit over a year ago he seemed to quit, and since then has gone from "normal size" (I wouldn't have been able to guess his BMI category from appearance) to remarkably large. I vaguely wonder at what point he would have been better off to keep smoking.
155: Allow me to be the first to suggest "Tiptonismo."
Also specifically to Breaking Away, the main difference you're seeing is that before the early 80s most actors didn't do bodybuilding; I doubt that otherwise the BMI of the actor-specific population has varied too much.
156: Having a bicycle pump stuck into your spokes at 40 mph by Team Cinzano is certainly not a healthy form of exercise. Also, hiding in a submerged refrigerator to frighten your friends is a bad idea as well.
160: jumping into quarries; taping your feet to bike pedals; suddenly working strenuously after taking sales as an occupation, the list goes on.
159: Not that they looked different from current actors (although you're right, other than Quaid they certainly did along the body-building front), but that they looked unlikely compared to kids that age today. I don't see groups of teens/young adults where everyone is either scrawny or built; the norm is at least somewhat pudgy, with notably skinny as kind of unusual.
You're comparing actors with regular people?
161: Cutting stone without dust masks... I spent most of the movie saying to Sally either "It was the seventies, safety hadn't been invented yet," or "It was Indianapolis in the seventies, no one had ever seen a real Italian."
163: I am. I suppose actors in the seventies might have been systematically skinnier, in a not terribly prepossessing way, than the general public, but that wouldn't be my first guess. There have to be clips of the movie on Youtube; other than Quaid, who could serve me tropical drinks by my cabana any day, the others don't look like an overly skinny body type you'd try to achieve on purpose, they look like young men who aren't carrying much muscle or much fat.
It was Indianapolis
Yes, Ms. Kael, yes it was.
Great movie, though. Ridiculous, but a great movie.
You're comparing actors with regular people?
In this case, the impression is valid. I'm a couple of years older than Quaid, and grew up in the same world. Photographs, my own family's or an artist's like the recently-discovered Vivian Maeer's, show a thinner world.
I knew that, really I did. I just kept on explaining the bicycle race as "the little Indy, like the Indianapolis 500", and got stuck on Indianapolis.
169: I'm having trouble finding a tactful way to say that I too have seen photographs from the 70s of a skinnier time.
I really am confused, though -- what were you asking in 163? I read it as an implicit statement that "Obviously, actors don't look like regular people, so relying on the cast of a movie you just saw to tell you about the population in the seventies is unreliable." And in general, you're right, it's unreliable, but in specific, I think that the cast of BA was a fairly ordinary looking group of young men in the seventies, build-wise, but would be unusually skinny now.
165: I'd guess male actors were more-or-less representative, females a little thinner.
I'm a little surprised that it was striking compaired to modern day New York though.
The Supersizers did an episode where they ate and drank like 70s people for a week, all booze and meat and way more calories, and they were surprised to learn afterward that they'd lost a lot of weight.
I must admit that if I were casting a movie where the main characters had to win a climactic bicycle race, I might think it added realism to cast people who aren't carrying much extra weight, whether or not that's the style of the day.
172: it just seemed like an odd comparison - "I was watching a movie and making a comparison with modern times, but not modern actors" - I get your case that it's not apples and oranges in this case, but usually that'd be an odd move.
Plus we watched Hot Tub Time Machine recently, and the 80s scenes looked about the same fat as the 2010 scenes.
My brother had basically the same build as my kid at the kid's age (young teenager), and I've confirmed with the family - there really wasn't a big problem finding him pants both long and small enough in circumference. It is nigh impossible today to get pants long enough that will stay up.
Cutting stone without dust masks... I spent most of the movie saying to Sally either "It was the seventies, safety hadn't been invented yet,"
When they were first showing the stone cutting, I was full of dread that the kid's dad was going to get in a terrible industrial accident. Don't worry, said Tweety, It's not that kind of a movie.
I'm a little surprised that it was striking compaired to modern day New York though
The NYC skinny field is, I think, pretty overstated. I think we have fewer morbidly obese people, and there's a very small population of people (tens of thousands, maybe, in a city of millions?) who are either in fashiony jobs or are the fashiony kind of rich, and they're super skinny. But there are plenty of kind of pudgy people: like I've said, I'm borderline overweight, but I don't think I look fatter than the average woman on the street around here.
I think LB and Sally should watch The Longest Yard (1974) next, and report back.
Everybody is so old and unhealthy here that I feel great.
Except the other Pittsburgh commenters.
176: Only one of them was supposed to be anything other than pretty hopeless on a bike, though.
21: Pam Poovey is certainly a positive example of healthy obesity. "You can't keep 'em down on the farm once they've had Pammy..."
176: Yes, I was thinking that normally in a Hollywood movie about a group of buddies there is one guy that is the fat slob. I think the makers of this film dared to deviate from this formula for the reasons Sifu elucidates.
155. Grain or gluten?
171. The fabulously named DOCUMERICA project from the 70s is up on flickr. for instance.
The Supersizers did an episode where they ate and drank like 70s people for a week, all booze and meat and way more calories, and they were surprised to learn afterward that they'd lost a lot of weight.
Ooh fun. The whole thing's a bit long for me to watch right now, but do they do other things to be more of the time (walking more or, I don't know, working all day in the Wedgewood factory, or something) as well, or is it all just food?
They try to imitate the exercise, work habits, parties, etc. They even meet with some swingers to talk about key parties.
I started watching the show because of the *amazing* Restoration episode (the most shocking, I think), but they're all fantastic. They get excellent historians involved. The medieval one is great too--it focuses on how surprisingly elaborate and global food trends were at the time.
Cocaine.
Goes with 70s Hollywood like __ with __.
Timely. Just this afternoon I was in a meeting on due diligence around a few "technical" aspects of my organization's potential participation in a "weight wager" program. This one. (Apparently only being evaluated at this point.) I dunno man, mixed feelings. There has been some push back on some other initiatives such as what some apparently saw as "food shaming"* in a very aggressive healthy food selection program in the cafeteria at my location. The CEO is a in fact something of a fitness fanatic.
*My characterization, not those of anyone as far as I know (I heard about the whole thing 2nd hand).
I met your grandson. He was very thin.
Also, he was governor of a boring state.
191: Yuck. A relative who works at a hospital told me they'll get bonuses based on virtuous behavior changes/penalized for bad. Something like a major discount on health insurance contribution for smokers to quit (think $100/month), incentives to lose weight, exercise, lower bp, manage diabetes, all kinds of stuff. I think is maybe not so appropriate for an employer to know. And, yours will have the added element of peer pressure! The cafeteria selection seems much less inflammatory, but maybe that's just me.
I can get like $50 for enrolling in some healthy living thing. On the one hand, that's a night of binge drinking (plus wings). On the other hand, fuck that.
191: Your organization is way behind the curve:
Nearly 90% of employers offer wellness incentives, or financial rewards or prizes to employees who work toward getting healthier, according to a recent survey from Fidelity Investments and the National Business Group on Health. That's up from 57% of companies in 2009. The perks are also worth more now: $521 per employee on average, compared with $260 four years ago.
I can get like $50 for enrolling in some healthy living thing. On the one hand, that's a night of binge drinking (plus wings). On the other hand, fuck that.
My last employer had a similar plan, which could save a similar $50ish bucks a year, to which I had a similar 'fuck that' response, and I never enrolled.
But now, participation in the healthy living plan offered by my current employer cuts $250/mo from my health insurance premium. (My wife and both have to participate.) To which I still have in instinctive 'fuck that' response, but it turns out for that price I'm willing to compromise my principles, so I'm enrolled.
Even though I make a reasonable effort to stay in shape, "Wellness" programs make me want to firebomb someone's house. It's a massively awful development that employers are being encouraged to think that they have a right to an opinion about what you do in your non-work related life.
That's five nights of binge drinking (plus wings) every month. No way I can pass that up.
It's a massively awful development that employers are being encouraged to think that they have a right to an opinion about what you do in your non-work related life.
196: Yeah, we have a had various others, this is just the most recent (and most relevant to this thread). We get a tobacco-free health insurance discount, something like Moby's thing in 195, and participate in a Walk a Gazillion Steps thingy where you get a pedometer. Of those, this one leaves me with the most mixed feelings.
"Wellness" programs make me want to firebomb someone's house. It's a massively awful development that employers are being encouraged to think that they have a right to an opinion about what you do in your non-work related life.
Seriously. BUTT OUT, EMPLOYERS. And yes, let us put more and more of our health care lives in the same basket as our employment! That always works out so well! Fuck that sideways.
I have two libertarian-curious friends who see coercive measures in insurance as the inevitable next step against freedom. On the campus where I work, there had been a long-standing permission to smoke outdoors, I had heard because psych patients like to smoke. Gone for two years now, so there's a camaraderie by the exits with their "no smoking near the buildings" signs.
I stopped in APril because of an injury, haven't taken it up again. I wish our workplace cared about employee health, because then maybe I could get back in to the military gym nearby. In fact, all of us here have been kicked out for a combination of petty bureaucracy and spiteful response to a verbal exchange from one of ours, with no administrative response from our side at all. The on campus gym is in a 4th level subbasement, and is poorly ventilated. In contrast, entering campus is a shambolic imitation of airport security, to which thousands of newly built square meters are devoted.
Don't order a whole dozen of garlic-parm wings. I did and I OD'ed on butter. The first one was so good. The 12th one was not worth it except to avoid hurting the cook's feelings.
I also find stuff like the United Way entirely odious.
We got a stupid Wellness Initiative at the same time that they decided it would be fun to stop staffing the mental health office at a residential college for mostly-troubled teens in a rural mental-health desert. It's SO FUN to be responsible for handling multiple suicide threats every semester while trying to teach college courses. It's so SO GOOD for my personal wellness goals to be used as a projection surface for young people with no supervision over their self-medication.
I take it back. Not mostly troubled. 25% troubled. (That's an actual percentage of my students whose undertreated mental health problems led them to drop out of school, not do major assignments, skip exams, become unable to attend class, etc. this semester.)
The United Way does lots of workplace campaigns and I just think that shit should stay home. It's gross, and I certainly can't tell on quick perusal if their initiatives are something I would actually support. Here's a line from their education initiative ("United Way works to end America's education crisis"): "The strategies proven to work are those that connect communities to their schools: parent involvement; literacy volunteers in the classroom; mentors for disadvantaged students; business leaders engaged in early childhood advocacy."
209: I have a new policy of not taking seriously any education initiative that thinks "parent" is an adequate shorthand for "parent or guardian." When interviewing candidates, I grant bonus points if they don't fall into that trap.
205: Agree. My most snitchy moment at work was after a middle of a political discussion during which a self-righteous right-wing prig (who was the United Way liaison) used someone's low (or non-existent, forget which) United Way contribution to bash them in absentia. I unashamedly took that one right to our mutual manager.
I'm bothered by Wellness initiatives mainly because of how clear it is that they're depending on the idea that the difference between good health (according to the markers they've chosen) and bad health is a matter of virtue, and picking low hanging fruit in terms of lifestyle changes. Without that I'm pretty sure that any attempt to implement them would get a pitchforks-and-fire reaction from people subjected to them.
Of course I'm also bitter because for various reasons there's pretty much no chance that I would ever meet the 'healthy' guidelines that I tend to see, no matter how much virtuous effort I put into things. I mean, that's not to say I couldn't do better on some things, but I could go complete abstinence from alcohol and unhealthy-ish foods and one and a half to two hours a day of moderately hard to hard aerobic exercise and still never get within spitting distance of a normal BMI or blood pressure (not hypothetical example). People with, e.g., prostate cancer probably incur higher health costs too but it's hard to imagine a 'no cancer' premium bonus not resulting in heads on sticks.
My most snitchy moment at work was after a middle of a political discussion during which a self-righteous right-wing prig (who was the United Way liaison) used someone's low (or non-existent, forget which) United Way contribution to bash them in absentia. I unashamedly took that one right to our mutual manager.
Snitch on!
I agree that workplace charity campaigns are evil, but does United Way do more workplace campaigns than other big charities? Everywhere I've worked has had a few different charity campaigns. One of which was usually the United Way but others of which were for other things. Leukemia or heart disease or the city's Fund for the Arts or (when in law firms) the indigent people's lawyer fund (whatever that is called).
I've never had any impression that the United Way did anything objectionable with the money. Don't they mostly (exclusively?) give it to other local charities that they deem to be needy and deserving?
they decided it would be fun to stop staffing the mental health office at a residential college for mostly-troubled teens in a rural mental-health desert
The parent listserv as been apoplectic about this, and the administration has promised to fix it pronto. We'll see.
A major part of our workplace Wellness Initiative seems to consist of the Wellness Professional on campus friending everyone on Facebook and making sure to praise or tut-tut everyone's posts to let them know whether they've expressed Wellness-Compliant sentiments or not.
"That sure sounds like a low-fat, low-calorie dinner for you to make! And with all fresh ingredients!" Etc.
Of course I'm also bitter because for various reasons there's pretty much no chance that I would ever meet the 'healthy' guidelines that I tend to see, no matter how much virtuous effort I put into things.
I don't want to defend these programs, since I hate them, but most (all?) that I've ever seen don't actually depend on meeting any 'healthy' guidelines in order to get the reduced rates/bonuses/whatever the carrots are. They are just activity-based. I believe there are actually regulations designed to ensure that every person in the company should be able to qualify for the reduced rates/bonuses/whatever the carrots are regardless of their health status. You just have to have a health screening, have a physical exam, and then complete certain activities, which can be big things like "stop smoking" or "lose 10 lbs" but are more commonly smaller things like "walk 1 mile" or "don't eat any donuts this week". You don't have to actually demonstrate any change in health outcomes as a result. Most of the things aren't even things they could ever actually verify whether you have or have not done--it's largely an honor system.
Don't get me wrong, I dislike all the workplace campaigns. The United Way is just the biggest and most noticable, though I do feel that the generic undirected blankness of the United Way's presentation of self adds a little extra dose of yuck. Even if I would ultimately find all their spending unobjectionable, the idea that the best idea is to exhort and guilt everyone into giving money to completely generic $CHARITY rubs me the wrong way.
And if this person is to be believed, these programs don't even save money.
The United Way sent me to DC as a "Future Leader" or some shit when I was in high school. I got sent home for drinking in a hotel room with boys. Story of my life.
Fuck, I lost my goddamn fitbit. Our company gave them to us and if we record enough steps (which I already did) we get $200 a year.
it's largely an honor system
Not for the smoker discount. Alcohol consumption would be another dial to turn, as could be screening for other drugs.
223: Get a new one and pay the mailman $5 to carry it around.
223: A friend lost his last week and Fitbit mailed him a new one immediately.
"it's hard to imagine a 'no cancer' premium bonus not resulting in heads on sticks."
My employer did something similar to what Harvard recently did and preemptively cut their health plan benefits to below "Cadillac tax" levels. Part of that involved creating a new, extra-expensive tier of prescription drugs, much of which is chemo drugs. So they basically said "Your cancer just got more expensive", to the tune of maybe several thousand dollars per year.
The employees are not happy about this, but it is below the heads-on-sticks level, mostly.
221 is great.
Without have clicked through to any of the various essays, just reading the passages quoted here makes me feel slightly sick to my stomach.
Fitbits just seem like expressway to OCD. When I hear certain people have adopted them my heart sinks.
Yes, some insurance plans on the exchanges are essentially saying, "No HIV patients please" by putting specific categories of drugs on the expensive list.
My problem with the Harvard thing is that they do it by adding coinsurance. Increase deductibles or copays, whatever- at least you know what things cost when you walk in the door. Instead you are on the hook (up to the OOP max) for 10% of whatever number is behind door number 1, which we'll reveal only after we've cut you open.
||
Somehow this seems like the right thread for this link:
Peanuts cartoons with the dialogue replaced with Smiths lyrics. Some fall flat, most are charming, and some are inspired.
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230: What if it's America's Swipple Best Friend, David Sedaris?
which we'll reveal only after we've cut you open
As people get older and sickness becomes more likely, it really pays to check the max out of pocket on plans and pick the lowest that you can afford.
With the caveat that I believe our reliance on employer-based health benefits is a fundamental design flaw, I can't get too exercised (no pun intended) about employers meddling in health and wellness. For the majority of Americans who get their insurance through work, the employer directly bears the expense of employees' medical bills and those of their covered dependents' (about 60% of covered lives in the employer group market are in self-insured plans, where the insurance company is merely an administrator and the employer bears all or most of the risk). Of course employers are going to try to manage those expenses down. What do you expect?
The major problem* with employee wellness programs is that the evidence of their efficacy is questionable, and evidence of their cost effectiveness is downright dubious. What we're seeing now is a period of "let a 1,000 flowers bloom", as employers collectively realize they've been spending billions of dollars a year on programs that don't have any ROI. All the vendors claim to have some secret sauce (Behavioral economics! Prospect theory! Social media! Gamification!) to crack the code on behavior modification, and they all have a cherry picked case study to prove it works. When and if someone figures out how to successfully "bend trend" with prevention in the workplace on a scalable basis, it will be a worthwhile endeavor.
*Another problem is that the HIPAA protections are leaky, which makes me more sympathetic to rfts's "BUTT OUT" stance, though I think that's a fixable problem.
233: usually I just find him unbearably annoying and awful but a skim of that piece while in a waiting room somewhere made me sad for him. Although I still find him completely ugh do not want make it go away.
230: I won a Fitbit in a fitness challenge at work, and gave it away after playing with it for a bit, because I was starting to think of food as something that needed to be balanced exactly with exercise, and it wasn't healthy for me, because I can totally win at any number-crunchy self-control game. Maybe it works for some, but it made me kind of crazy, so I gave it to a friend who had lost hers.
231: 20% coinsurance for maternity was crazy. Yes, I'd love to talk to hospital billing 24 hours after having had a traumatic delivery. Who wouldn't?
Yes, some insurance plans on the exchanges are essentially saying, "No HIV patients please" by putting specific categories of drugs on the expensive list.
Rumor has it that a regulatory crackdown on this practice is in the works. This is one case where the power of Big Pharma is a force for good.
If everybody keeps losing Fitbits, why don't them make them with a strap or something?
Of course employers are going to try to manage those expenses down. What do you expect?
This looks like classic is vs ought confusion.
Just because the programs don't have any monetary ROI doesn't mean that they won't remain popular among employers, who are people and as such tend to enjoy the ability to reinforce their sense of control over their employees. I mean, yeah yeah cynicism etc., but it's not like drug testing programs disappeared when someone pointed out that people who are in point of fact high when at work are easier to pick out by looking at what they're up to than with blood tests. One of the characteristic failures of predicting what employers will do is assuming that it will match some general revenue/cost calculation when in fact it's often responding to entirely different factors.
This looks like classic is vs ought confusion.
I guess I'm comparing it to other means that employers can use to manage the expense of their risk pool, like dismissing employees whose children have expensive congenital conditions (legal!), or changing job descriptions to weed out old and feeble applicants.
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I'm kinda non-functional today anyway but I keep googling "kitten mushroom" so I can look at this picture. It is, as the youth say, everything.
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Speaking of lifestyle changes and cheapness, I'm now thinking of getting one of these. Then I'd take up hiking. I already have a backpack and a ground cloth and a camping stove. I'd just need a sleeping bag I could carry easily and some Slim Jims.
Also um I enrolled in a wellness thingy which I of course totally failed to follow through with and I guess there was dietary stuff because at least once a week I get an email with the subject line MEAT MATTERS and it kind of creeps me out.
With the girls on Medicaid and me on insurance through my job, I see bother worlds and while particularly for mental health the kind of care you can get and speed you can get it differs, there is so much to be said for not having any financial insecurity about whatever turns out to going on with Mara. There would be a huge negative impact on my quality of life otherwise. I really wish we had single payor for all.
In any event, I totally get why people here are skeeved out by employer wellness programs, and why people hate deductibles and co insurance, and why single payer or something like it would be a blessing in many respects. Given the constraints of path dependence and our political landscape, Saint Augustine would have to file these all under things he needs to be serene about, and that's where I've landed, too.
I just want to skip all the January people at the gym. Just stop already like you are going to do in February anyways!
246: You get creeped out by that but are fine with kittens in penis costumes?
Moby, that's not a tent, it's a tarp with a pole.
Two poles. There is a little one at the back.
149 is a really interesting point. I hadn't thought about how Coca-Cola benefits from the meme that Americans are fat because they're lazy, not because they drink Coca-Cola.
253: My palms got sweaty just reading that.
Remember how my OB made me prepay my 2K deductible over the summer? Sure enough, post-delivery, the hospital and the anaesthesiologist sent their bills to the insurance company before my OB did, and so the deductible went to those bills, and I owed them $1600.
My OB has STILL not billed the insurance company, and Rascal is almost two months old. Supposedly my OB will send my 2K to the insurance company, who will then cut us an overpayment check.
Obviously I'm livid.
Also changing doctors will cost us $125 because they charge $25 per file that they send over. And it takes 2 weeks. They lose a lot of patients, see.
Does the $125 get applied to the year's deductible?
Be sure to review the fuck out of her.l
Shit please delete that someone. Paste error
How badly do you need them to transfer the files over? Most of the time a new doctor will just take a new patient history anyway. I know that often you have to pay to get a copy of your medical records, but that's the first time I've heard of a doctor charging to send the records on to a new doctor.
258: nope. Just an office fee.
262: don't they need the kids' shot record and stuff like that? I suppose we have our own copy of their shot records.
I called the hospital to see if they'd resubmit their bill to insurance in a few weeks, after the OB submits their own, and they said "sorry, no, but this happens A LOT."
259: s/review (.*)/beat $1 with a sack of oranges/.
I would write them asking for them to return the $2,000 directly to you, and asking for your files without the fee, and copy the Texas Attorney General consumer complaint office. Why should that money go through the insurance company? They charged you, when they shouldn't have, rather than the insurance company.
There's probably a $100 fee for answering angry letters.
Mass. has a consumer protection regulation that limits the amount docs can charge to give you a copy of your medical records. But there's a loophole: it only applies to a "summary" record. If you want all the details (lab results, etc.), they can charge you a dollar a page. When we switched pediatricians, we wanted the full record because of our child's complicated medical history. So they complied, and gave us about a ream and a half of paper, at least 70% of which consisted of "discharge instructions" - you know, the little canned sheets about "What you should know about otitis media (middle ear infection)". I'm sure the bastards were laughing all the way to the proverbial bank.
At the proverbial bank, a penny saved is a penny earned.
269. Doh. Now I understand why those reports, which could be formatted like Excel and take up about 1/4th of the room, are so free with the white space.
271: I find that in these matters, the most cynical explanation you can think of is usually the correct one. The major source of error when applying this rule is not being cynical enough.
The fact that its on paper at all is barbaric.
The fact that it's on paper at all is barbaric.
The heuristic described in 272.1 can be applied here, though most laypeople will fall victim to the shortcoming in 272.2.
As far as our excellent CFO could tell, and confirmed by the doc on the board who was part of a small PCP practice, EHR are a modest net cost for the M/dw/fe Center and most other frontline providers (maybe they're a net savings for big orgs with more back office stuff to be streamlined?). In theory there are savings from a more error-resistant system, but there's no way to budget them. In terms of staff time*, equipment, and software, it's emphatically not a savings.
*I gather that this is largely because, whereas a paper record can just get a couple notes and be updated in downtime, EHR need to be updated on the spot, basically during the appointment
276: I don't know about health records, but electronic data capture in my field often doesn't save time in the early phases; it saves time in later phases when processes like inserting standard text start to be used. Not sure what they are using, but the software should be smart enough that routine entries take a few taps of a stylus. That's where time savings usually accrue. If their software doesn't have appropriate templates or autotext that was customizable for their needs, that's really unfortunate. Of course, it may be that staff time is relatively cheap where you are, too, which would make small time savings less valuable. (A friend works on rollouts of electronic data systems. He tells me that there are real time savings on data entry, but employees don't generally become more productive with their newly available time - they mess around more.)
273. The medical practice I go to now has all the records available electronically, at will, for free. #nice
This seems like the thread for this weirdly funny link to bodybuilders arguing about how to count days in a week.
That's a much better link to it than the deadspin one I had. I was debating posting it, but the deadspin guy is so annoying that it distracted from the actual funniness of the lunkheads debating the number of days in a week.
[T]heorem: the space of all possible body builders, even ones confused about whether a week has a Sunday at both ends, modulo equivalence, is isomorphic to the real numbers.
279 should be an admonition for anyone who might be hoping to persuade someone on the internet with respect to any genuinely complex issue (e.g., political, ethical, social or religious questions).
I don't understand a word of the link in 281, but it's hilarious anyway.
Of course, it may be that staff time is relatively cheap where you are, too, which would make small time savings less valuable.
Yeah, we're talking total compensation in the 5 figures, and something like 40% of that time spent in EHR-relevant tasks; there's just not that much time available to be saved to make that add up to real dollars. There may be savings down the road, but the payback is long enough that it's not relevant.
There are eight days in a week. I know this because Beatles.
I'm disappointed one of them didn't start arguing in fortnights.
I tried to read it in a "Hanz and Franz" voice. Failed. Lost interest.
How many times a week could Grothendieck work out?
[It's a trick question; Grothendieck was never not working out.]
Some other mathematician ran into Grothendieck on the street, and was shocked to find out that he was coming from a movie. Up to that point the only thing anyone had ever seen him do was type on the IBM Selectric in his office. (Though Selectrics were pretty heavy, so he was probably just doing curls with it the whole time.)
