Tuesday, September 28, 2010

Well That's Just Not Fair

I wanted to post this a few days ago when the story came out...but I have been very busy.

A new study by George Washington University Scholars showed that it costs women nearly twice as much as it does men to be obese. Researchers tabulated the cost of medical bills, employee sick days, health insurance, lost productivity and even the need for extra gasoline to fuel cars carrying heavier passengers. In total, they found that the average yearly cost of being obese in America is $4,879 for a woman and $2,646 for a man.

I'm all for bringing up more reasons to have the fatties loose some pounds. Day in and day out in the ER, the majority of cases I see can either be attributed to or complicated by obesity. Now we have a study that brings up the obvious...being fat costs more money. Sometimes it takes saying the obvious to make an impact.

The reason, though, why it costs women more to be fat??? The study says it is because they get paid LESS than their fat male counterparts. Now that sucks.

Now for my liberal side....it is HARD to eat healthy when you don't have a lot of money. It costs a hell of a lot more. That's not an excuse for not exercising or controlling portion sizes...but there needs to be better regulations on what goes in food and their needs to be more AFFORDABLE healthy options. I was poor until moonlighting in residency.....that dollar menu used to be very appealing.

Now enough of the serious stuff. Let's get some funny comments about why it costs more to be fat. If you are sensitive, don't read.

-ER Doc

BTW, it doesn't take as much as you would think to be classified as obese. To calculate your BMI, click here. (Mine is 23...booyah!)


type1medic said...

23.8 BMI. I just wish people would slow down on the weight gain I mean a lot of those who end up in the back of my ambulance are there for a issue that weight has contriubited to! and really I should not have to look at my pt and then ask myself if they exceed the weight limit of my strecher.

Anonymous said...

What??? I'm 6'00" and 185 lbs. Apparently I just made the fatty category with a BMI of 25.1.

Meghan said...

BMI is not a good way to determine "fattness."

Measuring a person's actually body fat percentage would be better. There are lots of muscular people who are class as overweight by the BMI system, and there are "skinny" people who have a higher than normal body fat percentage who are classified as normal by the BMI.

Crazed Nitwit said...

Totally agree about the healthier standards.

I'm so glad I'm exercising and eating low fat, low salt, low sugar, no more Coke diet.

Love your liberal side!!

tracy said...

19.6. But i'm still a flabby mess. i exercise, but not enough, obviously. UGH...!!!!! i watch what i eat, 'til the binge monster attacks! :(

Great article! It inspiries me to make some major improvements!

Pissed Off Patient said...

Food is just too damn expensive.

As an example, butter was $2.48 last week and this week it's $3.12. Chicken went up a buck in just one week.

I can't cut enough from the list and find new recipes fast enough to keep up with inflation. Coupons are useless b/c we don't eat processed foods. I absolutely will not buy cereal--candy poison in a box--so coupons are largely useless. On a good week I can scrounge up $15 worth of coupons for dairy items.

We even did Angel Food Ministries once (crappy quality) and now I shop at Walmart which goes against my ideals, but I can't afford real grocery stores.

And I don't want to hear about how butter is evil, a low carb diet is part of my medical treatment and that includes some butter.

There's also a lot of information on how exercise doesn't help weight loss. Nor is it really so simple as exercise and portion control. PCOS (which affects up to 10% of women and is often undiagnosed) is a cause of obesity and leads to Type 2 Diabetes. If an OB/Gyn catches it, they'll usually advise a low glycemic diet which is key above and beyond any other lifestyle change.

Imagine how we could change the stats if we just sought out that 10% with PCOS and provided appropriate care?


P.S. I'm really tired, please excuse any rambling.

tracy said...

Even if exercise does not help with weight loss (and i believe it does), it is certianly a great mood booster.

Anonymous said...

There's also a lot of information on how exercise doesn't help weight loss. Nor is it really so simple as exercise and portion control. PCOS (which affects up to 10% of women and is often undiagnosed) is a cause of obesity and leads to Type 2 Diabetes. If an OB/Gyn catches it, they'll usually advise a low glycemic diet which is key above and beyond any other lifestyle change.

....hmm, I've been diagnosed with PCOS and my BMI is 19.1.

And you can say all you want that BMI is not a good way to determine fattness.....but it is an easily understandable way to compare height to weight that most everyone understands. And since most of my patient's aren't overly muscular and are simply fat, it works.

As to exercise not helping with weight loss....yes it doesn't do much without diet changes, but the diet will do more with exercise. Besides, people usually don't eat while they're exercising, so that helps right there!

Ninjamedic said...

noI wish I could accurately quantify the number of patients I've cared for who have needed my services because of their obesity - or a condition directly related to their obesity. As it is, I can't, so I'll just have to make do and call it 'a lot'.

A question I've often pondered is this: at what point does a person's weight become enough of a hindrance to them that they feel the need to do something about it? When they become diabetic? When they can't walk around the grocery store because they get short of breath and instead have to use those motorized carts? When they are required to pay for an extra seat on airlines, or can't fit into the seat at a movie theater or restaurant? When?

I was overweight once. I'm 5'4" and at my heaviest I was nearly 190lbs. My 'ah-ha' moment came when I realized I was avoiding walking up the stairs in my own home because it made me breathless. I started running (at night at first so people wouldn't see the chubby sweaty girl jiggling her way down the street), made an effort to eat less, and I lost weight. I'm now 125lbs (I have difficulty maintaining that weight because I have Crohn's disease and I lose lbs really easily now, which I find ironic). The point is, it CAN be done, it just takes some effort - and I think that's the stumbling block for most people.

Pissed Off Patient said...

@ Anonymous: A minority of PCOSers are thin. I have not personally met a thin PCOSer and I've done peer counseling in that demographic through non profit organizations. Your experience with the PCOS spectrum is going to be different and not representative of the majority.


My question is when is medicine going to get their act together on nutrition and diet?

It takes a village. We managed to spawn Snackwells with our low fat high carb paradigm and where did that get us? Fatter than ever.

Something isn't working.

Before I was diagnosed and given a low carb diet, I tried to lose weight for 10 years and could not. I had done it before, but when the insulin resistance hit, I couldn't exercise or low fat/high carb my way out of the weight. I think a lot of people are trying the best they can, to the degree that they have accurate information and appropriate medical care.

I go to my community's (free!) Zumba class and it is packed with like 100 inner city folks. Everyone is fat. But we are all working out, doing the right thing. People are not lazy.

The one thing I wish would change about the obesity debate is the inclination to blame people. Personal responsibility has a place, but it is only a part of the problem. We harp on laziness at the risk of missing other key pieces to the puzzle.


ERP said...

Pretty much it comes down to calorie and portion control. We just have to eat less and deal with being a little hungry.
As for why it costs women more? I would guess is that they tend to seek out heath care more often then men who often blow things off til the last minute.

Anonymous said...

Pissed Off Patient ~ I hate to rain on your parade, but obesity and weight managment is ALL about personal responsibility. (Except in cases of obesity in young children, which I believe is child abuse or neglect by the parents overfeeding toddlers and preschoolers!)

People make food choices every day--what to eat, how much of it, and when. We also choose our level of phyiscal activity, or at least we do until the point where mobility is limited by the obesity itself.

We can run through the cost of food, the lure of the dollar menu for the working poor, and the portions served in restuarants of all kinds. But it all boils down to personal choice over what goes in our gullet and how much we move.

And lest you think I am being harsh, let me add that my BMI is well into the obese range; but inching downward with every extra step I take and a healthy diet. My labs and vital signs are awesome, and my big focus is health, not how my ample rump looks in a three way mirror.

I got tired of excuses....mine and everyone else's.

Trisha K.

Ninjamedic said...

@ Pissed off Patient: I believe medicine DOES have it's act together for the most part when it comes to weight loss and nutrition.
We know that less calories in + more calories out out = fat burning weight loss.

I really don't think that it does take a village; I think that weight loss is the responsibility of the individual. A nutritionist can give all the advice they want, unless the patient takes the advice and sticks to the diet and exercise plan it won't work.
It's not easy or comfortable sometimes, and that's why (IMO) lots of people fail.

Pissed Off Patient said...

@ Ninja: If it took me 10 years to get a good diagnosis then, no medicine does not have its act together. I actually gave up. Kept exercising and kept eating 1000 calories a day of low fat high carb crap and didn't lose a damn pound. When we went through infertility, that was when the pieces fell into place.

I don't think I'm a rare exception either. I think there are a lot more people like me than anyone realizes. I know there are, simply because this post and the comments harp on the same old tropes. There's no new thinking.

I would argue with you on calories in and calories out, especially with insulin resistance, but I don't have the info at hand nor memorized. I will just say that persuasive alternative views exist and are worth reading.

@ Trisha: I take so much personal responsibility for myself it hurts. What I need, what everyone needs is a similar commitment from medicine.

I don't want to hear blame from medical professionals because they are the people who have the education and authority to do something. So do something and stop blaming the stoopid patients. Contribute. Even if it's just a handout on how pop, chips, and cereal are poison.

My mobility has never been limited by obesity. I have even taught aerobics when fat. What limits my ability and prohibits weight loss? Asthma, steroids, adrenal insufficiency, insulin resistance and medical science.

Trust. My ass is up off the couch so long as I can move it.

Ultimately my point is, we've been yammering about personal responsibility for how many years? Nutritionists have been yapping about low fat diets for how many years?

How's that paradigm working for everyone?

Let me see. Oh look, we are fatter than ever. Even if you personally have lost weight, no one else has.

Let's look at Duke University and their research on low carb diets. Let's look at how most, if not all, gastric surgery programs use a low carb diet after surgery.

Let's start looking for something new instead of rehashing all the same old stuff that has not gotten anyone anywhere.

Let's say for a year, we ban the words personal responsibility and instead require science to come up with something else.

Posts like these are the same old whining I hear from medical blogs over and over again. It's tiring. Let's see some original thought.

As for food, the cost is seriously getting scary for my family. Glad it's not affecting anyone else, but we are cutting back big time, including limiting quantity of food for the adults in our house.


SerenityNowHospital said...

Pissed off Patient:

I am sorry but you are the exception, not the rule. You do have a condition that makes your weight a different ball game than most.

Like most things in life, it is a balance. The VAST MAJORITY of individuals that are overweight do need to take more personal responsibility. They need to be healthier. They need to leave the poison foods that you mentioned on the shelves. Medical professionals should do a better job of educating, but with media coverage I think most people know.

Hell...even medical professionals need to take personal responsibility. Most doctors I know are fat asses and I see what they eat.

Ban the words personal responsibility and science come up with something else??? No way. How bout both. Science needs to come up with stuff for people in your situation, not the 95% of people who are obese because of themselves not their DNA. Should we ban personal responsibility from cigarette smoking and just have science come up with a way where we can smoke and not have the bad effects?? No. People need to take personal responsibility. That is what is the matter with this country as a whole right now....everyone wants someone else to pick up the slack and not have to be responsible.

You are in a different position than most and have a different perspective. But you need to stop looking at things from your microscope and see/understand what the reason the majority are overweight and sick from. Men don't have PCOS...so what's their excuses??

Again, sometimes there are medical reasons people are overweight. And even if they have a medical reason, one can contribute to making it worse by cheetos. We need to take personal responsibility. If we are doing everything properly and still have problems, then seek medical help to see if there is something else going on.

But when I walk into an obese persons room...and the nurse can't get an IV b/c they cant find their veins, they have shortness of breath and chest pain b/c they are too fat, they smoke, and they are eating a bag of cheetos....I really dont feel sympathy for them. And I dont think the government or taxpayers should have to pay a dime for them being irresponsible. And Im a freaking liberal...

-ER Doc

Arzt4Empfaenger said...

ER Doc, I totally agree with your last comment. no matter what reasons might coexist, everyone will have a part to which they can contribute by personal responsibility. (Am right on the move so I'm short of time these weeks, sorry.)

Pissed Off Patient said...

ER Doc: Thanks for the kind response.

I just don't think I'm as rare as everyone thinks. That's why I'm posting here.

I really think insulin resistance is rampant and once you have it, it's awfully hard to take mainstream nutritional advice and turn it into weight loss.

Irresponsible people are annoying. Lazy people are annoying. I tutor kids in families that echo the weirdest craziest patients that end up on the medical blogs. I go into their homes and see it up close and personal. It IS scary, but then I remember all those people at Zumba trying to do the right thing. And they are still fat.

A lot of people doing the right things are not losing weight. And I just hate when we default into fat bashing, because it is predicated on the belief that we've found the cure, when we haven't.

Okay, hopefully I haven't written a book this time :)

Anonymous said...

why do they get to insulin resistence tho??? bc they ate their way there

Crazed Nitwit said...
This comment has been removed by the author.
Crazed Nitwit said...

I spent this morning at the American Heart Association's walk doing wellness cholesterol/BP/blood glucose testing and counseling.

I've lost 25 pounds(more than 15% of my TBW) since June with walking, light weight training, and a diet low in fat, sodium, and sugar along with no processed foods and absolutely no fast foods. It's working for me. My BP is normal without medication, my cholesterol has lowered off medication(could not afford those meds when unemployed) and my energy level has gone through the roof.

All the people I met today were all going down the route I'm going.

I am not saying this will work for everyone. I do believe wellness medicine is where it's at in education and prevention.

Anonymous said...

Pissed of Patient:
you say you can't lose the weight due to insulin resistance, well the insulin resistance is there BECAUSE OF THE WEIGHT.

So, I'm really not buying that.

And it never takes a villiage. The village isn't shoving food down your face. You are. The village isn't stopping you from going for a walk, you are since you'd rather watch TV.
The village also cannot stop you from doing these things. Only you can.

It also doesn't take a village to raise a child, it takes a parent to stand up and say "no". But that is a whole different topic.

Pissed Off Patient said...

Anonymous: You are dead wrong, sorry.

I gained weight and got insulin resistance due to 15 years of being on prednisone more than off. With no information provided from my doctors on its effects either on my insulin response or my weight.

So it ain't my fault. I did everything I was supposed to, but medicine failed me spectacularly much to the detriment of my long term health. (Plus I get to deal with people like anonymous who think all obesity is self imposed.)

My point continues to be, I am not the only one medicine is failing.

Also, previously, I had lost weight and maintained it just fine using mainstream nutritional advice. That stopped working after my first round of exogenous Cushings followed by adrenal suppression.

Read my blog, maybe you'll learn something.

It is really sad to me that, with few exceptions, the tone on this thread is so sure that the fatties are doing it to themselves and deserve what they get.

But the science IS changing, just hasn't trickled down to the ground floor yet. The studies that are being published today are more like this one that is in Lipids: http://www.physorg.com/news205146842.html Which is counter to all the assumptions in these comments.


DarkAngel said...

I think it is depends on the humans body, for me it is all the same obesity is equal for man and women who really loves to eat..

Imaging and Diagnostic Services

Anonymous said...

Broke college student/overworked vet tech...bmi 18