Obesity Drives Car Size?

The following quote is taken from a recent article in the ECONOMIST on the discontent of Americans with the economic state of their country:

Petrol prices, despite their recent retreat, hurt nearly everyone. Adam Julch, an enormous former college football star who is now a manager at a trucking firm in Omaha, Nebraska, complains that he had to trade in his pickup truck for a little Honda Civic. “I’m 350 pounds,” he says, “I feel like I’m in a clown car.”

Two aspects of this quote deserve comment:

1) Yes, larger people need larger cars to move them around - more larger people could mean more larger cars. This is not unlike the idea that it may not be the huge portion sizes in restaurants that lead to obesity but rather it is obesity that leads to larger portions sizes in restaurants (yes, large people need more calories and generally have bigger appetites than thin people) - so restaurants have to serve up portions large enough to feed even their hungriest customers.

2) The fact that this was a former athlete, as are many of my biggest patients, emphasizes that even being a highly successful competitive athlete does not protect you from severe obesity later in life.

Now there is food for thought. Feel free to comment.

AMS
Dushesnay, Quebec

Hat Tip to Michael Dwyer for bringing this quote to my attention

Early Obesity Predicts Early Disability?

Given the strong relationship between excess weight and emotional, physical and economic health, it may be reasonable to pose the question whether obesity is a risk factor for early disability?

This question was just addressed by Martin Neovius and colleagues from the Karolinska Institute, Stockholm, Sweden, who examined the association between obesity status in young adulthood and disability pension in Sweden (International Journal of Obesity).

The aim of this study was to investigate risk of future disability pension according to body mass index (BMI) in young adulthood. BMI was measured at military conscription (1969-1994) in 1,191,027 young male recruits. Date and cause of disability pension, death and emigration dates were collected from national registers (1971-2006).

During 28.4 million person-years, 60,024 subjects were granted disability pension. The hazard ratios (HRs) for overweight (1.36), moderate (1.87) and morbid obesity (3.04) were significantly elevated compared to normal weight individuals.

Excess disability was associated with problems related to circulatory, musculoskeletal, tumor, nervous system, and psychiatric disorders.

Based on these data, the authors suggest that productivity losses associated with adverse BMI in young adulthood appear to be large (a rather stark understatement, if I ever heard one).

Remember, this was a study on people whose BMI's were high as far back as 1969. Given our present obesity epidemic in children and young adults, I wonder what disabilty rates will look like 20 years from now.

I don't want to be the fella spreading doom and gloom all over, but it sure makes me wonder whether, despite all the talk, we are really doing all we can to prevent and treat obesity.

AMS
Edmonton, Alberta

Employees' Obesity Costs Employers

This week, The US Conference Board released a report called "Weights and Measures: What Employers Should Know about Obesity" on the financial and ethical questions surrounding whether, and how, US companies should address the obesity epidemic.

Apparently employees' obesity-related health problems cost US companies an estimated $45 Billion each year in medical coverage and absenteeism - more than smoking or problem drinking.

Given the high costs of obesity, the report estimates the return on investment for employee wellness programs from zero to $5 per $1 invested. ROI aside, these programs may give companies an edge in recruiting and retaining desirable employees. The report also looks at the issue of awarding employees cash and prizes for weight loss rather than devoting resources to long-term wellness programs.

Interestingly the report also discusses the benefits of paying for employees' obesity surgeries. Apparently 9% of the US workforce would be eligible for such surgery, but because people often change jobs (e.g. in the retail industry), employers may not always recoup the full costs of supporting obesity surgery in their employees.

One big concern of course is how employers can address this issue without seeming intrusive or discriminatory. It is recommended that companies should involve employees in planning health initiatives, rather than working from the top-down, and should make sure personal privacy is protected.

While this report focuses on the US, and for obvious reasons cannot directly be transferred to the Canadian situation with its more or less universal health coverage, it is unlikely that obesity, at least with regard to absenteeism and early disability, is any less expensive to Canadian employers.

While preventive "wellness initiatives" may work for the 3/4 of the workforce, which does not yet have obesity, how do you provide effective obesity treatments to the employees who already have the problem?

Allow me to offer a few pointers:

1) Inform employees about evidence-based treatment options for this condition.

2) Encourage employees to seek treatments for obesity like they would seek treatments for any other chronic disease (e.g. diabetes, hypertension, etc.).

3) Supplement costs for evidence-based obesity treatments (including behavioural interventions, special diets, medications and surgery) as prescribed by qualified health professionals.

As I have blogged before - we may not have a cure for obesity - but we sure have treatments that work!

AMS
Edmonton, Alberta

The Real Cost of Obesity May Not be in Health Care

When you follow the current public discussion on the consequences of obesity, the focus is most often on the potential costs for health care. This is not surprising, given that obesity is directly linked to a wide range of chronic diseases including hypertension, type 2 diabetes, sleep apnea, osteoarthritis and many forms of cancer.

But health risk are not the only cost of obesity. Even a cursory glance at the patients presenting in our clinic immediately makes it evident that a disproportionate number are on short or long-term disability, not working to their full potential or simply unemployed. If you take into consideration that the average age of patients in our clinic is in the lower 40s, it immediately becomes evident that there are economic losses to society here that go well beyond the simple costs of health care.

Numerous studies have in fact documented that obesity may have important economic consequences for individuals - and thus society.

This was once again demonstrated in the largest study on this issue to date. Nina Karnehed and colleagues from the Karolinska Institute in Stockholm examined social mobility in over 750,000 men born between 1951 and 1965. Subjects were studied at age 10 and again at age 30.

Men who were obese at age 18 were almost 30% less likely to be upwardly mobile (achieve a higher socioeconomic status than their fathers) and 30% more likely to be downwardly mobile (achieve a lower socioeconomic status than their fathers) compared to normal weight men. This finding was independent of childhood socioeconomic index (SEI), IQ or education, suggesting that societal factors (e.g. bias and discrimination) may be responsible.

This difference is substantial. Downward social mobility means less income and lower SEI with all its consequences. These costs to society may be far greater than any costs to health care.

I am no economist, but I don't find it difficult to imagine that when a substantial proportion of the population (currently 25% of all adults) are at risk of not realizing their full economic potential this could mean a huge loss for the overall economy.

Thus, apparently obesity not only affects mental or physical health but also socioeconomic health - an important consequence of the obesity epidemic that I have not heard much about in the media or elsewhere.

Perhaps the increased health care costs of obesity are the least of our worries.

AMS
Edmonton, Alberta