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Where I'm coming from: I am an Obama supporter in most ways. I support health care reform in the US and want everyone to have affordable access to health care. I am concerned about some of the rhetoric of health care reform right now.

I would welcome your suggestions about fat-activist communities to send this message to.

The Obama administration's first forays into health reform focused on eating habits and exercise, without mentioning weight per se. But that seems to be changing. Over on http://healthreform.gov/ there are now a number of articles claiming that it is possible to "prevent" obesity, diabetes, and heart disease.

In one article there are claims such as "85 percent of the money spent on health care goes toward people with at least one chronic condition." The article also promotes the claim "Scientists say this generation of American children may not live as long as their parents did," which was literally mapped out on the back of a napkin and is based on the now-debunked "fat kills 400,000 people a year" statistic. http://healthreform.gov/forums/secretaryscorner.html

The first bullet point in the "Closing the Gap" article about disparities in health care availability among ethnic minorities is: "Obesity is debilitating and is often a catalyst to chronic disease. Seven out of 10 African Americans ages 18 to 64 are obese or overweight, and African Americans are 15% more likely to suffer from obesity than Whites." http://healthreform.gov/reports/healthdisparities/index.html (Lack of access to health care is a huge problem, and it's vital to bring health care access to under-served groups. But I don't think that sticking more African Americans on diets is the best first priority.)

One of the major items linked from the first page of healthreform.gov is an op-ed from the CEO of Safeway, which includes such claims as: "70% of all health-care costs are the direct result of behavior." "74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity)." "80% of cardiovascular disease and diabetes is preventable... more than 90% of obesity is preventable." http://healthreform.gov/forums/whatpeoplearesaying.html#rewarding_healthy_behavior

I think the fat activist communities need to address the Obama administration's overfocus on "obesity."

  • We need to explain that weighing more than the government approved BMI is not a health condition. If fat people incur more medical costs than thin people (which I'm not convinced is true), it's partly because so many of us are either (a) ignored with "go away and lose weight" when we go to doctors with real conditions, until those conditions become drastic (see the First Do No Harm blog for some tragic and infuriating examples), or (b) treated as if we are at death's door, just because we weigh more, and subjected to unnecessary tests and "treatments".
  • We need to explain that weight and diabetes are largely genetic and debunk silly statistical claims such as "90% of obesity is preventable."
  • We need to explain that weight is not a behavior.
  • We need to explain that blaming people with chronic health conditions for the high cost of health care in the US is not a good strategy for lowering health care costs or improving health care access for women and ethnic minorities.
(I would welcome being convinced that this is just a bunch of hot air and not a hammer about to come down on the backs of fat people. But I am worried.)

Note: I am not going to allow debates on the benefits of weight loss or the possibility of achieving permanent weight loss in this journal entry.


( 6 comments — Leave a comment )
Jun. 19th, 2009 12:10 am (UTC)
And there's been no causality. Maybe we're fat because we're sick.

I was grumbling when I saw in the WashPost that Michele Obama said childhood obesity was related to health care and nutrition.
Jun. 19th, 2009 01:30 am (UTC)
I would strongly support this idea.

I do think that there is a correlation between obesity and poor health generally - not a perfect correlation at all, but the environment in which we live is bad for us in a lot of ways, and some of those involve messed up metabolisms, and many of those contribute to obesity*. If this were about behavior, then behavioral changes would "cure" obesity.

It's completely inappropriate to tell people it's their own faults that they are fat. And it's completely inappropriate to tell people that any other health problems they have are because they're fat (which is of course their fault). But at the same time, there are some really fucking scary general health trends, and while I completely disapprove of a lot of the politics surrounding them, that disapproval doesn't make the underlying health problems go away. Nor does clucking one's tongue and blaming sick people for being sick, or telling people who aren't sick that they are.

(And yeah - the BMI is a terrible test of individuals. But it does have something to say about populations - in fact, that's the only thing it has to say about anything. And the only thing it was designed to say about anything.)

* For instance, anything that contributes to elevated cortisol levels or increased inflammation is likely to lead to increased fat and increased central obesity. Oh - and both will tilt people more towards type two diabetes as well. Yes, genetics is also a factor, but a lot more of the people who have these genetic predispositions are getting sick now.
Jun. 19th, 2009 01:39 am (UTC)
In the long run, I think it comes down to getting good data. BMI may be a useful proxy for health for people who got dealt a particular set of genetic cards, but it is not universal: there are triathletes who qualify as “morbidly obese” who are in superb cardiovascular health, for instance, and sedentary people with technically-healthy BMIs who are at high risk. If life insurance companies get a better model for evaluating risk, they’ll grab on with both hands, and once it comes down to dollars, the rest should follow.
Jun. 19th, 2009 02:10 am (UTC)
BMI is nothing more or less than a statistical tool. The fact that it got turned into a diagnostic tool is a medical farce.
Jun. 19th, 2009 07:53 am (UTC)
Re: Obama admin stepping up its anti-obesity rhetoric
i have no idea whether it's just hot air, though i find it unlikely a hammer is gonna come down on fat people -- but i think it's smart to get informed and organized and ready to counter any possible hammers. so, go you!
Jun. 19th, 2009 11:14 pm (UTC)
And 78% of statistics are made up.

Sorry, all those "statistics" sound like nonsense. I agree with what you're saying, and I also think the CEO of Safeway isn't exactly a scientific source (if by Safeway you mean the grocery store).

Hey Obama, how about focusing instead on all the unnecessary additives and unhealthy crap in the cheap food? When you have limited food money and a certain number of people to feed, sometimes the cheap food is all that's affordable. But that couldn't possibly contribute to people being overweight, naaaaahhh... we wouldn't want to focus on the CAUSES, let's just attack people who have the end result, regardless of how they got there.
( 6 comments — Leave a comment )

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