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Being sick has the strongest corelation with the use of medical resources - Input Junkie
October 24th, 2011
08:45 am


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Being sick has the strongest corelation with the use of medical resources
Well, thank you, Captain Obvious, but why is this interesting?

Because BMI isn't the strongest corelation.
We also investigated the relationship between obesity and the use of health care services including physician visits, hospital use, prescription drugs, home care, and personal care homes. This section, which capitalizes on the uniquely powerful health data system (the Repository) housed at MCHP, provides the most important contributions from this study. Overall, the results revealed that while the Obese group almost always had the highest rates of health service use, the differences between it and the Normal and Overweight groups were relatively small. That is, the health care system is not being overwhelmed by the demand for health services related to obesity. This finding is particularly important because no previous studies have been able to provide this kind of analysis on a large representative sample with such comprehensive data on health service use.
Furthermore, for a number of indicators, the higher rates were only evident for those at particularly high BMI values. For example, the Obese group had more physician visits per year than others, but only about 15% more overall...

Link and lots of interesting implications thanks to BigFatBlog.
Got that? High blood pressure is associated with being heavier, but heavier people do not have a higher prevalence of heart attacks. Could this be because of white coat syndrome or because many medical professionals measure fat people's blood pressure with cuffs that are too small? Or perhaps fat people naturally have slightly higher than normal blood pressure? All of those would result in higher brood pressure readings that wouldn't translate into a higher heart attack risk.

We've been seeing alarmist "studies" (and I use that term loosely) in recent years, purporting to show that fat people are going to bring down the world's health care systems with our high demand for services. Those papers are based on wild conjecture and statistical manipulation, but a lot of people take their claims for granted. Other papers have suggested that fat people have shorter life expectancies and will therefore use healthcare for fewer years, and that may cancel out our higher rate of health care use. Nobody, as far as I know, has challenged the idea that fat people use more health care resources than smaller people. Even I would have guessed that we use more resources on average, if only because of weight loss treatments. Weight loss treatments could certainly explain the 15% higher health care use by fat people in this report.

When the Flegal study revealed that people classified as overweight are at the peak of the life-expectancy bell curve, some people suggested this was because heavier people are being kept alive through the extensive use of advanced, modern medicine. This report makes that seem doubtful, as heavier Manitobans are not using significantly more healthcare resources than lighter ones.

The stress from stigma is likely to make some fat people sick
Second, to better tease these factors apart, I and a team of researchers sought to ascertain whether it was one's BMI or one's satisfaction with his or her weight that was most important in the relationship between adiposity and health.[38] To do this, we used the 2003 Behavioral Risk Factor Surveillance System dataset, which contains a question asking subjects to place a numerical value on their desired body weight. In analyzing these data, we found that the difference between a subject's desired body weight and his or her actual body weight (a measure that captures the psychological dimensions of obesity) is a much more powerful predictor of morbidity than is BMI (a measure that captures the physiological dimensions of obesity).

Dieting increases vulnerability to stress:
Chilling out might be the key to losing the weight you gained over Thanksgiving. New research shows that dieting makes the brain more sensitive to stress and the rewards of high-fat, high-calorie treats. These brain changes last long after the diet is over and prod otherwise healthy individuals to binge eat under pressure.

Actually, it's a mouse study, and I haven't heard about it being replicated in humans. What's more, it buys into the premise that fat loss is really important, and we've gotta find a way to make it work.

Thinking about it and the above link, I wonder if dieting history is as much a factor in stress for people who are unhappy with their weight as social stigmatization is.

I haven't seen any studies that track dieting history and health. For that matter, I haven't heard of any studies which track the prevalence of various types of diet by duration and intensity. I realize such a study would be dependent on self-reports, but people seem to have rather vivid memories of their diets.

When I first ran into the idea of fat acceptance, I found myself resisting the idea, and I realized it was because I didn't want to believe that my home society was that much meaner than it thought it was. Then I remembered that I spent eight years in Hebrew school and those hours wouldn't be wasted if I remembered that the history of anti-Semitism was a clue that people just make up reasons to hurt each other, and there was no reason to think contemporary culture was immune.

This entry was posted at http://nancylebov.dreamwidth.org/507850.html. Comments are welcome here or there. comment count unavailable comments so far on that entry.

(11 comments | Leave a comment)

[User Picture]
Date:October 24th, 2011 02:09 pm (UTC)
I've seen (long enough ago that I can't cite it) research that suggests that dieting raises morbidity and mortality more than obesity does.
Date:October 24th, 2011 02:19 pm (UTC)
Yes, especially repeated diets, with people gaining the weight back (and a bit more, usually) in between. And thus because many fat people have a history of dieting, people don't think to blame the diets (which are perceived to be virtuous) because fat people are morally lacking somehow.
Date:October 24th, 2011 02:16 pm (UTC)
High blood pressure is associated with being heavier, but heavier people do not have a higher prevalence of heart attacks makes me think of the last time I had my blood pressure checked at the doctor's (I need to every so often because of the birth control I'm on); it came immediately after I was weighed and lectured and told flat-out that I had to lose a stone in six months. Then she took my blood pressure, and no wonder it was the high side of normal!

Many people I know are anxious about going to the doctor because they know that whatever symptoms they present with, they'll just be told to lose weight. It's like white-coat syndrome times a million.
[User Picture]
Date:October 25th, 2011 02:45 am (UTC)
I was shocked the last time I went to the doctor because they used a wrist cuff rather than an arm cuff to check my blood pressure. Although my blood pressure is usually 120/80 (the cutoff of "normal," so not enough for my doctors to freak out at me over), it was 90/70 with the wrist cuff. That made me realize that what I thought was a large enough arm cuff -- because my blood pressure was still normal with it -- might actually be too small.
[User Picture]
Date:October 24th, 2011 04:30 pm (UTC)
In analyzing these data, we found that the difference between a subject's desired body weight and his or her actual body weight (a measure that captures the psychological dimensions of obesity) is a much more powerful predictor of morbidity than is BMI (a measure that captures the physiological dimensions of obesity).

This could be due to "stress from stigma," but it could also mean that people's own estimate of their ideal body weight is a more accurate measure on average than BMI.
[User Picture]
Date:October 24th, 2011 06:00 pm (UTC)
Aside from social conditioning regarding appearance, one problem with people's estimates of ideal body weight is that while they may have felt better at that weight, they may not have a good grasp of what was the weight and what was youth and/or good nutrition and exercise habits. The nutrition and exercise can be returned to, but very few people think of that alternative without an emphasis on the weight as well.

One part of fat acceptance that a lot of people don't get is that it's not only about what would be better for a person, but what is better and practical. Many of those people probably are not going to get down to their desired weight from their actual weight by the kind of sustainable habit change that medicine is advocating now.

I has a more middle-of-the-road thought: I know many people, especially middle-aged or older, who are basically of a fat-accepting temperament but have changed habits due to the onset of health problems such as arthritis and diabetes. Some of them (including me) do not have a "goal weight" involved, and in fact try to ignore weight loss that might occur because it makes us crazy; but I know some who do set weight-loss goals. Actually, those tend to be moderate; but I do wonder how many people who are not basically fat-accepting get a diagnosis and then decide they need to radically change their weight. The illness would then be cause, not effect.
[User Picture]
Date:October 24th, 2011 05:16 pm (UTC)
Nobody, as far as I know, has challenged the idea that fat people use more health care resources than smaller people.

Well, I know I've used a lot more health care resources than I would have if I were thin...because I've had to see many many more doctors in order to find someone who cares about my health instead of trying to diagnose me from across the room based on my size.
[User Picture]
Date:October 24th, 2011 05:26 pm (UTC)
We're seeing some equalization these days-- thin people with the diseases associated with fat people are also having problems getting diagnoses.
[User Picture]
Date:October 24th, 2011 11:53 pm (UTC)
After working for over 20 years for the Social Security Disability program, I can think of two problems where being overweight can make a difference--not being "socially inappropriate" in terms of weight but actually significantly obese. These are Type II diabetes mellitus, and osteoarthritis in weight-bearing joints. The former can be found in thin people as well, and often has a strong familial tendency which is probably why one may see it one overweight person and not in another who is equally, or more overweight. The latter often also has a familial component, but other factor may be involved--it's a "wear and tear" issue, and you will often find it in the thin and athletic as well as the overweight as wear and tear accumulates over time.

Other problems are more often the result of lack of fitness rather than simple weight issues. One 250-pound man may be quite fit, with good respiratory and circulatory function, while another of the same weight and height and frame may not, as he gets less regular exercise and smokes heavily.

One reason a certain amount of more-than-fashionable poundage may be important in old age is that it means there are reserves present in case of illness, which gives the elderly a better chance at fighting off sickness, whether it's an infectious disease or something calling for prolonged treatment, such as cancer. In addition, marked thinness in the elderly may also be marked by loss of muscle mass, which cannot be considered healthy--also, if one is very thin, given the decrease in metabolic rate you often see in the elderly, one may not be getting adequate basic nutrition in terms of essential nutrients like vitamins, calcium, and so on.
[User Picture]
Date:July 3rd, 2012 09:17 pm (UTC)
The impression I've got so far from reading the literature on heart disease and obesity is:

A bunch of the causal inputs to heart disease (high blood pressure, inflammation, metabolic syndrome) are more common among the obese.
being overweight or obese has a protective effect on mortality from heart disease, given that you already have heart disease. I'm not exactly sure about the mechanism of the protective effect.

It works out so that, on net, fat people are overrepresented among those who die of heart attacks. If you don't want to get a heart attack, all things being equal, it's better not to be fat. But if you have heart disease, it's unclear that losing weight will help protect your life; there is enough conflicting evidence on the effect of dieting on mortality that I'm not sure doctors should recommend dieting to heart patients.
[User Picture]
Date:July 4th, 2012 12:10 pm (UTC)
Thank you for looking into this.
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