You're listening to the face value podcast episode 166. The alleged cost of fatness on society let's do it
Hello, welcome to this episode so pleased that joy. Hope it's warming up wherever you are in the world. Oh, maybe it's getting cold, depending on what hemisphere you're in. In the Northern Hemisphere, we've had some sunshine. Yay. I don't do you to the to the beach, because we had sunshine for the first time in the year in the year, Sunshine enough to get into the water. Not Wow, for like three seconds before your legs froze off. And he was so happy. It was just like, it's so cute makes me happy. The difference in my brain between warm weather and hot weather is astonishing. It's like my brain is automatically like switched on. Do you feel like that you get like that. It's magic. And also sad for the colder months. So just an update on kofi. Kofi is a place that you can donate money to me if you so please watch to where we're at right now. I've got 27 active subscriptions, thank you subscriptions 27 oviya. And the subscription value that I'm making in 30 days is $175. 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And you know what I was doing my my taxes and expenses and bla bla bla bla bla and I was thinking I wonder if there are any people who have got like online businesses or are interested in what it costs to run an online business and and if I went through like my costs and you know for the all the different little software's and things that you need if anyone is interested in hearing about that like the cost of running an online business and yeah with different types of software and you wouldn't believe it like there's a software for everything and then it's just you know, anyway let me know message me if that's something interests you message me, you know, message me, I won't talk about it. But I don't care about that. I don't have an on my business where you like that. Okay, so today we are talking about the alleged cost of fatness on society. And I can't believe I've never spoken about this before in a whole episode. I've obviously probably spoken about it briefly in different episodes, but we see this a lot right depending on where you live. If you're in the UK, especially. I feel like the UK is like super awful in are in regards to tabloid newspapers and those messages really being in the daily conscience. You know, obviously I don't live in the US I live in Canada. But you know, obviously I don't live in other countries. But anyway, we see a lot of headlines like, you know, the Oh word is costing us so much money. And that seems to be justification to hate fat people, right? The fat people are such a, quote, burden on society. And especially in a country like the UK, where we have health care, which is government funded, we have the NHS and National Health Service, which is great. And in Canada, we kind of have a mix of half funded and half not funded. So for example, if I need an operation, it's free. If I need to go to the doctor, it's free. If I'm a permanent resident, if you're ever an immigrant, it's not free. Medications are not free. But people will have their employers will normally give them a health care plan, which then makes them cheaper, maybe free, depending. But if you're low income, you may get assistance, once you've spent a certain amount towards medications in a year, but they're not free, there are no apart from I tell you what, yeah, apart from COVID vaccinations, I was gonna say other vaccinations, they're not free from what I've had in Canada. So it's kind of like a half and half hybrid. And then Ireland In Ireland, it's not free to go to the doctor costs, I think, like 50 euros for a visit. And then medication isn't free, but medication is cheaper. And in the States, you know, it's just all fucked up. And the same with Canada, in the states, if you don't have an employer who's paying for health care, with benefits, then you are Sol. So someone like me, I work for myself, I have to pay for my medications. So these like we amusing these, these four countries as examples, obviously, everywhere else in the world is different. And in the US, even that rhetoric of being a burden is very much there. Right. But I feel like in countries where there is health care paid for by the Government is even more used as a justifiable excuse to hate fat people. So is it true? You know, we see all these figures around at the fat people are caught that are costing the NHS or the government or the country X amount. And obviously, it's a it's a giant figure. And this is a problem. Therefore, we need to stop people from being fat and greedy and lazy and being such a burden. So I want to go into where that number comes from. In regards to Canada, we're going to do a Canada specific, but guess what, guess what? This is relevant to a lot of countries because the way that they calculate how much fatness costs is, yeah, is, is pretty much very similar. So in Canada, the most recent report has estimated the cost of fatness to be 4.6 to 7.1 billion annually. Okay, so if someone has that number, oh my God, and love it the fact that it's 4.6 or 7.1 billion, I mean it that's a big difference, right? Like a few billion their difference. And so where does that come from? Okay, you can go to the links in the show notes to see the sources that I'm talking about. The first source is a report called obesity in it's just called obesity. That's it. That's what it's called. But it is a word in Canada. I'm going to not use the word anymore. From here on out. Hopefully I don't just slip it in because it's everywhere. And in this report, they talk about how They have
worked out that figure, the 4.6 or 7.1 billion. So in the report, and this report was recreated in 2011, this is the most recent report. So see how that's already a problem 2011. We're in 2023. So, but these numbers are still touted around everywhere. So the report goes into prevalence of fatness in adults, children and youth and Aboriginal populations. language wise, from my work in the Diversity, Equity and Inclusion field. In Canada, the preferred terminology is indigenous peoples, but they are using Aboriginal populations. Aboriginal means not original to the land. So AB is not original. So Aboriginal populations is that you say not original to the land, which is the absolute opposite of what it is. But you know, some communities will use different names. But the general consensus is that it's indigenous peoples. Anyway, so then the report goes into determinants and contributing factors, health and economic implications, opportunities for intervention, then going into the costs. And the costs they've got from information from 2007 and 2008. And extrapolated it to the time of writing the report. So again, we're going back even further to 2007 to 2008. Okay, so the first thing that I noticed that I was like, is the fact that they're reporting on the fact that indigenous peoples are bigger than the rest of the population. So they're stating that this is a problem with indigenous communities. And, and they talk about different communities like Inuit, First Nation, matey, and the differences in rates of fatness in those communities. So the reason why I think this is I mean, knowing how many people are fat is not a problem. But then framing this is as an issue is the same way in, in the States, how they frame black communities are, they're fatter, and it's a problem with black communities, versus the other systemic things that are happening. The other ways that black people have bodies as in fatness being a normal part of being a human being. And framing it as black people need to know how to learn how to eat properly, not like us white people who are thin and healthy. The we're gonna go and save black communities because they don't they're, they're doing this to themselves. They don't know any better. And framing it like that, versus Is this an issue? Is it? Are we talking about foreigners? Are we talking about health? And if there's health disparities up there is then why is that? Could it be racism? Yes, yes, it is. So that lens that they're showing this with indigenous communities is saying this is a problem, but not this is a racism problem. And the problem being health, not body size, right? They don't have that, that that viewpoint there. Okay, so they go into determinants determinants of fatness. So they recognize there are many reasons that fat people are fat, yet, they've decided to put food and exercise as the first factors as the as the first things that they mentioned. It feels like so there's a lot of people who wrote this report. It feels like there was, I don't know, however many. So at least one person who was like, hey, so this is kinda stigmatized. Um, so should we, you know, put in the fact that you know, there's there's many reasons that someone's fat and, and, you know, the social determinants of health and things like that and, and then you know, the other people will like Okay, fine, but we're still gonna tell them that they're too greedy and they don't exercise enough and the the person was like, Oh, okay. Like, that's what I feel like it is. Obviously, that's totally me guessing who knows? Who knows? They could be all you know, super liberal and but then their boss is like, you know, we need to tell people how terrible fatness is Oh, who knows, although I've no idea is just making me think about this. I know about a. This gets on my nerves so much I know about Health Care Authority, who is creating a it's got nothing to do with me. I just know it from a grapevine, who's creating a weight bias training. And the people that are leading the crease creation are the O word doctors. So the people who are in charge of eradicating fat people, and they are refusing to take advice from they've got consultants like dieticians, and fat people on consulting on this and they are refusing to take out the weight bias from the training because it's they use the Oh words they talk about how to not be fat. I just want to be so mad. It makes me so mad that they're just like patting themselves on the bad ring light. Well, we sound nice to fat people like when we tell them that they should not exist anymore. We do it with a smile. So it's not it's not Baez. So kind of those poor fat people. They don't even know why they're so fat. But we know it's because they're greedy. They can't help themselves, you know, really patronizing and against what we know, around anti VAT bias and they're just teaching more bias. I just hate it so much. I want to go in and flip tables and do some roundhouse kicks, you know, but anyway, so. So in the determinants of fatness, they make some totally wild statements. So, quote, for example, on the basis of this approach, they talk about a behavior. So they say this behavior emerged as the most strongly associated with fatness at the population level for both men and women, after adjusting for age, and other health, behavioral and social determinants. So two things here, they're only looking at men and women. There's no mention here of gender diversity. But the big thing here that I'm pointing out is that they've got this behavior, this one behavior is associated with fatness. Right is the most strongly associated with fatness. When controlling for age, other health, behavioral and social determinants. So how can you say that this one behavior and I'm not going to say the behavior because I don't want people to feel stigmatized? Because if they don't engage in this behavior? How can you say that this one behavior is the most strongly associated when you are discounting? All of the other reasons someone may have a bigger body. We've adjusted for age, health, behavioral and social determinants. And so there's one factor is the strongest. It's bizarre. It's like saying, for example, Donald Trump is a dickhead. Okay. Donald Trump is a decade when controlling for his personality, his beliefs, behaviors, and other factors to do with him as a person. The most strongly associated cause for being him being a dickhead was the type of shoes that he wears. And therefore, Donald Trump's footwear choice makes him a dick. Because we've taken out all of the other factors that could make him a dick. Jokes. I wasn't his tie. It wasn't his suits, it was his shoes. But hang on a minute, why can't we put in all those other reasons why someone might think he's a dead because I'm not sure it's his shoes. Right. What?
So quote from the study such research, while theoretical may help to inform decisions by can Canadian policymakers, health promoters and healthcare providers on targeting fatness prevention and treatment interventions okay. So that such research while theoretical, okay, so, these are theories they are presenting in this document and then they're saying It may help to inform decisions by policymakers. Lalalala. Right. So we have got these theories, and we're going to be developing policies. And we're going to be talking to health promoters about it and healthcare providers about this information, which are theories to target fatness and the theories and not based on you know, like, okay, so because everything's a theory, right? It's not, it's not based on robust evidence is based on deeply flawed evidence. Right? It just, it just, I'm just flabbergasted by, you know, one plus one equaling 27, you know, there was this, there was there was this Tiktok, lice or the other day, and it was a woman who was really angry, she was like a go at her, she was just having a rant, a well deserved around, in my opinion. And she said, she'd been a server for 12 years, or something like that. 10 years, whatever. And she, in that time, he was always looking at people with office jobs as people who knew better or, or were deeply qualified in some way. And, you know, she was told that she wasn't qualified enough to have an office job, she was only qualified enough to be a server, she eventually gotten off his job. And she was like, What the fuck, like, I do nothing. And people hear a ding dongs, and they don't know better than what I knew when I was a server. In fact, I was doing better work as a server, because I was helping many people I was, you know, busy and complex problem solving. And in the office, it's just, you know, way less difficult. And these people don't have some special thing that makes them be qualified to work in the office over something else, like this server job. And she was like, What the fuck? Why did no one tell me that you didn't have to be this special person to have an office job. And I think like, there's, I think about this, how, when I was in recruitment, I would get to meet a lot of companies, CEOs, CFOs, you know, company leaders of a variety of different companies, you know, huge ones, and little ones. And, and I was, I too had these people on a pedestal of, wow, they must be really smart to get to where they are. And some are really smart, and some are really hardworking, and some are really insightful, and etc. But the fact that they have a certain job doesn't mean that those characteristics are aligned with who they are. And I was really surprised because I used to be so nervous and shy talking to people. I've been meeting the CEOs, and they were donkeys. They didn't have an Kullu. Right. And I was like, what? Well, I felt these people were just otherworldly. You know, they did something to get there. It did, they were a die, and they were white, you know, they, they were born into the, quote, right situations, you know, and of course, not discounting. Many people have worked hard to get into different positions. But, you know, presuming that everyone is this, like, super smart person, when everyone is just, it feels like, you know, everyone's just kind of fumbling along and trying to do the best they can. And we shouldn't put these these these people on a pedestal, because maybe what they're saying is not as concrete as what we think, you know, maybe they're just, you know, pulled out from thin air or whatever. And, you know, a lot of you know, a lot of people are, have spent a lot of time and, and are experts and but when we're looking at things like this, of where they're saying, this is a theory and other places in here, they're saying like, hey, we don't really know. But let's, let's stop fat people being around. If we can kind of a lot, you know, a lot of times we can be like, Okay, well, that sounds fine. We don't really know why people are fat and why fat people might have associations with certain diseases, but we're just gonna guess that it's because they're fat, and that they're greedy and lazy. Anyway, so we'll go back to the to the to the Trump example. So they're saying this one behavior is what causes people to be fat, probably. We don't really know. But we've taken away all of the other factors that could make someone fat And so, you know, like with Trump or Trump is a dickhead we take we take away all the factors like his personality and his beliefs and his behaviors and all the other factors to do with him as a person, we've worked out that it's most strongly associated with the his footwear choice. And so when they're saying such research is theoretical, but it could inform decisions by policymakers, etc. It's like a ha, well, we don't like Trump, and what he stands for, so we're going to encourage people to wear different shoes, and then they won't be like Trump. And of course, I'm not likening fatness to being Donald Trump, because Donald Trump is a giant dick Ed. And it's not because of his shoes, or his suits, or his tie, or the way he looks or because he has a bigger body. It's because he is an odious human being, and a bigot and dangerous lalala. But it's kind of like, like I say they're going one plus one equals pineapple. So quote, however, because these analysis, these analysis use cross sectional data and rely on a number of assumptions, they cannot be used to make inferences about the causes of fatness, our collective understanding of the determinants of fatness will continue to evolve, as the effectiveness of policies, programs and interventions are monitored and assessed. Right. We so that it's so I find it so funny. It's kind of like, you know, they're saying, here's a here's a statement, which is is not great. And then hey, by the way, that statement wasn't great. Why not just take away that statement? That wasn't great. Why not just say, hey, we don't know why people are fat. And here's something that I would do. I just take out this whole thing. Why do we need to know why people are fat? There's nothing wrong with being fat, right? Because the reason they wouldn't, why would they want to know why people are fat is so that people stop being fat. Right? So the whole you know, there's lots of reasons why someone is fat we what it may be true, I feel like it's a moot point. Do we need to know like, so they go and they say determining the precise number of deaths attributable to fatness is difficult. However, as fatness often co occurs with other risk factors. It has been estimated that the fatness cost fact that fatness costs the Canadian economy approximately 4.6 billion in 2008. So, we've got the 4.6 billion number there and then we had that other number 7.1 billion, okay. So, that 4.6 billion number is they say a conservative estimate, as it is limited to those costs associated with the eight chronic diseases most consistently linked to fatness, another study using a comparable methodology and looking at 18 chronic diseases estimated the cost to be even higher at close to 7.1 billion. So this report has, has has has got the eight chronic diseases, diseases that are associated with fatness, big word that are associated not a big word, but it's a long word, but like important to no associated and then the other one the 7.1 billion it 18 diseases associated with fatness and they've got this other number. And it's so funny that they're saying it's conservative estimate when in my opinion, it's anything but so we're going to see two the approaches that they have decided for dressing fatness. They've come up with three ways to do it. Quote, a review of the national and international literature found that strategies to combat fatness and address fat environments can be classified into three main categories. One, health services and clinical intervention interventions that target individuals to community led level interventions are directly influence individuals and group behaviors and three public policies that target broad social or environmental determinants like smoking cessation. Effective fatness prevention may require multifaceted long term approach involving interventions that operate at multiple levels and in complementary ways. Relatively flute few population level fatness prevention and management interventions especially public policy approaches that target broader environmental facts 's have been systematically evaluated in terms of their effectiveness or cost effectiveness. Developing and implementing effective interventions will require close and frequent monitoring to identify which approaches work in different settings and with different populations as well as economic analysis to understand their potential value for money. Okay, so, so did you hear what I heard in that? We've got three ways that they're going to stop fatness, okay. And then they say
we don't know how to stop fatness. We have relatively few population level fatness prevention and management interventions. Why is it? Why is it after over 100 years of information about diets not working and dieting being a thing that we still still don't have information on how to make people not fat? How many more hundreds of years do we need to keep out this? Could it be? Could it be? Could it be that science has shown us there are no effective long term ways to make more than a tiny percentage of people. Not fat. What? It's, it's just so I was gonna say funny, but it's it's just white. We're gonna do 123 And then they go into the 123. Right? We're gonna they're gonna go deep into the individual community Lella but they're saying we don't know. We don't know how to make people not fat. This is really interesting. This this this sentence here. Concerned about fatness is not a new phenomenon. By the 1930s life insurance companies had been begun using height and weight charts to identify clients at increased risk of death. Since the 1950s. Health Surveys have made possible the study of height and weight in Canadians. Do you remember the 1930s? Louis Dublin from the metropolis, Metropolitan Life Insurance Company who pulled out some figures from his anus? And the world says Oh, Louie, you're genius. Fat people are bad. You're right. This is a way to codify them. This is a way to categorize them. And let's just go with it. And it's still talking about it is fucking report this big ass report, which probably cost 1000s and 1000s of 1000s dollars to create. They're talking about these dingbat from the 1930s. Who was who was looking for ways to make more money from fat folks. He was like, How can I increase these premiums? Hmm. Yeah, okay. Yeah, fat people, they're deviant. Let's charge him more. He was in the episode of like, nothing, it was the biggest charlatans of diet culture. He, he was he was a peach. is like, if they're so close, it's like they've got that information. Okay, so in 1930s This happened, I've got that information, but then they go on like to a different tangent of oh, okay, so, we've been doing it since the 1930s. Fat people are not thin. Hmm, let's think about this. But they haven't taken that next step. You know. So that they talk about what causes fatness and seem to guess is because we don't have access to exercise equipment. Problem solved. Oh my god. Okay, I'm gonna stop this podcast. Turns out it's because we don't have access to a treadmill is why people are fat okay. So, they say one avenue through which neighborhood physical and socio cultural characteristics may influence fatness risk is their impact on availability and accessibility of physical activity equipment, facilities or programs through the direction and extent of influence though the direction extent of influence may vary by age and so they linked to a study. Here's the thing is when people link to studies, click on it and see what the study says. Right. So they, they they've got like A 200 studies linked in this report. So I look at this one. So the study the link to environmental correlates, environmental correlates of physical activity in youth a review and update. And what that says is most studies retrieved used cross sectional designs and subjective measures of environmental factors, and P a physical, physical activity. variables of the home and school environments were especially associated with children's physical activity most consistent positive correlates of physical activity was Father's physical activity, time spent outdoors and school physical related policies, support from significant others mother's education level family income and non vocational school attendance, low crime and the characteristic of the neighborhood environment associated with higher PA. convincing evidence were an important role for many other environmental factors was however, not found. Further research should aim at longitudinal and intervention studies and use more objective measures of physical activity and its potential environmental determinants. So is what they just said, saying that in the study Hmm. So they flat out state state that they're that the data is problematic for drawing conclusions. And they say similar research from the UK says the same thing. So there's a box that says cautionary note on interpreting population impact numbers, and population attributable bull risks. They say they are useful for measuring characteristics of factors that may be associated with the prevalence of a disease or a condition at a population level. However, caution should be used when interpreting interpreting their results for example, pars, which is population attributable risks, unknown additive, so individual par values for risk severity, several risk factors cannot be summed together to derive an estimate of total attributable risk for the disease or condition of interest. This is because risk factors often cluster and influence one another particularly in complex health issues such as fatness. Another issue concerns the interpretation of Pars and pins pins is population impact numbers for non modifiable risk factors. In general, where causality is known, these measures can be seen as reflecting the extent of the population burden of a disease or conditions, that could be theoretically eliminated, if all individuals in the exposed target group were converted to the non exposed reference group. So in that sentence there is saying where causality is known. So if they they're saying if we know that fatness is caused by people wearing sunglasses, theoretically, we could eliminate people in the exposed group sunglasses, whereas to make them into non sunglasses, whereas, and therefore, we can reduce the burden of fatness because there won't be fat people because fat people know what we're at longer wear sunglasses. Such an interpretation which can help to inform decisions in public health settings about modifiable risk factors on which to focus limited resources and efforts is inappropriate when considering non modifiable risk factors. For example, immigrant station, immigrant status, urban versus rural revenue residents. So here they're saying, but what if fatness is just, you know, an inherent power inherent to the person or is correlated with a non modifiable behavior. That's a problem. So continuing however, the inclusion of risk factors in PA analysis can still be a value for informing public health action as it can help clarify which groups appear to be at higher or lower risk. So they're so close. They're so close, they're saying it's inappropriate to consider non modifiable risk behaviors. Okay, so what information do we have about what causes fatness? And what interventions can be taken to make people not fat. We don't know what interventions to take to make people not fat. So therefore, it is non modifiable. Currently. There is no way, right? Let's close this. And they say in the report, they're saying we don't know why people are fat and we don't know how to not make them fat. And then they're saying in this sentence, I took it, I didn't read it out, but they were using fatness as an example.
And fatness and physical activity is the example. We know that physical activity is a behavior that makes Fat people not fat, but they don't know. And so, so basically, to get that number they are listing the conditions right. So the health impacts they list things associated with fatness and then show data that thin people get those conditions as well. I'm like, so Okay. So, this is not just something that happens to fat people I think people get it too. So, mortality they say that fat people have decreased mortality, they say it themselves mortality so morbidity refers to illness or disease mortality refers to death so quote, in contrast people who were Oh word but not Oh word had significantly lower risk than normal weight populations. There was no significant difference in risk of mortality between fat people and normal weight respondents. What we know this right we know that you know, you and I know this. There is in the report. Oh, lordy, lordy, lordy. So the estimated the costs. The quote in the study, the economic burden of fatness was defined as both a direct cost to the healthcare system, ie hospital care, pharmaceuticals, physician care, institutional care, and indirect costs to productivity, ie the value of economic output lost as a result of premature death and short and long term disability. The study focus on eight chronic diseases consistently associated with fatless. So here's the problem. They are saying that the people with those diseases, one fatness cause those diseases and we don't have that information, right. We don't know why fat people might have a higher association with certain diseases. What we do know is it's not increased fat tissue. What we do know is that fat people have poor health outcomes because of weight bias because of subpar health care or delay in health care. And because of dating, we do have that information. So the costs of a fat person just engaging with the healthcare system, that is defined as a cost of fatness when it's just a fat person engaging with the healthcare system who happens to have a disease condition that's associated with fatness. And they're saying the indirect cost of productivity. So if a fat person's happens to have a short or long term disability, is because they were fat. It's not for whatever other reasons, right? If someone is a fat person dies, it's because they were fat. What? So they also like there's so many things to pick out about this report. They also make some dogshit claims about workplace wellness programs. So, quote, It has been argued that a strong business case can be made for workplace wellness programs. And then they linked to some garbage sources like one paper from 2002, whose own conclusion says statistically watertight, watertight conclusions cannot be drawn from this small sample of very different workplaces, nor was it the intention to do so. And then they brag about how effective workplace wellness programs are. They say a recent meta analysis of nine randomized controlled trials of such programs reported a net loss of how many pounds 2.8 pounds in 12 months. Oh well, six trials sharing a net reduction in BMI off nought point 454 7%. Not even half not present. Sorry, no point four, seven, put, you know, on the BMI point scale. So. So they're saying there's a strong business case. Wow. And I mean, any weight loss is, is a lot because we know that weight loss is, is not possible for the vast majority of people. But I mean, if I can bragging about a, you know, someone's BMI going lower, nought point four, seven. And notice how they're just talking about BMI, they're not talking about health, right? They're not talking about health, they're talking about body size. Then they say diets work. But only in the short term, a 2006 review of 158 Publications representing 147 studies of fatness prevention and management interventions for children and youth concluded that the majority lead to positive outcomes, at least in the short term.
Wow, I need to go find the link to that what they say the 2006 review of all the publications that positive outcomes in the short term. So okay, so that was the thing basically, if someone has a condition and they happen to be fat, then that is being labeled as a cost to society. So so someone came out with not someone, a group of people came out with an article in response. So this is from 2019. Is there more to the equation, weight bias and the cost of obesity? I said the O word again. I said I wouldn't so hard when it's like every third word is the O word. So I'm just gonna read this so you can read the whole thing. I'm gonna link to it. Basically, this group of people said, is there more to the equation? So the costs I'm reading from it, the cost of fatness have been well studied, with estimates in Canada reaching 7.1 billion annually. These estimates feel public and professional discourse about fatness as a quote, epidemic with substantial economic and public health consequences. However, cost estimates for fatness thus far have neglected to consider a critical variable weight bias. In this commentary, we propose that some costs currently attributed to fatness may be partially or fully attributable to weight bias. Taking a burden of illness approach we show that data derived from a purposeful literature search provided as proof of concept support the notion that weight bias may be an important variable to consider when calculating fat related costs. We propose that future research on costs of fatness should consider weight bias with goals of achieving more accurate cost attribute attributions and identifying appropriate leverage points for interventions to improve the well being of the population. They they kind of miss out on a point here to go like further but someone else does go further. So continuing, blah, blah, blah, I'm skipping a paragraph. The scientific literature on the cost of fatness has neglected the possibility possible contribution of weight bias. weight bias is defined as negative attitudes and behaviors against an individual based on their usually heavier body weight. For example, research has consistently shown that individuals with large bodies are characterized as lazy and lacking willpower. weight bias is widespread and pervasive. We propose at some costs that have been attributed to Oh word in existing burden of illness studies. Example delayed healthcare seeking to avoid bias doctors may in fact reflect weight bias in addition to or instead of weight alone, this Miss attribution of costs to the extent that it occurs has two main implications. First, existing cost estimates of fatness may be inflated. Second, these estimates could improve intervention efforts focused on preventing or reducing fatness No, new or close but no resulting in missed intervention opportunities to improve practices and settings to include larger individuals. This is where you can tell that some people in the the discourse here are If you like, yeah, they're doing it, they're doing it. They're doing it. Oh, they want to eradicate fat people. So close yet so far. Why weight bias matters in Estimating costs of fatness body fat is feared and reviled by many segments of society. For example, 25% of 4283 respondents in one study reported that they would rather be unable to have children than be fat. respondents who weighed less were more likely to endorse such statements. They talk about more about the why weights are bad, which one of them is that weight bias might make people fatter, and they say that that's a bad thing. Continuing they say through our literature review, we identified seven putative costs of weight bias in three categories one health, ie delayed health treatment seeking behaviors and medical treatment, contingent on weight loss, detrimental physical and mental health outcomes to societal ie lower education attainment, interpersonal problems, and three workplace ie workplace discrimination. And then they've got this kind of Venn diagram on so it's two two circles. One says fatness costs, and the other circle says weight bias costs and then they overlap in the middle. And so they say figure one illustrates that costs direct and indirect, that overlap between fatness and weight bias drawing from a lot of revival of law. four major areas of potential overlap between fatness and weight bias costs were identified, one employment, lack of promotions to fiscal health, three mental health and four other societal costs example diminished interpersonal relationships, these overlapping areas represent issues relating to weight bias are currently included in estimates of cost of fatness in Canada, and support our overall assertion that weight bias is an important yet missing component of fatness cost estimates. So this Venn diagram, so weight bias costs, they've said health workplaces societal. And then they're saying, oh, word costs, health. And so medical spending, diseases and complications, increased life and medical insurance, premature death, and reduced quality of life. So the thing is, though, with health, health spending, well, we're gonna have to have we have to have they're saying here specialized equipment, we have to have equipment for humans, you know, it's bizarre. Imagine if we had this like, oh, how much does it cost us to, to health spending on people who are are smaller, you know, children, or people with smaller bodies? How many gowns do we have to buy in size small? Well, that burden of people who were smaller really is massive, we have to buy X 1000s of gowns and have beds and blah, blah, blah, it's just not they're just part of the human population. It's not a burden that they exist. Diseases slash complications, example diabetes, heart disease. And they're putting that under Oh, word costs. But we don't know that those things are caused by fatness only that they are associated. So we can't have it under the Oh word costs, increased life and medical insurance or that's something that fat people have the burden of. Right? premature mortality, reduced quality of life. And even in the report there, they're saying that normal weight people have increased mortality, that that that quote, normal white people have a higher chance of of dying, right, versus people who are fat. The report says that and so you can't have that under health either. reduced quality of life. That is right. But is that that's a weight bias costs that is not an O word cost workplace, so they're going to MIT workplace. So an O word costs it they're saying private monetary losses due to reduced output, job performance and labor income slash profit. What. So in fact, people are bad at their job. Because of fatness versus fat people might have reduced output or reduced income because of weight. bias, absenteeism including paid sick leaves, public monetary costs and via taxes lost. It's just been like, using, let's use some thinking around this. Is that because of fatness? Or is it because of weight bias? So anyway anyway anyway, so basically they're saying, hey, like, most of this stuff is actually weight bias. And it's not fairness, okay? Now someone else responded to this. I love this. This is like a twit Twitter thread, but you know, for academics. And that was Dr. Angela Meadows. So, Dr. Angela Meadows is a rock star. So Dr. Angela Meadows responds letter to the editor response to the thing that I was just reading to you. So I'm gonna read it to you. It's a short thing, seeing a URL that's the author of that
article that I read just read, outline the role that weight related stigma plays in inflating the supposed economic costs of fatness. However, despite their thorough and helpful since synthesis of the literature, one cost that was not well alluded cated in their model was the direct impact of weight stigma on physical morbidity. In addition to indirect effects via delayed or inappropriate medical treatment exposure to a chronic, stigmatizing environment, even in the absence of personal discriminatory experiences, has a direct impact on physical health via the body's dynamic neuro endocrine response to stress. Aloe stasis. Aloe stasis, maintains homeostasis in the face of physical, environmental or psychosocial stressors, and involves multiple systems within the body, including the cardiovascular and immune systems, while Aloe stasis represents an adaptive response to acute stress, chronic or repeated stress over time can result in multi system biological dysregulation, a concept known as allostatic load, which is linked with a wide range of disease conditions, including cardiovascular disease, diabetes, hypertension, and cancer. This situation is not specific to high weight individuals. The wider stigma literature provides a wealth of evidence suggesting that exposure to personal and systemic prejudice and ill treatment places members of disadvantaged and marginalized groups a particular risk of developing these conditions, Pasco and smart Reitman. That's the paper. So, hostile environments may also advise adverse physical health outcomes, for example, chronic pain conditions and poor birth outcomes via a psychological distress. In the case of highway individuals experience weight stigma has been linked with higher levels of cortisol and inflammatory markers, and impaired glucose metabolism, with a recent longitudinal study study supporting a causal relationship in a cohort of 986 adults aged 25 to 75 years and the midlife development in the US biomarker sub study, perceived weight discrimination was associated with with a two fold increase in the 10 year risk of high allostatic load. Experienced weight stigma and weight related bullying. Were also linked with overt disease prevalence, including RT artery to sclerosis, that's something to do with your I looked it up it's something to do with your your arteries, diabetes and modern minor cardiac conditions in a sample of 21,000. Highway adults in the National Survey of alcohol and related conditions study. As many of these health problems are generally attributed to carrying excess weight, any calculation on the economic burden of a word and lover that she's put it in quotes, must consider the direct causal role played by weight stigma in health care costs associated with physical as well as psychological morbidity. Angela, and this is why it's important to have you know, people who in the fat activism community looking at this stuff and saying, you know, so Angela has been able to say you didn't even think about this. And this is The big thing to think about and that is weight stigma. And so seeing a owl have said, some, if not all of the cost of the burden of fatness on on society can be attributable to anti fat bias. They don't say anti fat bias is a weight stigma. I don't like saying weight stigma or weight bias because it it opens the door for people saying, Oh, we mustn't be mean to straight size people when it shouldn't be about that. It's about the violent anti fatness that is in society. Where was like what was my brain talking about? Yeah, so really, that would it was it they say 7.1 billion word 7.1 billion. Or if you go for the more conservative number 4.6. What 4.6 billion be the cost of weight bias. As said, by seeing al What 4.6 billion be the cost of anti fat bias? And would knowing that change that number. So that all of these programs that are designed to potentially end weight stigma, which is actually perpetuating any more that they end. And so anyway, in a nutshell, let me summarize what we've said here. What was sent him. So there's no way to predict how many people die from fatness in any accurate way. The reason for that is that there are zero health conditions that have been shown shown to be caused by fatness and something that only fat people get versus health conditions being correlated with fatness and something that people of all sizes get. You know, it's the crux of is fatness, a disease. And there's an episode where we talk about this. And the thing is the crux of it is, well, we can't show that fatness causes these negative outcomes. And we can't show that this is something that only happens to fat people. Right? That's the the backbone of this, also insisting that we need this data can be problematic in itself. You know, imagine if we did this with any other identity factor. And in the past this is this has certainly happened. Imagine if we costed the, quote, burden of women, for example. I mean, it would be fine to want to estimate, you know, the budget of how much we should be allocating to certain services, but framing an identity group as a burden, and then advocating for their erasure is beyond fucked up. Right? Imagine if we had like the, the burden of women on society. And then it was like, causes of people being a woman ways to stop people being women, so that we would then not have these burdens on society. Like it's ridiculous, right? You know, it clearly is what if that came out, then everyone be? What we want to just women is what is the same? Like people are just fat people have been fat forever. And anti fatness is the problem. So, in a nutshell, if you're fat and you have a disease that's related to fatness, that is where they're getting those numbers from, right? If you die, and fat and have a disease that's related to fatness, then you die to fatness basically. So basically, that number is how many fat people exist and US healthcare, how many fat people exist and have died. That number is the cost of having fat people exist in the world and framing it as a burden. And they've used the word burden in that report many times burden and I mean, you can use the word burden as in you know, just things that are there, but they're not in this in this instance and not reframing framing is just something that they're they're a big part of the report is how to make people not not fat and they say we don't know why people are fat maybe we should give them an exercise bike. When I know though, but you know, maybe he's actually helping inform policies but oh, it's fucking annoying. Wow. So Knowing about the you know, the stress that allostatic load I really was thinking about this you know fat people need to have a rest fat people need to relax and get a massage and try and get some of that stress from our brains if we can and you know what one way to to help from experiencing the the stress of weight white bias one way that is helpful that Angela Angela Meadows talks about and I'm going to talk about in another episode is to be in fact community.
It's almost like fat community can act as a as a kind of shield, right. Not an impenetrable shield. But it helps right. The framing of of fatness as as not an issue and being in community with others who have those same beliefs helps us not internalize weight bias which is which is good for our health right? So hey, just listen to this podcast might be good but I might it might be stressful just hearing about this bullshit. So if that's the case, you do just go and you have a like go and have a nice cup of tea have a nice little biscuit or something. A chocolate Hobnob if you're in the UK you can get them here actually in Canada there's a British section in different stores I get I get myself some rhiwbina I get myself lemon sherbets I get myself what else some chocolate that I don't do crisps so that's the thing that I miss the most is crisps. I'm a crisp person. So anyway I hope that you found this episode interesting and if you did and you want to support the work that I'm doing, go to Kofi KOF I search first fatty or do just go to the show notes and you'll find the link show notes for this episode is first fatti forward slash 166 Or they're probably they probably just on your phone where you're listening I don't know I don't know how we do it. Yeah, so thanks for hanging out with me today oppression all odds, stay fares fatty and I'll see you in a while Oh Allah Allah guide her bye
