How Does Ob*sity Cost the Workplace $73 Billion?

I read the headline “Ob*sity’s Hidden Job Costs –  73 Billion”. As someone with a background in research methods (and who is both ginormous and really productive) my first thought was “How did they come upon that number?”  I looked up a bunch of different articles online to make sure that they were all reporting the same basic thing, and they were.

So I went to the Journal of Occupational and Environmental Medicine and paid $20 for the article, which was titled “The Costs of Obesity in the Workplace.”

Allow me to attempt to elucidate, it won’t be easy because this study is kind of a cluster F&$#.  I’ll start with some basics, and include the longer more detailed nerdy explanation (that I love so much) at the end.

The study looked at three factors:  Medical Cost, Absenteeism (not showing up to work) and Presenteeism (being at work but being unproductive).  According to my spell check, presenteeism isn’t a word but we’re going to go with it for now.

According to the articles that I read online, the study was out of Duke University.  That’s true – the lead author is Eric Finkelstein, an associate professor at Duke-National University of Singapore.

Under “acknowledgments” it says “This study was supported by Allergan, Inc.”  It lists that as an acknowledgment, and that’s a problem for me because it should be listed as a conflict of interest. Why?

“Supported” here has the meaning of “funded by”.

Allergan is a pharmaceutical company.  They produce Botox, Latisse (it will grow your eyelashes and don’t worry, that eye discoloration is probably temporary) and…wait for it…the LapBand.  The item used to constrict your stomach as a weight loss surgery option.

Allergan is currently using this study from the good people of Duke Singapore to convince health insurance companies to encourage and pay for lap band surgery because it’s “cheaper than the loss productivity”.  Astonishingly [sarcasm meter is a 9 out of 10] according to this study, the cost of obesity per person was more than the cost of lap band procedures.  Let me muster up some shock…  Sorry – I’ve got nothing.

The study used two sources:

The 2006 Medical Expenditure Panel Survey where BMI data is self-reported, and the 2008 National Health and Wellness Survey which is a series of self-administered internet-based questions fielded by 63,000 members of an internet based consumer panel.  Every piece of information is self-reported and unverified. The $73 billion is an estimated projection based upon statistics that were created by doing computations with statistics and estimates, and statistics of other statistics. There are issues in the collection of data, the control of variables, the use of data (the study authors feel that the words “obesity” and “health problems” are scientifically interchangeable, that fat people’s health problems may be assumed to be caused by fatness, and utilizes BMI which has any number of problems as a statistic in and of itself which I talk about more here), and the conclusions that they drew.

The fact that news agencies reported this information as true without bringing up the limitations and issues is deplorable.  Studies are suggesting  that obese people already make less than their peers and are turned down for jobs based on prejudices about weight.  Now companies may think that they have scientific proof to back up their bias. How many of them are going to pay $20 to read and understand a complicated study?

As always, may I suggest that you DO NOT  need to believe everything that you are told is science, and DO NOT need to take this personally or allow it to affect how you feel about yourself, your health, or your productivity in any way.

Here come the details:

Medical Expenses

The calculation of this is statistically complicated because of the data.  To speak in the vernacular of the peasantry, the data sucks. Basically they used a two part estimate that created four categories of overweightness (hey, if they can make up words so can I) based on the self reported weight.  “Normal weight” were the omitted reference group    They controlled for race, household income, education, insurance coverage, marital status and smoking. They subtracted the average predicted medical expenditures for “ob*se” individuals in each category from the average predicted expenditures for those of “normal” weight.  Then they multiplied that estimated number times the number of people in each category and added them up and extrapolated based on the estimate of the total number of ob*se Americans.

Problems:

First of all, notice the number of times that the words estimate, average, and predicted appear in that explanation.  If I had more free time I would be doing a word count to give you an exact percentage of the number of words that are used in this study that essentially mean “um, maybe…”, there are many.

They also didn’t control for any genetic health issues, or health issues that aren’t even correlated to weight. They didn’t control for, or even mention weight stigma, weight cycling, and healthcare inequalities, all of which studies show can have a profound influence on fat people’s health. They appear to have assumed that any medical problems that obese people had over and above what normal weight people had were due to fatness.  They appear to have assumed that normal weight people’s health issues weren’t related to the same things that cause weight problems in overweight and obese people.  That’s just embarrassingly bad science.

Absenteeism and Presenteeism
This is my “favorite” (and by “favorite” of course I mean most rage inducing.)  These were measured based on a question that asked people “During the last seven days, how many hours did you miss from work because of your health problems?” and “During the past seven days, how much did your health problems affect your productivity while you were working?”  Participants indicated their level of work impairment via a rating scale ranging from 0 to 10.  Each response was assumed to represent a percentage reduction in productive work.  Then they annualized and monetized the predictions using age and gender specific wage data from the bureau of labor and statistics.

Problems

Respondents weren’t talking about  how much work they missed or productivity they lost due to their weight, they were answering about their health problems.  What they can reasonably conclude here is that people with health problems have more absenteeism and presenteeism than do people without health problems.  The study’s authors are basically substituting “ob*sity” (and by that they actually mean high BMI)  for “health problems” .  You can do that I guess, but you probably shouldn’t do it while calling yourself a scientist and your freshman research methods teacher would fail you on the assignment.

Then, they computed statistics using statistics, and statistics of statistics. Dude. They used a 7 day sample to calculate a year’s worth of data.   Once again, they assumed that any absenteeism or presenteeism over and above what “normal weight” people had was due to fatness.  Except that “overweight” men reported less presenteeism than “normal” weight men.  That was not reported in any news outlet that I could find  EXCEPT the study itself and they  gloss over it.

If I had turned this work in for my very first  intro level freshman research methods class I would probably have failed the assignment and possibly been asked to leave the program because of specific incompetence and general stupidity.  You don’t have to feel bad about yourself or your productivity- you are fine.  Feel embarrassed for the scientists who put their name on this.  I hope that they are the laughing stock of Singapore.