Fat Nation and The Costs
Two years ago, the Cleveland Clinic stopped hiring smokers as one part of a “wellness initiative.” The Clinic has offered smoking cessation classes for the surrounding community. The Clinic has a farmers’ market on its main campus. The “wellness initiative” is a good story, I think. Refusing to hire smokers seems to be a bold move, but somebody had to be the first. Smokers are being marginalized socially and now economically.
The CEO of the Clinic, a heart surgeon named Delos Cosgrove, said that if it was up to him, if there were no legal issues, he would also stop hiring obese people. Cosgrove was accused of being unfair.
“Why?” he asked. “People’s weight is a reflection on how much they eat and how active they are. The USA has grown fat because it is consuming more calories and burning fewer.”
Cosgrove went on to state that our national “fat” problem has huge costs, both medical and economic.
He wondered why we did not present an anti-obesity agenda with the same urgency that we have gone after smoking.
Doctor Cosgrove summarized his feelings, “We should declare obesity a disease and say we are going to help you get over it.”
In 2008, $147,000,000,000.00 of the health care expenditures went to treat diseases caused by and associated with obesity. That is $50,000,000,000.00 more than we spent to treat cancer. It is about 3:1
Obesity over cancer.
Every single one of you has patients whose Type II diabetes would disappear if they lost 100 pounds. You frequently review a treacherous delivery of a dozen or so prescriptions for one obese person. I did it yesterday. Fourteen prescriptions. Hypertension. Diabetes. That should be enough, but the doctor wrote for a steroid nasal spray and an Rx-Only antihistamine for allergic rhinitis. He wrote for an albuterol HFA inhaler and another steroid for her to huff. She showed attitude when I told her that the multiple vitamin and Vitamin C were not covered by her insurance.
I could smell that she smoked so I bit the bullet and took my shot. If Delos Cosgrove, MD could do it on an international scale, I could do it locally.
“You know, Maam, your weight and your smoking could take years off your life.” That was a pretty bland comment, I thought.
“I’m a healthy woman,” she claimed. “I just need some medicine temporarily.”
How do you answer that? I chickened out. “I hope so,” I said.
In 2008, the treatment of diseases associated with obesity came to $477.00 for each American. $159.00 per person for cancer. In 2008, the average American in their fifties is 20 pounds heavier than we were in the late 1970s.
Since we are having the national debate about health care, I ll ask this. “Should obese people be charged higher premiums for their health insurance?”
I will admit that I am prejudiced. At the pharmacy, I do not act the same with a fat person as I do with a person who is fit. The difference is the light-hearted banter that I engage in when counseling a person who takes care of themselves. I am all business with an obese person. I don’t look at a fat woman the same way I look at a woman who is in shape or even a woman who is packing a few extra pounds but is pleasantly round and soft in the right places.
I’ll remind you that pharmacists are at the bottom of the funnel. We are the last chance for the medical system to make a difference. What can we, as individual pharmacists, do to help? I’m leaving it up to the individual pharmacists because our pharmacy organizations seem to have other things to do rather than make a difference in society.
The drive-through. There are times on Fridays late when I have to wear all the hats. Pharmacist, Technician, Counselor, Cashier and also be the caretaker of the drive-through. It is interesting that a very high percentage of drive-through patrons are obese. Galveston is hot and humid in the summer. Some of these obese people sit and sweat. No air conditioning in the car of they choose not to use it. Some of them can barely get in behind the steering wheel. They can’t reach the drawer to get the prescriptions and their change. They are often surly, mean and demanding.
There are many obvious reasons for my drive-through fat prejudice. The one I am not proud of is the little voice that repeats, “Just stop eating. You are weak and not worthy of more than my perfunctory attention.”
I treat walk-ins differently, I just realized. I am polite to everyone who comes to the pharmacy counter. Fat or not. Why do I often feel that drive-through fat people are substandard human beings?
I can’t imagine pharmacy taking the lead on the “War against Obesity”, but we are perfectly positioned to do it.
By the way, I have never seen an obese pharmacist. Twenty pounds is like lugging around a car tire. I don’t see how anyone who is carrying five car tires could be on their feet all day.
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I agree with most of what you said. I do have one question, though: how does your opinion change if you find that your Type 2 diabetic patient is taking Zyprexa or Remeron? Do you tell them to ask the doc for something else?
I actually have met obese pharmacists, but they all worked in hospitals (one of the few desk jobs in pharmacy).
I have met obese pharmacists. I am actually obese myself and heading down that “fat pharmacist” road if I don’t lose weight. I do think it is kind of prejudiced to treat fat people at the drive-thru different than everyone else. Lots of skinny people could get off their butt and come in too. That drive-thru, in my opinion, is mainly for patients with 3 screaming kids in the car or the disabled and/or elderly person who would be in agony walking to the back of the store. (How bad off an elderly person has to be before they shouldn’t be driving period is another arguement for another time.)
Now, as for losing weight, it is hard to get started. Smoking, given one or two failures, could still be stopped in a few months time. Also, a person who is quitting gets a pat on the back even for trying.
A fat person in the gym is ridiculed even though their purpose is to lose weight. You can’t even eat a healthy salad without wondering if people are thinking “There she goes again… stuffing his/her face,” or, “Does he/she really think that salad is going to help?” Apparently fat people are supposed to start consuming a diet of pure air. If a person is successful, losing those 100 pounds is still going to take a good year or so… much longer than smoking cessation.
It is an uphill battle. As an obese person, I know how many obese people who WANT to change feel. As a pharmacy student, I know there isn’t really much outside of the “eat right and exercise” motto. Oh… well there are runny diarrhea-causing drugs.
Obese people need support. I would love to have more support myself. Keep up with your counseling. Your patients really do need it.
We once had lady come thru the drive thru one morning looking for hyroxycut, or some OTC weight loss product. It wasn’t busy yet, so I told my tech it would be alright if she got it for her and ring her up (won’t happen when we’re busy). After she left, I said to my tech “You know the first step in weight loss is diet and exercise.!!” We both had a good laugh that day that somebody, who was obviously overweight, would be so lazy as to go thru the drive thru for a weight loss supplement
although the following link doesn’t speak directly to what you are referring to, i think it addresses some important points related to the topic: http://shakespearessister.blogspot.com/2009/08/evil-fatties.html
if you don’t have time to read that blog post, the main point i’m trying to get at can be summed up by this line: “Framing [the issue of of a health tax on food] as a fat v. thin issue (where fat = unhealthy and thin = healthy) is bullshit—and counterproductive, demonizing bullshit at that.”
not every fat person is unhealthy, and not every skinny person is healthy. not every fat person is fat because they don’t take care of themselves, etc. making that assumption about every fat person is pretty unprofessional, in my opinion.
i also think the issue is a combination of personal choice and environmental factors. if we take smoking, for example. i don’t smoke tobacco myself, and i think smoking is stupid. i have several friends who do smoke, though. i don’t hate them, belittle them, or consider them to be subhuman for smoking. yes, they are responsible for the choices they make, but i don’t demonize them for their choices. i also believe that tobacco companies and the marketing of tobacco products is a bigger problem than the smokers themselves.
rarely is the conversation about “the war against obesity” ever focused on the food industry, and on how food is marketed in our every day lives. i’d say that the food industry’s interests (getting us to to buy and eat more processed foods) possess a bigger threat on our mission to make the u.s. a healthier place than some moody fat person whose been having a bad day because everyone has been treating her like shit because she’s fat. just an oversimplified thought for a complex, multi-layered issue.
I do it too, JP. I’m not a good counselor through a glass window. Also, the diet supplements are located right in front of the drop off area. I have a thing about people asking for a diet supplement. Most of the time they are not overweight, I wonder if they are fishing for a complement? Also, I tell them that if they want something they can try the alli (also the most expensive thing out there), but if they really want to lose weight they need to stop putting more food in their mouths than they use during the day. If it were easy…everyone would be skinny!!!
Someone needs to tell Dr. Cardio to shut it. Who died and told him all the answers to longevity. If we all lost weight and quit smoking he would be out of businees…brilliant doctor!!! What will you do with all your free time? Go for a jog maybe?? The irony is he’d probably get run over by a fat man eating a Big Mac instead of watching the road.
I wish my employer would stop hiring idiots. Smoke all you want, eat all you want, just have a high enough IQ to complete sentences and put the right pill in the right bottle in a semi-quick manner. Am I asking for too much?
Individual responsibility for health choices.
The Nike slogan probably is most apt when it comes to exercise, ‘just do it’; my mother in law at 88 hops on her bike to go shopping every day at the local market.
Family, and local society choices in health care decisions.
As a young person without car, or public transportation in our college town, my husband and I walked everywhere. The grocery load tended to be basic e.g. no smashable processed foods. (With a lot of luck we got by without health insurance in this lifestyle!) Throw in a few pregnancies, kids, and a longer commute, MD ordered absolute bedrest and a little rheumatism, etc., and the mobility factor comes into play. Time Magazine recently featured the energy component–exercising more vs. eating less.
Informed choices by intelligent members of society.
One of the keys of diabetes treatment is regularity in timing as well as content of meal and snack intake balanced against activity, and insulin secretion or supplementation; a ‘regulated’ lifestyle would probably be helpful for anyone. How often is ‘regularity’ possible for everyone? We Americans tend to go for what we want when we want it, some lives are fraught with more stress than others.
(Own a healthy, active dog and see what kind of regularity one is forced to adhere. There aren’t that many of us that prefer the smell of urine or howls and barking to letting the little beast fend for itself.)
Broad, societal impact on collective choices.
On the other hand, can’t help but feel irritation on hearing about those of us that arrive to the pharmacy drive-thru refill pick-up line with the trendy gear, paying with Medicaid. But, also, cannot help but feel that there must be similar emotion on hearing of destruction of northern forests for world paper supply (tallest Sitka pines logged for toothpicks?) and communities from whence they came with highest rates of child homelessness, alcoholism, crime and or poverty. Imagine those residents with the satellite TVs are wondering why their neighbors have a higher standard of living.
Effect of unknown on health-care choices.
There is also PharmGirl’s other point to consider. What exactly is the relationship between obesity and emergence of DM2? Facts are available. Syndrome X and decreased DM2 disease sequelae associated with even 10% weight loss. The Seroquel speaker last week couldn’t answer the question of why/how some psych drugs seem to promote obesity or increased incidence of DM2…increased antihistamine or decreased dopamine effects, or?
Occasionally with less prejudicial and judgmental antisocial eyes undesirable ‘anti-social, obesity-type’ behavior of those with DM2 are associated more with side-effects of erratic hypoinsulinemic hyperglycemic and hypoglycemic episodes, than choices made in disease-promotional behaviors, i.e. a sort of ‘mental illness’.
Another choice in health-care decisions?
As for Cleveland Clinic, what say we get 50 individual State Health Organizations supported across the board by Washington, based on the most successful health-type programs in the area become the model/leader e.g. Kaiser-Permanente in for, Sioux City Health for SD, Virginia Mason Network in WA, Mayo Health in MN, etc. I wonder if proposal of a single-payor but state-run HMO would make Republicans happy.
For the first time in my life, I felt overweight. I am a thin 6′1″ and 175 lbs but I have begun to “shift” weight from by extremities to my belly….yeah, like in beer belly. That little poochy thing that I always detested in men and women. Believe it or not, I always felt better when I was at about 150 which put me in the “stick” category.
But cold winters and too many snacks made me begin to get a little belt lap. I decided to rid myself of my new friend. I wondered in silence if I were going to have the issues that most of my overweight patients experience in getting thinner. Could I easily lose weight or was I destined to begin a life long struggle?
I changed. I ate 2 meals instead of 3. I cut out most snacks and turned the TV off in the evening. I worked in the yard and sweated. In 2 months, I am back to my comfortable 165. The buddy has left me.
So now I am convinced that losing weight is simply a matter of discipline. Eat less, exercise more and voila, the tummy disappears. Its not fast but it is relatively simple. It just requires willpower.
America has lost its willpower. No one wants to sacrifice anything to get what they want. They would rather take Alli or some other concoction that only serves to fatten someone’s wallet. Obesity is mostly compulsion (yeah I know, you have a thyroid problem).
Want to lose weight? Take your own advice. Its actually easy.
My stepdad just toured the Cleveland Clinic and was very impressed with the healthy attitude. It is a model of prevention and community support. He even said that ingredients for the cafeteria food was purchased from local farmers.
I know a fat pharmacist. She works part time, and sits on a stool from about 7-9pm. Go figure.
I gotta agree with justsomeguy. Obese people are not always unhealthy and not always lack “willpower.” Thin people are not always healthy or have “willpower.” Sure, lots of people overeat and don’t get enough exercise, but I’m willing to bet that a lot of obese people have the odds stacked against them via the food industry and drugs that cause weight gain and the almighty media. There really are people out there who are obese and really do try to lose weight but then give up when all they see is food advertisements and anorexic models and disapproving stares from strangers. I’m not saying these are excuses like the old thyroid excuse, just that we have to be realistic about the power of our environments.
Telling an obese person to just eat less and exercise more is like telling a clinically depressed person to just get over it, mind over matter.
Obesity is not that simple, and showing prejudice against the obese doesn’t help anyone. I imagine they feel bad enough about themselves that they don’t need any help from any of us to feel worse.
From Jay Pee. Beloved, I will be the first to admit that I have an unexamined prejudice against the obese. I do not see tham as thinking, feeling human beings. I rarely make eye contact. I give them only perfunctory attention. When I ring up their Rx and they add popcorn, Doritos, candy and soft drinks with corn syrup, I am disgusted. That’s about me.
I can overcome that, in an instant, when I allow myself to. If I allow myself to look into their eyes (as with the burn patients) I can see a compromised human being, but a real human being. There have been times in my long career when they tell me the truth. I have a talent at getting this. Usually, it ends with a hug and, sometimes, tears. Thank you, Parrot, for reminding me that I am a flawed human being in this part of my job. I will get over it. Because of this, I will get better.
“From Jay Pee. Beloved, I will be the first to admit that I have an unexamined prejudice against the obese. I do not see tham as thinking, feeling human beings. I rarely make eye contact. I give them only perfunctory attention. When I ring up their Rx and they add popcorn, Doritos, candy and soft drinks with corn syrup, I am disgusted. ”
Prior to this I had a lot of respect for you. Now, I have to look at you as no better than a racist who hates solely based on the color of skin. You are a bigot who hates based on how much adipose tissue a person has. How sad is that?
How many of your obese patients have health issues that cause obesity? How many are depressed and over eat? How many are genetically disposed to being fat? Why are they not people to you? How can you dispense medications for COPD to a smoker and not hate him, yet you dispense any medication to a fat person and your hatred comes out?
I am a fat woman. I do have health issues. Things like kidney cancer and a recurrent abdominal infection. Neither of those are because I’m fat. The cancer is hereditary, the infection they are still working on the cause but they do believe it is due to a urachal cyst. Obviously that isn’t caused by obesity.
I was a stick as a child, one of those who were forced to eat. When I hit puberty I began to gain weight. Until I was 28, I had horrendous periods. I eventually researched and researched until I figured out what was causing so many of my problems. I had PCOS that had gone undiagnosed for many years. Once I was, and on proper medication I lost 70 pounds. I’m still fat, I always will be. I am a person. I am worthy of your respect.
Admitting one’s evils is the first step to correcting them. I don’t even have to work on this. I have acknowledged that I have an issue. I had never done that before. Now, I can move on. I don’t have to be automatic anymore. I can behave in a transformed manner. The truth will set me free. I can handle this, Suzy.
60% of America is fat or obese, with 30% being obese. You can’t tell me that 60% of the population has a glandular problem. This is an issue about personal choice and lack of responsibility, as so many other health issues are (addiction for one, lots of consumer debt for another). Obesity continues to be a problem because society and gov’t allows it to.
I had 3 aunts, all obese and diabetic. 2 of them had to die before the third decided to lose weight. That’s not just ignorance, that’s stupidity.