Manitoba fats are not overusing medical resources or dropping like flies
A report developed for the provincial government by the University of Manitoba has found that fat people are using only 15%* more medical resources than normal weight people per capita, and are not dying earlier. That is, Manitobans with 26+ and even 30+ BMIs are generally as healthy and long-lived as people whose weight is in the "normal" range.
This story has been all over the Canadian press this weekend, and I'll provide some links to the coverage tomorrow. However, I've tracked down and read (okay, skimmed) the original 200 page report.
Here's a link to the pdf: ADULT OBESITY IN MANITOBA: Prevalence, Associations, & Outcomes.
Let's take a look at it, shall we?
On the reasons for and uses of the report:
The main goal of this study was to combine administrative and survey data to provide Manitoba–specific results on the prevalence, trends, and outcomes related to obesity. These results will be used to inform public policy and program initiatives of Manitoba Health and the 11 Regional Health Authorities (RHA) in Manitoba.
On the use of health care resources by BMI:
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...
...Causal modelling of health service use rates indicated that illness level was by far the strongest predictor of health service use, followed by sex, and then other factors including BMI, age, and socioeconomic status.
On the relationship between BMI and mortality:
Initial analysis of death rates by BMI value (and BMI group) revealed no systematic relationship between BMI and mortality, though the follow–up period for most participants was less than 10 years. Multivariate analysis including age, sex, and other variables confirmed that obesity does not have a significant direct association with mortality.
On the relationship between BMI and disease:
Among the diseases studied in this project:
- Diabetes prevalence and incidence were strongly related to BMI group, especially for females. Among males, diabetes prevalence was 2.6 times higher in the Obese group than the Normal group; the incidence rate was 4.4 times higher. The corresponding values for females were 4.4 and 7.5, respectively.
- Hypertension prevalence and incidence were also strongly related to BMI group in both sexes. The Obese group had rates nearly double those of the Normal group.
- Heart attack (AMI) incidence rates were strongly related to BMI for males, but not for females. Conversely, total respiratory morbidity (prevalence and incidence) was modestly related to BMI among females but not males.
- A number of indicators revealed no statistically significant associations: dialysis initiation, heart attack prevalence, ischemic heart disease prevalence and incidence, stroke incidence, and hip fracture rates...
- Cancer incidence rates were also analysed and revealed few significant associations with BMI groups...
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 rate.
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. These 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 real news here is that when you look at the actual statistics that are produced by a public health care system, fat people are not using significantly more health care than anyone else, and are not dying earlier either. These are notable facts, as they demolish pretty much all of the common wisdom about weight, health, and life expectancy. Not only that, they expose as myth the idea thin people's taxes and insurance premiums are disproportionately being used to treat fat people's health problems. This is important.
* note: "15% more" means that, for example, people whose weight is in the obese range visit the doctor 23 times for every 20 times so-called normal weight people visit the doctor. Not such a big difference, especially considering the fact that fat people are constantly being told that we're inherently diseased and at increased risk for this or that health problem, which would make almost anyone paranoid about their health.
Tomorrow: a look at the news coverage of this report.