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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.

All Bodies are Goofy; All Bodies are Beautiful | News Coverage on the Manitoba Report

DeeLeigh's picture
October 24th, 2011 | Link | Just to clarify the

Just to clarify the seemingly contradictory information about heart attacks in the last quote, Wikipedia has this to say about incidence and prevalence:

Incidence should not be confused with prevalence, which is a measure of the total number of cases of disease in a population rather than the rate of occurrence of new cases. Thus, incidence conveys information about the risk of contracting the disease, whereas prevalence indicates how widespread the disease is. Prevalence is the ratio of the total number of cases in the total population and is more a measure of the burden of the disease on society. Prevalence can also be measured with respect to a specific subgroup of a population (see: denominator data). Incidence is usually more useful than prevalence in understanding the disease etiology: for example, if the incidence rate population of a disease increases, then there is a risk factor that promotes the incidence.

vesta44's picture
October 24th, 2011 | Link | High blood pressure in fat

High blood pressure in fat people could also be explained by nurses/doctors expecting said fat people to have HBP, and pumping up a correctly-sized BP cuff too fast and too high. Not only is this painful to the patient, it gives an inaccurate reading. It could also be explained by the added stress fat people live with due to the marginalization and stigmatization they face on a daily basis just because they are fat.
As for the 15% more usage by fat people, that could be also be explained by multiple visits for the same complaint, trying to get the doctor to diagnose the actual cause of the complaint instead of blaming the cause on the patient being fat (been there done that) and recommending the Nightmare on ELMM Street as the cure instead of treating the actual cause (been there done that). Until they actually ask the fat patients themselves why they visited their doctors more often, they aren't going to know the real reasons that fat people use medical care 15% more often than not-fat people - you know doctors aren't going to put in their notes that they fucked around and blamed a fat person's weight for a problem for years when that problem was really caused by something else and they didn't figure it out until the patient either demanded a 2nd opinion or went to another doctor who wasn't fat-phobic and looked beyond the fat for cause.

WLS - Sorry, not my preferred way of dying. *glares at doctor recommending it*

Meowzer October 24th, 2011 | Link | Weight loss treatments

Weight loss treatments could certainly explain the 15% higher health care use by fat people in this report.

As could the fact that fatness itself often has iatrogenic causes (e.g. medication use), as well as organic medically-related ones (e.g. PCOS) for which treatment (and/or yearly lab testing) might be sought. (I don't have diabetes or hypothyroidism, but since I have PCOS and a family history of hypothyroidism, in addition to having a goiter and what I would consider to be classic hypothyroid symptoms despite normal thyroid panels, I get full diabetes and thyroid panels every year, just to make sure.)

And seconding Vesta, I noticed too that techs have a tendency to over-inflate BP cuffs on fat people, to the point where it's actually painful for me. Recently a tech did that twice because the first machine she used was broken, and sure enough, third reading, doing it on just the wrist, the systolic was 20-30 points higher than usual for me. Fortunately, my doctors are not irrational and they don't freak out about things like that.

DeeLeigh's picture
October 25th, 2011 | Link | They always over-inflate the

They always over-inflate the cuff with me, too. Hurts like hell. And they never use the large cuff unless I ask them, even though my upper arms are in a size range where they should be using it.

vesta44's picture
October 25th, 2011 | Link | DeeLeigh - I got around that

DeeLeigh - I got around that problem with my doctor's office by taking my wrist blood pressure cuff with me to appointments and telling them that they would use that to take my blood pressure or they wouldn't get to take my blood pressure at all.
My endocrinologist's office, on the other hand, uses the machine, with the small cuff, but they put it on my lower arm, just below my elbow. Even with white coat syndrome, my bp is always in the normal range doing it that way. And when I was in the hospital having my enlarged thyroid removed, the hospital staff took my bp the same way, and wonder of wonders, it was always in the normal range then too (it was even low a couple of times). So using the machine with the smaller cuff and placing it on my lower arm actually gave accurate bp readings.

WLS - Sorry, not my preferred way of dying. *glares at doctor recommending it*

richie79's picture
October 25th, 2011 | Link | My wife ended up on

My wife ended up on completely unnecessary BP meds for six months due to repeated use of the 'regular' cuff at our GP surgery (coupled with a good dose of white coat syndrome resulting from fat-phobic treatment in the past). There's also the increasing use of trolley-mounted automatic blood pressure monitors (Welch-Allyn seems to be the main provider of these), which simply don't seem to be able to deal with larger people irrespective of which cuff is used and return a string of error messages instead of a reading. Numerous attempts were made to to measure my wife's BP with these during her pregnancy, with increasingly exasperated staff ultimately having to accept our advice to fetch a hand-pumped unit with a large cuff. Heaven forbid that a fat person should know more about what does and doesn't work for thir body than someone they met five minutes ago.

Along with the demands from doctors that otherwise perfectly healthy fat people submit to weight-loss treatments they don't need and Meowzer's very plausible theory that for some people 'obesity' is merely a side effect of treatment for other conditions for which they are already using the medical system, this apparently widespread attitude of casual dismissal could be one of the many factors that easily account for that 15% extra spend. It's a classic example of why fat people need to be better informed about their own health and empowered to speak up and challenge the lazy assumptions and 'we-know-best' attitudes of medical 'professionals' who often regard them as an inconvenience.

"What is right is not always popular and what is popular is not always right" - Albert Einstein

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