Wednesday, March 26, 2008

Fit or Trimmed

People were watching what I was putting on my buffet plate and this is not just paranoia or a woman wrestling with a serious eating disorder speaking. At breakfast eyes burned into me as the line moved past the yogurt and onto the pastries. The pastries, bursting with sugary goodness, called my name but there was no way I could enjoy even a bite with an attentive audience. Then there was the French fry bar at lunch, oh how I love French fries with toppings like cheese and chili; as if the fries are not unhealthy enough on their own. Alas there was just no way to enjoy grease laden potatoes when everyone anticipated a plate full of fruits and veggies before me.

Recently I had the pleasure of attending a conference for companies looking to improve the health and well being of their employees with a major focus on programs and incentives geared towards physical and mental health. My reasons for attending the conference were quite different then most of the attendees; I was looking to learn what health issues companies were struggling with and what competitors were doing to address them. At any other conference an eye would nary be batted at a person loading their buffet plates and ordering a fourth beer but this was neither the time nor the place to test the limits of my stomach or tolerance; I was now representing my company as an example of our commitment to personal health and wellness.

Referencing the press conference playbooks of fallen sports heroes, I was not looking to be a role model; just looking to play my game. Like those sports heroes caught in scandal I felt any wrong move at snack and meal times and I would bring shame (and therefore less business) to my employer. This is something I have struggled with over the previous year or so and this conference made it all too apparent that moving up in this business meant working hard in the office AND at the gym. A very subtle evolution at work that those not sensitive to the struggles of the overweight would even notice is occurring; to be the face of the organization you must physically portray the mission of the company. Our mission is to improve the quality and affordability of healthcare through providing care and support to people, empowering them to make better decisions about their health and care. Our nurses and coaches touch the lives of millions every year by coaching them to make better personal choices; find who will give them top quality healthcare, determine what is the best course of action for better health outcomes, schedule when and where to see the best doctors and educate callers on how to take better care of themselves whether they are chronically ill or trying to live a healthier lifestyle. Moving up any organizational chart often requires an increased amount of client facing time. As many sales people know there is an intense pressure to look good when in front of clients and this pressure is extra intense when trying to sell health. Our clients are looking to see if we practice what we preach and any indication of an unhealthy lifestyle, like smoking or carrying a few extra pounds, does not align with our mission to promote a culture of health and is ultimately a poor reflection on our commitment to promoting healthier lives.

Executives and benefit coordinators from companies nationwide are seeking ways to decrease their healthcare dollar spend and increase workforce productivity through promoting a healthier workplace. In the past our business worked on helping sick people take better care of themselves but that is only a band-aid which did not help people from becoming sick (read: expensive) in the first place. Our customers are now looking to promote a culture of health to keep people healthy before their healthcare becomes expensive and their productivity decreases due to increased absences and disabilities. Smoking programs aimed at getting people to quit are quite popular with employers and for good reason; according to the Centers for Disease control smokers cost employers and extra $1,623 in medical care. The Center for Health Promotion reports that smokers have a 50% higher absentee rate then non-smokers and are 15% more likely then non-smokers to be out of work on a disability. For those employees who keep on smoking employers are increasingly likely to place an extra insurance premium on them to make up for the costs.

In the world of healthcare the focus on smoking is so 20th century. Those who think that they are immune from pressure to live a healthier lifestyle and lose that extra weight at work are ignoring the similarities between smoking and weight in our culture. The days of smoking being chic and accepted in the workplace and beyond are long gone, replaced by smokers hiding their habit for fear of extra insurance premiums or job loss. It was not long ago (although before my time) where people would sit in a board room with heavy smoke wafting through the air; can you imagine that now? Now it is socially acceptable to attack smoking due to the unarguable health issues associated with it; weight will become the next target.

The stats cannot be refuted; overweight individuals cost and average of $1,400 more a year in healthcare costs then people who are at a healthy weight. Beyond direct healthcare dollars us overweight people (I do fall into that category) miss more work (I wish!) then our thinner counterparts. With more sick days, higher medical claims, more workplace injuries and the risk of weight related chronic diseases it is estimated that a person costs their employer and extra five-dollars per pound overweight each month. With stats like these, the inability to hide a weight problem and the sheer number of people who are deemed overweight (66% of our country) is it easy to see how weight discrimination claims are on the rise. The discrimination is hard to fight; the obese are an unprotected “group.” Only one state, Michigan, the District of Columbia, and a scattering of cities have laws making weight discrimination illegal. Then there is the difference between blatant discrimination, like being fired because you are fat, and the subtle discrimination like receiving lower raises, being passed over for a promotion or new job, or being put into positions with little room for advancement, that are hard to prove. People generally support anti-smoking legislation because of tobacco’s cost to our overall society. When people realize their overweight co-workers are costing the company more money and effecting raises and healthcare premiums will they rebel against the overweight for affecting their personal finances?

The pressure to practice what we preach and become the outward picture of health that aligns with our mission and vision is overwhelming but also motivating. Even as an overweight person I found myself looking around the room at the conference and wondering if I would take a few of the morbidly obese people representing other health and wellness companies seriously; were people looking at me and wondering the same? I was also dumbfounded at the number of executives who did not understand why their wellness campaigns and incentives for smoking cessation and weight loss were not working while they were sucking on a cancer stick and shoving a cookie into their pudgy mouths; ever hear of leading by example? It is sad that this career pressure to be thin is a more effective motivator in losing weight then my health and well being ever was; knowing all I do about healthcare I am still like most Americans and pay more attention to my job then my own health. Beyond just the job pressure to be thin studies that conclude that overweight people earn less over their lifetime due to subtle discrimination, limited advancement opportunities and increased cost of health related issues; weight is bad for your health and wealth. But as the cost of healthcare rises beyond the rate of inflation and contributes to recessionary times the time is not far away where everyone, not just those whose career is in the healthcare field, will feel pressure to eat, or not eat, like their job depended on it. So long as your employer, or the government, is paying towards your healthcare then weight, like smoking, is fair game and no longer a personal lifestyle choice.


Nursedude said...

Wow, 'Chelle! A lot to digest on this posting(No pun intended). There is no question that now that smokers and the tobacco companies have been more or less dealt with, overweight people and junk food are going to be the next big target by insurance companies and the government. I don't think it is going to be in the distant future when you start seeing special taxes and surcharges on potato chips, ice cream and fast food.

When I was going to nursing school, I had an instructor who was a smoker.(she quit a couple years later after she had a coronary bypass) Eventhough she was in her early 60's, she still looked really good, very trim, nice figure-and a very diginified lady. She told me how frustrated she used to get when people would see her smoking and ask her if she knew how bad smoking was for her. She would say, "No, I have been in a coma since the Surgeon General's warning in 1965-just what did he say?" She would highlight that a person would never walk up to a fat person eating a Big Mac and confront them about being sloppy and their lousy food choices.

If you want to see a couple of documentaries dealing with fastfood and obesity, see "Supersize Me" and "Fastfood Nation". I just saw Sicko, a documentary by Michael Moore.I am not a huge Michael Moore fan, and he takes a really romanticized view view of socialized medicine-but there are some pointed and valid critiques about Managed care thrown in-Irregardless of politics, it's a documemtary that is worth a look.

Explosive Bombchelle said...


I was wondering if in your profession there was some increased pressure to be physically fit. You might not have as much as a phone triage nurse, but when having to deliver advice to people that includes the need to lose weight do medical professionals feel like they should adhere to the same guidelines? I remember one doctor telling me to lose weight years ago and laughing my way out of the office as to what a hypocrite he was at 80 pounds overweight to tell me I needed to go on a diet. Some of the least healthy people in our organization are our nurses who are telling people with diabetes, CAD and Heart Failure everyday to lose weight and quit smoking in-between their cigarette and Twinkie breaks.

While Insurance Companies are partially to blame I cannot stomach the one-sidedness of Michael Moore’s films. Glorifying socialized medicine is easy when just focusing on the good. Government based systems are wrestling with many of the same issues as our system; out of control costs, ever increasing number of available drugs to pay for, new treatments, people not taking care of themselves, malpractice, etc. etc. I am trying to write another article on this topic with some recent news of the issues happening in the UK and Canadian systems. Let’s just say they work really well until something goes wrong and out of the norm. Plenty of people seek treatment in the United States because they are denied coverage and care in their home countries because procedures that are considered routine here are not given elsewhere.

But, like the old saying goes, an ounce of prevention is worth a pound of cure and if we each take a few measures to take better care of ourselves we’ll help not just ourselves but our overall public health.

mk said...

Good for you! I maintain that sticking to just the fruit & salad fluff will leave you starving.
I am very worried about insurance companies constantly finding new targets upon which to discriminate. I'm suspicious that various "health screenings" are of any use to me.

if you haven't already, check out sandy szwarc addresses both the emphasis on obesity as a new "problem" and sneaky insurance practices.

Nursedude said...

Hi 'Chelle,
You bring up more interesting points in your comment. There ARE a ridiculous amount of nurses who are really, really out of shape. As health educators, we lose a lot of street cred because so many nurses look so sloppy fat.

In some of my nursing journals, I have seen some articles talking about the idea that nurses need to do a better job of taking care of themselves.

I know for me personally, the main motivators for me to hit the gym are: Pride and personal vanity, having diabetes on both sides of the family, heart disease on one side of my family, playing rugby and not wanting to be a liability on the field, about to be a grandfather and want to be active with my grandchild for a long, longtime, love of my wife, and want to be with her a long, long time...being a nurse and having some street cred is there-but far down the list.

Maybe the recent finding linking abdominal fat and Alzheimers might help get chubbies off the sofa.

Explosive Bombchelle said...

Interesting article from Becca & Brian's backyard on some hidden costs heavier people are bringing to the health care system.

husband said...

From the article in the comment above:
"Good Sam also has spent $60,000 to convert eight rooms into bariatric suites, with larger dimensions to accommodate larger patients and reinforced toilets that can support heavier loads."

Tee hee hee... he said "loads"...

Anyway, on a more serious note, it is surprising/scary that hospitals need to retrofit for the frighteningly obese (morbidly just doesn't truly describe it). On the other hand, it would be nice to have waiting room chairs that were a bit wider. 16 inches? I'm about 15 pounds over weight and even at that weight there is no way I would fit into 16 inches of width. How about some love for the big and tall (yet not obese) man?!?!