Does Fatness Really Cost the Workplace $73 Billion a Year? A Weight Loss Company Wants You To Think So

Studying the Studies

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I first learned about one of the most egregious examples of the diet industry’s involvement in weight science when I saw a headline that read “Ob*sity’s* Hidden Job Costs – 73 Billion.” My anti-fatphobia side immediately realized that any time you are calculating the “cost” of a group of people you are headed down a bad road. The research nerd in me immediately thought “That’s a really difficult number to get - what was the study design here?”

I looked up a bunch of different articles online to make sure that they were all reporting the same basic thing, and they were. I finally found the original paper in The Journal of Occupational and Environmental Medicine and paid $20 for the article, which was titled “The Costs of Ob*sity in the Workplace.” I wrote about the article when it first came out in 2010, but I just saw this number used in a current article, so we’re going to talk about it again on this newsletter today!

To use a technical term, this study is a hot garbage mess, which can make it a bit complicated to explain. I’ll start with some basics, and include the longer more detailed nerdy explanation (that I love so much) below.

The Basics

The study looked at three factors: Medical Cost, Absenteeism (not showing up to work,) and Presenteeism (being at work but being “unproductive”).

Under “acknowledgments” it says “This study was supported by Allergan, Inc.” Again, that appears in the “acknowledgment” section, so let me make sure to clarify that “supported” here has the meaning of “funded by”.

Allergan is a pharmaceutical company (it’s an American company that is domiciled in Ireland to avoid taxes.) They produce Botox, Latisse (it will grow your eyelashes and don’t worry, that eye discoloration might not be permanent) and…wait for it…the LapBand. The item used to constrict your stomach in a dangerous procedure meant to force behaviors that mimic eating disorder behaviors that Allergan themselves has called a “major surgery.”

Allergan used the “results” of this study to try to convince health insurance companies to pay for lap band surgery for employees with the rationale that this study shows that the surgeries are cheaper than the loss of productivity. Astonishingly [sarcasm meter is a 10 out of 10] according to this study, the “cost” of each fat worker’s “lack of productivity” was more than the cost of giving them lap bands. Honestly, considering that this is coming from a company that once ran a contest where you could literally win a lap band surgery (and give it away to someone else) I’m having some trouble mustering up any shock, but that doesn’t make this study any less terrible.

The study used two sources, the 2006 Medical Expenditure Panel Survey, 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 (for example, the study authors seem to believe that the concepts of “ob*sity” and “health problems” are scientifically interchangeable, that fat people’s health problems can be assumed to be caused by fatness, and utilizes BMI which has any number of problems as a statistic in and of itself, including a racist basis,) and finally in the least surprise ending ever, there are issues with the conclusions that they drew.

The fact that news outlets reported this information as factual without bringing up the limitations and issues is deplorable. Research shows that fat people are already hired, paid, and promoted less than their thin peers, so we didn’t really need Allergan to try to convince current and potential employers 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? (Not to mention that we are getting into issues around the capitalist idea of “productivity” being morality, which is deeply problematic in ways that often reinforce and perpetuate existing marginalizations, which is beyond the scope of this article.)

Here come the details:

Medical Expense Calculation

The calculation of this is statistically complicated because of the data which is to say that, using more technical jargon, the data sucks. Basically they used a two-part estimate that created four categories of fatness based on self-reported weight. “Normal weight” people were used as the 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 failed to control for (or even discuss) weight stigma, weight cycling, or 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 fat people had over and above what normal weight people had were due to fatness. They appear to have assumed that, even if “normal weight” people and higher weight people had the exact same health issues, fat people’s health issues were due to their size, and thin people’s (exact same health issues) were due to…something else? That’s just embarrassingly bad science. I want to say that you learn that on the first day of research methods class, but I feel like even if you had to miss that day, they would still expect you to know better than this.

Absenteeism and Presenteeism

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 the study authors 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. (It’s also not clear to me that participants were given any instruction as to what 1-10 meant, which means that people could have been using the scale in wildly different manners.) The study’s authors are basically substituting “body size” 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. 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 “overw*ight” men reported less presenteeism than “normal” weight men. That was not reported in any news outlet that I could find. It was included in the study itself, but they glossed right over it.

Look, 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 lack of understanding of the most basic principles. It’s so bad that it makes me think that they tried a bunch of different study designs before they hit on the design that gave them the number they wanted.

You don’t have to feel bad about yourself or your productivity- you are fine. Feel embarrassed for the authors who put their name on this for the sake of helping Allergan profit from weight stigma, healthism, and a dangerous surgery. And let this be a cautionary tale about believing the headlines (or even the study conclusions) that you read around weight and health.

Before I go today, I want to make sure to bring your attention to the labor being done by Marquisele Mercedes around an interaction with Lindo Bacon specifically and, in general, thin and white allies weaponizing their privilege against fat people (including and especially BIPOC fat people) in Health At Every Size, Fat Studies, and Fat Activism work and communities. You can find her post (and support her!) on her Patreon here.

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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.