Seeing only fat

No doubt, you’ve heard the news claiming a study has found “Fat workers cost employers more,” that “Fat staff eat into profits,” and that “Obese employees weigh heavily on bottom line.” These headlines have made their way around the world with lightning speed.

Yet it is unimaginable that they are talking about the same study I read, because its findings actually support dramatically different conclusions.

According to the press release, more conservatively titled, “Obesity may be associated with disability in workers, elderly:”

Obese individuals appear more likely to file workers’ compensation claims for injuries on the job, according to a report in the April 23 issue of Archives of Internal Medicine...Truls Østbye, M.D., Ph.D., and colleagues at Duke University Medical Center, Durham, N.C., studied 11,728 health care and university employees who completed at least one health risk assessment questionnaire — available yearly to all employees eligible for health benefits—between 1997 and 2004. The assessment included a measure of height and weight....

Over an average of three years of follow-up, workers with higher BMIs tended to have more workers’ compensation claims—those in the group with the highest BMI (40 or greater) had twice the rate of claims as those at the recommended weight...."The number of lost workdays was almost 13 times higher, medical claims costs were seven times higher and indemnity claims costs were 11 times higher among the heaviest employees compared with those of recommended weight."... The types of injuries most strongly related to BMI were sprain or strain, contusion or bruise, and pain or inflammation. [We’ll talk about the second study mentioned in this press release next.]

“Maintaining healthy weight not only is important to workers but should also be a high priority for their employers given the strong effect of BMI on workers’ injuries," the authors conclude.

The press release provided immediate fodder for various obesity interests, especially advocates for employer wellness programs. MedPage Today offered continuing education credit to doctors for reading their review, which gave two Action Points for medical professionals:

Action Points

· Advise patients that this study further supports the link between obesity and a variety of health risks.

· Encourage patients to take advantage of work-based wellness programs that emphasize physical activity and a healthy diet.

The bottom of the Associated Press story (cut from many newspapers) included a cautionary note to employers not to overreact with discriminatory policies. New York employment attorney Richard Corenthal said: “Employers need to be careful not to view this study as a green light to treat obese or overweight workers differently.” But if employers never learn what this study actually found, it’s hard to imagine them not coming to any conclusion other than the one being shouted in the headlines — that fat people are jeopardizing their companies!

If the public and employers saw the extent that the data had been misinterpreted, what would most concern them wouldn’t be fat people, but that any objective source would have concluded it was primarily an issue about fat at all.

The researchers did not look at all Duke University and Duke University Health System employees, they considered data gathered on only 15.8%, a very different and select group: those employees who had been convinced to complete one of those online Health Risk Assessments as part of an employee "wellness" program and to give their employer and insurer (Blue Cross Blue Shield of North Carolina) personal information about themselves, their lifestyle habits, and medical histories. It wasn’t the professionals, executives, professors or doctors who participated in this electronic database. The employees in this study were mostly lower paid, nonprofessional workers — maintenance workers, medical supply assembly workers, laundry staff, technicians, housekeepers, etc. — and nurses. These workers were also more likely to work longer hours and be older, minority and longer-term employees.

Looking at the actual Worker’s Compensation Claims reported between 1997 and 2004, overall, while these workers filed slightly more claims per hour worked, they actually had lower rates of lost workdays and lower medical claims costs and indemnity claims costs than the general population of employees in the company. Their lost work days per 100 full-time hours worked were 30% lower, the medical claim costs 5% lower, and indemnity claim costs were 18% lower.

The details of the claims and costs in this study group also reveal that on-the-job injuries were notably higher among minority workers, those with less experience, and men (even though women made up 2/3 of this cohort); but most key, among workers doing more intensive manual labor: maintenance workers, laundry staff, medical equipment/supply assembly, undescribed positions listed as “high-risk,” nurses aids and nurses.

In fact, the researchers specifically noted in their results:

Large differences in claims rates were observed by occupational group. Jobs in the low-risk referent group included faculty, house staff and scientific and administrative personnel. Much higher rates of claims were observed for physically demanding jobs involving lifting or other ergonomic stress.

And who were the employees doing most of this hard, physical work? The heavier employees.

“Employees in several of the high-risk occupations were heavier than average, emphasizing caution in the interpretation of the bivariate relationships,” wrote the authors.

Even after their statistical analysis looking for correlations, occupation proved to be associated with significantly higher risks than weight (or any other correlation, such as minority status). The highest relative risks for claims were among laboratory animal technicians — 17 times greater — followed by medical equipment/supply assembly workers, at more than 9 times higher risks. Laundry staff, housekeepers, and maintenance workers had the next highest risks for injury claims.

The relative risks associated with weight were considerably less, by comparison. The relative risks associated with Workman’s Comp claims were a mere 9% higher among “overweight” employees, 21% higher among obese with BMIs 30-35; and 33% higher among those with BMIs up to 40. The risk ratios among the very highest BMIs, which made up a very small portion of employees (4.9%), were still only 45% higher. For statistically derived relative risks, these small numbers could just as easily been due to error, chance, or other factors not included in their computer model.

As the researchers noted, there could be potential underlying factors they didn’t consider that could explain why heavier workers in this cohort might be more likely to file claims. No doubt already obvious to readers, is the fact that the heavier workers were clearly in the lower-paying jobs and more apt to need to take advantage of these benefits since they would have fewer financial resources to weather the lost pay and medical costs on their own. And, given they were in more physically-demanding positions, they would miss more work days after an injury than say, an employee with an office job.

The highest medical and indemnity claims costs and lost workdays also reflected the severest injuries and were among nurses aids, doing the bulk of patient lifting (about 27 times higher risk ratios for lost workdays, for example); medical equipment assembly and maintenance workers (about 22-20 times higher risk ratios for lost workdays); and inpatient nurses (15 times higher risks). And risk ratios seen among indemnity claims costs, for example, were about 12 times higher among laundry workers, nurses and maintenance workers. Obviously, risks associated with types of job performed are considerably higher than anything the researchers could pin on being related to weight.

If employers were told what the study actually found, would any unbiased, critically-thinking person actually conclude that employees’ fat is what’s costing them money or simply that some types of jobs are riskier than others? Would anyone actually believe that this study offered proof that heavier workers performing some of the most physically demanding jobs weren’t active enough and that making them lose weight should be a company priority? Not likely.

Yet, these researchers and the media seem to think so or want us to believe that.

What possible public service did these headlining stories actually serve but to heighten perceptions of the horror of obesity and discrimination against fat people, and deter employers from hiring fat employees?

Addendum: If employers uncritically accept these reports, we can probably expect more stories of discrimination like the recent one reporting: “If you’re fat, you most probably won’t get that job” or the one about the prejudicial statements made by a BBC reality television star: “I wouldn’t like to hire fat people.”

© 2007 Sandy Szwarc