9 thoughts on “I don’t work in…”

  1. Hilarious about the bike brake!
    The Bama thing isn’t at all new; I’ve heard about rebates for doing thing like being of a healthy weight, going to a nutritionist, going to the gym… The bill actually does sound like it takes behavior into account, not just a blanket “how much do you weigh?”

  2. Mary Anne Mohanraj

    I think part of what bothers me about this is that while I’m relatively okay with giving people money to do ‘healthy’ things, I’m worried about charging them money if they don’t succeed in losing weight. Maybe they’re just two sides of the same coin, but they feel different to me on a gut level.

    Also, they’re doing things like giving the supposedly obese (and BMI is such a terrible measure for this kind of thing) free subscriptions to Weight Watchers, which is basically just organized calorie restriction — I’m dubious about the long-term health value of WW. It’s not the same as a free gym membership, or free nutrition counselling, for example, or a free supply of nicotine patches.

  3. “they feel different to me on a gut level”. I think it’s worth exploring that difference for yourself. Because from what I read, demonstrating healthy behavior is part of the equation for both sides of the coin.

    Neither you or I have ever been in that BMI of 35 range. For that matter, I can think of one person in my (500-member) overweight extended family has been there. And that person wouldn’t have been paying either because they were doing something about the situation.

    WW for the average (otherwise healthy, not a body builder) BMI 35 person is like handing a budgeting tool to someone in bankruptcy. It’s a sledgehammer for a complicated problem but it’s a tool to start with.

  4. Mary Anne Mohanraj

    Hm. Still thinking about it. Still bothers me. Here’s Shapely Prose’s take.

    Part of what bugs me is that you know this is going to disproportionately affect poor people who can’t afford the time to exercise, so aside from anything else, it’s classist — and by extension in this country, racist.

  5. Sigh…. I wrote out a comment yesterday, but my connection went out just as I was posting….

    I too have issues with this. First, practically speaking, I suspect that any cost savings the state manages to achieve will be eaten up by lawsuits brought by people who do have genetic predisposition to some of the factors mentioned as criteria. I think the money would be much better spent offering incentives, such as limited release time (say, 3 hours per week) to attend on-site personal training consulations, WW, exercise classes, etc.

    Second, I also see a difference between rewarding someone for “good” behavior and punishing them for “bad” behavior, especially as relates to such a nebulous area. There are so many factors that can go into weight gain, such as trouble at home, tangential health issues, etc. The state can’t possibly account for them all, and it’s wrong to punish people for things like that.

    I also note that the article does not mention any such insurance premium increase for smokers. Surely obesity is not a bigger health problem for their workforce at large than smoking? If they must “punish”, I’d much rather it be the smokers (although again, better to offer work release time for smoking cessation programs).

  6. I’ve noticed your concerns here and elsewhere about calorie restriction. I agree that exercise is better than “dieting” in the sense of severe caloric changes. But I’m not sure why you think any reduction in calories is bad. I’ve known many people on WW who said they like it because they don’t feel hungry. I agree that feeling constantly deprived would be discouraging and counterproductive, but I also think (as a broad generalization) that Americans in general have gotten this idea that they should be able to eat what they want, when they want, darn it! And since our restaurants and processed foods have gotten out of control with portion size, calories, and saturated fat, I think we do have a need and even responsibility to monitor our own caloric intake, if only to a slight degree.

  7. But, you’re still missing the point that the article doesn’t mention the smoker/non-smoker thing Because It Doesn’t Have To. That’s well-accepted. And that you’re quibbling about a difference that is, essentially, in your head. If they had phrased it as “everyone with a bmi under 35 or demonstrating working towards it gets a rebate” then you’d be okay with it, except it would be the exact same policy. And it would STILL disporportionately affect the poor.

    The question to me is – should the poor be any less accountable for poor eating habits? If you think they’re overweight because they can’t afford to eat well, then adding a $25/month surcharge just makes it worse. If you they’re overweight because they’re choosing cheap junk instead of cheap beans/rice, then it’s fine. I do think, also, that the extent of the charge itself matters. One of the things I HATE about Shapely Prose is the rant-ish-ness about it. You can tell when someone’s irrational when everything is black and white, when a $25/month charge is inflated to “we’re not insurable!”

  8. Mary Anne Mohanraj

    Amy, I do agree that it’s useful to pay attention to calories for a bit, to get a better sense of exactly what you’re eating. I’m glad I counted calories for a few months a few years ago — I definitely have a much better sense of what I’m eating now.

    But calorie restriction seems like a supposedly simple answer to a complex problem. One aspect that I don’t understand fully yet is how cutting back on calories can sometimes send the body into ‘starvation’ mode, such that fat isn’t burned at the rate you would expect. And then there’s the whole ‘set point’ thing. Plus the metabolism aspect. It just all seems like such a complex system, and restricting calories doesn’t necessarily seem to have the results you want — in fact, the results are often brief weight loss followed by more weight gain, such that people end up weighing more than they did before they started restricting calories. So I guess I would say that I am now very suspicious of pure calorie restriction diet plans.

    As for ‘not’ — I think you missed the bit where I was talking about exercise and the poor. I think one huge factor in weight is time to exercise, and if you’re working two jobs just to survive and support your family, there’s no time left for exercise. Or, conversely, if you can afford to hire a weekly personal trainer, you probably will be noticeably more effective at being fit than someone who can’t afford that.

    If you want to bring food into it, you can look at what’s affordable, especially in your neighborhood — if McDonald’s offers dinner for your family for $5, and the local grocery stores charges exorbitantly for fresh vegetables and good meat, you may end up making the fast food choice based simply on economics. Yes, you could eat beans and rice, but I could certainly imagine parents thinking that at least the McDonald’s food has meat, and imagining that would be better for their kids. And again, fast, which becomes important when you don’t have time to actually cook.

    So given that there’s a clear class-based bias already against the poor being able to exercise and eat well, anything that penalizes them further for them seems cruel. Whereas something that would make it actively easier for them to exercise and eat well — such as a cash bonus, or a free gym membership, etc., works to redress the issue.

    And when you’re living on $10,000 a year, and that’s supposed to cover everything, then yes, an extra $300 a year may well be more than you can afford, and may make you effectively uninsurable. I had several years when I lied to my university about my having health insurance, because I couldn’t afford the premiums. That’s not uncommon.

  9. I’m a little confused about whose remarks “not an attack” were addressing, and I’m assuming your (Mary Anne’s) paragraph starting “As for ‘not'” is responding to the “not an attack” entry…. Amazing how quickly online discussions can become confusing. Think how much easier this discussion would be in person!

    I do agree that economic factors do not get nearly enough attention in most discussions. Your fast food example is spot on. And people who work at McDonald’s, making minimum wage, get discounted or free food there — so that’s all they’re eating in some cases!

    Regarding calorie restriction, I do still think that people expectations (including American “instant gratification” syndrome) may be unfairly crippling the “system.” If for some people fat isn’t burned at the rate they expect (or want), that doesn’t necessarily mean fat isn’t being burned. It may mean that it will take that person longer to see effects. I suspect people give up when it doesn’t happen as fast as they would like — and I don’t want to judge them, because it’s really, really discouraging when you can’t see effects for a long time.

    Also, when the results are brief weight loss often followed by weight gain, that isn’t because of the calorie restriction itself, is it? I would have to imagine it’s because the person gave up on the calorie restriction. It’s not reducing calories that’s necessarily the problem, but rather many other emotional, social, and perhaps sometimes physical factors (like feeling fatigued, which leads to discouragement, which is in itself a reason not to overdo the restriction!). Hmm, I guess in a way we’re saying the same thing, because you’re saying it’s complicated, and I just agreed, didn’t I? 😉

    But I do think American expectations come into play again. If it’s not a “quick and easy”, then it’s not good, so I might as well not bother trying. If statistics show that a lot of people don’t keep the weight off, it must be that it doesn’t work! — even though it may actually be because the people themsleves stopped following the plan.

    Again, I definitely do recognize that calorie restriction isn’t the end-all, be-all answer. I think WW recognizes that too — I don’t know firsthand, but surely they strongly recommend some exercise as well? I’m also in favor of some of the thought behind “healthy at any size,” but it’s a bit misleading — it’s really “somewhat healthier at any size,” because at some sizes, a person will not be healthy even if they’re walking an hour a day. They’re improving things, but a morbidly obese person will not be “healthy” because he/she will have enornmous strain on some systems.

    No easy answers, are there?

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