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Spare Tire —

April 10, 2013

Armchair Activistm

Please sign our two Change.org petitions asking CVS Pharmacies and Michelin North America to stop discriminating against its fat employees.

First CVS, now Michelin:

Employees at the tire maker who have high blood pressure or certain size waistlines may have to pay as much as $1,000 more for health-care coverage starting next year… the company will reward only those workers who meet healthy standards for blood pressure, glucose, cholesterol, triglycerides and waist size — under 35 inches for women and 40 inches for men.

Et Tu Michelin Man

According to that Wall Street Journal article, the tire maker claims they have to penalize fat employees because of “rising health-care costs and poor results from voluntary wellness programs.” But we already know what is driving healthcare costs and it is not, by and large, the fatties.

But, okay, for the sake of the skeptics out there who think fatties are driving the costs of healthcare, let’s run with that assumption to simplify the argument. Even if finding and “treating” all the fat people is the solution to out-of-control healthcare costs, let’s look at the two ways we have for finding those fatties.

First is Body Mass Index (BMI), which is what CVS is using. Everyone knows that BMI sucks because it doesn’t distinguish between fat and muscle. It’s just a ratio of height to weight, so it winds up including a lot of people who don’t have a lot of body fat into the net. Studies that actually measure the correlation between BMI and body fat percentage find this metric lacking:

Commonly used BMI cutoffs to diagnose obesity showed a pooled sensitivity to detect high adiposity of 0.50 (95% confidence interval (CI): 0.43-0.57) and a pooled specificity of 0.9… Commonly used BMI cutoff values to diagnose obesity have high specificity, but low sensitivity to identify adiposity, as they fail to identify half of the people with excess [body fat percentage].

The key here is specificity and sensitivity. A high specificity means that BMI is fairly good at finding people who have a low BMI and low body fat. But a low sensitivity means that only half the time does a person with a high BMI also have high body fat. As a result, even if CVS thinks making fat employees thin is an effective way to control healthcare costs, using BMI to find the culprits is highly flawed.

Which brings us to waist circumference (WC), which gets floated as a viable alternative to BMI whenever BMI is criticized. Except researchers have found WC is just as flawed as BMI when it comes to filtering out the fatties.

BMI, WC, and WSR [waist stature ratio] all performed very similarly as indirect measures of body fat, and they were more closely related to each other than with percentage body fat. Percentage fat tended to be slightly but significantly more correlated with WC than with BMI among men, but significantly more correlated with BMI than with WC among women; the differences were slight…  As shown previously, and as would be expected from considerations of body composition, percentage fat does not increase linearly with body weight.

In other words, BMI, WC, and WSR produce similar correlations to body fat, and therefore WC is no more effective than BMI. The fact that CVS uses BMI and Michelin uses WC does not improve their chances of finding the deviant fatties and putting them on the path to thinness.

But the most damning testimony as to the futile nature of Michelin’s proposal comes from the man who originally proposed waist circumference as a risk factor for metabolic syndrome back in 1988. His name is Dr. Gerald Reaven, and they even named the cluster of symptoms associated with insulin resistance after him: Reaven’s Syndrome.

I wrote about Reaven’s 2005 change of heart, and how he believes that these risk factors have become a highly-flawed diagnostic checklist that is no longer useful in identifying those with insulin resistance, which is the underlying health problem that CVS and Michelin ultimately want to solve.

Reaven’s objection is simple and speaks straight to the heart of the problem with Michelin’s plan:

[A]lthough being overweight/obese increases the chances of an individual being significantly insulin resistant, by no means are all overweight/obese individuals insulin resistant, and, of greater clinical relevance, weight loss in overweight/obese individuals who are not insulin resistant does not lead to substantial clinical benefit. [emphasis mine]

Reaven also points out how BMI and WC are essentially identical:

At the simplest level, the values of the two variables were highly correlated in a recent analysis of data from ~20 000 participants in the National Health and Nutrition Survey (NHANES) from 1988–1994 and 1999–2000. More specifically, the r values were >0.9 in every subgroup analyzed and were essentially identical irrespective of differences in sex, age, or ethnicity.

You can read Reaven’s full objection in the journal Clinical Chemistry.

Michelin is stepping in and saying “All fat men and women need to lose weight or take a de facto pay cut of $1,000 per year,” except they’re dredging for fatties using a flawed metric and demanding a treatment that does not lead to “substantial clinical benefit” in those fat people who are not insulin resistant. Most importantly, though, is that even if they do get all their fat employees to go on diets, there is not one single weight loss method that shows the kind of long-term success rates that would pay off for Michelin in the long-term.

With zero evidence to back up their efforts, Michelin has launched one of the most intrusive and ineffectual employer wellness initiative ever developed, and this experiment in controlling healthcare costs is being conducted at the expense of their employees. Even worse, this is becoming the new normal for employers.

But even setting aside the flawed metrics and lack of solutions, this is out-and-out discrimination. They are singling out heavy employees for targeted health interventions, when similar health interventions aren’t forced upon their thin counterparts. I do not see any suggestion that Michelin will pressure health improvements from employees who smoke, drink, use drugs, practice unsafe sex, don’t get enough sleep or drive recklessly. And yet, all of these choices (if we’re assuming that being fat is a choice) contribute both to the poor health of employees and the cost of healthcare.

The reason Michelin will not go after other health choices is that if they did, Americans would overwhelming reject this as a gross invasion of privacy. Michelin and CVS are counting on the panic surrounding obesity to give them cover while they enact legal discrimination against fat employees

If Michelin is really, truly concerned about reigning in healthcare costs, then maybe they should do something about the gouging of our for-profit system by the device manufacturers and the pharmaceutical companies, rather than scapegoating fat people.

If you feel the same way, I encourage you to sign both the CVS Pharmacies and Michelin North America petitions, and to contact Michelin’s leadership team directly to let them know how you feel. If you need an idea of what to say, check out this letter I wrote to CVS management with a list of questions about their program. And as always, please spread the word about our petitions. THANK YOU!

Pete Selleck
President
Pete.Selleck@us.michelin.com

Wayne Culbertson
Chief Human Resources Officer and Executive Vice President of Personnel
Wayne.Culbertson@us.michelin.com

Rich Kornacki
Executive Vice President
Rich.Kornacki@us.michelin.com

Jean-Dominique Senard
Managing General Partner of Michelin Group
Jean-Dominique.Senard@us.michelin.com

Michael Ian Fanning
Vice President of Corporate Affairs
Michael.Ian.Fanning@us.michelin.com

Craig Hodges
Director of External Communications
O  864-458-4698
M  404-593-6049
Craig.Hodges@us.michelin.com

Lauren Davis
External Communications Coordinator
O  864-458-4692
M 864-350-7984
Lauren.Davis@us.michelin.com

Lynne Fowler
Director of Consumer Public Relations, Passenger Car & Light Truck
O  864-458-6365
M  864-561-9914
Lynne.Fowler@us.michelin.com

Tom Sullivan
Public Relations Manager, BFGoodrich
O  864-458-4321
M  704-222-5488
Tom.Sullivan@us.michelin.com

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17 Comments leave one →
  1. Duckie permalink
    April 10, 2013 12:53 pm

    WC is also discriminating against tall people. A 40 inch waist is way different on someone who is 5’0″ than someone who is 6’5″.

    It’s also quite a sexist policy, encouraging smaller, frailer females.

    Bottom line – Michelin can suck it. I’m never buying their product again.

  2. fatology101 permalink
    April 10, 2013 2:28 pm

    Did I understand this right? “If one is not insulin resistant..” Does that mean if you are insulin resistant and work for Michelin you get a pass? That is good, now let me say, it seems in my research that a good 90% of fat people are insulin resistant. Also, the other 10% have something causing them to gain weight. That is the whole point. Being fat is not a flaw, or a sin or whatever. It is a symptom of something going on in the body that is different than a naturally thin body. Makes me think of the prison test where they forced the men to eat 10,000 calories a day and they couldnt eat that much and they didnt gain enormous amounts of weight. How can we educate these people making the decision to penalize fat people for being fat????

    • Elizabeth permalink
      April 10, 2013 5:11 pm

      fatology, I always thought I understood insulin resistance (too much of triggering foods, too much insulin released, insulin receptors shut down), but when you say 90% of fat people are insulin-resistant, I become not sure. I thought about a third of fat people have absolutely normal numbers, including blood sugar numbers, and I’m one of those fat people who has trouble keeping her blood sugar up not down. Medicos try to link up hypoglycemia with hyperglycemia, but I trust Dr Broda Barnes far more, and in his book about hypothyroidism he said they are often NOT linked. Can you help me understand?

    • April 11, 2013 12:02 am

      … it seems in my research that a good 90% of fat people are insulin resistant.

      I haven’t read this research. Would you be willing and able to share it with us?

      Thanks!

    • April 11, 2013 9:56 am

      I haven’t seen any research that says 90% of fat people are insulin resistant. In fact, it’s awfully hard to actually diagnose anyone as insulin resistant because the best method we have for identifying it is a list of risk factors associated with insulin resistance. But as I wrote in my post on Gerald Reaven, the arbitrary nature of that checklist makes it a poor diagnostic tool at best. But one of the best indicators of insulin resistance is a fatty liver, though it’s difficult to measure that in an office setting, so they use the checklist instead. But in my interview with Dr. Sam Klein (and in his role on Weight of the Nation), he says that 30% of obese people have perfectly healthy livers and no signs of insulin resistance.

      As far as why people are fat, I think it’s largely an environmental issue that’s so complicated that there’s no one single contributor and, therefore, no silver bullet. Two examples: endocrine disruptors and gut bugs. There is a growing body of evidence that endocrine disruptors in certain chemicals we use in plastics are contributing to obesity, possibly through some kind of epigenetic switch. The influence gut bugs is another fascinating area where researchers have found that lacking a certain intestinal microbe, or having an abundance of others, can cause an increase in weight:

      What causes changes in gut microbiota? Many things, says Gewirtz, including the use of antibiotics, cleaner water and improved sanitation and hygiene in general, which influences the type and amount of microbes that reside in the intestines. In the current study, scientists found that in TLR5-deficient animals, the total percentage of 150 species of bacteria in the gut was three to four times higher than in normal mice, while 125 other types of bacteria were less common. “We don’t have a sense of which is more important yet — that some of those species are missing, or that some are in greater abundance,” he says.

      But again, I think these are just two contributors and they don’t, in and of themselves, explain the entire increase in obesity rates. I think the biggest contributor, by far, is the socioeconomic shift that has happened since the 1970s, coupled with food policies that made food cheaper for all Americans, including the poor. But whatever the cause, financially penalizing employees until they lose weight is not the solution, period.

      Peace,
      Shannon

      • Elizabeth permalink
        April 11, 2013 1:59 pm

        Shannon, I know that one thing that contributed to my weight — besides the dieting which definitely is a part of it — was my undiagnosed hypothyroidism. Dr Barnes estimated decades ago that 40 percent (if I remember correctly, my book is out on loan) of Americans were hypothyroid. It’s so common among northern peoples and is aggravated by neck injuries (which I had), pregnancy (which I had), etc. I had so little metabolism it is horrifying to remember as I couldn’t even read before I was treated (common symptom). My weight stabilized once I was on desiccated thyroid and I am so grateful. A century ago people were treated and now they are just ignored, as I was. Common symptoms: fatigue, depression, hair loss, dry skin, heavy menstrual flow, digestive problems, etc, etc.

        • April 12, 2013 9:54 am

          I’m hypothyroid too. I’ve experienced a lot of these symptoms you describe above. I take Armour thyroid.

          • Elizabeth permalink
            April 12, 2013 3:37 pm

            Hi, Cie, I’m currently taking Armour. I suspect I’m still undermedicated, but I’m grateful for what I’ve got. I don’t think I would be able to walk or function much at all if not for the nurse who suggested I might be hypothyroid. Horrible, horrible symptoms for years and totally ignored. I hope this was not your experience.

  3. violetyoshi permalink
    April 10, 2013 3:20 pm

    NOT AGAIN!

  4. Fab@54 permalink
    April 10, 2013 3:57 pm

    See, this is the kind of story that not only sets my blood boiling… but gives me an overall sense of doom and gloom as far as where this Everyone-But-Me-Be-Damned! country is going — to Hell in a hand-basket.
    So what are we really saying/seeing here? FAT people don’t deserve to have JOBS now?? Because, heaven forbid they cost some corporation an extra dollar or two in health coverage! Oh the HUMANITY!! I am so fucking pissed now……..

    • vesta44 permalink
      April 10, 2013 7:08 pm

      If an employer thinks fat people need to become thin in order to have a job/benefits, then that employer had better be prepared to pay for the employees’ diet plans and pay for them for life. And then not be surprised when the employer sees that all of those diet plans don’t work for permanent weight loss.
      And if those fat people don’t have jobs, then taxes are going to go up to provide welfare and Medicaid for all the unemployed fatties. Which is going to cost a fuck of a lot more than providing affordable health care for those fat people.

  5. violetyoshi permalink
    April 10, 2013 7:08 pm

    I wonder how long this will go on until people realize that weight discrimination is real, and no, the answer isn’t that fat people must become thin.

  6. April 11, 2013 9:03 am

    I’m not going to argue the logic behind these policies, because this isn’t a matter of logic. It’s employers thinking that if they claim they’re Cutting Costs, they have carte blanche to invade and control their employees’ lives. And why not? It’s been working for them so far (hands over urine sample).

  7. April 12, 2013 9:52 am

    Reblogged this on The Cheese Whines.

  8. Christine Mead permalink
    April 15, 2013 2:44 pm

    Funny enough I was just listening to a report on my local news radio that said that thin people are not necessarily more healthy. That some may be slim but their internal body fat and other issues may make them very unhealthy. Hmmm, I wonder how that would figure in with Michelin’s plan.

    • Elizabeth permalink
      April 15, 2013 4:45 pm

      Isn’t this the new ploy to designate even thin people as fat? They don’t say thin people are not necessarily more healthy because they don’t eat well and don’t exercise, it’s because even though they look thin, they’re really FAT.

  9. April 23, 2013 3:55 pm

    I’ll be watching Patient Privacy Rights (http://patientprivacyrights.org/) to see if there’s any sign of a class action or discrimination lawsuit. (Or, a chance to get involved IRL.)

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