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Know Your Rights: Obesity, Disease, Employment Discrimination

Laurie and Debbie say:

In the last month or so, the AMA, acting against its own science council’s advice, has declared obesity to be a “disease.

Vik Khanna is an “independent health consultant with extensive experience in managed care and wellness.Looking at the first of his two-part series on obesity and the AMA, it is clear that he is no fat activist, and not much of a believer in HAES:

This decision’s willful disregard of salient facts is staggering: first, most obesity is not the result of a disease process or a frank genetic defect, it’s the result of algebra. We eat more and move less than our ancestors, even of just four generations ago. Second, a surprising number of obese people are still quite healthy. Third, the ones who work hard enough to improve their fitness level will do more for their survival than those who remain unfit, regardless of BMI. Fourth, telling everyone who’s obese that they are sick is a cruel canard that encourages dependency on the professions in such a way that must make Ivan Illich roll over in his grave.

So, here’s the challenge for the AMA. Since you’ve now told the culture to show you the (obesity-related) money, here’s what we taxpayers and funders of your enterprise want: win the war on obesity using a very clear metric…restore the status quo ante…the distribution of BMI in American adults in 1980. And, while you’re at it…fix the industry’s obsession with overdiagnosis and overtreatment because there’s no money to be made in the obverse. Finally, measure both fitness and health-related quality of life in all these “sick” people so we can see how much they really benefit from your efforts. Still think that medicalizing a lifestyle problem was the best step toward long-term success? Fat chance.

So far, this is centrist common sense, and we wish doctors would listen. The second part of his post, however, is even more important. In this post, Khanna is talking about how the disease label can be used in employment discrimination. He doesn’t address the ongoing issue of people not being hired because they are fat, including the relatively new version of that where fat people are seen as more expensive employees. (Of course, to the extent that this is true at all, the medical/social perception that fat people are unhealthy is the reason fat employees can be more expensive.) Instead, he is focusing on mandatory wellness programs, which gain significant teeth from this decision. And he’s giving us a roadmap for how to face these programs in our various workplaces. As Khanna says, these “wellness programs … often hinge [on] vastly overblown claims of being able to help the obese who they almost universally label as ‘high risk’ people.”

Well, what if people who are obese, who are no doubt tired of being condescended to, first by wellness companies, and now by the AMA, decide that they are going to seek medical approval to opt out of wellness programs?  A study recently published in the journal Translational Behavioral Medicine reports on a highly coercive, electronically monitored walking program for obese people: 17% opted not to participate and another 5% actually got their physician’s approval to opt out.  The physician approval to opt out is key to any resistance strategy.

Under the final wellness rules issued by the federal government earlier this year, physician certification that it is medically unadvisable for an employee to participate in a wellness program creates a burden for the employer and wellness vendor.  They must provide reasonable alternatives that do not disadvantage the employee in terms of either time or cost and that address the physician’s concerns. … The coup de grace is that “adverse benefit determinations based on whether a participant or beneficiary is entitled to a reasonable alternative standard for a reward under a wellness program are considered to involve medical judgment and therefore are eligible for Federal external review.”

As many fat people know, it isn’t usually going to be easy to convince your doctor that such a program is bad for you, but it will probably be easier than convincing your employer, if your employer is the type of place that goes for these horrible programs. (Electronically monitored walking programs can kiss my ass!)

Khanna goes on to state his opinion of current medical thinking on fat in no uncertain terms, and we intend to quote this forever:

Targeting people based on body mass index (BMI) is an intellectually, morally, scientifically, and mathematically bankrupt approach.

Finally, his clear conclusion is not only an argument against the disease model of obesity, it’s a brilliant argument against the childhood obesity panic. We’d like everyone in the country–every teacher, every doctor, every employer, every parent–to post it on the wall and read it every day.

Above all else, tell your people (obese or not) that your wellness goal is not to insult them, diminish them, or make them feel sick when they aren’t.  Wellness, by any reasonable definition, should give people tools that empower them.  How much they are willing to do is ultimately up to them.


One Response to “Know Your Rights: Obesity, Disease, Employment Discrimination”

  1. Jesse the K Says:

    Outstanding summary, thank you.

    Khanna almost went here, but I have no hesitation:

    If obesity is defined as illness, then obesity becomes a disability. Especially if employers don’t hire, or don’t promote, or most particularly don’t accomodate fat people, it’s actionable under Title II of the ADA.

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