Tuesday, July 9, 2013

I am what I am

Popeye was famous for saying "I am what I am." We now struggle with what we are, as a nation we are becoming more obese, more lethargic, and yet more concerned about our diet and health. 

I remember years ago getting my first FWCI Reference Manual at the annual Florida "Comp Convention" (now known as the Workers' Compensation Education Conference, but still "comp camp" to many). I was tasked as a young lawyer with pursuing claims against the Special Disability Trust Fund (SDTF). Long story short, that led me to read the Table of Average Weight of Americans. You see, the law (Fla. Stat. 440.49) says that if someone was "obese," then that obesity condition might be a foundation for an SDTF claim. 

The statute says that if "the employee is 30% or more over the average" in the published table, then they are "obese" by this statutory standard. You can imagine my chagrin when I did the math back then and learned that I was "obese" under this standard. You may also share my joy when I tell you I just calculated it again and find that I am no longer obese (I haven't really improved on the weight issue, but the tables are adjusted for age and so my "average" from the tables has increased in the last 20 years).

Obesity has been in the news lately. In the 1960s about 43% of Americans were "overweight." That has increased to about 54% in the 1990s, according to the National  Bureau of Economic Research. According to a 2003 article, obesity rates in 2003 were about "two times higher" than the 14% figure found in "the early 1970s."  The authors noted in 2003 that "Americans are fatter than medical science recommends, and weights are still increasing." There has been some finger pointing, see my blog on super sized sodas. And there has been much prognosticating about the cause of the obesity trend. 

The 2003 article blames "technological innovations" that have made calorie consumption more convenient. You be the judge. But, according to the latest news, the trend seems to continue, with 35.6% of Americans projected to be overweight or obese in 2013. Another article cites a Duke University study estimating that 42% of us will be obese by 2030. Unlike my handy weight table, the definition now has to do with "body mass index, a ratio of weight to height." I could probably calculate my BMI, but having learned from my reference to the tables that I am no longer "obese," I will refrain from doing math that might contradict that!

Why is this relevant? A couple of interesting articles from the American Medical Association (AMA) convention last month. The American Medical Association Council on Science and Public Health concluded last month that obesity is not a "disease." Their conclusion is that "without a single, clear, authoritative, and widely accepted definition of disease, it is difficult to determine conclusively whether or not obesity is a medical disease state." 

The next day, however, the AMA House of Delegates rejected the Council conclusion and designated obesity "a disease and not simply a condition."  One member explained in a Medpagetoday article "we think that's going to send a message not only to the public but to the physician community that we really need to make it a priority and put it in our cross hairs." The article explains that 60% of the AMA House agreed to the designation, which suggests there is a significant minority with a different view. One dissenter questioned "why should a third of Americans be diagnosed with a disease if they're not necessarily sick?"

The point for workers' compensation is debatable. The Duke study prognosticates that "obesity increases the healing times of fractures, strains and sprains, and complicates surgery." There are some who predict that employer responsibility for treating obesity will be increased by the AMA designation of "disease." There is also discussion of new requirements for reporting such condition, now that it is a "disease." That perspective is here. I find it interesting to consider these perspectives. I am certain that in coming months we will all hear more about obesity, and its new "disease" designation.

The larger issue is probably that we could all use a little more exercise and a little less calorie consumption. I am going to walk down to the corner and get a sandwich (I am not technically obese right now, as far as I know, relying for now on my admittedly outdated tables). After all, "I am what I am."

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