How Does Ob*sity Cost the Workplace $73 Billion?

I read the headline “Ob*sity’s Hidden Job Costs –  73 Billion”. As someone with a background in research methods (and who is both ginormous and really productive) my first thought was “How did they come upon that number?”  I looked up a bunch of different articles online to make sure that they were all reporting the same basic thing, and they were.

So I went to the Journal of Occupational and Environmental Medicine and paid $20 for the article, which was titled “The Costs of Obesity in the Workplace.”

Allow me to attempt to elucidate, it won’t be easy because this study is kind of a cluster F&$#.  I’ll start with some basics, and include the longer more detailed nerdy explanation (that I love so much) at the end.

The study looked at three factors:  Medical Cost, Absenteeism (not showing up to work) and Presenteeism (being at work but being unproductive).  According to my spell check, presenteeism isn’t a word but we’re going to go with it for now.

According to the articles that I read online, the study was out of Duke University.  That’s true – the lead author is Eric Finkelstein, an associate professor at Duke-National University of Singapore.

Under “acknowledgments” it says “This study was supported by Allergan, Inc.”  It lists that as an acknowledgment, and that’s a problem for me because it should be listed as a conflict of interest. Why?

“Supported” here has the meaning of “funded by”.

Allergan is a pharmaceutical company.  They produce Botox, Latisse (it will grow your eyelashes and don’t worry, that eye discoloration is probably temporary) and…wait for it…the LapBand.  The item used to constrict your stomach as a weight loss surgery option.

Allergan is currently using this study from the good people of Duke Singapore to convince health insurance companies to encourage and pay for lap band surgery because it’s “cheaper than the loss productivity”.  Astonishingly [sarcasm meter is a 9 out of 10] according to this study, the cost of obesity per person was more than the cost of lap band procedures.  Let me muster up some shock…  Sorry – I’ve got nothing.

The study used two sources:

The 2006 Medical Expenditure Panel Survey where BMI data is self-reported, and the 2008 National Health and Wellness Survey which is a series of self-administered internet-based questions fielded by 63,000 members of an internet based consumer panel.  Every piece of information is self-reported and unverified. The $73 billion is an estimated projection based upon statistics that were created by doing computations with statistics and estimates, and statistics of other statistics. There are issues in the collection of data, the control of variables, the use of data (the study authors feel that the words “obesity” and “health problems” are scientifically interchangeable, that fat people’s health problems may be assumed to be caused by fatness, and utilizes BMI which has any number of problems as a statistic in and of itself which I talk about more here), and the conclusions that they drew.

The fact that news agencies reported this information as true without bringing up the limitations and issues is deplorable.  Studies are suggesting  that obese people already make less than their peers and are turned down for jobs based on prejudices about weight.  Now companies may think that they have scientific proof to back up their bias. How many of them are going to pay $20 to read and understand a complicated study?

As always, may I suggest that you DO NOT  need to believe everything that you are told is science, and DO NOT need to take this personally or allow it to affect how you feel about yourself, your health, or your productivity in any way.

Here come the details:

Medical Expenses

The calculation of this is statistically complicated because of the data.  To speak in the vernacular of the peasantry, the data sucks. Basically they used a two part estimate that created four categories of overweightness (hey, if they can make up words so can I) based on the self reported weight.  “Normal weight” were the omitted reference group    They controlled for race, household income, education, insurance coverage, marital status and smoking. They subtracted the average predicted medical expenditures for “ob*se” individuals in each category from the average predicted expenditures for those of “normal” weight.  Then they multiplied that estimated number times the number of people in each category and added them up and extrapolated based on the estimate of the total number of ob*se Americans.


First of all, notice the number of times that the words estimate, average, and predicted appear in that explanation.  If I had more free time I would be doing a word count to give you an exact percentage of the number of words that are used in this study that essentially mean “um, maybe…”, there are many.

They also didn’t control for any genetic health issues, or health issues that aren’t even correlated to weight. They didn’t control for, or even mention weight stigma, weight cycling, and healthcare inequalities, all of which studies show can have a profound influence on fat people’s health. They appear to have assumed that any medical problems that obese people had over and above what normal weight people had were due to fatness.  They appear to have assumed that normal weight people’s health issues weren’t related to the same things that cause weight problems in overweight and obese people.  That’s just embarrassingly bad science.

Absenteeism and Presenteeism
This is my “favorite” (and by “favorite” of course I mean most rage inducing.)  These were measured based on a question that asked people “During the last seven days, how many hours did you miss from work because of your health problems?” and “During the past seven days, how much did your health problems affect your productivity while you were working?”  Participants indicated their level of work impairment via a rating scale ranging from 0 to 10.  Each response was assumed to represent a percentage reduction in productive work.  Then they annualized and monetized the predictions using age and gender specific wage data from the bureau of labor and statistics.


Respondents weren’t talking about  how much work they missed or productivity they lost due to their weight, they were answering about their health problems.  What they can reasonably conclude here is that people with health problems have more absenteeism and presenteeism than do people without health problems.  The study’s authors are basically substituting “ob*sity” (and by that they actually mean high BMI)  for “health problems” .  You can do that I guess, but you probably shouldn’t do it while calling yourself a scientist and your freshman research methods teacher would fail you on the assignment.

Then, they computed statistics using statistics, and statistics of statistics. Dude. They used a 7 day sample to calculate a year’s worth of data.   Once again, they assumed that any absenteeism or presenteeism over and above what “normal weight” people had was due to fatness.  Except that “overweight” men reported less presenteeism than “normal” weight men.  That was not reported in any news outlet that I could find  EXCEPT the study itself and they  gloss over it.

If I had turned this work in for my very first  intro level freshman research methods class I would probably have failed the assignment and possibly been asked to leave the program because of specific incompetence and general stupidity.  You don’t have to feel bad about yourself or your productivity- you are fine.  Feel embarrassed for the scientists who put their name on this.  I hope that they are the laughing stock of Singapore.

22 thoughts on “How Does Ob*sity Cost the Workplace $73 Billion?

  1. Ragen, what is your degree in? I have my masters in clinical psych and my research methods professors would have smacked me about the head and shoulders if I presented these!

    Isn’t Duke University the one who has that live-in diet program also?

    Thanks for the lesson today! I love these!

    xo Susie

    1. I’m not Ragen, but I’m fairly sure you are correct that Duke is the one with the live-in diet program. That is if I’m remembering “A Fat Girl’s Guide to Life” correctly.

      1. Duke University in Durham NC has the diet programs.

        Duke-National University of Singapore is not the same place.

  2. You are awesome. Thank you for doing all this research. It’s lovely to have the information on how pathetic this reporting/research is, for when morons I know quote “known science!” on how fat is destroying the world economy.

    1. Thank you. “Known science” is such a misnomer and people seem so willing to just believe anything someone tells them is “science”.

  3. Companies that buy into this research can create self-fulfilling prophecies from their own attitudes.. A friend of mine has lost a quarter of his body weight through the Lap Band, and now that he’s skinny, suddenly he’s getting great performance reviews and overtures for promotions– for doing the same work the same way that he’s been doing it with no recognition (other than of being the fat guy) for years.

    1. Hi Tree,

      Unfortunately I think that’s all too familiar. Since the lapband only has a 20% chance of success that also means that he has an 80% chance of going back to being the fat guy who gets passed over. Shameful.

  4. Ragen you are simply and truly amazing. Thank you thank you for all your hard work and time and effort you put into finding the truth. This study is ridiculous and an embarrassment!


  5. Face, meet palm…oh and while you’re at it, head meet desk. Ugh! My hubster and I were talking about junk science like this. Heck, I even reminded him that I finally realized (thanks to you) that I am a human capable of reading studies myself and drawing conclusions on my own. If you ever want to see a prime example of “science gone bad” simply ask me about dark suckers sometime. One of my favorite HS science presentations ever!


  6. Wow, just wow. Crap science at it’s finest and most Americans are just going to bend over and take it. It’s attrocious what people are doing to “save the fatties.” WE DON’T NEED SAVING PEOPLE!!!!

      1. Thanks – glad that you liked it. And I agree, the fatties are fine, let’s have a campaign to save the people who are naive enough to believe this kind of reporting and weak science.

  7. Absolutely fantastic article, Ragen! It’s a must-share on my Facebook page! From the second I first saw a headline like that anywhere, I wondered how they had arrived at the quantitative estimates and what the level of uncertainty was. Now that I know that their data collection was solely from self-reporting survey respondents who were asked to give answers to highly-subjective questions with a low sensitivity in the possible range of responses, I feel that this research is not only laughable, not even shameful, but quite obviously shameless!

    Thank you for acquiring the actual article and helping to shine a light on a very shameful marketing ploy!

    1. Sorry I missed approving this for so long. Glad that you liked the blog! Just to be clear, it wasn’t that normal weight people were excluded, it was that they were used as the “control” group which means that they assumed that anything that happened to fat people beyond what the control group experiences was caused exclusively by their weight. It’s just horrible science.

  8. I’m a late-comer to this discussion, having only found this post today, but here goes, anyway.

    This study is scary, because the conclusions will get quoted all over the place without any basis in fact, kind of like the eight-glasses-of-water-a-day canard. We’ll never root it out of the common-wisdom domain.

    This is one of those articles which, I suspect, may have been actually ghost-written by publicists at Allergan and the Associate Professor (a kid, by definition, unless a not-very-competent older person) just signed off. I’ll probably get sued for that sentence, but there you go.

    Your description of the article reeks of the kind of thing the pharmaceutical companies have been sneaking into the literature on psychotropics. They use other people’s data–a review, not original research–cherry-pick studies, which even a decent lit reviewer would never do, cherry-pick the data from the cherry-picked studies, which is equally intellectually dishonest if not downright unethical, and line up somebody to sign off on it. (Although usually they can get somebody with more chops, from a U with more chops–think Nemeroff at Emory. In this case, I’ll bet they were hoping that everybody would assume this was a subsidiary campus of the real Duke.)

    Anyways, after it’s published, they buy a hundred-gazillion reprints for their sales people (often cute little ex-cheerleaders with little or no scientific training) to hand out. The PR people then add yet another layer of cherry-picking, by going through the article with a yellow hi-liter to call attention to the lines they want to be sure that the targeted M.D. sees. They buy busy docs and their staffs a nice lunch, and the too-busy-to-read (never mind check out the studies reviewed) docs see “Fat costs $” flash by in yellow on its way down the tables, and that’s it. Reps are trained to make their pitches based on their reading of the doc’s personality, and all the head-games going on at the lunch table further blunt any objective tendencies the docs might otherwise display. The docs now believe, and will teach all their patients, students, and staff (who will all then tell their families, co-workers, and friends) that fat is expensive: Factoids like this replicate in the dark much like mushrooms.

    There are hundreds, if not thousands, of these crap studies in circulation. I get depressed just thinking about it.

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