Embarrassingly Bad Science

Today’s blog is a re-post of a blog that I did about a year ago with some slight edits.  I wanted to repost it because I discussed it at my talk at Google today (see how I worked in that I gave a talk at Google today…) and I really think that it’s very representative of a huge problem that we have getting true information about our health and I have a bunch of new readers since a year ago so I wanted to give it a little more attention:

I read the headline “Obesity’s Hidden Job Costs –  73 Billion”.  I’m ginormous and as or more productive than anyone I know so  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? [Edit:  Since this was published friend of mine in HR have sent me e-mails from their bosses linking to an article about the study and asking “is it legal to just not hire fat people?”]

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 obese 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 obese 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 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.  These were measured based on two questions 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 took a week’s data and extrapolated it to a year, multiplied it by the estimated number of obese working people, and then  monetized the predictions using 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 “obesity” (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.

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 – you are fine.  Feel embarrassed for the scientists who put their name on this.  I hope that they are the laughing stock of Singapore.

27 thoughts on “Embarrassingly Bad Science

  1. I guess I am part of the problem then – I have missed 3 days of work this week with “health problems”. Who knew influenza was a result of my weight?!

  2. And my Meniere’s disease! It must be because my inner ear is fat! Why have I not figured this out yet?

    Thanks for breaking that down. It makes sense, it’s easy to understand. $20 well spent.

  3. I am considered obese by BMI standards. I miss a lot less work than most of the other women I work with. I say women because I am an elementary teacher and the staff is 90% female. I can’t remember the last time I missed school because I was sick. I have taken days off as family leave days to care for sick children. I miss a lot less work, stay a lot later at work, and feel I am as productive if not more than a lot of other staff.

    Thanks for sharing.
    new follower* first time commenter

  4. I keep missing work due to migraines! If I’d known being fat gave them to me, I’d be thin!

    Oh wait…my skinny mom gets them worse than I do…


  5. Please submit this as an article to organizations like the Society of Human Resource Management etc. And it would be great if you could get it into a major news outlet. Why not send it out? Perhaps Salon or Huffington Post, or Jezebel….I bet a lot of HR and hiring managers read those. (but not on company time, that would be presenteeism LOL)

  6. So ridiculous. I took a half sick day this year because someone slammed into my car whist at lunch. I guess they did it because me and my car are so fat that they couldn’t NOT hit me. And I went to the ER once because I had an allergic reaction to something. So I guess I have allergies (which I’ve had since birth) because when I was born a 7-pound baby that was too fat. Oy. Really, really sad.

  7. Such flawed data is just another “reason” for employers to deny larger people employment. It stems from the same mind set that allowed Jim Crow that laws that included imposslbe-to-pass literacy tests for blacks before they could enter a polling place to vote.

    Unfortunatly, by viewing larger people as “financially unfit” emplyees, we are on the way to sanctioned reasons to make large people an even more disenfranchised second-class citizenry than we already are. Many larger workers are already having problems finding work, are under employed, or denied promotions simply based on size. By having another “reason” for not employing or promoting ffat people we only get even poorer fat people.

    To continue on with the Jim Crow analogy, the trend to charge more for health insurace for people who do not engage in “healthier” behaviors, such as lowering their BMI, seems akin to the old poll taxes to me.

  8. “They used a 7 day sample to calculate a year’s worth of data.”

    Really? REALLY? I got a D in statistics in college and even I know that’s BS. Though maybe I got a D in stats because I’m fat and therefore was “presentee” all class. Did I use that word right?

    1. There is no way to correctly use a non-word. If you didn’t have all that fat clogging your brain, you would know that. Where’s the sarcasm symbol on this keyboard?

  9. They completely overlook other factors that cause lack of productivity at work, too. Lots of smokers take several extra breaks a day that non-smokers do not take. And Muslims pray five times a day (early morning, around noon, around 2:30, around sunset, and again around 7pm. So it is likely that at least two extra breaks are taken during working shifts by Muslims. So fatness also causes you to smoke and convert to Islam. Who knew?

  10. What I’ve read here does not surprise me one bit. I’ve worked in health care my whole career and I know that pharmaceutical companies pay scientists heaps of money to do these studies…if only the results paint that company in a good light. This is why there are so many conflicting “studies”…e.g., one study says coffee is good for your health, one says it will kill you, one study says a vegetarian diet is the best, another says it will give you cancer…ad nauseam, till we don’t know what to believe. It’s disgusting and one of the reasons these pharmaceutical companies need to be regulated.

  11. I am SOO glad you mentioned this article and have been waiting for the day you would.

    My hubby is a Duke Alum and gets the Alumni Magazine which I read every month because it’s a rollicking good ride, runs the gambit from “Well, that’s actually a very good point” to “Are you @*&$ing serious?? GET THE HELL OVER YOURSELVES!!” because there’s very much an attitude of “We are Duke. We are genetically superior to you.”

    When I read that same article, I was as outraged as you were. I don’t have the mathiness that you do–in fact, I’m hamstrung by dyscalculia–but even I could see the data and the conclusions drawn were based on a very shaky framework, namely, the BMI.

    So I did a little research into the history of the BMI. If you haven’t looked at its backstory, go read it on Wiki. It will stun you how this indication of health, which is based on pretty much a trial-and-error approach, has become the gold standard for health…and insurance coverage.

    I’ve kept a blog for a good 10 years now. A group of us took part in WTF Fridays for a while where we tackled inane ideas like this. Here’s the entry I wrote for that same article (and if this violates a rule you have about linking other blogs, I apologise…and feel free to remove it):



  12. So… I got thyroid cancer two years ago because my BMI’s over 25? I better go tell my doctor so he can warn others.

    I’m higher maintenance health-wise than the average bear, but not a single thing I’m dealing with is even remotely connected to body weight.

  13. Duke University, huh? As in “We burn babies” Duke University? As in “We killed a pre-teen illegal alien by transplanting the wrong blood-type heart and lungs into her after she was moved to the top of the transplant list because she was a Clinton pet project” Duke University? THAT Duke University? Yeah… “Credible” is NOT their middle name…

  14. I go to the doctor lots because I have regular problems with low iron. I guess that must be related to my size! But I’ve also had 0 sick days in the past 2 1/2 years. Hmmm.

  15. Hmm, when I read your blog above I assumed that Duke-National U of Singapore had nothing to do with Duke University here in the US. However, on doing a little research, I found this:

    “Duke and the National University of Singapore signed a formal agreement in April 2005 under which the two institutions would partner to establish a new medical school in Singapore.

    The school’s curriculum is patterned after that of the Duke University School of Medicine. The school is part of the National University of Singapore system, but unique in that it is overseen by a Governing Board, including a Duke representative who has veto power over any academic decision made by the Board.”

    So, it seems like there is some connection, but not much. (Mostly the name & 1 person on the governing board with veto power?) Doesn’t seem like much to me, and it certainly doesn’t seem like enough to warrant crediting the research to “Duke University”. Not to mention, wasn’t there *any* peer review for this study? Regardless of where it was done?

    1. I saw that this morning, and for some reason I read the comments section. Maybe I thought that NPR commenters would be smarter than your average CNN commenter. Nope. Same dumb crap in the comments section. *sigh* They’re all worried about the fatties, I’m worried about the dummies.

      I thought NPR was better than that. They usually have very compelling science articles (I’m very interested in the creation vs. evolution debate), and this is really disappointing.

      1. I did not comment. I don’t even bother. Sometimes I feel that I should to spread the HAES message, but most of them are so stupid that it’s not worth it.

        I’d rather see a series like, “Education in America”, about the declining state of our public school system, or “Science in America”, about how no one really gives a damn about science any more, or sees the value in a space program, etc. Again, *sigh* “Obesity is America” is such an easy cop-out because they can just take worthless, sensational sound bites from the AP without having to do any REAL research. And I don’t imagine that they have any opposing views.

  16. The Journal of Occupational and Environmental Medicine claims that its articles are peer-reviewed. Seriously? This sack of cat crap (much fouler than bullcrap) got through the peer-review process without being torn to shreds? One of my professors has been working on an article for more than a year now, primarily because the reviewers keep sending it back to the authors for edits. He says that this is normal for a peer-reviewed article and you’d better have all your ducks in a row or you will be shot down by your usually anonymous reviewers.

    Maybe there’s a reason why I can’t find this journal in any of my university’s research databases… now I’m wondering if Allergan owns the journal outright, or if they’re just bribing the editors to assign peer reviewers who are also on their payroll.

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