The Fat Tax at Work

The title of this piece is a two-fer, because it refers to the condition of someone who is inconveniently overweight in the job market and the workplace, but also it describes how obesity stays on the job every minute of every day, always doing its best to cheat a person of the full enjoyment of life in all its aspects.

Evidence that this is a widespread problem is provided in an essay, “The Real Cost of Being Fat.” Author Christian Curet begins with some thoughts about time and how a person tends to become careless, and to underestimate its worth. It does seem that in life, the specifics are negotiable. A person might put the highest value on work, or on personal relationships, or both, and that is a matter of individual preference. The point to keep in mind, however, is that wasted time is something we will never get back. Also, we will regret (sometimes bitterly) its loss.

As a prime example of a time-waster, the author offers, perhaps surprisingly, “excessive leisure,” an intriguing idea that stirs curiosity but is not discussed further in this essay.

Back to business

Meanwhile, he describes how much of his time is wasted by an activity which, while stationary and maybe even relaxing, could by no means be described as leisure. That is sitting in an outpatient clinic with a needle in his arm, receiving infusions to treat Crohn’s disease and ankylosing spondylitis.

To that information, he adds, “Because I’m about 100 lbs overweight, I have to sit in this chair for an extra hour every time because the volume of medicine is based on weight.” A repetitious weekly chore is organizing all the medications for the following seven days. In confessional mode, he writes:

I have to take time each day to deal with my CPAP machine for my sleep apnea. I have to take time to measure my blood sugar because I’m a Type 2 diabetic. I have multiple doctor appointments for these conditions too. You add all that up and I’m losing hours of my life a month because I didn’t take time to take care of myself before.

The great majority of this patient’s health problems are routinely associated with obesity. He admits, as many of us will if we are honest, that in our younger years, we were in fact quite careless, taking on board a plethora of inappropriate foods, and too much of them, as well as ignoring the necessity for frequent and meaningful exercise.

But wait, there’s more

Medical care is not the only cause of monetary outflow. Clothing is a major expense, and a sensitive issue. (See “Fatsploitation is Alive and Well.“) And food? Eating well is more expensive. Only junk food is cheap.

Now, here is an aspect of carrying too much weight that never occurs to most healthy-weight people. With 100 or more extra pounds of body weight, even the most motivated customer can find that the equipment for many health-inducing activities is forbiddingly expensive. A person who wants to get some exercise could be forever discouraged by the price difference between two different kayaks, one of them extra-large.

To finish up, this very fortunate writer credits his wife and kids in a lovely tribute:

I’ve found that if I ask, my family will do most of these things with me. They’ll cook healthy foods with me, join me in exercising (if it’s fun) and will slow down and climb the steep trails with me. I just have to be humble enough to ask and not see it as a burden for them, but as an opportunity. For all of us.

Your responses and feedback are welcome!

Source: “The Real Cost of Being Fat,” Medium.com, 08/21/20
Image by CDD20/Pixabay

Pediatric Obesity Management: Insights From the AAP 2025 Conference

Managing pediatric obesity requires more than just prescribing medication. Experts at the American Academy of Pediatrics (AAP) 2025 National Conference and Exhibition emphasized that successful treatment demands a whole-child approach, such as addressing not only physical health, but also psychological and social factors that shape a child’s well-being.

Key takeaways

• A whole-child approach is essential, considering physical, psychological and social health.
• Medication choice depends on patient preference, comorbidities, contraindications, and insurance coverage.
• Open communication, stigma awareness, and family engagement are critical for long-term treatment success.

Establishing criteria for pharmacologic therapy

According to Ihuoma Eneli, MD, MS, professor of pediatrics at the University of Colorado,

Obesity is defined by a body mass index above the 95th percentile. We always treat obesity as part of a whole-child approach.

This means evaluating not only a child’s physical condition, but also their mental health, environment, and social drivers of health. Shared decision-making between clinicians, patients and families helps determine whether to introduce pharmacologic therapy.

Jaime Moore, M.D., a physician researcher at Children’s Hospital Colorado, added that lifestyle interventions and patient interest should always be considered before moving to medications.

Choosing between medications

Several medications are available, but the best choice depends on the individual child. Dr. Moore highlighted commonly used options: Phentermine, topiramate, liraglutide, semaglutide, and metformin (off-label but frequently used).

Factors that guide selection include:

• Patient preference: oral vs. injectable, daily vs. weekly dosing
• Contraindications, such as a kidney stone history or mental health considerations
• Comorbidities: Children with prediabetes or fatty liver disease may benefit more from GLP-1 receptor agonists due to their effects on hemoglobin A1c and liver enzymes

Addressing barriers to access

Access to medications remains one of the biggest challenges in pediatric obesity care. Dr. Moore emphasized:

We want to use the medications that are easy to access and are inexpensive.

Phentermine, topiramate and metformin are more likely to be covered by Medicaid and commercial insurance. Clinicians can also advocate for policy changes so that insurance coverage keeps pace with evidence-based treatment.

Engaging families and addressing stigma

Treatment conversations with families must be sensitive and inclusive. Dr. Eneli explained that families typically fall into two groups: Those actively asking about medication, and those unfamiliar or hesitant about medication. For both groups, the clinician’s role is to listen, reflect, and present all treatment options, including behavioral strategies, pharmacotherapy, and even bariatric surgery where appropriate.

Stigma also plays a major role in care. Dr. Moore shared the advice of one patient:

When you walk into the room, don’t let my weight be the first thing that you see.

This reminder underscores the importance of reducing bias and treating each child as more than their weight.

Both physicians agreed that more research is needed to understand the long-term safety and effectiveness of pharmacologic therapy for pediatric obesity. But one thing is clear: Effective treatment requires partnership with families, awareness of social context, and a compassionate, stigma-free approach.

Your responses and feedback are welcome!

Source: “Ihuoma Eneli, MD; and Jaime Moore, MD, discuss pediatric obesity management,” Contemporary Pediatrics, 10/2/25
Source: “What’s New in Obesity Management,” presented at the American Academy of Pediatrics 2025 National Conference & Exhibition, 9/26 – 9/30/25
Image by Luis Quintero/Pexels

Obesity, It’s Everybody’s Baby

Childhood obesity will ultimately cost someone a significant amount of money; whether it be the parents, the institutions of learning that the kids attend; the kids themselves when they grow up; their employers; the airplane manufacturers who are required to provide wider seats; or the general public, in the form of taxes collected to alleviate medical conditions both congenital and acquired, for the betterment of society as a whole.

The harm generated by childhood obesity involves more than just the individual child’s health. Whether or not it is their fault, and whether or not others spitefully blame them, and regardless of whether it is fair — in one way or another, obese people constitute an expense to society.

On this blog, much attention has been focused on one very important facet of the societal impact of obesity, namely: It eventually touches everyone in some way. In many cases, this impact is physical, as the person joins the ranks of the overweight and obese. Still, hefty as those numbers are, direct physical participation in obesity is not universal. But financial participation is inevitable.

Big research

In 2018, much current information and many previous statistics were consolidated by Hugh Waters and Marlon Graf of the Milken Institute into a major report.

They looked into the costs that health conditions related to overweight and obesity were racking up, because these expenses would ultimately be paid for by “individuals and their households, employers, government, and society.” In other words, sooner or later, directly or indirectly, every person in the country would be liable for these costs. In some cases, it might be considered fair, because 60% of Americans (just over 180 million people) were either overweight and heading inexorably toward obesity, or had already arrived there.

Startling hindsight

Travel back in time for a moment, to 1962. In that year, a young teen could look around and observe an adult population in which only 13.4% of the men and women were obese. In 2016, that same person’s adolescent grandchild could look around and see 39.8% of the grownups in an obese condition. Where there used to be one obese person in a family, now there were three. Where there used to be 100 obese people in an auditorium, now there were 300.

To break it down another way, in that year about 100 million Americans were obese, and about 80 million were overweight, and these two combined statistics accounted for…. wait for it….

$480.7 billion in direct health care costs in the U.S., with an additional $1.24 trillion in indirect costs due to lost economic productivity.

If numbers like this do not cause people to sit up and take notice, nothing will. Just in case the message was not getting through, a mathematician did another calculation, which was announced at the same time:

The total cost of chronic diseases due to obesity and overweight was $1.72 trillion — equivalent to 9.3 percent of the U.S. gross domestic product (GDP).

Another formidable finding went like this:

Obesity as a risk factor is by far the greatest contributor to the burden of chronic diseases in the U.S., accounting for 47.1 percent of the total cost of chronic diseases nationwide.

“By far the greatest contributor…” Strong words, indeed. Where does the “risk factor” accusation come from? Apparently, obesity is implicated as a causative or exacerbating factor in a large assortment of diseases, from head (Alzheimer’s and vascular dementia) to toe (type 2 diabetes).

The report from the nonprofit, nonpartisan think tank notified the public about a major fact. Of all the factors that contribute to the continuing existence of chronic diseases, obesity is the undisputed champion because it “increases insulin resistance, blood pressure, LDL cholesterol, and triglycerides. Further, obesity lowers HDL cholesterol and places the body in a pro-inflammatory state.”

The authors explain how fat cells, even though they are distributed throughout the body, have perfected the technique of ganging up in a network to function as one discrete endocrine organ, and with ferocious effect. The report gives specific examples of how this works, and notes that together, “these multiple related pathways are referred to as metabolic syndrome.”

The report’s Table 8 is frightening, with its presentation of the direct and indirect cost per case (in 2016) of 23 serious conditions. (Two varieties of carcinoma come out on top.)

For the minutiae-minded, the report also offers over 100 source footnotes.

Your responses and feedback are welcome!

Source: “America’s Obesity Crisis: The Health and Economic Costs of Excess Weight,” MilkenInstitute.org,” 10/26/18
Image by World Obesity Federation

The Importance of Hydration Recognized

We have mentioned that businesses are interested in learning how to discourage workers from “doing things on company time that will eventually cost the company many dollars.” One of those factors is the consumption of sugar-sweetened beverages, which have been shown to cause obesity. The particular methodology of this threat is that employees who become obese tend to bend the “bottom line” expensively.

Most people probably do not have a clue about all the history behind the availability (or not) of water in either public locales or in places of business. Over the years, many laws have been argued, passed, contested, and rewritten, over the issue of water in the workplace. Considering the enormous number of different kinds of workplaces that exist, keeping up with the whole field must be an exhausting responsibility. It is good to know that special attention has been paid to the importance of water in preventing obesity.

In the USA, the Occupational Safety and Health Administration requires that potable water be available to workers, and that they should be encouraged to drink it, and cannot be asked to pay for it. The rule is not confined only to readily accessible water for the quenching of thirst, but encompasses every use for which potable (technically, safe to drink) water is utilized:

[…] for drinking, washing of the person, cooking, washing of foods, washing of cooking or eating utensils, washing of food preparation or processing premises, and personal service rooms.

Furthermore, “Each industry contains specific requirements tailored to the conditions of these fields,” including guidance on the provision of “reasonable opportunities” to hydrate. Of course, these considerations may be extended not just out of warm regard, but because companies have caught on to the fact that obesity costs them a considerable amount of money.

Perhaps the availability of good water might help to wean some workers off their habitual high-cal drink habits. Never mind that coffee with three spoons of sugar, and forget about sodas and juices, especially those with added sweetener.

In 2014, the Centers for Disease Control and Prevention produced the multiply-authored and lengthily titled “Impact of Individual and Worksite Environmental Factors on Water and Sugar-Sweetened Beverage Consumption Among Overweight Employees”. It was described as “the first extensive evaluation of the workplace environment and its influence on water and SSB consumption.”

After taking into consideration many reports, the researchers concluded that workplace factors definitely influence the behavior of overweight employees. They found that reduced access to vending machines could steer habits into healthier channels. Consultants also looked further into the roles played by water coolers, vending machines, and break frequency. Here is the bottom line from that study:

Future intervention trials are warranted to determine whether reducing SSB consumption and increasing water consumption could be an effective dietary strategy for worksite-based weight management interventions and whether individual and environmental intervention features mediate or moderate intervention effectiveness.

A few years ago, similar research scrutinized both “intensive-labor and static-type workplaces” and concluded that promoting the water consumption habit “may benefit employees,” which is pretty weak sauce, considering how the phraseology implies “… or it may not.” Well then, could the provision of both water and nudging reminders induce employees to drink lots of water in order to “diminish their tendency to gain weight”?

At the same time, this research project was looking for more than just how to encourage increased water consumption. Managerial and executive eyes were on a bigger prize, and WHPPs (Workplace Health Promotion Programs) were created to serve the need, and a sentence in the Conclusion affirmed the hope.

“If reminders about water intake can be sent to employees in a timely manner, and if they can be informed with the health benefits brought by drinking water regularly, combined with unforced health education, it may be possible to obtain other additional benefits in addition to enhancing employees’ water intake.”

Of course, businesses are not only concerned about employees’ health, and it would be silly to believe they are. But to discover a factor that can improve the lives of workers while at the same time reducing employer costs, well, that is something to write home about for sure.

Your responses and feedback are welcome!

Source: “Summary: OSHA Water Requirements,” ZTers.com, 09/09/24
Source: “Effectiveness of a Water Intake Program at the Workplace in Physical and Mental Health Outcomes,” NIH.gov, 2022
Image by Picsues/Pixabay