Study: Fat workers cost employers more

By CARLA K. JOHNSON, Associated Press WriterTue Apr 24, 7:17 PM ET

Overweight workers cost their bosses more in injury claims than their lean colleagues, suggests a study that found the heaviest employees had twice the rate of workers' compensation claims as their fit co-workers.

Obesity experts said they hope the study will convince employers to invest in programs to help fight obesity. One employment attorney warned companies that treating fat workers differently could lead to discrimination complaints.

Duke University researchers also found that the fattest workers had 13 times more lost workdays due to work-related injuries, and their medical claims for those injuries were seven times higher than their fit co-workers.

Overweight workers were more likely to have claims involving injuries to the back, wrist, arm, neck, shoulder, hip, knee and foot than other employees.

The findings were based on eight years of data from 11,728 people employed by Duke and its health system. Researchers found that workers with higher body mass indexes, or BMIs, had higher rates of workers' compensation claims.

The most obese workers — those with BMIs of 40 or higher — had the highest rates of claims and lost workdays. BMI is a measure of height and weight. A 6-foot, 300-pound person, for example, has a BMI of just over 40.

Study co-author Dr. Truls Ostbye said the findings should encourage employers to sponsor fitness programs.

"There are many promising programs," Ostbye said. "We'd like to see more research about what is truly effective."

James Hill, who heads the Center for Human Nutrition at the University of Colorado, said managers will pay attention to the findings because injuries mean more immediate financial losses than the future health-care costs of diabetes and heart disease.

"When you see that claims rates double, I think that's going to get people's attention," Hill said.

But there isn't enough good information about employer-sponsored programs that work, said John Cawley, an expert in the economics of obesity at Cornell University. Employers don't know whether paying for nutrition counseling, obesity surgery or anti-obesity drugs through health insurance makes economic sense, he said.

"It's now apparent to everybody that obesity is a big problem," Cawley said. "But the research isn't there to know where to get biggest bang for the buck."

Cawley noted that BMI does not distinguish muscle from fat and can equate a buff body builder to a couch potato. Although BMI, a measure of height and weight, is used in most obesity research, Cawley's research has found that blacks are particularly likely to be misclassified as obese by BMI.

New York employment attorney Richard Corenthal cautioned employers not to overreact with discriminatory policies.

"Employers need to be careful not to view this study as a green light to treat obese or overweight workers differently," Corenthal said.

The study, appearing in Monday's Archives of Internal Medicine, got funding from the National Institute for Occupational Safety and Health.

Been reading about free radicals

Book: Chasing Life
Author: Sanjay Gupta

Should I add cancer to this list?

Interesting Article on Taking Culture into Account in Health

J R Soc Med. 2002 October; 95(10): 489–490. Copyright © 2002, The Royal Society of Medicine Diabetes in Ramadan Bashir Qureshi, FRCGP Islam is the second largest religion in Britain, after Christianity. In 2001, the number of Muslims in Britain was around 2.5 million. Devoted healthy Muslims commemorate the revelation of the Holy Quran by Allah to the Prophet Mohammed by fasting in the month of Ramadan every year. Ramadan lasts for 29 or 30 days, depending on the sighting of the moon. While continuing their daily occupation without time off, fasting Muslims abstain from food, liquids, tobacco, sexual activity and medication (oral, inhaler or injection) from sunrise to sunset. However, the sick, the pregnant and nursing mothers and children are exempt; moreover, if a fasting person becomes ill, he or she is allowed to end the fast in the day. Ramadan directly influences the control of diabetes because of the month-long changes in meal times, types of foods, use of medication and daily lifestyle1,2. Doctors and nurses who encounter Muslim diabetic patients need to understand the practicalities. What does a controlled diabetic Muslim do in Ramadan that a health professional should know about? CUSTOMS IN RAMADAN The religious goal of enhancing physical, psychological, social and spiritual wellbeing is achieved by the following daily customs. Physical activities In Ramadan a Muslim fasts from dawn to dusk and ends the fast with dates (or prunes if dates are not available) and water or juice. Iftari, a big evening meal with extra sweet and savoury foods, but still a balanced diet, is taken after the sunset prayer. Men walk to the local mosque for night prayer whilst most women pray at home (for reasons of safety). Sehri, a light meal is taken before sunrise. Some Muslims omit this meal so as not to disturb their non-Muslim neighbours. This may contribute to hypoglycaemia during the day. Psychological activities Prayer and meditation—which are akin to group therapy—result in self-audit and relaxation. Religious leaders, elders and colleagues of the same sex provide counselling. Social activities Friends and relatives are invited to iftari, making it a feast and social event. Sick friends and relatives are visited, with sharing of the care as appropriate. Spiritual activities Taraveeh is a special night prayer: standing in the mosque the Muslim listens to the Holy Quran. A hafiz (who has the Holy Quran by heart) recites all 30 chapters of the Holy Quran through the month. There is extra listening to sermons, and the Muslim becomes more pious and sensitive; he or she feels more guilty if a religious taboo is broken, even by medication. This guilt may be accompanied by self-disgust and spiritual pain—very unpleasant. TEN (actually only nine) POINTS TOWARDS IMPROVING DIABETES CARE IN MUSLIM PATIENTS A Muslim may be devoted, liberal or secular; assess carefully how religiously devoted your patient is. Health professionals are also human and may have negative feelings about Muslims. Referral to another doctor will sometimes help both parties; take it or leave it, but do not proceed half-heartedly. Communication with the patient begins with respecting names. Even if they do not show it, many will be upset if you write Muslim as Moslem and Quran as Koran, if you use initials instead of full first and middle names (because these have religious connotations) and if you ask ‘what is your Christian name?’. These cultural issues, and the minutiae of diabetes management, have been discussed elsewhere3,4,5. Here are ten practical points. Ramadan fasting improves diabetes by lowering the blood glucose and HbA1c because of fewer post-prandial peaks. Adjust medication if necessary Meditation and prayers tend to lower blood pressure. Adjust the dosage of antihypertensive drugs in a hypertensive patient Pork and non-halal meat are absolute taboos in Islam. Thus pork insulins, pork-based synthetic insulins, and beef (non-halal) insulins are unacceptable to devoted Muslims. Non-porcine synthetic (human) insulin should be given in preference. If a forbidden insulin is the only choice, a religious leader or doctor should be encouraged to mediate and reduce the patient's guilt feeling and spiritual pain. These advisers would use the doctrine of ‘the sanctity of life’, permissible in Islam. It means that life must be saved at all cost ‘Human insulin’ may be misunderstood by the patient as signifying manufacture from human flesh or pancreas, leading to non-compliance. Some non-westernized Asian and African Muslims do not understand diabetes as western people do. Explain that ‘human’ simply means ‘akin to human’ In Ramadan, a person with type 2 diabetes can take a sulphonylurea at the end of the fast, with the evening meal started within 30 minutes. Advise not to miss the sehri (before sunrise) meal so as to avoid hypoglycaemia later in the day. Repaglinide (NovoNorm) can be particularly useful, since it need only be taken when a meal is eaten, therefore no change in drug therapy will be required in Ramadan. A meal must be eaten within 15 minutes The patient may concurrently be taking alternative medicine from a hakim (a Muslim healer) e.g. karela powder (an oral hypoglycaemic). Ask the patient, and adjust medication or advise accordingly Glycaemic foods should be taken into account. Muslim sweets taken in Ramadan, khir (rice pudding) and vermicelli are sugary and may necessitate a change in drug therapy. Savoury foods such as karela (a vegetable), onion and garlic are hypoglycaemic. Again, adjustment of medication or dietary tips may be needed Medical advice is sometimes ignored for religious reasons. Occasionally a devoted Muslim will say, ‘Allah will protect me’. He or she may not fear death or may even want to die so as to meet the Creator. Counsel the patient by saying ‘to see the doctor and comply with treatment is Prophet Mohammad's sunnat (precedent)’. To refuse would be a sin Article 9 of the 1998 Human Rights Act, which came into force on 2 October 2000, requires freedom of thought, conscience and religion. This has been incorporated in English and Scottish law and all general practitioners and hospital doctors are bound by it. I hope that general practices and hospital clinics will use these notes as a starting point for drawing up guidelines according to local needs and circumstances.

Jeremy Greene

I attended a colloqium with Jeremy Greene today.

Some Ideas I came up with

1. Getting clubs on campus to use alternatives to sugary snacks for fundraising (i.e. instead of boob cakes, boob-shaped soaps)

2. Encourage professors to talk about heart disease in their classrooms (natural history of the disease in biology, different symptoms among gender in gender studies class...)

3. Offer free cholesterol tests frequently on campus

4. Teach about simple waist to hip ratio and the significance of it

5. Nutritional information on the hazards of drinking soda

6. Smoking cessation services (yes, college-educated students DO smoke and binge drink)

Heart Disease and Diabetes Prevention on College Campuses

I thought about starting to blog last night while watching a program about heart disease in America on PBS. It wasn't the first time I thought about doing something on campus. In fact, I had previously tried to persuade students in a club that I'm part of to address the issue. But there doesn't seem to me much interest. I'm going for this campaign alone... though I earnestly hope that this will not be for long.