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The Sound of Ideas

Who is Responsible for Health Risks?

Posted Wednesday, September 30, 2009

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In the debate over the future of health care, we've spent more time talking about access than we have about what actually determines our health to a large degree: our behavior. A New England Journal of Medicine study says close to half of our illnesses are caused by unhealthy behavior. If that's so, what’s our individual responsibility to avoid bad habits that lead to illness? Should health reform include incentives to help us diet…or even penalties if we don’t? Wednesday morning at 9, join ideastream®'s Dan Moulthrop for a conversation about personal responsibility and the ethics of pushing people toward wellness.


Economy, Government/Politics, Health


Jessica Berg Professor of Law, Bioethics, Public Health, Case Western Reserve University
Carl Biats President, Morningstar Insurance & Financial Services, Inc.
J.B. Silvers Professor of Health Systems Management, Case Western Reserve University

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Ana 9:20 AM 9/30/09

Our culture often pathologizes fat people.  Yet I’ve read research recently that suggests that poverty--and not obesity--is the key factor for health problems.  Poor thin people have much higher mortality rates than rich fat people.  I agree that obesity is a public health issue, but I think that fat people are an easy scapegoat.  I’ve included a link to a Slate article on this issue:

Terry 9:24 AM 9/30/09

Have any of you worked in a hospital??? Half the time the nurses don’t even have a chance to go to the bathroom, let alone go to the cafeteria to get something healthy to eat. On an off shift the cafeteria isn’t open. I took up smoking as an excuse to leave the floor for a minute. After an 8-12-16 hour shift all you want to do is go home and have a drink!!!!

Sheila McKibben 9:29 AM 9/30/09

I have battled weight problems for 40 years. One of the things to consider is that you don’t have to smoke,drink alcohol or take illegal drugs to survive. When food becomes an addiction you have to ingest that addictive item daily and struggle to control that addiction . I hope that one day some medication can be found to curb that addictive behavior. In the mean time , I an grateful for the ongoing help programs.

Steve 9:30 AM 9/30/09

Good Morning Dan,
I was self-employed and paid for insurance out of pocket. During that time, I quit smoking ran up to 30 miles a week and exercised regularly but my insurance increased every year because I got older. I don’t see any company rewarding my or anybody’s healthy life style because of the reason our insurance/medical system is based on revenue generation not assisting and rewarding healthy lifestyles.

paul 9:34 AM 9/30/09

As a pulmonologist, The majority of my time is spent with obesity as the cause of breathing problems far beyond smoking , infections etc. We should not subsidize corn syrup and it should be taxed.

Tim 9:40 AM 9/30/09

Employers would “prefer” not to hire a lot of classification of emploees.  Luckily this called discrimination and for the most part is illegal.  As someone who has struggled with obesity my entire life, I am insulted my worth is diminished because of my disability.

Teresa 9:41 AM 9/30/09

I think we tend to oversimplify many health issues - for example, obesity often stems from psychological issues (such as sexual abuse) that must be treted in order to reach a healthy weight… Yet in many cases this psychological factor is disregarded and treatment is NOT covered by health insurance, leaving many with weight and addiction problems to repeat a cycle of bad behavior. When the root of the problem is ignored by th health care industry it seems unfair to expect everyone to “just stop eating ho hos” or “just stop drinking.”

Michelle 9:46 AM 9/30/09

Several thoughts

1. I find it ironic that we are moving toward making it illegal for insurance companies to discriminate against consumers with health conditions and in the same breath, we talk about how we can make the obese pay. It seems to me we’re just transferring the prejudice and discrimination to another format. Further, this kind of discrimination just starts with the obese. If left unchecked it will continue to include people with migraines (who miss lots of work) and people who get cancer. Oh and lets make diabetics pay for all their care and the asthmatics too--they’re too expensive.

2.Obesity is still not well understood. You have several major magazines this year (i.e. Time, New Yorker) running articles talking about how exercise does not work. 10-20% of women have PCOS a hormonal disorder characterized by insulin resistance that can lead to obesity and difficulty losing weight. Are you going to tell them it’s their fault and they need to pay for their fat? You’re going to make the obese fully culpable for something that is still not well understood?

I have PCOS and take steroids for asthma which are known to cause insulin resistance. Am I going to become unemployable because of my weight issues that are more rooted in a medical disease than in any poor habits I may or may not have?

3.Fat people contribute to society too. It’s not a one way equation where we just take,take, take. I myself nurtured and developed a $16 million dollar business unit. I now run my own business and mentor at risk youth, materially contributing to my community.

I’m not some blob sitting on a couch, but society is awfully anxious to punish me as such.

4.Obesity is a societal problem. These so called unhealthy choices available to the obese are driven by our culture, economy, and flawed science. Please invite Gary Taubes on your show to talk about the science of obesity, heart disease, and diabetes. His perspective is important in these kinds of discussion

Martha 9:47 AM 9/30/09

Our brutal maternity leave/family leave policies, as well as the lack of convenient, good day care, contributes to unhealthy eating as well.

Kathy Wendorff 9:49 AM 9/30/09

I was surprised to read on my Walgreen’s sales receipt that the bags of Hershey chocolate bars are “Food stamp eligible.”

Joane 9:50 AM 9/30/09

I am a 60 yr old black woman.  I am a widow and I have had a weight problem most of my life.  I did smoke less than a pack a day and did not start until I was 24.  The most i have suffered is a cold every two or three years.
My husband and I have 3 children.  They played hard and I cooked for them.  Fast food was a ‘treat’. Period.  Not a regualr meal and to this day they will not eat too much of it.  My son was 30 lbs at a year old.  I was told he would grow up to have a weight problem.  I ignored the doctors.  My son is 6’6”, 36 and never had a weight problem in his life.  Usually he was too thin.  My daughters never had a weight problem.  I used real butter.  Surgar. Nothing packaged.  Everything I cooked was from scratch.  Kool-aid, the drink of choice when they were younger was made @ 4qt made with 11/3 cups sugar.  To this day they cannot tolerate over sweet drinks.  My son played his video games, too.
Now, I have 4 grandchildren.  We refuse to give them artificiallly sweetened anything.  If it is in a drink or a food, we nix it.  They are children not adults. Their growing bodies have needs not met with artificial crap.  Sugar for brain growth is one.  How do we know the rise of autism isn’t due to the intake of artificial sweeteners versus natural sugar.  My grandson, the oldest, was also over 30 lbs at a year, like his uncle.  His pediatrician read my daughter the riot act.  I told her to ignore her.  Look at her brother.  Sure enough, he is in the 95 percentile for height and 50 percentile for weight at 7.  His sister is in the 40 percentile for both.  The two younger girls are 18 months old and 3 months old.  There is a 3 lb and 2 inch difference between the 18 month old and her older 3 yr old sister.  She is in the 95 percentile for height and 60 percentile for weight.
As for fast foods.  Grow up.  Just say no.  I will not blame fast food because I am too weak to say no.  Who cares how many signs are out there.

Rob Mihaly, Lakewood 9:52 AM 9/30/09

Just before your program, Frank DeFord had a piece about how major league baseball teams are hiring nutritionists to help the ball players eat more healthily. These guys make a minimum salary of $300,000, and many make multi-millions. If they can’t find a way to eat a healthy diet, without their employer stepping in, and with the amount of time available throughout the year to pursue a healthy lifestyle, how does Average Joe get there? We need to stop subsidizing the unhealthy food that’s so prevalent and shift our resources to lower the cost of fresh fruits and vegetables. We also need better schooling than I got in health class years ago.

Danielle 9:55 AM 9/30/09

Can and shouldn’t health insurance companies be mandated to be not-for-profit?

Carey, Lorain 9:56 AM 9/30/09

I’m a “recovering” compulsive overeater (also referred to as “emotional eater") trying to learn to take care of myself without getting sucked into the diet/binge cycle that is far too prevalent in our culture.
A few reactions I’ve had to your program:

For people like me, threats like losing my job if I don’t quit an “unhealthy” behavior or don’t lose weight would only increase my anxiety and stress, which are the major causes of my behavior in the first place.  This would be less than helpful and would most likely only make things worse.

Also, it really makes me angry to hear people (who I would assume are not significantly overweight) talking as if losing weight is as easy as “just do it”.  If all we had to do was “just do it”, there wouldn’t be an obesity “crisis” in the first place.  It’s not like people who are overweight enjoy it.  There are already plenty of built-in disincentives: judgment from your friends, family and neighbors; physical discomfort; difficulty finding clothes that fit right; health risks. 
I would recommend you and/or your guests consider the fact that the only tool we are given to try to lose weight (going on a diet) hardly ever works long term, and often leads people to a lifetime of diet-binge-diet-binge-diet-binge cycling - which some studies indicate is actually worse for your health than just being overweight in the first place!

Keith, Cleveland 9:58 AM 9/30/09

I am amazed at the premise of your program today.  You are trying to pin blame on individuals for not eating or living a healthy lifestyle without looking at the choices that society is providing for people to meet those ends.  For the last 50 years this country has subsidized the production of highly processed, highly unhealthy food.  This food has been marketed for it’s cheapness and convenience to the exclusion of it’s health benefits.  During this same time we have adopted a vastly more sedentary lifestyle, especially in the workplace, a place that people spend more and more of their time.  So the lifestyle that is being pushed by society on a daily basis is the opposite of a healthy one.

Your show today should be focused on the giant corporations and marketing companies who have pushed this type of lifestyle to the citizens of this country.  They control what is available to eat, what hours we work, how far we have to commute to get there.  Until this is addressed, the individual will be fighting an uphill battle to good health.

Gregory Switlik 10:00 AM 9/30/09

Great show Dan!

Rae, Tallmadge 10:11 AM 9/30/09

Hi, I’m in a bit of a rush but I want to say, that if my employer offered me a membership to a local gym I would gladly utilize it!

Secondly, I think a lot of the views on this show regarding obesity, smoking and other obviously unhealthy habit which are so apparent are at the same time very superficial.  Why not deal with the psychological aspects that cause the need for such vices.  And what of things that cause illness that are not so apparent, such as the fact that a thin person might be more likely to consume more alcohol and engage in unhealthy sexual behavior - who pays for the long term benefits of stds, hiv and aids?  There are also so many illnesses that are genetic and people have no control over such as thyroid, arthritis, fibromyalsia and other auto immune diseases and so on that are not so visually apparent, but are in fact every bit as costly to the health care system.  The point that I would like to make is that we need to stop pointing the finger and just take care of the problem.  We need to all take care of each other, because it’s the RIGHT thing to do.

I think that the government, federal, state and local should also be rewarded for encouraging people to lead healthier lifestyles by putting in more sidewalks and bike trails that encourage people to drive less, thereby helping to maintain a cleaner and healthier environment also.  Europe has done this for years.

Also, how about charging less for healthy food and more for the unhealthy choices.

Cathy Leuenberger 10:18 AM 9/30/09

During the panel discussion on the costs of poor health today, one of the panelists was all too ready to dismiss individual responsibility for personal health.  In my opinion, an individual’s ability to control themselves accounts for at least 90% of their state of health.  I speak as an ex-smoker (2-1/2 packs a day) and someone who is currently bordering on being obese.  I quit smoking because I REALLY wanted to.  I was motivated not for financial reasons, but because I wanted children.  I have children now and that is a large motivator behind me choosing to lose weight (to join Weight Watchers), to control the type of food and the amounts I consume and the level of exercise I engage in.  I really want to remain a parent to them and an active one as well, so I need to be healthy.  That’s what we need to explore – increasing each individual’s DESIRE to make better choices.

Yes, our society supports an entirely too sedentary lifestyle – spending way too much time in front of our computers or televisions and behind the wheel of a car.  But also as a society, we have learned to excuse our own poor personal behavior, blaming it on external circumstances or the environment, and not taking accountability for it ourselves.  Other societies tend not to have such obese populations because they aren’t as sedentary, they walk more, they don’t watch TV as much, etc.  But it really comes down to our willingness to use personal self-control and not be so self-indulgent (I really include myself in this), and to learn and adopt new ways of living that promote health.  It doesn’t matter that much from where someone hails – any person in this country has plenty of choices available to manage a healthy diet and more exercise. 

If insurance companies are being asked to not deny people with pre-existing conditions, they should also be allowed to reward people who choose healthy lifestyles and charge larger premiums for those who don’t.

Thank you for listening.

Akron, OH

Terry 10:19 AM 9/30/09

I don’t think the audience got the point of my comment about smoking breaks. Being a nurse is one of the most stressful occupations on the planet. Staffing shortages and sicker patients land square on the shoulders of the nurse. We don’t have a cushy office to retreat and make judgments about other people’s behavior. We work long hours, overtime and do more with less everyday. For rewards we get more work. Now a major hospital in town brings nurses from other countries because they are less likely to complain about working conditions. I worked with a nurse with type 1 diabetes that got fired because she had low blood sugar because there were times she didn’t have time to eat dinner. How does someone stay healthy in such work environment, who want to stay after work for a wellness program after you have had a nightmare shift?

Katy 10:34 AM 9/30/09

I’m a healthy 39 year old woman—great blood pressure, exercise regularly, eat well—who weighs 254#.  For those who wish to penalize behavior, I’ll make a deal with you:  I’ll develop bulimia to help control my weight, if you promises no knee replacements for marathon runners.

hanson 10:36 AM 9/30/09

I listened to part of your program this morning, and I was struck by how your participants focus on “systemic”, corporate or institutional scapegoats. We can’t blame our poor eating habits on MacDonalds, especially now that they have become more health conscious. I love going to MacDonald’s when I travel because I know I have choices, and the quality is the same no matter where I go. The bioethicist seemed to make the most sense. Education and improved government policies
are important, but let’s emphasize individual responsibility and not try to find “faceless scapegoats” to blame.

John, South Euclid 10:58 AM 9/30/09

"Freedom” and “personal responsibility” are archaic 20th century notions that predate our knowledge of brain chemistry. Get with the program, ‘CPN. We now know that human beings are simply robots of protoplasm and soon all our dysfunctions will be eliminated by chemical applications. Progress in mental health technology marches on and those who refuse to recognize the benefits of behavioral engineering are nothing but pathetic Flat Earthers.


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