David Satcher, M.D., Ph.D.

U.S. Surgeon General

Hubert H. Humphrey Building

200 Independence Ave. SW

Washington, DC 20201


Dear Dr. Satcher,


I recently became self-employed, and in need of health insurance. 


I applied first with BlueCrossBlueShield of Tennessee, since they had insured me for five years at my previous place of employment.  During that five-year tenure, I only filed one claim against BlueCrossBlueShield, and that was for a physical that I received just before I left my place of employment. I knew I would be uninsured for a while, so I wanted to make sure I was in good health.


As a result of that physical, the doctor said I was "disgustingly healthy."  My cholesterol is 175, my blood pressure is 110/70, and my resting pulse rate is 70.  I'm 5'5" tall, and weigh 243lbs.  The doctor said it was obvious that I take very good care of myself.  I am 54 years old, and am not now, nor have I ever been under a physician's care for anything except a very normal pregnancy 23 years ago.


After I became self-employed, I applied to BlueCrossBlueShield of Tennessee for individual insurance for my family.  I was turned down, based only on my weight, and told that they would not insure me even if my doctor sent them a letter stating that I had never been sick, and he didn't ever expect me to become sick.  Then they proceeded to tell me I could get a letter of denial from them for $25.00, so that I could get on the state insurance, TennCare. 


Just out of curiosity, I called and asked what BlueCrossBlueShield charges on their premium for a smoker.  They don't charge anything extra if a person smokes!  I was in such a state of disbelief, I called back, long-distance, just to make sure the first person I had talked with hadn't made a mistake, and was told the same thing by a different person. They don't charge any extra premium for smokers.


Over the past six months, I have talked with approximately 30 insurance companies.  Out of all those companies, one told that they would insure me, but my premium would be 150 percent higher than the normal premium.  I was told by one that I would be "looked at" and charged 40 percent to 50 percent more, the rest of the companies I spoke with just told me a flat "no." 

With each call, I told them that my husband was a smoker, (which he isn't), so I could get an idea of how much a smoker as penalized.  The rates varied from nothing (BlueCrossBlueShield), to 10 percent, with 20 percent seeming to be the average, but one or two said 40 percent.


Sir, I'm reaching out to you, in hopes that you can help change the horrible discrimination that is going on in this nation towards a group of people who don't fit the misguided criterion of size acceptance that is so out of hand in this country of ours.


What other segment of humanity is lumped into one pile and judged by nothing but a number on a scale? 


It is a fact that over 90% of all diets fail.  "Since many people cannot lose much weight no matter how hard they try, and promptly regain whatever they do lose, the vast amounts of money spent on diet clubs, special foods, and over-the-counter remedies, estimated to be on the order of $30 billion to $50 billion yearly, is wasted."  ("Losing Weight--An Ill-Fated New Year's Resolution," The New England Journal of Medicine, January 1, 1998--Vol.338, No.1)


The diet pushers love to quote the unproved figure that 300,000 people die each year from obesity.  "Thus, although some claim that every year 300,000 deaths in the United States are caused by obesity, that figure is by no means well established.  Not only is it derived from weak or incomplete data, but it is also called into question by the methodologic difficulties of determining which of many factors contribute to premature deaths."

("Losing Weight--An Ill- Fated New Year's Resolution," The New England Journal of Medicine, January 1, 1998--Vol.338, No.1)


I know we're told repeatedly that fat people are more prone to certain kinds of diseases, but are we really?  "Given the enormous social pressure to lose weight, one might suppose there is clear and overwhelming evidence of the risks of obesity and the benefits of weight loss. Unfortunately, the data linking overweight and death, as well as the data showing the beneficial effects of weight loss, are limited, fragmentary, and often ambiguous.  Most of the evidence is either indirect of derived from observational epidemiologic studies, many of which have serious methodoligic flaws.  Many studies fail to consider confounding variables, which are extremely difficult to assess and control for in this type of study." ("Losing Weight--An Ill-Fated New Year's Resolution," The New England Journal of Medicine, January 1, 1998--Vol.338, No.1).


Could it be possible that fat people are being exploited by the multibillion dollar diet industry, and that the so called studies that supposedly "prove" how unhealthy we are, are misinterpreted to say just the opposite of what is really being found?  "Obesity researchers' thinking is distorted most by the fact that almost everyone who funds their work is in the diet business.  Scientists' careers depend on publishing studies, and they often have to scramble to get the money to do them.  In 1995, the National Institutes of Health spent about $87 million on obesity research (out of a total budget of $11.3 billion), which funded only a small portion of the studies done that year; the lion's share was funded by companies that are in the business of promoting diet treatments. " 'The so-called clinical research in this field has been largely paid for by the formula and drug companies, ' "says Wayne Callaway, himself a moderate who opposes most diet treatments in favor of long-term lifestyle changes.  Researchers who oppose dieting don't stand much of a chance of getting funding from companies who know the research will undermine their product.

            "Diet and pharmaceutical companies influence every step along the way of the scientific process.  They pay for the ads that keep obesity journals publishing.  They underwrite medical conferences, flying physicians around the country expense-free and paying them large lecture fees to attend." (Fraser, Laura,  Losing It- America's Obsession With Weight and The Industry That Feeds On It, pg 211, 212 )


But what do the real studies show?  The studies that aren't supported and influenced by the dollar signs of the diet industry tell us a totally different story.  Let's look first at what we're told about obesity and it's relationship to high blood pressure.  Glen Gaesser, associate director of the Adult Fitness Program at the University of Virginia, says this,  "I've counseled hundreds of men and women over the past few years who seem to me living proof that obesity is a neutral factor in matters of health.  The majority of the individuals I've encountered with high blood pressure have not been obese, and the majority of obese people have not had high blood pressure.  Countless research studies have confirmed what I've observed firsthand.  Typically over 95 percent of the variation in blood pressure within a population is found to have nothing to do with obesity."  (Gaesser, Glenn, Big Fat Lies, pg 62)


What about how we're fed the constant story that being obese increases our risk of having heart problems?  Dr. Gaesser continues exploring the aspects of atherosclerosis on page 68 of his book, Big Fat Lies, siteing tests that were done during autopsies.  When the autopsies were done in studies dating back to the 1940's and 50's, "with results that were consistent and surprising: Neither weight nor body fat was related to atherosclerosis." (pg 68) "Even Massively obese men and women show no connection between obesity and vascular disease.  NIH researchers Drs. Carole Warnes and William Roberts published a report in 1984 describing the autopsy findings on men and women who weighed between three hundred and five hundred pounds at the time of death.  There was no more atherosclerosis in their coronary vessels than in nonobese people of the same age." (pg 69)


Dr. Gaesser continues, "Perhaps the most definitive of the autopsy studies was the International Atherosclerosis Project, which began collecting autopsy results in 1960 and eventually evaluated the coronary arteries from twenty-three thousand people in fourteen different countries.  The number of specimens analyzed, and the broad spectrum of ethnic groups and geographic locations from which they were drawn, made this study unique in comprehensiveness.  When the results of the landmark study were summarized by twenty-three physicians and scientists in an article published in 1968, the finding was unequivocal: no association between body weight (or other measures of obesity) and atherosclerosis." (pg 69)


But maybe those test that were run in the 1940's and 50's are too old and outdated for us now?  Well, Dr. Gaesser sites more tests done, starting in 1976 and ending in 1994.  These test were done on living people, and done with the modern technology of angiography, and the results were quiet interesting.  "A research team headed up by Dr. William Applegate of the University of Tennessee examined angiograms from over forty-five hundred middle-aged and elderly men and women-the largest, most comprehensive investigation of its kind. In the report that they published in 1991, they concluded that weight, far from being a contributing factor for cardiovascular disease, seemed to be the opposite.  Every eleven-pound increase in body weight was associated with a 10 to 40 percent lower chance of having atherosclerosis of the coronary vessels.  The fattest people, not the thinnest, had the cleanest arteries.  These remarkable findings not only challenge the notion that obesity is a cause of coronary vessel disease but also suggest the opposite:  Obesity may actually be protective!" (Big Fat Lies, pg 70, 71)


Oh, but we still have diabetes...or do we?  "Since type II diabetics are very commonly obese, and the diet and exercise programs that frequently help to alleviate their health problems often result in weight loss as well, it has been assumed that obesity itself is a major part of those problems, weight loss the solution.  If weight loss were such a crucial aspect in solving these problems, however, then one would expect to see a good correlative relationship between the amount of weight lost and the improvements it is generally thought to be responsible for.  But in fact many programs and studies have found that such improvements can come about when little or even no weight is lost, so long as certain key changes in activity and diet are made".  (Gaesser, Glen, Big Fat Lies, pg 75)


Again quoting Dr. Gaesser, "It is possible to greatly improve or even "cure" diabetes and other serious health problems while still remaining markedly overweight."  (Big Fat Lies pg 77)


" 'Nobody ever dies of obesity,' says David Levitsky, a nutrition and obesity expert at Cornell University.  Obesity, he says, is often a marker for other health problems caused by a sedentary lifestyle, but is itself not necessarily dangerous.  'If you're a large person and you do not suffer from any other health problems, then there is no reason for you to lose weight.' " (Fraser, Laura,  "Losing It, pg 176)


Dr. Satcher, what I have given you is only a tiny scratch on the surface of the truth about obesity that is "out there." So, are obese people really that big of a health risk, or are there other, underlying causes for our situation?  "In this age of political correctness, it seems that obese people can be criticized with impunity, because the critics are merely trying to help them.  Some doctors take part in this blurring of prejudice and altruism by overstating the dangers of obesity and the redemptive powers of weight loss." ("Losing Weight--An Ill-Fated New Year's Resolution," The New England Journal of Medicine--January 1, 1998--vol 338, No.1) 


 I would just like to ask; in a nation like the United States of America, where we have committees and groups and establishments to make sure everyone is taken care of, we even have the Office of Minority Health, (OMH), how is it possible and even okay, to have a group of people that can be shoved to one side, discarded, as if they were scum, denied proper health care, and the insurance to get the proper health care, and told, in most cases, that even if they are in perfect health, they won't be insured?  How is it possible that we have come so far in our discriminatory thinking about a body type, that we are willing to let a group of people, who work and pay taxes, and vote, just like "average size" people, fall by the wayside, not caring whether they get the proper health care and preventative health care to live a meaningful life?  And how is it possible that all the rest of the masses who weigh what some special chart designates (a chart that was started by an insurance salesman-the Metropolitan Height/Weight chart), can be insured, even though they may be walking dead, smoking like a locomotive, ready to blow, with high cholesterol, clogged arteries, high blood pressure, and all kinds of pre-existing conditions?


"Finally, doctors should do their part to help end discrimination against overweight people in schools and workplaces.  We should also speak out against the public's excessive infatuation with being thin and the extreme, expensive, and potentially dangerous measures taken to attain that goal.  Many Americans are sacrificing their appreciation of one of the great pleasures of life--eating--in an attempt to look like our semi-starved celebrities.  Countless numbers of our daughters and increasingly many of our sons are suffering immeasurable torment in fruitless weight-loss schemes and scams, and some are losing their lives. (Emphasis mine)  Doctors can help the public regain a sense of proportion." ("Losing Weight--An Ill-Fated New Year's Resolution", The New England Journal of Medicine--January 1, 1998--Vol. 338, No.1)







Pat Ballard