Should Fatties Pay More for Health Insurance?

I was in line at the grocery store today when I noticed the woman behind me eyeing my enchiladas. Always one to make conversation I said “They are actually really good for frozen food, no preservatives or weird chemicals, and they’re tasty.”

She sighed, in what I would call “longing,” and said – “I can’t, I’m on Atkins.” She paused, smiled wryly and said, “sixth time’s the charm, right?”

I must have made a “huh” face because she went on. “My work charges me extra for my insurance if I’m overweight – it costs me about $600.00 a year. I’ve been on and off every diet and I’m heavier now then when I started. I’ll lose 30 pounds and gain back 35, lose 20 and gain back 40, it’s a vicious cycle but $600 is a lot of money to me, so I have keep trying, right?”

Now, this is something that I’ve heard of, but don’t know much about. Since I run my own business, I am not covered by a company policy. I am the picture of health, but I guess I don’t fit the insurance companies’ frames because I am literally too fat to qualify for insurance.

So I went to a friend who I know is charged $50 per month extra for her insurance and asked her how it works. For her company, if her BMI is over a certain number OR if her BP/Cholesterol/Glucose does not meet a certain standard, she is charged $50. She meets the BP/Cholesterol/Glucose standard but her BMI is too high, so she gets charged.

The problems with this?

• The tests are correlational at best, and in some cases known to be inaccurate – skewed against the employee.
• Nobody can prove that their method of dieting sustains long-term weight loss.
• Dieting and weight cycling can be much more detrimental to health than being obese.

Whether you call it an additional premium for large employees or “incentives” for small employees, companies and their insurance plans are penalizing their employees for not doing something that nobody can prove is possible, for a reason that nobody can prove is valid, with a probable outcome of leaving their employees less healthy than they were when they started.

It’s not just size discrimination, it’s ludicrous. You’ll hear that size is a matter of personal responsibility. I think that personal responsibility extends to researching popular claims to be sure of their source and validity before we use them as the basis of widespread discrimination.

It also sets a dangerous precedent. When these fat penalties stop being fun money for insurance companies, what group will they target next to increase revenue?

Why not charge employees who bike to work an extra premium because their sun exposure increases their risk for skin cancer? Charge people who eat a lot of fish since high mercury levels in fish correlate to health issues. What if they find out that people who live in a specific zip code tend to get the flu more often – can they be charged more too?

Currently the Genetic Information Nondiscrimination Act precludes charging more based on the results of genetic testing. In reality though, isn’t that just until the insurance and pharmaceutical lobbies go to work? They’ve managed to lower the threshold for obesity as well as the numbers that indicate high blood pressure and high cholesterol to help bolster their profits. They are already charging based on outcomes of genetics (like cholesterol and body size) so I can’t imagine that working on charging based on genetic predisposition is far behind.

It’s not right, it’s unfounded discrimination, and it needs to stop. Right now.

Are you a numbers and research person? Good, me too. Here you go:

BMI and It’s Many Problems

Belgian polymath Adolphe Quetelet devised the BMI equation in 1832. He never intended for the number to be used as a measure of individual health, he created the formula to be used as a statistical tool across large populations.

Three members of the committee responsible for releasing the standards for obesity including BMI as a risk measurement had direct ties to pharmaceuticals that manufactured diet pills for profit. A fourth member was the lead scientist for the program advisory committee of Weight Watchers International. This committee advocated dieting for everyone who has a BMI more than 24. They shaved 15-20 lbs off the definition of “ideal weight” which made over 60% of Americans “overweight” over night. Soon we were hearing that 300,000 deaths a year were attributable to obesity.

In January 2005, the CDC came out with new “obesity and death” figures. These figures stated that no more than 110,000 deaths per year could be connected in any way with obesity. They also stated that the link “may be a weak one.” The lead scientist of the CDC also said that a critical analysis of their data found that people whose weights fell within the overweight, obese, and severely obese BMI ranges tended to live longer than those whose weights fell within the so called “normal BMI” ranges.

Weight Loss Doesn’t Work

“There isn’t even one peer-reviewed controlled clinical study of any intentional weight-loss diet that proves that people can be successful at long-term significant weight loss. No commercial program, clinical program, or research model has been able to demonstrate significant long-term weight loss for more than a small fraction of the participants. Given the potential dangers of weight cycling and repeated failure, it is unscientific and unethical to support the continued use of dieting as an intervention for obesity.” — Wayne Miller, an exercise specialist at George Washington University (emphasis mine)

Surprised? If you are it’s probably because the diet industry spends 60 billion dollars a year trying to sell…I mean tell…you otherwise.

In a recent discussion I was having online about this, someone cited the study “Behavioural correlates of successful weight reduction over 3y,” from The International Journal of Obesity (2004, volume 28, pages 334-335).

I researched it and it turns out that it gets cited a lot. There are lots of interesting things about this study:

• “Success” is defined as “weight loss of 5% or more from baseline” over the three years. So if a 5’4″ person who was 350lbs loses 17.5 pounds and now weighs 332.5lbs, this study calls them a success, despite the fact that they are still considered “morbidly obese” on the BMI scale.

• Other studies have shown that 95% of people gain their weight back within 5 years, so this study gave itself a two year efficacy cushion.

• The study had a 77% dropout rate. And they don’t know why people dropped out. One reason could certainly be that they followed the strict guidelines, didn’t lose weight and so quit the program.

• In total, 198 out of the initial 6,857 people actually obeyed the seven required diet restrictions. 40% of those “elite dieters” failed to lose even 5% of their body weight. So, about 119 of 6,857 (.017%) actually followed the diet lost 5% of their body weight. Which, unless they were only slightly overweight to begin with, would have little to no effect on their BMI. But people cite this study and say that the other 99.983% of people clearly just lacked self-control.

“Just eat less and exercise more” doesn’t work.

In the 1960s scientists experimented on prisoners, doubling their calorie intake to see if they could cause them to gain 20-40 pounds (of course this was before ethics and IRBs rendered such a study unethical). From Garner and Wooley:

“Most of the men gained the initial few pounds with ease but quickly became hypermetabolic and resisted further weight gain despite continued overfeeding. One prisoner stopped gaining weight even though he was consuming close to 10,000 calories per day. With return to normal amounts of food, most of the men returned to the weight levels that they had maintained prior to the experiment.”

So when fat people are able to lose weight, is it because they are now eating like “thin people” eat? Actually, studies show that a high percentage of fat people who keep weight off, become, for all intents and purposes, disordered in their eating. From Garner and Wooley:

“Geissler et al. found that previously obese women who had maintained their target weights for an average of 2.5 years had a metabolic rate about 15% less and ate significantly less (1298 vs 1945 calories) than lean controls. Liebel and Hirsch have reported that the reduced metabolic requirements endure in obese patients who have maintained a reduced body weight for 4-6 years. Thus, successful weight loss and maintenance is not accomplished by “normalizing eating patterns” as has been implied in many treatment programs but rather by sustained caloric restriction. This raises questions about the few individuals who are able to sustain their weight loss over years. In some instances, their eating patterns are much more like those of individuals who would earn a diagnosis of anorexia nervosa than like those with truly “normal” eating patterns.

And from the New England Journal of Medicine:

“Many people cannot lose much weight no matter how hard they try, and promptly regain whatever they do lose…

Why is it that people cannot seem to lose weight, despite the social pressures, the urging of their doctors, and the investment of staggering amounts of time, energy, and money? The old view that body weight is a function of only two variables – the intake of calories and the expenditure of energy – has given way to a much more complex formulation involving a fairly stable set point for a person’s weight that is resistant over short periods to either gain or loss, but that may move with age. …Of course, the set point can be overridden and large losses can be induced by severe caloric restriction in conjunction with vigorous, sustained exercise, but when these extreme measures are discontinued, body weight generally returns to its preexisting level.”

Yo-Yo Dieting (aka Weight Cycling) may be worse for you than being overweight.

“Obese humans typically show repeated loss and regain of large amounts of weight. Men with large fluctuations in weight between the ages of 20 and 40 have increase systolic and diastolic blood pressure and cholesterol. These yo-yo dieters are two times more likely to die of coronary heart disease, even after adjustment for known risk factors, than are men with stable or steadily increasing weight. Fluctuations in body weight have been shown in many other major epidemiological studies to have deleterious cardiovascular effects resulting in increased mortality.” - Case Western Reserve University’s Paul Ernsberger

Dangers of Yo-Yo Dieting include:

• Liver issues
• Lower metabolism
• Heart disease
• High blood pressure
• Loss of muscle
• Stroke
• Type II Diabetes
• Cancer
• Shorter life-span
• Loss of muscle and lower metabolism make it nearly impossible for you to lose weight

I will say it again…

Companies and their insurance plans are penalizing their employees for not doing something that nobody can prove is possible, for a reason that nobody can prove is valid, with a probable outcome of leaving employees less healthy than they were when they started.

It’s not right, it’s unfounded discrimination, and it needs to stop. Right now.

My research for this project came from a number of sources including (where not otherwise cited):

www.nejm.org (the New England Journal of Medicine)

http://www.healthread.net

http://www.junkfoodscience.blogspot.com

www.nature.com/ijo

www.suite101.com

www.bodylovewellness.com