Friday, November 6, 2009


I was leaving my office to do a quick errand the other day, and I caught a snippet of a radio interview about the current state of health insurance. The guest (I can't tell you who he was...) was suggesting that certain groups should pay higher premiums because of their increased risk for illness and injury.

I already knew what was coming...

On the positive side, he mentioned a few categories of people who engage in a variety of risky behaviors - ski jumping was part of the list - before he went to the F word to explain who should take on more of the high costs of insurance. Not surprisingly, he spent the most time (at least what I heard) explaining that people who are fat put a burden on our healthcare system.

If you've been listening to the healthcare debate, undoubtedly you've heard this idea many times by now - people who are "overweight" and "obese" need to lose weight or pay higher premiums because they are costing us too much money. I have a big problem with this thinking.

First, let me say that I have nothing against people losing weight - if that's what their bodies naturally do when they live a life of wellness. It's just that I'm weight neutral. Body size is a characteristic - not a behavior - and therefore not necessarily malleable. We cannot know anything about a person's health status based on size - and many of the correlations between health and weight have been debunked.

Think about this: The person who is fat because of an illness, or a medication, or genetics, or a history of yo-yo dieting. Should they be punished with higher premiums?

How about a person who eats a healthful diet, exercises regularly...and is fat. Should they be punished with higher premiums?

How about a person who never exercises, eat a poor diet...and is thin. Should they be rewarded with lower premiums?

All of these scenarios exist. If companies want to offer incentives, they need to be based on behaviors that can be quantified and applied to ALL individuals, regardless of gender, race, ethnicity and size.

If insurance companies want to offer incentives for reduced premiums, the fair approach is to target behaviors we can all potentially engage in, such as not smoking or participating in regular exercise. Many will argue over whether even these incentives are fair; but at least if we level the playing field, then people of all sizes can potentially improve their health and lower their insurance costs - isn't that what everyone wants?

This focus on weight loss is damaging to our individual and cultural psyches, and does not move us any closer to solving the healthcare crisis.

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