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Alabama 'Obesity Penalty' Stirs Debate

Plan Calls for State Employees to Pay More for Health Insurance if They Don't Lose Weight
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Opponents of the Obesity Penalty

While the plan might seem practical, some experts question whether paying a fee for being obese is the best motivator for overweight people.

"We certainly wouldn't support these kinds of punitive measures," says Jeffrey Levi, PhD, executive director of Trust for America's Health and associate professor of health policy at George Washington University School of Public Health. "The successful measures by health plans focus on incentives rather than punishment."

The Alabama requirements, Levi tells WebMD, could be interpreted as a genetic penalty for those who are predisposed to having extra weight or high cholesterol. Some people also require a variety of treatments or medications before finding one that is effective. Making those who fail pay from their pockets also places more economic pressure on them, he says, which could lead them to turn to cheaper, calorie-dense food.

"We need to recognize the complexity of these things," Levi says. "Just addressing this through the health care system is insufficient. What are we doing about the workplace environment? What's served in state cafeterias and hospitals? We need to do the voluntary things first for people to be able to make healthy choices before forcing punitive measures."

Alabama employees at risk will receive some help in their quest. The state is arranging programs with Weight Watchers and offering employees YMCA discounts. Information will also be available at behealthy.com, a Blue Cross-Blue Shield web site that provides online wellness tools and news.

But the prime motivator for this policy is hefty health care costs. And the attitudes of employers and employees may reflect an ambition to help remove obesity from the equation.

Employees and Employers: Seeking Obesity Solutions

A recent survey conducted by the National Opinion Research Center (NORC) at the University of Chicago, partnered on the research with the George Washington University School of Public Health and Health Services , showed that:

  • 80% of employees, regardless of weight, believe healthy lifestyles/weight management programs belong in the workplace.
  • 67% of employers are concerned about obesity's effect on medical claims expenses.
  • 93% of employers see obesity as a preventable condition and due to poor lifestyle choices.
  • Fewer than half of employers believe their company has given enough attention to the problem of obesity.


Christy Ferguson, director of the STOP Obesity Alliance in Washington, D.C., which commissioned the survey, tells WebMD that while employers are eager to promote weight loss, only about a quarter of those surveyed believe financial penalties should be placed on those who have difficulty succeeding.

"While employers and employees favor positive financial incentives, they oppose negative financial penalties," she says. "There's a strong support for the carrot, so to speak, and not-so-strong support for the stick."

Key in all of these programs and findings is that shedding excess pounds is intrinsic to good health. But does thin and trim always equal fit and healthy?

A report released this month by The Archives of Internal Medicine, which weighed cardiometabolic risk factors vs. weight, revealed that among the 5,440 participants -- U.S. adults 20 years old and older -- 23.5% of "normal weight" adults were metabolically abnormal. Conversely, 51.3% of adults deemed overweight and 31.7% classified as obese were declared "metabolically healthy."

Lifestyle and activity levels certainly vary between individuals, but the link between weight and health doesn't appear to be absolute. And unlike many conditions which remain discrete, obesity is on full display.

"I don't think we can arbitrarily pick out one specific set of people with health risks," San Francisco internist Ann Haiden, MD, tells WebMD. "There is evidence that fit people with a little excess weight can actually be healthier than unhealthy normal-weight people. What we don't need is for a policy like this to turn into yet another reason to exclude as many people as possible from the insurance pool."

Even with a $25 monthly bill, Alabama state workers boast a plum health care plan. Single state employees pay no insurance fees, Unger says, while family plans -- which can include a spouse and several children -- only cost $180 per month. Spouses and children of state workers will not be subject to the wellness screenings.

Legally, these new protocols could face few serious threats.

Myra Creighton, an Atlanta labor and employment attorney who specializes in health-related issues, says many people are unsympathetic to obese individuals, which could make civil liberties organizations reluctant to pursue opposition. Michigan, she says, is the only state where weight is categorized as a protected class for workers.

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