OT--Alabama 'Obesity Penalty' Stirs Debate

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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

By Don Fernandez

WebMD Health NewsReviewed by Louise Chang, MDAug. 25, 2008 -- Obese

Alabama state workers may soon pay a health insurance penalty for

their excess pounds.

Beginning in January 2009, state employees will be required to

receive medical screenings for several conditions, including body

mass index (BMI). Those who are considered obese -- along with

exhibiting other negative health factors -- will have a year to get

in shape.

The penalty for failure? A $25 increase in their monthly insurance

costs.

Although critics view the penalty as a " fat tax, " Alabama officials

believe the new policies will result in fitter, healthier, and

happier employees -- as well as help reduce the state's mounting

health care costs.

" Our goal was to make our members aware of those risk factors, "

Deborah Unger, RN, clinical director for the Alabama State Employees

Insurance Board in Montgomery, tells WebMD. " As long as you are aware

and are doing something to correct it, there won't be a fee. We

either do something to control claims costs or you pay the premium

anyway. "

Alabama now ranks as the second most obese state in the U.S.,

according to the CDC -- perhaps a clear sign that change is needed.

In addition to BMI, the state will screen three additional criteria:

cholesterol, blood pressure, and glucose levels. These four risk

factors have consistently resulted in costly treatments for the state.

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 Levi, PhD, executive director of Trust for America's

Health and associate professor of health policy at 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 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.

Ethical Issues of Penalty Proposal

Still, she does question certain ethical aspects of these actions.

" Do I have any privacy interests in my body weight? " Creighton

says. " I'm just glad my firm doesn't require me to hop on a scale. "

While the converted are often the most zealous agents for change, one

Alabama resident who triumphed against the scale finds the state

requirements somewhat troubling.

Enterprise, Ala.-resident Shultz, this year's runner-up on the

NBC TV show The Biggest Loser, nearly cut his formerly obese physique

in half while appearing on the show. Shultz, who lost 164 pounds, has

kept his 6-foot-3-inch frame at a lean 222 pounds since the show

ended. He's now a spokesman for Scale Back Alabama, a state-sponsored

campaign that promotes weight loss and exercise.

Keeping trim in Alabama is sometimes challenging: " We deep-fry

everything, " he tells WebMD. But instituting fines for failing

doesn't seem like the right step to him.

" I worked for a state institution and I'd hate to see something

monetarily taken away from me, " says, Shultz, who was employed at two

Alabama colleges. " We have to be healthy, but I don't think you

should penalize people for being heavy. "

--

Dodge

Resolve to be tender with the young, compassionate with the aged, sympathetic

with the striving, and tolerant of the weak and wrong, because sometime

in your life you will have been all of these.

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