I was reading this article from the recent obesity series in the Lancet the other day and found myself becoming increasingly incensed at the discussion of “examples of shifting the cost of obesity to the obese”.

According to the article, the American government now “allows group health insurance plans to charge 30% higher premia to enrolees who are overweight and refuse to participate in qualifying wellness plans.” While I am well aware that obesity is a risk for many diseases, and may be classified as a disease in and of itself, this approach left a bad taste in my mouth. My immediate response was “WHAT ABOUT HAES (health at every size)??”. Not everyone who is overweight is unhealthy, and plenty of people who are “healthy” weights are not actually healthy and live unhealthy lifestyles. In addition, how do we know that these “state endorsed” wellness plans are any better than any other measures an individual might undertake to lose weight and/or become healthier?

This approach becomes even more suspect when you read a little further down the paragraph and see: “an insurance company can give a 30% premium discount to those with a body mass index of 26 or less. To get the same discount, those with a BMI greater than 26 must walk 150 min per week…” Considering that it’s widely known that BMI is a poor indicator of overweight and obesity (and weight, in turn, not an accurate indicator of health) I find this statement disturbing. It’s possible to be classified as overweight, even obese, by BMI and to be healthy. I’m also curious about the rationale of making the criteria for obtaining a discount walking 150 minutes a week. If the aim is to make people lose weight, it’s highly unlikely that 21 minutes of walking per day is going to achieve that goal. Even if the goal is to make people healthier, regardless of weight, that level of activity is going to make minimal impact. I can’t help but wonder if there was any scientific rationale whatsoever behind this decision.

Reading on… The next example was of a public-health insurance programme that won’t cover nutrition education, bariatric surgery, nor weight-loss management in its basic plan, but if enrolees who, “sign an agreement outlining their responsibilities for meeting health goals receive an enhanced plan with expanded coverage for such services.” That makes sense <– read in sarcasm font. Of course, let’s not allow people to access services in a preventative manner, let’s wait until they’re in need of bariatric surgery to cover their visits to a dietitian. Sigh.

It get’s even better… New Zealand apparently has an “immigration ban on individuals whose body mass index is in the obese range, because they are considered to be a potential burden on the health system.” Yep, that’s right, somehow discriminating against people because of their body weight is thought to be a reasonable public policy. All I can say is “wow”.

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