Greetings from Hanover, NH. I’m preparing for my talks at Dartmouth tomorrow and Thursday, in the meantime the always brilliant Dr. Deah sent me this interesting and problematic article [Trigger warning – headless fatty picture, obesity epi-panic talk, comments are as expected]. On the plus side it recommends an end to blaming and shaming fat people for our body size and points out that the government may be happy to blame us because then they can avoid facing controversial issues, some of which they caused, that affect all of our health. On the negative side they are still pathologizing body sizes rather than acknowledging that health and bodies come in many sizes, and the final paragraph is the most problematic to me:
The IOM report urges employers and insurers to do more to combat obesity. UnitedHealth Group offers a health insurance plan in which a $5,000 yearly deductible can be reduced to $1,000 if a person is not obese and does not smoke. Some employers provide discounts on premiums for completing weight-loss programs.
This is an issue that is really important to me. I already did a case-specific piece about Whole Foods fat punishment program, I am working with my publicist to do more corporate talks about this, and today I want to talk about it from a more global perspective.
Let me say this upfront: I think it’s great if employers want to support their employees’ access to varied food choices, safe movement options that they enjoy etc. I do not think it’s ok for an employer to force their idea of health or healthy habits onto employees.
It has become increasingly popular to use a “carrot and a stick approach” for, in theory, benefits cost savings. The supposed goal is encouraging employees to become healthier by making benefits more expensive for those who are perceived as unhealthy, using measurements like Body Mass Index, cholesterol, and blood pressure. These programs charge more to people who don’t measure up, either by giving “discounts” to employees who are perceived as healthy (carrot), or penalizing those perceived as less healthy (stick).
I’m going to give employers the benefit of the doubt and assume that they are just misinformed, though of course there is a possibility that since the majority of people in the United States are classified (in a very problematic way) as overweight or obese, employers are just using this as an excuse to save money by making their fat employees pay up. But, giving them the benefit of the doubt:
As a former CEO and Operations Consultant, I get that this could look attractive from a cost savings perspective, and altruistic if one believes that encouraging employee thinness is the same as supporting employee’s individual health goals. But I also know better than to buy into the latest thing without doing my research. It turns out, in the long term, these programs are most likely to leave employees less healthy, less productive and cost more.
Full disclosure – were I employed by a company using this approach I would be paying higher premiums. Not because I’m not healthy – all of my metabolic health markers are in the exceptional range. And not because I’m not active – I’m a three time National Champion Dancer who can do the splits and leg press almost four times my body weight. But my BMI puts me in the obese category. The problem is that BMI was created to compare relative body size among large populations and we incorrectly use it as measure of individual health. I’m not the only healthy person who would be caught by the use of this poor measuring tool – Arnold Schwarzenneger, Matt LeBlanc and many professional athletes would be paying up with me. So would anyone who is very tall or very muscular since BMI does not take body composition into account. Beyond which I think it’s inappropriate and a slippery slope to charge me more even if I was unhealthy and inactive but we’ll get to that in a minute.
Consider the fact that the employers have no proof that what they are requiring is even possible. Studies since 1959 have all shown that intentional weight loss, whether it’s called a diet, eating plan, lifestyle change, or something else, fails 95 percent of the time in the long term. So if employees are encouraged to lose weight, 95 percent of those who try will be as heavy or heavier with worse metabolic health than they started within a couple of years. Plus, it encourages employees to participate in unhealthy behaviors to “make weight” for the annual evaluation which can lead to health dangers including weight cycling (yo-yo dieting) and even eating disorders. In what other area of business would we look at these numbers and decide to move forward?
Organizations including the American Heart Association, American Cancer Society, Obesity Action Coalition and National Women’s Law Association have come out against these programs because of legal issues. Employees are starting to challenge these programs using the Americans with Disabilities Act because blood pressure, cholesterol and body size can be caused by genetics and/or health issues over which employees have no control, and they are being punished for something that there is no proof that they caused or that they can change. Employees are also suing employers who partner with programs like Weight Watchers and force employees to go or pay up since Weight Watchers and similar programs have been successfully sued by the Federal Trade Commission for deceptive trade practices and have no proof of long-term efficacy.
It’s going to get messy and expensive and I would think that nobody wants a piece of that action. In case you’re not already convinced, studies show that these kinds of incentives may work short term but can the opposite effect in the long term – “crowding out” intrinsic motivations that actually do work to motivate long term changes in healthy behaviors.
Let’s Review: Carrot and stick programs don’t lead to healthier employees, don’t save companies any money, and do create completely unnecessary exposure to legal action. Luckily, there are much better, more cost effective ways to give support employees who are interested in pursuing health.
Evidence strongly suggests that focusing on fitness rather than weight is the best chance for long-term health. Researchers have found that fitness trumps fatness and that simple healthy habits (like eating 5 servings of fruits and veg, walking 30 minutes a day, drinking moderately, and not smoking) even the playing field among people of all sizes. Thus giving options to support employee’s personal goals and choices without focusing on employee weight is the best choice. There’s a great case study of a Health at Every Size workplace health program in action on page 42 of this zine.
Punishing employees for perceived health risk is a very slippery slope. What is next? Surcharges for employees who mountain climb, ride motorcycles, have the breast cancer gene, have a family history of heart disease, don’t sleep the recommended amount? Can vegan employers charge non-vegan employees extra? I don’t personally think that employers should be in the business of policing employee health or providing health insurance – I think employers should be focusing on hiring the best person for the job, not trying to guess which employee is going to cost the most for their healthcare plan or trying to tell employees how to prioritize their health and how to get there. Given the current system, a Health at Every Size Approach is the only approach to supporting employee’s personal health goals that has an evidence basis. Some suggestions to support employees:
- Allow 30 minutes of break time during the day for employee walks
- Classes in the conference room – yoga, Zumba, Tai Chi, before work, at lunch, and after work
- Work with local gyms, dance studios, martial arts centers etc. to get employee discounts
- Consider subsidizing fitness classes as an employee benefit
- Have good filtered water at the office
- Bring in speakers to talk about Health at Every Size
Whatever you do, the research clearly shows that punishing employees for their size does not increase health or a company’s bottom line.
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