Should companies tie health insurance premiums to employee’s health?

Marketwatch.com is reporting that, when employees sign up for some company-provided health insurance plans, physically fit workers are charged less, fatties more.

... as companies struggle to curb rising health-care costs, they are increasingly pointing a finger at workers’ ballooning bellies. Obesity-related health problems account for a big chunk of medical claims, insurance experts say, leading some executives to believe the best way to trim their budgets is to get workers to trim their own fat first. ... For the past few years, companies have experimented with tying health insurance premiums to people’s health. Here’s how it works: Employees go through medical and biometric testing as part of their health insurance open-enrollment process. They are weighed, their height and blood pressure are measured, and their blood is drawn. Those with high scores on cholesterol, glucose and blood-pressure and — or with chronic conditions like diabetes — are told they will have to pay higher premiums unless they actively try to improve their risky condition.

It's entirely fair to make people whose lifestyle choices result in higher health risks to internalize the medical costs of those choices. (It's a different matter for people born with health challenges, even though they, too, tax the medical system more than people without congenital maladies.) However, it's questionable whether requiring fat people to pay more will actually incentivize them to lose weight.

Fat people already pay a high price for being overweight. They are usually ashamed of their condition. They know they are putting their health at risk. They literally have trouble comfortably fitting in society. Everyone prefers to look good and feel well. All else held equal, no one wants to be obese.

So while I support a higher medical premium for those who are overweight or who smoke or drink or do drugs, I doubt the added cost will tip the scales toward making fat people drop down to a healthier weight.

I think the two major factors needed for an obese person to get healthy are internal motivation and dietary education.

For some, the internal motivator may be a health crisis, such as a heart attack or developing diabetes. It might be turning age 40 or 50. It could be the birth of a child or an imminent marriage or a divorce. Whatever it is, the fat person has to desperately want to lose the weight and has to use that motivator to drive himself to do everything possible to change his lifestyle, including eating properly and exercising regularly.

Dietary education is something seriously lacking in our society. The main reason so many people are so fat is because they eat foods with added sugars. Sugar is what makes you fat. There has long been a focus on animal fats and calorie counts in diets. That's mostly a waste of time. The key educational component that fat people need to understand is that they are addicted to sweets, and they need to eliminate all added sugars from their diet. They need to cut out all sodas (even diet sodas), all cakes, all candies, all honey, all ketchup (which is loaded with sugar) and all processed foods where sugar is added.

The one sugar that is okay to eat is fruit, as long as the fruit is loaded with fiber. Our bodies can process the sugar in fruits without turning that sugar into fat. But fruit in the form of juice, where the fiber has been removed, is very much the same as drinking a can of Coke. It's unhealthy, and to the fat person it is poison.

Once obese people completely eliminate all foods with added sugars -- it takes a few weeks to detoxify a body from sugar and end all cravings for sweets -- dieting is easy. The rest is just common sense: Eat a modest meals and don't pig out in between or after dinner.

Less obvious -- and not hard to follow -- is the need to eliminate all foods with gluten and dairy. It's not so much that milk and cheese or pasta and bread are addictive or that your body cannot process them. It's that these food groups cause chronic inflammation, and in fat people inflammation results in added belly fat. As it pertains to health, belly fat is worse than other bodily fat deposits.

Keep in mind that because fat people are food addicts, eliminating entire food groups (dairy, gluten and sugar) is far easier than trying to eat modest amounts of these groups. It's very much like an alcoholic. He can maintain his sobriety if he resolves to drink no alcohol. His addiction makes it impossible for him to just drink in moderation. Fat people need to address sugar, gluten and dairy in the same way.

The final component to good health is the need to move, to burn off the calories once takes in. With internal motivation, a fat person will be able to gradually increase the amount they exercise. An adult who wants to get and stay fit should work out for 30 minutes twice a day. That is achievable by starting out doing less and slowly adding more. It really doesn't matter what the exercise is, as long as it involves movement. A 30 minute walk and 30 minutes on a stationary bike would be sufficient. A half an hour of skipping rope and 30 minutes more swimming laps will do the trick, too.

If a fat person is in terrible shape, it's fine to start off with a 5 minute walk in the morning and 5 minutes dancing at night. After a few weeks of that, just add 5 minutes to the morning walk, and a few weeks later add 5 minutes to the dance. In a few months, he can achieve 30 minutes of exercise, twice each day.