Alabama 'Obesity Penalty' Stirs Debate

WebMD has a good story on Alabama's plan to do BMI (body mass index) screenings on state employees and require those classified as obese to pay an additional $25 per month on their health insurance-- a so-called "fat tax."

Count Dr Jeffrey Levi, executive director of the Trust for America's Health, as an opponent of the state's plan. "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."

How punitive is the new measure? "Even with a $25 monthly bill, Alabama state workers boast a plum health care plan," notes the article. "Single state employees pay no insurance fees, [Deborah] Unger [clinical director for the Alabama State Employees Insurance Board] 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."

The implicit assumption behind the new program is that obesity correlates with poor health, which in turn correlates with higher health care costs. But, asks WebMD, "does thin and trim always equal fit and healthy?" Not necessarily. Citing a recently-published study on cardiometabolic risk factors and weight (which I noted in a previous post), WebMD concludes: "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."

So, the debate over Alabama's "fat tax" encapsulates two larger issues that invariably get raised in any discussion of ways to improve people's health (and thereby bring down costs of the healthcare system): first, whether a recommended intervention approach is adequately grounded in findings of empirical research; and second, what kinds of incentives are most effective at getting people to change their behaviors. These are two issues that I hope to be looking at in more detail over the next few months.