Talk of the fiscal cliff and ObamaCare makes me worry about my overweight friends. I fear it’s only a matter of time before they are blamed for dragging down the economy. Obesity is a huge expense, and unlike other costly health problems, obesity is in plain view.
Today, just over one third of Americans has a Body Mass Index of 30 or more, the obesity range. Per-capita medical spending for those individuals is 150 percent higher than for those who are not obese. The Institute of Medicine and other experts estimate the United States spends between $150 and $190 billion a year on obesity-related problems. Spending is driven by prescription drugs and medical procedures for heart disease, cancers, diabetes, and the other chronic diseases of obesity and by days missed from work and the long-term disability that commonly occurs. When public funds from Medicare and Medicaid pay the bill, everyone is impacted, but even when public funds are not involved, everyone pays higher insurance premiums to cover the cost.
Few of us realize that the U.S. health care reform law of 2010 (ObamaCare) allows employers to charge obese workers 30 to 50 percent more for health insurance if they decline to participate in a qualified wellness program. A growing number of companies have begun to make obese workers enroll in weight loss programs or pay higher insurance premiums. For instance, state workers in Alabama are subjected to at-work weigh-ins and body fat tests. Anyone with a BMI of 35 or more must attempt to lose weight or have $25 automatically deducted from their paychecks. To opt out of the weigh-ins, one can accept the $25 deduction.
This approach assumes that all obesity is a matter of personal control, but is it really? Research suggests that some obesity has as much to do with biology as with will power. Genetics, intestinal microbes, viruses, and unknown factors may play a role, and when weight is lost, metabolic and hormonal changes can make maintenance difficult for many. The role of society comes into question as well. The food industry manipulates the human brain to respond to food cues for corporate profit and communities make it difficult to get around without using a car.
Don’t shoot the messenger, but I predict that obese individuals will incur more discrimination as money gets tighter and obesity rises. By 2030, 42 percent of adults are forecast to be obese. We have a lot of room for change, and not a lot of time.