Should Health Insurers Charge Overweight People More?

I was flipping through the latest issue of Money Magazine and at the very end was a poll question: Should health insurers penalize people for their behavior?  The two big culprits for medical expenses in the US are obesity and smoking.  We've been effective at decreasing smoking (only 21% of Americans smoke these days), but not so well on controlling obesity since 34% of Americans are obese and over 50% are overweight. We curbed smoking in the US by scaring the bejesus out of everyone with pictures of black lungs and pale people hooked up to ventilators wheezing away.  We added a Surgeon General's warning to the packaging.  We taxed cigarettes into the stratosphere and made it difficult for people to smoke around others; smoking bans are in place in most public places now and many of the healthy and haughty look down their noses at those who smoke.  My sister got offered a job that was later rescinded when her potential employer learned that she smoked.  This was entirely legal for them to do and it was the impetus to get her to finally quit the habit. Should we charge by the pound for obesity? The magazine poll had 31% of respondents in agreement that we should penalize unhealthy behavior.  To the poll responders' credit, 38% said no to penalties, but felt insurers should offer incentives to help people live a more healthy lifestyle. The American Lung Society heavily promotes the Great American Smokeout, a random day chosen to encourage smokers not to light up for 24 hours, and maybe quit altogether.  ALS offers lots of support and corporate sponsored programs and t-shirts and water bottles. Should the American Obesity Foundation (I made that up) create the Great American Scale Day where everyone who is overweight gets weighed and embarks on a rigorous diet and exercise program?  Is anyone getting uncomfortable yet?  Does anyone feel Big Brother breathing down our necks? We took cigarettes off the shelves and sequestered them behind counters, available only with proper ID.  Will we be forced to do that with Doritos too?  Yeah, right... There are some parallels to both health problems; most smokers don't want to be smoking, and most overweight people don't want to be overweight.  But there are some pretty distinct differences, most glaringly that smokers can live without cigarettes, but people can't live without food. So what are some smarter ways to address the problem? Here's some options: Encourage grocery stores to reorganize their shelves to put the healthy stuff at the front and the not-so-good stuff in the back.  Feel free to cut down on the availability of unhealthy stuff, too. Educate children on how to eat well.  I was sadly shaking my head watching Jamie Oliver on his TV show in front of a class of grammar school students who couldn't even identify a potato.  These kids had only ever seen processed food!  Teach them to eat well and maybe they'll shame their parents into making better choices.  That's what the green movement is doing and it's working wonderfully as children make their parents swap out incandescent light bulbs for flourescents. Continue to ramp up and fund the US government's campaign against obesity.  Michelle Obama's "Let's Move" plan is targeted towards kids but it will spill over quickly to adults for the reasons mentioned above.   By getting the message out there, over and over again (like the smoking campaigns of the '70s and '80s), we'll provide people with information and educate them to make wiser choices. Calorie labelling in all restaurants. This trend has started coming to the larger chains, but I'd love to see this trickle down to every restaurant we visit.  It's really not that hard to figure out the calories of a dish.  Simple computer programs do it in a few minutes.  In New York state where this law is already in effect, researchers have already seen changes in behavior; people are choosing the lower calorie, and presumably healthier, meals. Give the biggest risk groups more tools. Inner city kids need safe places to play and burn off energy.  When revamping school lunch programs, start with the poorest school districts and work our way up.  The upper middle class has the least problems, statistically, with obesity.  Put the money where it really needs to go first.  If we can turn around our poorest schools successfully, then it should be easy to encourage the more affluent ones. What would you do?  Should health insurance companies charge "by the pound"?  Please share your thoughts. Lisa

About Lisa Johnson

Lisa Johnson here. I've been a personal trainer since 1997, a Pilates instructor since 1998 and the owner of Modern Pilates since 1999. I'm hoping to give you some good ideas to get or stay in shape with a healthy dose of humor and reality. Thanks for joining me.

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17 Responses to Should Health Insurers Charge Overweight People More?

  1. Sherry May 30, 2010 at 10:08 pm #

    Interesting article!

    I’m Canadian and we have a condo in Florida. I have to tell you that every time we go to the condo, I am absolutely dumbstruck by the number of obese people that I see. Not that all Canadians are slim, far from it, but there is definitely a difference. One of the reasons (in my humble opinion) is the size of the portions that are served in restaurants that we frequent near our condo. They are enormous!!! The portions are 2 – 3 times larger than they should be and I see folks cleaning their plates! My recommendation is to eat no more than half of what you are served and take the rest home for tomorrow’s lunch!

  2. Jason May 31, 2010 at 12:35 am #

    I like the idea of giving breaks for those who workout and do things to take care of themselves. It does not sound as good too charge more for fat people, I guess it is all the same in the end.

    The better you take care of yourself the better rate you get.

  3. Lisa Johnson May 31, 2010 at 9:02 am #

    Sherry, I agree that portion sizes is one of the most “sneaky” ways for Americans to inadvertently gain weight. If you’re like me you were raised to “clean your plate” because there were starving children in Africa … (I have to say it is the one thing I wish my parents did differently when they raised me!).

    Jason, I think you’re right, it’s always better to encourage the positive instead of penalizing the negative. At least as far as personal behavior goes. I think there’d be a few early adopters and then a few more and then there’d reach a tipping point and we’d be back to where we were in the ’60s and ’70s with a relatively controllable obesity problem.

    Either way, we’ve got a lot of work to do.


  4. Gini May 31, 2010 at 11:30 am #

    I am not a fan of legislating what people can or cannot eat. (That includes trans fats & salt.) I think it’s important to analyze what motivates people to change. There’s a great program called Motivational Interviewing that addresses this subject.

    It’s a no brainer to me that smoking is bad. I’ve never had the urge to light up, not even during those experimental college days. But, it isn’t so black and white to others and the same goes for over eating, eating poorly or even under eating which is also bad for you.

    I love incentive programs but have a feeling that will only inspire the already inspired to keep at it and will have little affect on those nowhere close to being inspired.

    As for charging more for health insurance, well, if you are a male under the age of 25, you (or more accurately, your parents) are likely paying more for your car insurance precisely because you are deemed a greater risk to the insurance company. So, if you choose to live in a manner that puts you at greater risk for long term insurance payouts, it’s logical the insurance company is going to want to charge you more for your premiums. This might be a necessary action unless everyone else is willing to take a premium hike to pay for the costs. Long term, though, I think getting to the root of the problem in a positive and constructive way is what’s necessary to create real change in our country.

    P.S. Sherry, My parents lived outside the US for several years and were always awe struck upon their return home, particularly the Super Sizing of soda drinks.

  5. Lisa Johnson June 1, 2010 at 12:46 am #


    Thanks so much for the comments. I have to say, since I’ve written this post. I’ve been thinking if we reinforce positive behavior we are defacto charging a premium for obesity.

    For instance, say we give a “bonus” for people with health BMI, then we’re basically penalizing people who don’t have healthy BMI … trust the people who are overweight will be well aware that it’s a way to discount for healthy behaviors and a backdoor way to charge overweight people more.

    Still, I also see your point about young men having to pay more insurance for their cars because they are a greater risk. Those of us who are healthy are already shouldering the additional costs of those who are not. Each diabetic costs $1,400 more per year for an HMO. But they’re not paying $1,400 more. There’s a slippery slope here though … would you charge more money for someone who is genetically predisposed to obesity? Even if they aren’t yet?

    We need to keep the dialogue open and try to find solutions that work for everyone, in a positive way. It’s tricky but it’s doable and it definitely starts with lots and lots of education …

    Thanks for the comments,


  6. Gini June 1, 2010 at 7:55 am #

    This is such a great topic, Lisa!

    The other aspect to look at is how much education the medical community has about nutrition during their training which is nearly nil. And the education they do have is antiquated. So much of what ails us can be healed (or prevented) by what we eat, yet there is rarely a dialogue between patients and doctors regarding nutrition unless the patient has already developed life threatening symptoms and even then, because of the deficit in adequate training, the information can be confusing and overwhelming to the patient.

  7. Christine June 1, 2010 at 11:51 am #

    Hey, I kind of talked about this subject on my own blog on Friday: The idea of penalizing people for their lack of weight-loss attempts (or, for being fat) is an interesting idea. Many researchers are showing that it’s a more motivating reason for losing weight than financially rewarding for “good behavior.” I see the pros and cons of the subject, personally. On one hand, I support individual businesses doing what they can to cut down on healthcare costs. On the other hand, I think that work should be concerned about my actions and work and should stay the hell out of my personal life. (Like most things in life, the answer is probably somewhere in the middle.)


  8. Andrei June 7, 2010 at 11:34 pm #

    To answer your question, Should we do the same thing with obesity? ( As in what we did with smocking) Short answer is no. Smoking had a direct impact on non-smokers. Thus, other people’s poor decision affected everyone’s health around them.

    Relative to smoking, obesity doesn’t seem to have direct second hand negative impact on others. Unless it’s a caregiver or a family member that is burdened with taking care of the obese relative. Obesity is literally one person’s problem. I am not even calling it a disease, because ultimately we are responsible for our own actions. No one is holding a gun to our heads and forcing us to eat a dozen glazed donuts, fried chicken, and super sized fries in one sitting everyday. Yes, there are some people that do have underlying medical conditions that cause weight gain, I’m referring to those who can’t put the fork down.

    There’s enough information about what’s healthy and what’s not. I don’t buy the argument that people just don’t know.

    With that being said, insurance companies without question should charge by the pound. Thats the price you pay for 10 seconds of euphoria.

  9. Karen (NYCEsthy) July 6, 2010 at 2:05 pm #

    Such a tough topic, Lisa. And a slippery slope, and honestly I am not sure how I feel about it.

    That said, I believe insurance companies are already charging as such, although perhaps not due to obesity specifically.

    When our medical insurance went up another whopping percent this year, after a large increase the year before, my husband asked the benefits administrator why. The person said that the insurance company was raising rates because of the age group and conditions of the insured within the company. So while the increase was spread out company wide, it did have to do with the relative health of those within the company.

    Now, this could be total bunk and a way for my husband’s employer to kind of pass the buck on the astronomical increase, but that’s the story we were given. So if there was a younger, healthier pool of insured, I would assume that our costs would not be so high.

  10. Lisa Johnson July 6, 2010 at 10:17 pm #

    Karen, you’re right. They take a risk assessment and one of the risks they look at is age as the older you are the more likely you are to have expensive things like heart disease and hip replacements (both related to obesity BTW). If 7 of the top 10 diseases are related to obesity then using age as an “ok” determinant will automatically also penalize people who are obese. (We gain weight as we age, i.e. the middle age spread.)

    There have been years where my husband’s insurance went up more than the raise he got for that year, which is pretty sucky to see your standard of living decreased by your health insurance. Sigh.

    So if you were thin and knew you were paying for obese coworkers who were taxing the system would you want to pay for their foibles? To ask the question from a different perspective, would you want to pay extra to cover someone who was engaging in other types of “risky” behavior, say sky diving or smoking? We pay for those folks too … Is it fair? What would those people have to pay if the healthy types were taken out of the equation? Would that be enough to make them change their behavior?

    I don’t have the answers, I’m just asking the questions …


  11. Jessica October 30, 2010 at 10:49 am #

    Yes, health insurance companies should charge more for individuals who are obese. In the least, they should charge more for those who are obese and are not on some type of valid weight management program. I work in the operating room as a surgical tech (I assist surgeons at the surgical field). We are faced daily with patients who come in for minor to major surgeries whose weight and/or poor diet are the main contributor for their need of surgery. I cannot tell you how sad it is see 300-500 pound patients who are so ill because of their weight. The expense of how many people are in need a sugery would be drastically reduced in this country if we were forced to do all we can to be of a healthy weight. Those of us who are trying to take care of our bodies are being ripped off by insurance companies who increase premiums annually due to more oand more folks being fat and needing more care. Obesity is like a cancer, the disease spreads to different bodily systems and creates an avalanche effect on one’s overall health. Just as people have shown us what black lungs look like, we should start posting photos in ads of fat, inches of fat, fat around organs, etc. When you see what it looks like on the inside, it has a very powerful impact.

  12. Lisa Johnson November 1, 2010 at 8:48 am #

    Jessica, thank you for a very powerful contribution. It’s a harsh reality that obesity kills and we’ve been trying to sugar coat it for years. Maybe we should be more direct. I could see it backlashing in a bad way though … I don’t know. I really appreciate the insight into the operating room however.

  13. Ally Speirs November 1, 2010 at 9:11 am #

    I have been an OR nurse for 25 years. More and more patients enter surgery for procedures which cause a higher risk than normal due to obesity. People are coming in for procedures such as total knee joint replacements at a younger age, because they are wearing out their joints due to being morbidly obese. They cannot move themselves from a stretcher to the OR table without help,they have sleep apnea, and wear CPAP machines at night. We are talking people in their 30`s and 40`s here.They suffer from skin infections under the folds of fat, liver problems, heart and blood pressure problems, truly it is scary.
    It is grossly unfair to expect people who are trying to lead a healthy lifestyle to pay increased premiums due to the growing numbers of obese citizens in our communities.
    A lot of it has to do with education, but I find a lot of it has to do with them just not desiring to stop eating the way they do. I also have to add that a record number of health care workers also are falling into the same sad state of affairs, not very good role models.

  14. Lisa Johnson November 1, 2010 at 9:15 am #

    Ally thanks so much for your comments, it’s interesting having two OR nurses back to back with their opinions. You’re on the front lines of the obesity war. You see the true “casualties” mounting up. With 25 years experience it looks like you’ve seen the shift happening too as Americans become more obese. Thanks for stopping by.

  15. ER RN February 10, 2011 at 1:31 am #

    I am a nurse as well, in the ER. I have taken care of many overweight patients, and I have a hard time feeling any sympathy for them. Why? Because I myself lost 60 lbs, while working night shifts and 12 hr shifts, and have kept it off for 7 years now. It’s hard work to get out there and exercise and eat right, but I do it for my children. I want to set the best example possible for them, and be around to see them grow up and live their lives. Also…with the technology we have today, you can keep anybody alive with a pulse. BUT, our country needs to realize that it’s more important to think about quality of life over quantity of years alive. You may be alive, but if you can’t move or feed or bathe yourself, or get out of bed even…is that any kind of quality of life?

  16. Lisa Johnson February 10, 2011 at 2:06 pm #

    ER RN, what I find surprising is how adamant the nurses are about telling people to just “get off their butts and do it.” It really came as a surprise to me. You guys are a little cold!

    It is hard to lose weight, it’s super easy to gain weight, there are tons of societal pressures, lack of education on the topic, and conflicting information if you do try a diet or lifestyle change. It’s so easy to get confused and just give up.

    I am always conflicted on this point, do you give “tough love” or do you give little nudges to get them going in the right direction? It probably varies by person for effectiveness but yes, we should try. I do think we’re moving in the right direction, albeit ever so slowly. I’m hoping for a leveling off of obesity or maybe even a slight drop in the annual numbers this year.

    Maybe I’m being Pollyannish, but I hope not.


  17. Deb June 1, 2013 at 12:58 am #

    I believe if you will charge more for fat people, then you need to charge more for ‘old’ people. There is more cost to providing for an older person then for a younger fat person. On that basis, you should charge more for someone with a highly expensive illness like HIV, too. How is it fair to single someone out for being fat? Most who are don’t want to be. Many have tried to diet. On that basis, you claim someone ‘who had unprotected sex’ and caught HIV is ‘more innocent’ then someone who ‘gained weight.’ Do you know why they gained weight? Were they raped? That is one reason people do it. Just be fair.

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