Do you have to meet some criteria during the checkup or just make sure you get it?

In the article it says:
If you're deemed fit, you're exempt. But if you flunk the BMI exam, it's shape up or pay up. Obese workers will be required to see a doctor and will have to show proof of their attempt to lose weight.

So.. yeah. You pay if you fail the exam. The criteria is that BMI OVER 35 is obese... Medically accepted, BMI over 30 is "obese."

Great. Unless they also charge the fee to people with low BMI who have high blood pressure, or smoke, or have a family history of cancer, it's straight up ignorant anti-fat bigotry.

disgusting. i agree with kris that it's a little better if they charge other people who qualify as unhealthy as well, but even still it is a disgrace. why why why are fat people treated with such disdain and made to feel that we deserve any discrimination we are subjected to? if we are fat, that means we are too lazy to get up and do something about it. as if there aren't thousands - maybe millions - of fat people who have tried diet after diet and failed every time, who work out daily and are healthy but never skinny, who eat in moderation just like tons of thin people, but always stay the same weight. come on! this is pure greed!

Smokers pay more. When they whine we turn our heads and don't listen.

You're just paying for the risk, it's not personal, it's a business.

I'm sorry your feelings are hurt, but the reality of it is that you cost more, you take up too much space and your gluttony is killing you. It's also costing a fortune.

According to the article, you have to have a BMI below 35 in order to keep from paying the $25 fee (BMI of 30 and above is considered obese). So a woman and man of 5'8" would have to weigh 230lb to be considered too fat.

A quote:
"He said employees with a BMI of 35 or higher cost the state 40 percent more than those with a BMI under 35."
BMI is just another number that makes us feel bad about ourselves. How the hell do height and weight (without body type) help determine if someone is healthy or not? It's so stupid.

Although as a woman living in the U.S., I have deep seeded body issues and occasionally "fat hate," people can be fit and fat. Just because someone has a BMI of 35 does not automatically mean they have diabetes and hypertension and high blood pressure, cholesterol, and glucose levels.

I just figured out if I gained 5 lbs, I would be considered overweight. Fucking BMI.

If smokers pay more, then the obese should pay more. It's a lifestyle problem. Family history or other genetic indicators are a completely unfair means to assess insurance rates. The potential for abuse here is if the BMI limit becomes unfair. 35 BMI seems very reasonable.

How the all get rich: AKA How they are killing us:

U.S. government subsidizes corn and has tariffs on sugar, therefore, High-Fructose Corn Syrup is used in most processed foods and drinks of the U.S. High-Fructose corn Syrup has been linked to the growing waistlines in the U.S.
Now enter the diet and health industry. There are new diets out almost every month (Atkins, Zone, Weightwatchers, Jenny Craig, Nutrisystem, etc.). A new fitness gimick (thighmaster, bowflex, p90x).
Also enter advertisements full of skinny boob-a-licious women and ripped men.
So we are made to think we are unhealthy and that our bodies are gross, and that diets can fix them. But diets don’t work, and the government subsidizes the one thing that we SHOULDN’T consume.
And then they charge us for being good consumers.

It makes perfect sense.

Obesity is mostly genetic, not a "lifestyle problem". This is completely wrong - I just hope it's not a test case for more such programs elsewhere.

Not to mention that the BMI is a ridiculously one-dimensional measure of anything.

All sorts of nasty products are advertised in an attempt to get them into our bodies. Yet nothing is forced upon us. Eating right and substantial exercise are proven to lead to better health. There's no conspiracy, just poor attitudes about physical health and a populace indifferent to obnoxious advertising.

I view this like someone with a bad driving record forced to pay more for insurance.

How is obesity a mostly genetic problem? There a genetic predispositions that cause many to have a less efficient metabolism than others, but how it being physically obese a product of genetics? We are all born with different gifts and different obstacles to overcome. Someone's genetics does not define there life, just as having red hair does not make one have a fiery temper.

I'd have no problem with this if the language didn't leave it so open ended. As it is, it's too much of a slippery slope. Also, BMI is an outdated and just crappy way to measure health.

We charge smokers more for insurance already. This is just a logical progression in a society where obesity has become endemic and the results are showing. The simple truth is that obesity, by and large, is an imperfect measurement, but it has its merits.

No, it's not a perfect gauge for diseases like diabetes or increased risk of heart attack, but it's a solid predictor in those cases. It's also a good indicator of the likeliness of joint damage/wear and tear. Insurance companies don't just pay for diabetes meds, they pay for things like surgeries to fix one's hip or knee.

As for obesity being a mostly genetic problem, that's a really, really weak answer. Given the fact that our predecessors had lower obesity rates and the time frame it takes to affect genetic change on a national scale the idea that genetics is the primary contributor is a flawed premise.

Does genetics matter? Of course. But obesity is still primarily a lifestyle issue, in the same way that many heart problems are. And obesity does have negative effects aside from the monolithic fears of heart attack. Carrying excess weight on one's body has negative long-term health effects in the areas of joint health, has been shown to contribute to things like sleep apnea, and can compound existing problems.

The truth is that our ideas of a healthy lifestyle have changed, and along with that our health as a whole has changed. I know I've been sedentary at times, and a slim waistline is no barometer of triglycerides sometimes, but I've definitely had to change my attitude towards fitness as time has passed. What I thought was sufficient really wasn't, and I was forced to ramp up my exercise routine in order to maintain the kind of health I want.

If we can't give those with obesity additional charges for insurance how can we charge those who smoke cigarettes? It wouldn't be logical.

"mostly genetic"

Thats an overstatement. Excess calories paired with little physical activity is the primary cause of obesity.

Also, body composition by fat (skinfold) should be used instead of BMI.

BMI is oversimplified and ignores things such as age, muscles and gender.

Re: Genetics

I think people need to be careful when defending with the "It's genetics, I can't help it" defense. Some people are predisposed to cancer. "Hey, I can't help it if I've got lung cancer. It's not the two packs of cigarettes a day - it's my genetics."

"It's not my fault I drink a six-pack when I wake up, down a mickey at work, and then have another six-pack when I get home." The problem is, if you bust out the genetics defense, then damn near every ill-advised lifestyle choice which may result in poor health can simply have any personal responsibility written right out of it.

While I find the use of such a defense in the aforementioned cases to be of relative inconsequence to *my* existence, I let you ponder this, what happens if they successfully identity a rape or serial killer gene? Think about that, for a moment. I know they've been doing studies on it. Have been for quite some time. And I did not like where some of those studies were leading in terms of possible future legal defenses. Granted, it's a big stretch. But there's a lot of people out there convinced that there are obese genes, gay genes, cancer and alocholism genes, perhaps rightly, perhaps wrongly. But all they need to do is convince one person out of twelve behind a bench; and all of a sudden genetics runs rampshod over personal responsibility. Then, all of a sudden, "Couldn't help it, your honor - she was asking for it." becomes "Couldn't help it your honor - it's genetic."

Just a thought. Proceed.

On a personal note, I would certainly hope that they would rely on a battery of tests, rather than a simple BMI index. Because there are just so many issues with that little gem it's not funny.

Actually, as a second note regarding "I've tried hundreds of different diets and never lost weight, but there's nothing wrong with what I'm doing, so there's got to be something wrong with the diets"

I swear I've heard a similar phrase before.
Let's play some word substitution.

"I've dated hundreds of different women, and none of my relationships worked, but there's nothing wrong with me, so there's got to be something wrong with women."

There's a common denominator in both these sentences. Hint: It isn't the word "women" or "diets".

Just a few random thoughts.
I get them from time to time. They're very rare.

The BMI metric is pure bigotry.

...nurses will check for diabetes and hypertension and measure blood pressure, cholesterol, glucose levels and Body Mass Index (BMI).

If you check for hypertension, blood pressure, cholesterol, and glucose levels, the BMI gives you almost no medically relevant information. (Obesity is associated with many health problems, and almost all of those problems are *indicated* by the other metrics.)

Why psychoanalyze or overthink this? Fat people are usually unnattractive, with little if any sex appeal. We just don't like them!

Ignoring the obesity question for a moment, I find myself wondering how much leeway an insurance program should be given for requiring treatment. My cholesterol has recently (finally) crept into the "high risk" levels, and my physician prescribed Lipitor. I don't want to take Lipitor, so instead I've started taking Omega-3's and adjusted my diet (which isn't all that unhealthy anyway). I'll have my cholesterol levels re-checked in a couple months to see what's happened.

But should my physician -- really, my insurer -- be allowed to require that I follow my physician's prescriptions? Should they be allowed to "fine" me (either tacitly or explicitly)? It's not a simple ethical question, and I'm quite troubled by the precedent being set by the State of Alabama here.

i think many people here are not seeing that this is also a class issue. the south happens to be one of the most impoverished areas in our nation. people living paycheck to paycheck are naturally going to want things to be cheap, including food. unfortunately, as someone else realized above, the cheapest food in this nation is riddled with high fructose corn syrup, trans-fat and highly processed. all of these are a recipe for poor health.

on the exercise front, most poor people cannot afford to join a gym, and some lack a safe area outside in which to exercise.

also, i think the comparison to smoking is disingenuous. maybe it is true that smoking and obesity are both choices-- but smokers aren't subject to public mockery and humiliation, smokers don't have to deal with spiteful ignorance from people claiming only to be "concerned for their health". smoking continues to be portrayed as glamorous and cool, and i seriously doubt smokers are faced with the same level of vitriol that the obese are.

obesity is definitely something to be concerned about, but i'm not sure if this is the right way to encourage healthful choices.

This issue I'm on the fence about. I would be okay with it if they'd just get rid of the BMI indicator and relied only on the information that is actually relevant to someone's health: cholesterol, blood pressure, etc. I do think it's a good way to start this country down the road of preventative medicine, but perhaps a better way would be to give people who are not unhealthy incentives instead of punishing those who are unhealthy. Of course with *only* a 30% obesity rate, that would cost the state of Alabama more money so I doubt they'd do that...

Dear me. The point of this country's obsession with health and fatness driven home by the web ad I saw just underneath this post: glycemic impact diet: are you heavy or healthy? :-P

Dondo, while you're right about the tests for cholesterol and diabetes giving a majority of the information necessary to really understand someone's health from a life-in-danger perspective you ignore the slew of other issues that obesity either contributes to or compounds, specifically in the realm of ligament, tendon, cartilage, and bone health, a very serious set of problems that can cost an insurance company a lot of money.

If obesity doesn't have any negative effects at all then yes, this rule makes no sense, but medical evidence is really, really clear in this regard that even if obesity won't give you a heart attack the odds are good it will at least be a contributing factor to SOMETHING. Given that with proper diet and exercise many obese people can alleviate these issues to some degree it makes sense to ask those in this category to pay more or cut back, in the same way we charge smokers.

The BMI metric is nowhere near perfect, but it is a simple mass-versus-height calculation that can be indicative in some cases.

And I'll echo Bunner's sentiments in the "I tried hundreds of diets and exercise plans, and none of them worked". It's not impossible to lose weight and become more fit, and while some workouts and diets are fads that do very little and others require a comfortable middle class existence to be effective that doesn't mean there aren't effective solutions out there.

http://kateharding.net/bmi-illustrated/

So, if someone has a lot of muscle mass and therefore a higher BMI, they have to pay more.

If someone is deemed "overweight" or "obese" by the BMI and "healthy" by their doctor, they have to pay more.

My two best friends who are physically very large people, yet are vegetarians and go on frequent ONE HUNDRED MILE bike rides, would have to pay more.

Oh yeah, terribly fair, not biased at all. /sarcasm

Alabama doesn't seem to charge smokers more. In general, yes, but the company offers a flat fee, and is going to increase it based on fatphobia.

It's one thing when you have an actuary analyzing many factors to determine an appropriate price, as they do for individual health care and other insurances like for driving, but if you have them ignoring things like family history, and just increasing prices based on BMI (which is highly inaccurate), it's straight and out fatphobia.

I'm really disappointed to see the fat-hating here. So, I'm fat, that doesn't mean I'm lazy or a bad person, there are plenty of skinny people who make worse lifestyle choices than me, but wouldn't be charged extra because they keep the weight off, through a naturally high metabolism, or whatever. Referring to obesity as a lifestyle choice is inaccurate, it just means that I like to eat through a bag of Doritos more than a normal person, and I have more trouble squeezing an hour at the gym into my schedule. That's not a lifestyle, and it doesn't give you the right to judge me.

As an Alabama resident, this doesn't surprise me all that much. We're a poor state desperately in need of revenue, but this is pushing it.

It'd be much better to educate people on healthy ways to modify their diet then punish them for their ignorance.

Yikes, this is my home state.

I go back on forth on this particular topic. Yes, being obese is a health issue and one that should be taken seriously. I have no problem with those who take up others' space on planes being charged for an extra ticket, or for those who are larger in size to not be allowed on roller coasters for safety reasons.

This, however, reeks of slippery slope. (And yes, I think it's slippery that smokers are charged more as well.)

I suppose as long as it stays in the realm of the "is", I'm okay with it. By that, I mean that there is a clear definition of what is "fat" and what is a "smoker". If Sally IS a smoker, then fine. But where do they draw the line? If Sally smoked for thirty years and quit two months ago, is she still a "smoker"? If Bob is at a high risk for prostate cancer, does he count as a health threat? If Nancy is an alcoholic who's been on the wagon for three years without a drink, is that a hazard?

All health risks. And like others have said, the BMI isn't a clear measurement of health and "appropriate" fatness, whatever the heck that is.

Actually, nightingale, most every choice we make is a "lifestyle choice". A peculiar love for coffee (or in my case iced tea), an aversion to running, enjoying the internet more than most, all of these are, in fact, lifestyle choices.

That said, someone's choice is fine as long as it only affects them. Whether or not I would do what one person does is not in and of itself judgement, in the same way that I would never sky-dive due to severe altophobia. However, some groups do have a vested interest in one's health, including family, friends, and yes, insurance companies.

I was unaware that Alabama didn't charge smokers more, and as I said previously it's illogical to charge for one thing and not the other.

Again, insurance companies do have a right to take health into account, and weight is a part of health. Not just in regards to one's heart or arteries but also their joints, bones, and so many other things. That's not "fat hate", it's logical. An insurance company puts a stake in your health, so obviously they should be interested in how healthy one is.

I didn't see anyone here calling overweight Americans "bad people". But that doesn't mean that we should allow rampant misinformation to spread, either ("it's mostly genetic", "diets can't work based on statistics", etc.).

I think this has another angle which is the way insurance companies are working to begin policies like this. Health insurance in this country is pathetic and it leads to companies trying to cut costs in ways that discriminate against its employee. Obese employees are the easiest target right now but trust me, it will get worse.

I hate sizism and fatphobia so much! This is blatant discrimination!

Given the dramatic rise and timespan of America's obesity trajectory common sense and the internal logic of evolution dictate that the main cause can't be genetics.
Simply put, too many people too quickly have become obese in America for us to scientifically blame it on "genes".

So, for the sake of a dignified debate that must be grounded in sound science, can we please, please retire the notion that all, or the majority of obesity in the US is mainly due to "genetics"?

Genetics are not the issue, societally speaking. It may be for the individual commenter, but in general, politically speaking, genetics are not relevant in the debate about obesity.

It's simply not scientifically viable to assume that such a large part of the population has undergone a seemingly spontaneous genetic mutation, resulting in the obesity levels we see now.

Acknowledging that does not mean open season for "fat hating". On the contrary. We must be able to discuss with honesty, courage and dignity.

But I can't freakin' abide science twisted for a moral purpose, however noble it may be - in this case to remove any undue moral stigma of being obese.

Well, I think the overall problem is the way the health insurance/health care system works. And yes, I guess it is discriminatory, but it's far from the only example. Obese people have to pay more, so do smokers, and people who have pre-existing conditions often can't get insurance at all. If you want to gripe about the health care system in America, there is a lot to gripe about, but you gotta think bigger.

Happy to be a healthy, fat Canadian with universal health care when I hear about ridiculousness like this from south of the border.

A cash grab like this at the peril of people's health care is morally repulsive and people who support it should be ashamed of themselves. The health of EVERYONE - addicts, the mentally ill, smokers, fatties, pill-popping Type A personalities, whoever - is important and beyond a price tag.

Smokers have to pay more for life insurance, men have to pay more for car insurance... like it or not, it's all about who's statistically at more of a risk for costing the insurance company money. Obesity causes more health problems, whether genetic or not in origin.

Overweight and obesity disproportionately affect people living in low-income communities in the US. It's really easy for people to point out that eating fruit and veg and lean meats are great for you but, they are hardly available at a price in which the majority of people on a fixed income can afford them. And if you want them organic, forget about it completely.

"smokers aren't subject to public mockery and humiliation, smokers don't have to deal with spiteful ignorance from people claiming only to be "concerned for their health"."

Uh...clearly you're not a smoker. Strangers feel comfortable approaching smokers in public to lecture them about the ills of smoking and yell at them for being "stinky", and family members can be frighteningly judgmental upon discovering that one smokes. Fat bashing may be worse, but you'd be surprised at how some people treat smokers.

Some quotes from the article...

1) Beginning in 2010, Alabama, which has the second highest obesity rate in the country, will start charging all of its employees an extra $25 per month for health insurance. (Currently, single workers pay nothing; family plans cost $180 a month.)

2) The $25-per-month fee is not the only way Alabama hopes to discourage bad health decisions by state employees, said the program's creator, William Ashmore, executive director of the Alabama State Employees' Insurance Board. Alabama already charges smokers a monthly $25 insurance fee.

3) employees with a BMI of 35 or higher cost the state 40 percent more than those with a BMI under 35

4) critics say it's just not going to work. "There's the thought that obese people are weak-willed, and if we charge them more they won't be as fat," Stern said. "This assumes they have control over what's involved, and often they don't."

1-3 aside, I agree with #4

I'd like to echo the people who pointed out the classism in this. It used to be that the rich were fatter, because they got more leisure time and more access to rich food, while the poor had to do more physical work and eat whatever they could come by. Now the rich can afford gyms, personal trainers, nutritionists, and healthy food, while poor people work long hours in sedentary jobs and have fifteen minutes to grab lunch.

For a quick comparison, look at the price of a health-food bar versus a candy bar.

As a few others have mentioned, the States badly needs universal health care. It's been shown time and again that private insurance companies will make any excuse they can not to do what they're being paid to do -- and that's even for those who can afford to pay them.

I just don't see any compelling argument against this policy. The parallel with smokers is absolutely and perfectly established: an unhealthy lifestyle issue. The links between obesity and health problems are unbelievably well-established. The links between lifestyle and obesity are also well-established. There's simply nothing missing here. I'm sure some people are more genetically predisposed to being addicted to cigarettes as well, but we still hold them accountable for that risk. Furthermore, if anyone can explain to me how a (mostly) genetic issue has somehow magically appeared in the last thirty years, I'll change sides. And finally, the anecdotes of hard-working, healthy-living obese people are largely irrelevant. While it's great that they are healthy, and somewhat unfortunate for them to get caught up in the high-risk bracket (I'd be happy to see a similar deduction for an active lifestyle, if that were possible), insurance is based on statistics. My grandpa smoked ten cigars a day and lived to be 95, but it doesn't make smoking any less dangerous.

Well, thanks for using up all my Sanity Watchers points, people. Where do you all get your "facts" about "just how things are," from fucking Cosmo?? This crap is ridiculous.

I don't care if it's a business, health insurance should not be charging people for HAVING RISK FACTORS. Although the risk factors associated with BMI are murky and poorly constrained AT BEST (yeah, please learn to statistics, folks), that's what we're talking about here - slightly higher RISKS for things. We're not talking about every fat person having a heart attack tomorrow. A small percentage of the population actually has heart attacks; translate that and you get the probability that the average person will have a heart attack in his or her lifetime. If twice the percentage of fat people have heart attacks as the heart-attack percentage in the average population, guess what: two times a small number is still A SMALL NUMBER! So they have double the small risk, but most fat people? STILL DON'T HAVE HEART ATTACKS.

And yup, sorry if you don't like it because your magazines promise you otherwise, but ~70-80% of your body shape and size is inherited; the rest of the variation observed is environmental. Of all the environmental factors, you only have control over a small number, so your ability to change the size and shape of your body is overall pretty small. In very short time periods it's possible to cause larger changes, because it takes time for the body to reequilibrate. But if we're talking long term, it's basically impossible, because your body maintains a status quo. And don't start in with the "it's simple thermodynamics" crap, because clearly, no one with a basic textbook understanding of biomechanics or bioenergetics would ever say that. Biology isn't simple, for fuck's sake.

davenj, eva, and lots of others here: clearly you do not know what the fuck you are talking about. Study after study has FAILED TO SHOW that fat people eat or exercise differently or in different quantities than thin people. Study after study has FAILED TO SHOW that any diet works to keep a large amount of weight off a person's body for 5 years or longer for more than 5% of the population. There is NO CONCLUSIVE EVIDENCE that being fat is dangerous for joints or tendons or any of that crap. The "estimates" of how much obesity "costs" the health industry are spurious bullshit that don't mean anything. As a population, you know who costs everyone with health insurance the most money? People who live the longest, not people who are sickest. (And it just so happens that people with "overweight" BMIs live the longest, so hey, I guess you can hate away at them for being so damn healthy.) YOU ARE JUST EATING UP WHAT THE DIET INDUSTRY FEEDS YOU (haha food analogy, isn't it funny). Most of the information reported in the news on this subject is completely misrepresentative of ACTUAL DATA. But hey, don't let factual information get in the way of your fat-hating or anything. That'd be a buzzkill.

Back to the subject at hand. The "It's wrong to charge more for genetic risk factors!! but for fatties it's okay because they take up space and people/women shouldn't take up space and because i don't want to fuck a fat woman and women only matter if they're fuckable" shit just doesn't hold water, and all your yelling and