the HAES® files: Obamacare’s Misfire on Weight—New Workplace Provisions that Deserve a Pink Slip

by Health At Every Size® Blog

by Linda Bacon, PhD

The Supreme Court’s decision to uphold President Obama’s Affordable Care Act is good news for Americans in many ways, but not without significant problems. It’s a big coup for the diet industry, for example, but less settling for a populace already suffering from weight anxiety and misinformed advice.

The Act enforces the recent recommendation from the U.S. Preventive Services Task Force stating that all doctors should warn “obese” patients that their weight puts them at high risk for disease, but that weight loss and lifestyle changes can help – and then direct them to intensive weight-loss counseling. Currently, few insurance companies pay for such programs. Under “Obamacare,” however, insurers will be required to cover most medically advised weight-loss expenses and employers will almost surely intensify their anti-obesity campaigns. Weight Watchers’ stock has already surged in anticipation of the bounty to come.

If this made Americans healthier, it would be all to the good. But it won’t. Before Jenny Craig counts more millions, before more doctors mete out bad diet advice, and before more well-intentioned American executives mandate disordered eating as a condition of employment, here’s what they (and all of us) need to know…

Dear Boss: It’s Time to Give Anti-Obesity Programs the Pink Slip

An absence of results in our national war on obesity hasn’t dimmed enthusiasm in the private sector for a spate of workplace “wellness” initiatives aimed at weight loss. As discouraging as it is to see the government wasting its efforts and spreading fat stigma without effect, the workplace trend is far worse. That it won’t work is only the start of the problem.

When fat prejudice comes from government, disgusted citizens at least can walk away or change the channel (and maybe even vote its authors from office). When it comes from a boss, though – or, more commonly, a human resources department – employees have little recourse. That’s when anti-obesity initiatives cross the line from merely offensive and ineffectual to something worse: They become hostile and coercive.

I leave to lawyers the technical arguments against discrimination and when this constitutes a hostile work environment – not an easy case to make, given that just one state (Michigan) has outlawed discrimination based on size. But whether it’s benefits like health insurance at stake or “only” the insult and prejudice of a workplace “educational campaign” stressing the dangers of obesity, workplace obesity initiatives induce stress, anxiety, and bad feelings while increasing the likelihood of disordered eating and other maladies.  On top of all that, they make it seem okay to discriminate against colleagues and subordinates based on externalities unrelated to job performance.

This is not to demonize the people behind these efforts. Given today’s general misunderstanding at all levels about the roles of fat in disease, it’s easy to imagine that most HR and health professionals have only good intentions in trying to induce colleagues to get thinner. If that worked – and if it didn’t induce harm – this blog post might be unnecessary.

But evidence so far shows that hardly anyone can lose weight and keep it off long term, despite widely touted claims by some scientists. Which shouldn’t be so surprising, given well established evidence that the body’s regulatory mechanisms resist weight loss. So we are left with anti-obesity messages that wield no practical impact while shaming the larger members of a community (and causing their colleagues to fear becoming like them).

As I ask in my online form letter opposing such campaigns (paraphrased here), “What does our organization gain by shaming some of us for how we look? Is there any evidence to suggest it will stimulate improved health behaviors?”

Yes, evidence. It’s surprising, really, that corporate employers, who have their own or shareholders’ money at stake, are undeterred by the abysmal return on investment of pretty much every obesity-education measure ever tried. If measured by the yardsticks applied to other commercial efforts – in marketing, say, or research and development – weight-loss “health” initiatives would be history, so the hate question would be moot.

But when it comes to the obesity bogeyman, even MBAs quail and comptrollers quake. Cost-benefit ratios fly out the window along with reasonableness itself. No one seems to care or calculate whether a campaign will make workers healthier, only whether it will slim them down and, in that case, only in the short term.

Some companies incentivize thinness, without regard to health, by providing better benefits for thinner employees. Whole Foods, for example, has a “health incentive” program which allows a higher discount for in-store purchases for employees with lower body mass indexes (BMI).

Other companies penalize fatness, also regardless of employees’ health status or habits, as in this example from a correspondent on the West Coast who faces a frightening bind (and therefore remains anonymous). “I work in an outpatient medical clinic,” she wrote, “and heard that, come open enrollment time, employees are going to be screened and face either insurance premium raises or a requirement to enroll in Weight Watchers” or an in-house weight-management class. (Again, this is absent any evidence that such programs offer any lasting health benefits for most people.)

Government workplaces make the same error, as another correspondent has just reported: “The Navy now has policy that ensures members are separated without compensation because they do not fall within Navy [BMI] standards. What bothers me the most is the fact that the Navy is discharging personnel who do not weigh/measure up to their standard without even allowing them to take a physical fitness test. I know many people who are very unhealthy and are within standards only because they weigh less than others.”

As an exercise physiologist and nutritionist and an avid athlete myself, I’m as eager as anyone to see more people caring for themselves by enjoying movement and eating well. It makes sense – and dollars, too – to refocus the energy behind our anti-obesity campaigns into promoting good health behaviors for everyone, regardless of what they weigh. That philosophy is at the heart of my book, Health at Every Size: The Surprising Truth About Your Weight, and the HAES® movement that it’s named for, and drives the mission of the Association for Size Diversity and Health, an international coalition of HAES professionals. I just know that fat shaming will never get us where we want to be, and it’s time corporate America learns that, too.

12 Responses to “the HAES® files: Obamacare’s Misfire on Weight—New Workplace Provisions that Deserve a Pink Slip”

  1. Actually, in my eyes, a focus on health would be just as destructive as a focus on weight, and it’s a mystery to me why so many people, including fat activists, support this level of nannying for any reason. Does anyone really think that governments and employers, in our deeply healthist culture, will not abuse the power given them?

    And given the genetic, age, and stress components to diseases like diabetes, high cholesterol, etc. why do people keep proposing lifestyle based solutions to the problem? Fitness also has a strong genetic component and there is little evidence that “more is better” when it comes to exercise. Regular, moderate exercise is sufficient, and we get this from everyday activities. No gym membership or team sport necessary.

    The topics of health, fitness, and lifestyle are just as riddled with myths and lies as the topic of weight, but no one seems to care about that. Some days, I think HAES has turned into just another diet. Just because there is no weight loss at the end does not mean it’s not a diet.

    • I don’t think HAES is a diet at all, and I don’t think there’s anything wrong with gently encouraging people to consider their health–but I think it’s deeply wrong to allow workplaces to do these things, because of the coercive component of having this come from the people who sign the checks that pay your food and rent bills.

      But the problem is that we live in a deeply Calvinist culture and now that policing people’s sexual behaviour is no longer an accepted way of identifying the Elect, the just, the true, and the righteous, we’ve begun to consider physical fitness, beauty and health to be the signs of righteousness. That’s not any better.

      Numerous studies have shown that the single most robust and reliable predictor of mortality and morbidity from all causes is socioeconomic status. Rich people are healthier. Stress, overwork, skipping meals/eating lousy food, enforced sedentary time, going to work sick–these are all things people lower on the food chain are subjected to, so it’s not really surprising.

      It’s not an accident that America has got sicker (and fatter–”obesity” is genetic, but gene expression is often regulated by environmental stresses and there is quite a bit of research that shows stressing people out and making them oversecrete cortisol makes them fatter than they would be otherwise) as our middle class has diminished and working people lose their protections and benefits.

      If Obama really wants to make people healthier (and thinner, which of course does not equal healthier) he needs to fix the economy.

      Also I have serious problems with the notion that people need to be punished for taking “risks” with their health. If our health system and our workplaces are going to be allowed to discriminate against people who eat the “wrong” foods (whatever they are this month) or have the “wrong” kind of sex, what about people who insist on riding bicycles on busy roads or climb mountains or run marathons? Surely they too have a high risk of developing expensive health problems.

  2. Thanks, this is so well said. What can I and others do to help your movement?

  3. This is brilliantly said, like everything else from Linda Bacon. Generally, I have supported the federal health insurance initiative (“Obamacare”), but with some concerns about the feds getting involved in anything that delves into people’s private lives, “for their own good…” I suppose I support taxation similarly, as annoying but necessary.

    Bacon rightly points out the transient nature of weight loss. It almost always comes back within 3-5 years. However, I don’t expect most employers will care about that. The average job lasts about 3 years. By the time you regain the weight, you won’t be their employee any more, on average.

    But they should care, because within that 3 year period, a stigmatized and demoralized employee, hounded by human resources to lose weight, cannot possibly be productive. I remember how I felt when, as a new employee at Eastman Kodak Co. in 1964, I was handed a slip for a mandatory appointment with the company nutritionist, because I was deemed to be 15 pounds overweight. The diet mania is nothing new–what would be new is the federal government requiring Kodak to do that.

  4. This is some really scary stuff.

    I worked really hard to get a degree and training to be qualified to do the work I enjoy. But I am female, so I’m paid less to do the same job as the male sitting in the next cubicle. Now I’m going to be subjected to higher insurance premiums (effectively a pay decrease) because sitting in an office chair all day has made my BMI go up while others haven’t? Biases like these only add more stress to the ever increasing “how can I accomplish more in less time and with less resources so I don’t lose my job” stress that is so prevalent in this flailing economy. And here’s the kicker: when I did get laid off, twice in the past decade, my BIM went even higher while I tried to stave off panic about finding another job where few existed. So, at least in my case, the government helped create a situation that it is now taking advantage of.

    I think billfabry is right: companies don’t care that these measures will have an adverse affect on individuals because they’re often gone in 3-5 years. Increases in premiums for “too fat” people likely will be deferred to the specific employee, and incentive programs will save them money overall on insurance premiums. The only question will be how the office environment changes. If dieting people become cranky, less focused, and less productive, and/or the culture becomes hostile between the “too fat” and the “within range” employees, will management intervene to protect the bottom line? Will they just fire the “too fat” people to ease the tension? I shudder to imagine.

    If health insurance companies are going to be required to mandate weight-loss initiatives in the name of health, then I think they should also be required to significantly discount (or pay for) other activities: pool fees, rock climbing gyms, dance lessons, kayak or canoe purchases, community sports fees, etc.

    And I think they should provide unlimited mental health coverage, instead of the severely limited (or nonexistent) coverage most plans I’ve seen offer. After all, we’re going to need it! With any luck, will all find HAES practitioners and stand together to fight this political nonsense. :)

    With such a well-funded diet industry lobby doing all it can to promote distorted facts and incite fat phobia, with the support of the insurance industry and politicians along for the ride, I wonder how long it will be before we “high BMI” citizens will have to fight for the basic human right of all people to eat what, how much, and when we want.

  5. I agree with Linda. It would be nice if fat hatred could be replaced with meaningful changes in health insurance and workplace practices that actually support physical and mental health. For a company to seriously address their employees’ health would require changing many aspects of typical American work environments. Underpaid, overworked, stressed, and disrespected employees not only produce more stress hormone (with myriad bad health effects), but they are also less likely to have the time and resources to devote to basic self-care. So, yes, they may be less healthy than their genetic potential would allow. But, once a person’s life is in balance with their physical and psychological needs they will achieve their optimal health and trend to their natural weight, something that is not predictable or under anyone’s control. While natural weight is not under anyone’s control, bringing one’s life in balance with one’s natural needs IS amenable to change. But that might look too expensive for employers, perhaps requiring changes like higher salaries and more vacation. Everyone in business and government is hoping that by focussing on size they can produce a magically more productive and cheaper workforce without having to invest in compassionate and humane workplaces that allow for healthy, balanced and satisfied lives.

  6. It seems to me that there ARE things that large companies can do to help their employees be healtiher. But they should be done without equating health with size and without pressuring people for choosing not to take advantage of these opportunities.

    1) Have an on-site gym. Encourage employees to work a REAL 8-hour day so that they can use the gym if they choose to do so. Make the gym a friendly, non-judgemental place.
    2) Have a cafeteria that has healthy, tasty options. By “healthy,” I do not mean low-calorie or low-fat. I mean nutritious. Include non-”healthy” options as well. Sometimes, we all want a burger or some ice cream. Make the cafeteria be a friendly, non-judgemental place. Encourage employees to take a lunch break (instead of a “working lunch”) so that they have time to enjoy their food.
    3) Offer regular classes on yoga and meditation aimed at stress reduction. Actively work to encourage a less stressful work environment.

    Do I think any of these things will ever happen? Unfortunately, no. But a girl can dream…

  7. I see it coming: eat as instructed, or face a pay cut. It will be framed as Weight Watchers and premium increases, but it will be the same. Or, spend your free time working to burn off the calories. Perhaps a lawyer could comment on this as unpaid work OVERtime, since is must be spent, if you choose to eat freely, in order to obtain the additional money in the form of the lower premium?

  8. Such a well-researched post Linda! Employee wellness programs do need some attention, past the accepted norm of encouraging gym memberships. We’ve noticed that more often than not, nutrition plays no significant role in the employee wellness conversation. And it’s a vital resource for all employees, with the potential to foster the physical & mental well-being that should be the goal of workplace programs. Thanks for the great read!

  9. I have days when I feel as if I and other fat people have been treated like a black woman in the 1950s South who is dying of thirst and can’t even use the nearest water fountain because it’s for white people only. We are living well beyond the New Millenium, aren’t we? Furthermore, All people deserve the opportunity to have sufficient and attainable Health-Care no matter what. “Big Brother” and “The Machine” of our dysfunctional society will not win in our lives if we don’t allow it to. :-D

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