the HAES® files: Workplace Wellness and Weight

by Health At Every Size® Blog

by Fall Ferguson, JD, MA

stethoscope and globeRecent news reports have featured stories about U.S. employers instituting “wellness programs” that wind up requiring some employees to pay more for their health insurance than other employees, sometimes termed “health penalties.”  In the U.S., a majority receive their basic health care coverage through employer-sponsored health plans purchased from insurance companies.  Most employers pay for a portion of the health insurance premium, and pass along a portion of the health insurance premium to the employee.  In essence, the “health penalty” results when employers require some employees to pay a larger premium than others. These health penalties, which will disproportionately affect fatter people, can be based on “results” or on “participation.”

“Results” include a variety of metrics that employers and health insurance companies deem beneficial to health. Unfortunately, employers all too often require that employees lose weight or have a certain waist measurement in order to avoid the health penalty. A recent Wall Street Journal article entitled “When Your Boss Makes You Pay for Being Fat” reported that Michelin dictates that employees meet required levels in three out of five health metrics (waist size, blood pressure, glucose, cholesterol, and triglycerides) in order to receive the lower health insurance premium.

Tying health penalties to “participation” rather than “results” may sound like a kinder and gentler approach, but can also be very problematic. Employers are increasingly asking employees to “participate” in wellness programs by providing personal health data such as weight, blood pressure, and other health metrics. Employers such as CVS Caremark claim that a primary purpose of collecting the data is to make employees “aware” of their own health. The data may then be used to tailor health messaging directed at the employee. So, the kinder, gentler version is that in order to have affordable health insurance, many of us will have to submit to intrusive exams, surrender private health information, and receive unwanted health messages.

Moreover, these wellness programs are often run by third-party consultants who collect employees’ health data and create the tailored messaging based on the collected data. These companies promise confidentiality, but frankly, the more widely my confidential health information is scattered, the more nervous I get. Readers will forgive my cynicism in an era when health insurers buy data from credit card companies to find out such things as what food we buy and whether we shop in plus-size clothing stores.

Employers have long had the legal right to put such wellness programs in place, but the Affordable Care Act of 2010 (ACA) increases the incentives so that starting in 2014, employers will be able to charge noncompliant employees up to 30% more. It appears that recent media reports (CVS, Michelin) are just the beginning of the tide. The following figures from a recent poll demonstrate that employers are just getting started:

Currently21% of employers use health penalties tied to participation or results in workplace wellness programs
Next 3-5 Years: 58% of employers plan to use health penalties tied to participation or results in workplace wellness programs

Currently24% of employers give rewards for specific health results*
Next 3-5 Years: 66% of employers are considering giving rewards for specific health results*

*I would argue that these rewards actually constitute a health penalty on the employees who cannot or choose not to achieve the required “results.”

Shifting Costs, Not Lowering Them

One might conclude from the institutionalization of health penalties and creation of even higher incentives in the ACA that there is evidence to support the notion that such penalties lower health care costs. Employers exult over their lowered costs, but research suggests that the costs actually remain the same and are simply being shifted from employers to certain employees: namely, those whose physical characteristics are deemed problematic by the current medical paradigm. UCLA law professor Jill Horwitz, lead author of a Health Affairs Journal article on how employers are utilizing wellness programs to reduce costs, doubts that employers are actually reducing overall costs; she told a Washington Post blog: “The question is whether charging those higher premiums leads to the slowing of spending, or is [it] a cost-shift onto less healthy employees.”


What’s most disturbing to me about these health penalties is not the greed demonstrated by the employers who seek to shift health care costs to some of their employees; I am prepared to believe that most corporations will seek to reduce costs in any legal way they can. It’s the rank healthism of the enterprise that really sticks in my craw. In this context, healthism may be defined as the view that one is morally responsible for one’s own health status, and that it’s not just ethically permissible, but socially desirable to penalize those our culture deems to have acted in an irresponsible manner with respect to their own health. Apparently, being fat or having high blood pressure constitutes a moral lapse in our healthist culture.

Of course, many of us saw this coming. In 2009, a number of ASDAH and NAAFA members went to Capitol Hill for a coordinated day of visits with Senate and Congressional staffers to advocate for omitting these incentives from what eventually became the ACA. I don’t regret speaking out against health care policies that negatively affect fat people, even though we lost that battle. If anything, we need to speak out more. The healthism in our culture is accelerating and must be countermanded. I was disturbed to note that in a poll accompanying the WSJ article mentioned above, almost 64% of respondents seem to be perfectly OK with employers shifting health care costs to employees who don’t meet “company specified health and lifestyle standards.”

A clear majority of respondents to a Wall Street Journal poll accompanying an article about Michelin’s “wellness program” believe it’s OK to shift costs to employees whose health and lifestyle fail to make the grade.

A clear majority of respondents to a Wall Street Journal poll accompanying an
article about Michelin’s “wellness program” believe it’s OK to shift costs to
employees whose health and lifestyle fail to make the grade.

Sounds good until you are one of the people who doesn’t meet the health standard du jour. Here’s what I have to say to the 64%: Be careful what you ask for, people. You just might not be thin or in perfect health forever…

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Sizing Up Workplace Wellness

ASDAH has started a website to collect employees’ stories about their experiences with workplace wellness programs. Please visit the site and share your story about weight and workplace wellness programs at Sizing Up Workplace Wellness.

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ASDAH Educational Conference – June 28-30, 2013

To learn more about these issues and brainstorm strategies for fighting bias in healthcare, make sure and attend the upcoming ASDAH Educational Conference in Chicago on June 28-30, (Early bird registration rates available through May 1 only!)

9 Responses to “the HAES® files: Workplace Wellness and Weight”

  1. Tell me again why you guys voted for Obama?

  2. Thanks so much, Obama voters.

    • I understand the impulse to hang this on Obama, Kell, but the institutionalized healthism apparent here is deeply rooted in our culture and traverses both sides of the aisle. I don’t think either party has a corner on weight bias or on misguided healthcare policy. The rhetoric of “individual responsibility” has some very unfortunate implications when we use it to drive healthcare policy decisions.

  3. Please. As if it would have been any better under McCain/Palin. At least now fat people cannot be denied health insurance outright as a “pre-existing condition.”

  4. This is so distressing, as I am imagining how whether or not you had to pay extra (or endure some other penalty or mandatory class, etc….) will become fodder for gossip in people’s workplaces. One more way to “other” people and separate and shame.

  5. Thank you, Fall, for your reply to Kell. We have two corporate political parties, and it really doesn’t matter much which one we get, except perhaps in some little ways. What we should be fighting for is Medicare for all, and ending the domination of our so-called health care system by the medical-industrial complex, which includes health insurers. Neither of our current political parties has the least interest in doing this, and apparently the American public doesn’t either. The day we truly want a rational and decent health care system we will fight for it.

  6. Note that there are only SOME “lifestyles” that are deemed morally inferior by healthism evangelists. You can break your back falling off a mountain or require numerous surgeries to correct the damage suffered in a motorcycle accident, or become paralyzed from the neck down requiring lifetime care while diving off a cliff, or get killed participating in some other inordinately dangerous “extreme sport” and if your BMI was below 25 you will still be considered a “lifestyle and wellness hero.” But if you feed the poor, care for the sick, and organize fundraisers to help the homeless rather than spending time in the gym perfecting your own physique, you will be deemed morally inferior.

    We do make choices. We could all “choose” to spend every spare minute of every day obsessing over various exercise and eating regimens that are alleged to make us ‘healthy’ or at least ‘normal’. It is worth asking who benefits from that.

    I mean, when all those pesky activists become obsessed with their bodies rather than with addressing social and political issues or exposing corporate misdeeds — who benefits?

    Its worth asking.

  7. I also want to know about corporate liability.

    I’ve been around for long enough to know that there are many things we’ve been told to eat or do or take “for our health” that later turn out to be ill advised or dangerous — or actually to harm rather than improve our health. Phen-fen comes to mind, as do a number of other medications and “lifestyles.” (I remember when I was warned by my pediatrician that if I didn’t stop including my child in my health food vegetarian lifestyle she might have to report me for child endangerment, because the medical wisdom of the time was that vegetarian diets were fad diets that were not safe for children.)

    People seem always to believe that previous generations were dumb and scientifically naive, but that “now” “we” are much smarter and have all the “right” answers rather than silly wrong answers attributable to our silly and unscientific ways. So even though all those stupid people in the past thought “X”, NOW we are much smarter and “know” that “Y.”

    Except whaddya know — it is not at all unusual for “further research” to then reveal that “Y” wasn’t really very good advice either, and may actually cause more harm than good.

    So … what happens when your employer has been financially bullying its employees to do “Y” — and it then is later discovered to harm rather than improve health?

    Will that be considered a workers comp injury? Can you sue your present or past employers for bullying you into accepting medical treatments or ‘lifestyles’ that actually harmed rather than improved your health?

    Or will “personal responsibility” be invoked yet again?

    For example, if this were 1993 and your employer was telling you that you had to lose weight in order to get decent health insurance rates … so you went to your doctor who told you that, hands down, the safest and most effective treatment was Phen-fen, and prescribed it for you, and you took it as prescribed for several years trying to get your weight down to a “healthy” level that would allow you to get affordable health insurance — and then you developed one of the life-threatening side effects that eventually got that drug pulled from the market … could you sue your employer? Your health insurance company? Or would they (once again) invoke “personal responsibility” BLAMING you for “chosing” to take a dangerous drug and BLAMING you for “wanting” a “magic pill” to help you lose weight?

    I wonder…


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