It is WRONG to Charge Large People More for Insurance

I was in line at the grocery store today when I noticed the woman behind me eyeing my enchiladas.  Always one to make conversation I said “They are actually really good for frozen food, no preservatives or weird chemicals, and they’re tasty.”

She sighed, in what I would call “longing”, and said – “I can’t, I’m on Atkins”.  She paused,  smiled wryly and said “sixth time’s the charm…”.

I must have made a “huh” face because she went on “my work charges me extra for my insurance if I’m overweight – it costs me about $600.00 a year.  I’ve been on and off every diet and I’m heavier now then when I started.  I’ll lose 30 pounds and gain back 35, lose 20 and gain back 40, it’s a vicious cycle but $600 is a lot of money to me so I have  keep trying, right”.

Now, this is something that I’ve heard of but don’t know much about.  Since I run my own business, I am not covered by a company policy.  I am the picture of health, but I guess I don’t fit the insurance companies’ frames because I am literally too fat to qualify for insurance.  Even catastrophic.  I just can’t get it.

So I went to a  friend who I know is charged $50 per month extra for her insurance.  I asked her how it works.  For her company if her BMI is over a certain number OR if her BP/Cholesterol/Glucose does not meet a certain standard, she is charged $50.  She meets the BP/Cholesterol/Glucose standard but her BMI is too high so she gets charged.

The problems with this?

  • The tests are correlational at best, and in some cases known to be inaccurate – skewed against the employee
  • Nobody can prove that their method of dieting sustains long-term weight loss
  • Dieting and weight cycling can be much more detrimental to health than being obese

Whether you call it additional premium for large employees or “incentives” for small employees, companies and their insurance plans are penalizing their employees for not doing something that nobody can prove is possible, for a reason that nobody can prove is valid, with a probable outcome of leaving their employees less healthy than they were when they started.

It’s not just size discrimination, it’s ludicrous.   You’ll hear that size is a matter of personal responsibility.  I think that personal responsibility extends to researching popular claims to be sure of their source and validity before we use them as the basis of widespread discrimination.

It also sets a dangerous precedent.  When these fat penalties stop being fun money for insurance companies, what group will they target next to increase revenue?

Why not charge employees who bike to work an extra premium because their sun exposure increases their risk for skin cancer?  Charge people who eat a lot of fish since high mercury levels in fish correlate to health issues.  What if they find out that people who live in a specific zip code tend to get the flu more often – can they be charged more too?

Currently the Genetic Information Nondiscrimination Act precludes charging more based on the results of genetic testing.  In reality though, isn’t that just only until the Insurance and pharmaceutical lobbies go to work?  They’ve managed to lower the threshold for obesity as well as the numbers that indicate high blood pressure and high cholesterol to help bolster their profits. They are already charging based on outcomes of genetics (like cholesterol and body size) so I can’t imagine that working on charging based on genetic predisposition is far behind.

It’s not right, it’s unfounded discrimination, and it needs to stop.  Right now.

Are you a numbers and research person?  Good, me too.  Here you go:

BMI and It’s Many Problems

Belgian polymath Adolphe Quetelet devised the BMI equation in 1832.  He never intended for the number to be used as a measure of individual health, he created the formula to be used as a statistical tool across large populations.

Three members of the committee responsible for releasing the standards for obesity including BMI as a risk measurement had direct ties to pharmaceuticals that manufactured diet pills for profit.  A fourth member was the lead scientist for the program advisory committee of Weight Watchers International.  This committee advocated dieting for everyone who has a BMI more than 24.  They shaved 15-20 lbs off the definition of “ideal weight” which made over 60% of Americans “overweight” over night.  Soon we were hearing that 300,000 deaths a year were attributable to obesity.

In January 2005, the CDC came out with new “obesity and death” figures.  These figures stated that no more than 110,000 deaths per year could be connected in any way with obesity.  They also stated that the link “may be a weak one”.  The lead scientist of the CDC also said that a critical analysis of their data found that people whose weights fell within the overweight, obese, and severely obese BMI ranges tended to live longer than those whose weights fell within the so called “normal BMI” ranges.

Weight Loss Doesn’t Work


“There isn’t even one peer-reviewed controlled clinical study of any intentional weight-loss diet that proves that people can be successful at long-term significant weight loss.  No commercial program, clinical program, or research model has been able to demonstrate significant long-term weight loss for more than a small fraction of the participants. Given the potential dangers of weight cycling and repeated failure, it is unscientific and unethical to support the continued use of dieting as an intervention for obesity.” — Wayne Miller, an exercise specialist at George Washington University (emphasis added)

Surprised?  If you are it’s probably because the diet industry spends 60 Billion Dollars a year trying to sell…I mean tell… you otherwise.

In a recent discussion I was having online about this, someone cited the studyBehavioural correlates of successful weight reduction over 3y,” from The International Journal of Obesity (2004, volume 28, pages 334-335).

I researched it and it turns out that it gets cited a lot.  There are lots of interesting things about this study:

  • “Success” is defined as “weight loss of 5% or more from baseline”  over the three years.  So if a 5’4 person who was 350lbs loses 17.5 pounds and now weighs 332.5lbs, this study calls them a success, despite the fact that they are still considered “morbidly obese” on the BMI scale.
  • Other studies have shown that 95% of people gain their weight back within 5 years, so this study gave itself a two year efficacy cushion.
  • The study had a 77% dropout rate.  And they don’t know why people dropped out.  One reason could certainly be that they followed the strict guidelines, didn’t lose weight and so quit the program.
  • In total, 198 out of the initial 6,857 people actually obeyed the seven required diet restrictions.  40% of those “elite dieters” failed to lose even 5% of their body weight. So, about 119 of 6,857 (1.7%) actually followed the diet lost 5% of their body weight.  Which, unless they were only slightly overweight to begin with, would have little to know effect on their health.  But people cite this study and say that the other  99.983% of people clearly just lacked self-control.

“Just eat less and exercise more” doesn’t work

In the 1960s scientists experimented on prisoners, doubling their calorie intake to see if they could cause them to gain 20-40 pounds (of course this was before ethics and IRBs rendered such a study unethical). From Garner and Wooley:

“Most of the men gained the initial few pounds with ease but quickly became hypermetabolic and resisted further weight gain despite continued overfeeding. One prisoner stopped gaining weight even though he was consuming close to 10,000 calories per day. With return to normal amounts of food, most of the men returned to the weight levels that they had maintained prior to the experiment.”

So when fat people are able to lose weight, is it because they are now eating like  “thin people” eat? Actually, studies show that a high percentage of fat people who keep weight off, become, for all intents and purposes, anorexic. From Garner and Wooley:

“Geissler et al. found that previously obese women who had maintained their target weights for an average of 2.5 years had a metabolic rate about 15% less and ate significantly less (1298 vs 1945 calories) than lean controls. Liebel and Hirsch have reported that the reduced metabolic requirements endure in obese patients who have maintained a reduced body weight for 4-6 years. Thus, successful weight loss and maintenance is not accomplished by “normalizing eating patterns” as has been implied in many treatment programs but rather by sustained caloric restriction. This raises questions about the few individuals who are able to sustain their weight loss over years. In some instances, their eating patterns are much more like those of individuals who would earn a diagnosis of anorexia nervosa than like those with truly “normal” eating patterns.”

And from the New England Journal of Medicine:

“Many people cannot lose much weight no matter how hard they try, and promptly regain whatever they do lose….

Why is it that people cannot seem to lose weight, despite the social pressures, the urging of their doctors, and the investment of staggering amounts of time, energy, and money? The old view that body weight is a function of only two variables – the intake of calories and the expenditure of energy – has given way to a much more complex formulation involving a fairly stable set point for a person’s weight that is resistant over short periods to either gain or loss, but that may move with age. …Of course, the set point can be overridden and large losses can be induced by severe caloric restriction in conjunction with vigorous, sustained exercise, but when these extreme measures are discontinued, body weight generally returns to its preexisting level.”

Yo-Yo Dieting (aka Weight Cycling) is worse for you than being overweight

“Obese humans typically show repeated loss and regain of large amounts of weight. Men with large fluctuations in weight between the ages of 20 and 40 have increase systolic and diastolic blood pressure and cholesterol. These yo-yo dieters are two times more likely to die of coronary heart disease, even after adjustment for known risk factors, than are men with stable or steadily increasing weight. Fluctuations in body weight have been shown in many other major epidemiological studies to have deleterious cardiovascular effects resulting in increased mortality.”  Case Western Reserve University’s Paul Ernsberger

Dangers of Yo-Yo Dieting include:

  • Liver issues
  • Lower metabolism
  • Heart disease
  • High blood pressure
  • Loss of muscle
  • Stroke
  • Type II Diabetes
  • Cancer
  • Shorter life-span
  • Loss of muscle and lower metabolism make it nearly impossible for you to lose weight

I will say it again

Companies and their insurance plans are penalizing their employees for not doing something that nobody can prove is possible, for a reason that nobody can prove is valid, with a probable outcome of leaving employees less healthy than they were when they started.

It’s not right, it’s unfounded discrimination, and it needs to stop.  Right now.

My research for this project came from a number of sources including (where not otherwise cited) (the New England Journal of Medicine)

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26 thoughts on “It is WRONG to Charge Large People More for Insurance

  1. I definitely agree that charging people extra for carrying extra pounds is absolutely wrong. Unless, I am misunderstanding you, if none of those methods of weight loss work, well, what DOES work?

    1. Part of the question is about what you are trying to achieve – being healthy or being skinny? They are definitely not the same thing. Based on what we know the best way to create a healthy body is through healthy habits: move your body 3-5 times a week in a way that you enjoy, eat food that nourishes you most of the time and eat enough of it). If you want to be smaller than you are now, that may not be possible for you without extreme measures that lead you to be a smaller size but with less health. That’s why I advocate a goal of being healthy rather than a goal of being a certain weight or size. I highly recommend Linda Bacon’s Health at Every Size and Golda Poretsky’s Body Love Wellness
      as places to start.

  2. I love reading your blog but it makes me sad that even you don’t make a distinction between Type 1 and Type 2 diabetes. Yo-yo dieting does not cause “diabetes,” though it may cause Type 2 diabetes, which is a metabolic disorder. Type 1 diabetes is autoimmune and has no relationship whatsoever to eating habits or weight.

      1. Thanks! It may seem like a small thing, but every little correction means one less person asks me if I got Type 1 diabetes from eating too much sugar. 🙂

  3. Thank you for shedding more light on the BMI scale. I knew it was bogus, but now I have evidence. I feel a lot of people counter this argument though by saying something along the lines of well, why are people fatter than they were 50-100 years ago? As you mentioned, the BMI scale has caused this perceived increase in the size of Americans, but are there other factors involved? How do you dismantle this argument?

    1. I don’t know that it can be dismantled with our current data. Since, despite a mountain of evidence, most medical professionals still say that being fat is just a lack of self-control or being on the wrong side of a calories in/calories out equation, there aren’t many people researching what else might be the cause. People have postulated that it’s from our food quality, from the hormones in food, or from a rise in cortisol – a stress hormone that, when raised over a long period of time, causes most of the health issues currently correlated with obesity. Scientists are studying that as a possible reason why people who are obese in countries where there is no stigma attached don’t have the negative health outcomes of people who are obese in countries where they are publicly stigmatized. The hypothesis being that being fat leads to stigma leads to constant stress leads to a rise in cortisol, leads to negative health outcomes. Take the stigma out of that equation, studies are starting to show, and you have happy, healthy fat people.

  4. Hi Ragen,

    I wanted to add a couple of thoughts to your notes. As you know I live in the health care arena and fight these issues regularly.

    First, lab values are reevaluated occasionally. For example, the blood sugar levels were adjusted down in 2005 which is a contributing factor to more diagnosis of diabetes.

    Second, the pharmaceutical companies lead the efforts for drug studies and therefore lab results changing. Hmmmm…. gee.. I wonder what connection that is.

    Third, the new legislation you mention only protects you from discrimination for health insurance benefits. It does not prevent your genetics from affecting your life insurance or disability access. People need to be careful about getting the tests run to ascertain genetic predisposition for diseases. There will be consequences.

    And last, I think it is always important to identify optimal health as the goal. We come in different sizes and shape but that also means that we must know what is healthy for each of us as individuals. No one else can be responsible for me.

    Thanks for another good blog Ragen.


    1. Thanks Penny. Fantastic points, especially about the legislation – thank you so much for clarifying that!

  5. This is not the point at all I realize, but as an American living in Europe, it sickens and embarrasses me that there are ANY barriers–weight, money or otherwise–to healthcare whatsoever.

    1. I hear this a lot from my international friends when they find out that I am completely ineligible for insurance at all. I find it completely embarrassing that this country, for all its claims of ingenuity and being a super power can’t (or won’t) figure out a way to keep it’s citizens healthy.

      1. Nothing can be a “right” that requires another to provide it for you. Just how much health care do people have a right to? Everything they want? Everything the state thinks they should have? This is a slippery slope indeed, for if there is a right to health care, then there is also a right to a house, food, water, shoes, a job, etc. etc.

        What this means is that all things are communal, which has always failed and always will.

        Don’t you realize that the same government that tells you it is going to “give” you health care can also tell you how to live, what to weigh, what to eat, and whether you are worthy or not of the state’s attention?

        If we had a true free market in medicine and insurance, then the costs for everyone would be reduced. What makes it so expensive now is the massive intrusion of government in the system.

        “Government is the great fiction through which everybody endeavors to live at the expense of everybody else.” ~ Frederic Bastiat

  6. Thanks for bringing this discussion to light. I really appreciate our conversation and the blog that came from it.

    Just one note on the “fax tax:” If I make a 5% improvement in either BMI or the score derived from BP, cholesterol, and blood glucose, I get all the money paid in for the calendar year back.

    This might be a nice touch, but what if my 5% BMI improvement is from 55 to 52.5? Yup, lather, rinse, and repeat! We won’t even discuss the morale problem stemming from those subject to this tax…

    1. Wait – so your insurance company gives you the opportunity to provide them with an interest free loan for a year. And they are allowed to default on it unless you can achieve something that only .017% of people are able to do? What a fantastic offer – I take it all back!

      Seriously, they are now actually rewarding weight cycling – something that they very well know will leave you less healthy than when you started. What crap. Sorry you’re having to deal with this.

  7. Thank you for writing this! It’s going to be a handy reference for my tiresome “eat less, exercise more!” acquaintances, none of whom give me the least amount of credit for knowing how my own body works.

    Also, was at a multicultural festival yesterday, and saw some amazing fat female dancers doing a tribal-style performance. They were so talented, and so beautiful. It made me think of this blog. 🙂

    1. Glad that you liked it! I am a big fan of tribal belly-dance so I’m just a little envious of your spectator experience 🙂

  8. I’ve heard of this – I think it’s ridiculously unfair. I certainly know that I’m guilty of measuring myself up against international standards (BMI, height, weight, etc) and I know now that just because I have a lower BMI than someone else doesn’t mean I’m healthier, more fit, or most importantly, happier. Thank you for writing this post!

  9. Excellent post! I passed it along to several friends and family members. My son-in-law is one of those people who never gains weight, no matter what, so he thinks being fat is a matter of choice.

    Since dieting doesn’t work, and I don’t believe the drugs used to lower blood glucose levels actually do anything positive (they lower glucose, but do not prevent long-term complications), what is a person with type 2 diabetes to do? It scares me to think that type 2 diabetes may be like MS or some other chronic disease for which there are few good treatments. My dad took his pills for years and still ended up a double amputee with congestive heart failure. I am so afraid of ending up the same way.

  10. It sounds like a cash cow to me. Most of the population is above the ridiculously arbitrary measurement for a “healthy” BMI, so who better to charge an extra fee than those who fit the criteria of “most of the population”? And the beauty of it? You don’t have to make up some kind of absurd justification – the entire culture of the country has that prejudice built in, so you just ride it all the way to the bank.

    Thank God we have universal health care in Australia and private health insurance here relies on “winning” the customer, rather than having a captive audience through employers.

  11. “Why not charge employees who bike to work an extra premium because their sun exposure increases their risk for skin cancer? Charge people who eat a lot of fish since high mercury levels in fish correlate to health issues. What if they find out that people who live in a specific zip code tend to get the flu more often – can they be charged more too?”

    shhhhhhhhhhhh, don’t give them ideas 😉

  12. Hey, Ragen… Do you have a post just on the BMI part of this post? I’d like to share that part with friends without them getting distracted by the insurance pricing part (at the moment).

  13. 119 of 6,857 (.017%)
    That would actually be 1.7%–you forgot to move the decimal place (i.e. multiply by 100) when converting it from a decimal to a percentage.

    It’s still a pretty pathetic success rate.

  14. My husband and I are trying to get life insurance – for me it’s possible but expensive, for him it’s insanely expensive or completely impossible with many companies. His BMI alone (no high blood pressure, cholesterol, or anything else) puts him in the same group with people who have cholesterol off the charts, immediate family members with heart disease and cancer, etc. I am so frustrated that we will have to pay 4 times as much for life insurance (and with a few more pounds we probably couldn’t get it at all) just because of our weight. We’re considering doing a crash diet to get into the overweight or less obese category, getting the term life insurance, and then probably gaining all the weight back plus more. Super unhealthy, but what are we supposed to do?

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