Punishing Employees for Their Size: Bad Idea

Greetings from Hanover, NH.  I’m preparing for my talks at Dartmouth tomorrow and Thursday, in the meantime the always brilliant Dr. Deah sent me this interesting and problematic article [Trigger warning – headless fatty picture, obesity epi-panic talk, comments are as expected].  On the plus side it recommends an end to blaming and shaming fat people for our body size and points out that the government may be happy to blame us because then they can avoid facing controversial issues, some of which they caused, that affect all of our health.  On the negative side they are still pathologizing body sizes rather than acknowledging that health and bodies come in many sizes, and the final paragraph is the most problematic to me:

The IOM report urges employers and insurers to do more to combat obesity. UnitedHealth Group offers a health insurance plan in which a $5,000 yearly deductible can be reduced to $1,000 if a person is not obese and does not smoke. Some employers provide discounts on premiums for completing weight-loss programs.

This is an issue that is really important to me.  I already did a case-specific piece about Whole Foods fat punishment program, I am working with my publicist to do more corporate talks about this, and  today I want to talk about it from a more global perspective.

Let me say this upfront:  I think it’s great if employers want to support their employees’ access to varied food choices, safe movement options that they enjoy etc.  I do not think it’s ok for an employer to force their idea of health or healthy habits onto employees.

It has become increasingly popular to use a “carrot and a stick approach” for, in theory, benefits cost savings. The supposed goal is encouraging employees to become healthier by making benefits more expensive for those who are perceived as unhealthy, using measurements like Body Mass Index, cholesterol, and blood pressure. These programs charge more to people who don’t measure up, either by giving “discounts” to employees who are perceived as healthy (carrot), or penalizing those perceived as less healthy (stick).

I’m going to give employers the benefit of the doubt and assume that they are just misinformed, though of course there is a possibility that since the majority of people in the United States are classified (in a very problematic way) as overweight or obese, employers are just using this as an excuse to save money by making their fat employees pay up. But, giving them the benefit of the doubt:

As a former CEO and Operations Consultant, I get that this could look attractive from a cost savings perspective, and altruistic if one believes that encouraging employee thinness is the same as supporting employee’s individual health goals. But I also know better than to buy into the latest thing without doing my research. It turns out, in the long term, these programs are most likely to leave employees less healthy, less productive and cost more.

Full disclosure – were I employed by a company using this approach I would be paying higher premiums.  Not because I’m not healthy – all of my metabolic health markers are in the exceptional range. And not because I’m not active – I’m a three time National Champion Dancer who can do the splits and leg press almost four times my body weight. But my BMI puts me in the obese category. The problem is that BMI was created to compare relative body size among large populations and we incorrectly use it as measure of individual health. I’m not the only healthy person who would be caught by the use of this poor measuring tool – Arnold Schwarzenneger, Matt LeBlanc and many professional athletes would be paying up with me.  So would anyone who is very tall or very muscular since BMI does not take body composition into account.  Beyond which I think it’s inappropriate and a slippery slope to charge me more even if I was unhealthy and inactive but we’ll get to that in a minute.

Consider the fact that the employers have no proof that what they are requiring is even possible.  Studies since 1959 have all shown that intentional weight loss, whether it’s called a diet, eating plan, lifestyle change, or something else, fails 95 percent of the time in the long term. So if employees are encouraged to lose weight, 95 percent of those who try will be as heavy or heavier with worse metabolic health than they started within a couple of years. Plus, it encourages employees to participate in unhealthy behaviors to “make weight” for the annual evaluation which can lead to health dangers including weight cycling (yo-yo dieting) and even eating disorders. In what other area of business would we look at these numbers and decide to move forward?

Organizations including the American Heart Association, American Cancer Society, Obesity Action Coalition and National Women’s Law Association have come out against these programs because of legal issues. Employees are starting to challenge these programs using the Americans with Disabilities Act because blood pressure, cholesterol and body size can be caused by genetics and/or health issues over which employees have no control, and they are being punished for something that there is no proof that they caused or that they can change.  Employees are also suing employers who partner with programs like Weight Watchers and force employees to go or pay up since Weight Watchers and similar programs  have been successfully sued by the Federal Trade Commission for deceptive trade practices and have no proof of long-term efficacy.

It’s going to get messy and expensive and I would think that nobody wants a piece of that action.  In case you’re not already convinced, studies show that these kinds of incentives may work short term but can the opposite effect in the long term – “crowding out” intrinsic motivations that actually do work to motivate long term changes in healthy behaviors.

Let’s Review:  Carrot and stick programs don’t lead to healthier employees, don’t save companies any money, and do create completely unnecessary exposure to legal action.  Luckily, there are much better, more cost effective ways to give support employees who are interested in pursuing health.

Evidence strongly suggests that focusing on fitness rather than weight is the best chance for long-term health. Researchers have found that fitness trumps fatness and that simple healthy habits (like eating 5 servings of fruits and veg, walking 30 minutes a day, drinking moderately, and not smoking) even the playing field among people of all sizes. Thus giving options to support employee’s personal goals and choices without focusing on employee weight is the best choice.  There’s a great case study of a Health at Every Size workplace health program in action on page 42 of this zine.

Punishing employees for perceived health risk is a very slippery slope.  What is next?  Surcharges for employees who mountain climb, ride motorcycles, have the breast cancer gene, have a family history of heart disease, don’t sleep the recommended amount?  Can vegan employers charge non-vegan employees extra?   I don’t personally think that employers should be in the business of policing employee health or providing health insurance – I think employers should be focusing on hiring the best person for the job, not trying to guess which employee is going to cost the most for their healthcare plan or trying to tell employees how to prioritize their health and how to get there.  Given the current system, a Health at Every Size Approach is the only approach to supporting employee’s personal health goals that has an evidence basis. Some suggestions to support employees:

  • Allow 30 minutes of break time during the day for employee walks
  • Classes in the conference room – yoga, Zumba, Tai Chi, before work, at lunch, and after work
  • Work with local gyms, dance studios, martial arts centers etc. to get employee discounts
  • Consider subsidizing fitness classes as an employee benefit
  • Have good filtered water at the office
  • Bring in speakers to talk about Health at Every Size

Whatever you do, the research clearly shows  that punishing employees for their size does not increase health or a company’s bottom line.

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21 thoughts on “Punishing Employees for Their Size: Bad Idea

  1. Offer fitness classes and speakers? Provide healthy snacks? 30-minute breaks? Silly rabbit, those things cost MONEY. It’ll never happen. It’s much easier to pay lip-service to the idea of caring about employee health by blaming scape goats, then forcing employees to spend their own money on useless interventions so they can keep their jobs and healthcare.

    That’s the corporate way.

    1. I agree. If these companies actually cared about people, they would look at these ideas. But they don’t. I doubt they care a bit whether it is possible or fair what they are doing. And if it becomes legal to penalize people (i.e. spend less on them or get more from them) because they have breast cancer genes or diabetes or whatever, they WILL DO IT. It’s all about what they can get and who they can run over to get it.

  2. I finally quit my job last year after my company instituted an “incentive” plan. (Trust me, it was SO not an incentive plan; it was punishment all the way.) Not measuring up to standards meant the percentage the employee paid toward his or her insurance premium would increase dramatically. Of course, this could be somewhat mitigated if you agreed to health coaching, and WW attendance if your BMI wasn’t ok according to their arbitrary and ridiculous standards. (But you had to go to live WW meetings, so your attendance could be checked. And these were not offered onsite.) Opting out of this madness (which I did) meant an even bigger increase in the amount the employee would pay toward the premium. And even with opting out, I was constantly bombarded with emails from the new wellness company running the whole farce. It truly felt like harrassment. (You’d think paying extra to opt out could at least provide peace from the constant nagging!)

    Of course, even as the company was instituting this joke of a program and claiming they were so invested in the health of their employees, they were laying off employees and asking everyone else to pick up the slack. Most people worked through lunches, worked plenty of OT in the the office, and then took work home. (Not sure when anyone was supposed to have time for those WW meetings, even if they were so inclined to go.) As if that wasn’t bad enough, the company then decided that sick days and vacation time would no longer be credited to employees at the beginning of a calendar year, as was always the case, and many people started the new year with no time to take if they were sick or just needed a day off here and there. (They didn’t tell us about it until November of the prior year, either. Guess they didn’t want anyone saving time to rollover?) What saved some of us who were in management is that we had been prohibited from using our vacation time during the prior year in case the union went on strike, so we had time to roll over anyway.

    The program was vile to begin with, but what finally made it unbearable to me was that it was touted as the company being so concerned for the employees, even as all their other business decisions made the environment stressful and unhealthy. And they even presented it was a way for employees to save money, although in truth only those who met all the criteria would continue to pay what everyone was paying to start with. No one would actually SAVE money, even those the company deemed “fit” according to their BS criteria. It was a joke from beginning to end, and the way it was presented was an insult to the employees.

  3. My office building has a fitness gym in it – the problem is that it is only for the police agencies in the building. The new database that my agency is developing has so many duplicate steps and layers in it, it takes 4 times as long to input data than the old one did but we are stuck with this duct-taped database because… I got a lot more movement in 9i.e. walking, returning files, etc.) before this database and I can feel the difference in my body, but what do I matter, I’m just an employee, a support staff employee at that. Enough whining, I’ll have some cheese please. LOL

  4. Do you by chance have a link for the American Heart Association coming out against companies with stepped benefits based on weight? I’ll look around too, but if you have something handy, that’d help a lot. Thanks!

    Your blog is awesome, and you’re awesome.

  5. My husband works at the Forest Service. As deemed by the First Lady, they were forced to make a “fitness room” for the office that comprised of a couple of exercise machines, scales, exercise balls, etc.. so that people can work out during the day. They’re allowed 30 minutes of paid time to work out (I assume so they don’t feel like they’d have to use up their lunch time to do it). That’s a peachy arrangement.

    Do you think anyone exercises? Nope. Not a single person in his office actually uses the room, even when getting PAID to do it (only 7 or 8 people work in his office). They have too much other work to do! His office is desperately understaffed and none of them are about to spend precious time on a treadmill when they could be making calls, filling out paperwork, or entering in data. The money that they were forced to spend on buying exercise equipment could’ve been used for a seasonal to help lessen the load (*coughlikegiveMEajobcough*), but the higher-ups don’t care. The exercise room is a big joke and it’s only collected dust since they made it. Perhaps if the entire office wasn’t swamped with work they might consider it. Maybe. Some of the employees are fit and exercise already, but most of them don’t. And at the end of the day, none of them feel like exercising in a tiny room with a few machines and no TV; they’d rather be home with their families or high-tail it back home if they live an hour away (some do).

    I see the concept was in the right place, but it’s just not practical–when you’re stressed and overworked–to be told by your bosses to go and exercise. In theory I guess it’s a fine idea, but nobody takes it seriously when they’re already pissed off at their superiors for unrealistic expectations of the amount of work that only one person can do.

    BTW: My husband’s office had to *make* a “gym” because we live too far away from a gym (50 miles). If your town had a gym, the office didn’t need to set up an exercise room. They didn’t force you to get a membership but did give you (I think) $250 a year towards a gym membership. Not too shabby! I doubt that $250 equates to the 1/2 hour every day that my husband could be exercising in there and the amount he’d get paid for it, but whatever works I suppose. A real gym with real equipment and a pool and everything is a lot more motivating than a tiny dark room in the basement with a few pieces.

    I guess it really depends on the person whether or not they’d take advantage of something like that. But at least it’s the RIGHT kind of incentive. Even though the exercise room is a joke, it’s a better situation than being told that you’re going to be penalized for a too-high BMI, “or else”!

  6. If they ever institute that at my workplace, I hope they don’t mind if I strip naked for the official weigh-in — I tend to be “overweight” when stepping out of the shower, and “obese” once I get my clothes on. I’d strip naked in a physician’s office hallway for a $4,000 reduction in my deductible….

    In theory, I guess, I go from being simply unhealthy to OMG she’s going to drop dead if I wear my Dansko clogs. Makes perfect sense, eh?

  7. Not workplace related, but BMI-nonsense related. My husband is part Korean and when we first started talking about adoption, we wanted to adopt from Korea because of the link of culture, etc. Unfortunately, one of Korea’s requirements for adoptive parents is that their BMI be less than 29.9. When I pull up Korea’s BMI chart, it would require me to weigh 206. The least I’ve ever weighed as an adult, while in the middle of killing myself (figuratively) on Weight Watchers and at the gym every single day, is 232.

    It just makes me so sad and angry that we’ve lost this opportunity because of random numbers. The idea that somehow I will be less of a parent because I’m fat is ludicrous. It’s not just Korea that has such requirements though, China has something similar in place.

    We’re still moving forward with adopting, but we have changed countries.

    1. I can’t believe that BMI is a factor in approval/rejection of adoption. It’s not like that in the States, is it? Why is that even a concern of theirs? You’d think they’ve got more kids that need adopted than they can get rid of over there and something as stupid as that wouldn’t be a limiting factor. How terribly absurd. I’m sorry you’ve had to deal with that.

      1. Technically, adoption agencies don’t look at BMI, but they totally do. My husband and I had been trying to adopt through the foster care system in Texas and it became abundantly clear that we were never going to get a child due to our weight.

      2. No offence, but Korea isn’t a third world hell hole with lots of kids lying round waiting to be picked up by Westerners.

      3. My comment has nothing to do with BMI (which is a dumb measure of fitness), but with the idea that Korea has more kids “than they can get rid of” – just to clarify.

      4. @Alexie
        You’re totally right, that was a really insensitive thing for me to say. That’s just the impression that I get from that side of the world, and I wonder what that says about ignorant people like me!

  8. I read this article yesterday. At first, I was heartened that it was not just a “All fatties did this to themselves!!!!” article. Like you, I was disappointed when I read the last paragraph. These wellness programs just don’t make sense. Sure, my BMI is high, but like you, I have great metabolic markers. I don’t see why I should have to pay more than a thin person with horrible cholesterol, glucose, or blood pressure just because the number on my scale is higher.

  9. I’d like to point out that these ‘incentive’ programs are a travesty not only because blood pressure, cholesterol, diabetes and body size are mostly a result of genetics, but also because the likelihood of having higher blood pressure, cholesterol and body size or getting diabetes goes up with advancing age in everyone, making this a pretty obvious example of age discrimination.

    1. Thank you for this. That is what often gets lost in these discussions about health. There is more than enough emphasis on how to make everyone healthier or, alternatively, how to make people of all sizes pay more for their health problems. The primary focus, however, should be on the discriminatory nature of measures like these, not just on the basis of age, but also of genetics (and possibly ethnicity).

  10. God, I hated that article. And the comments, with a lot of people advocating a “sin” tax on junk food. All that will accomplish is making it even harder for low income people to feed themselves. Why is it the same people who want to make junk food more expensive balk at the notion of making healthy food less expensive?

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