Clydesdales/Athenas (200+ lb / 91+ kg) - Not so sweet home Alabama

Alabama, #2 in the national ranking of percent of population overweight, is going to enact a "fat tax" for state workers. If you have a BMI of 35 or above, your health insurance premium goes up 25 dollars a month.

http://www.webmd.com/diet/news/20080825/alabama-obesity-penalty-stirs-debate

Thoughts?

Oh, and by the way, the standard for tacky just got lower:

http://alabamaobesity.com/

Note that aside from pushing surgery as the answer to obesity ("Only a small percentage of Alabama residents are successful with diet and exercise alone...") , they've reproduced the Alabama state seal on the website, leading the casual reader to assume this site is "official" in some way or another.

Not that the website operators care about my opinion, of course. I expect these folks will tell old Neil that a Southern man don't need him around anyhow.

Yeah, I read about that one. I'm sure it has my mother stewing since she and I share the same sturdy build and she lives in AL.

I think this is a sign of thing to come. I know some private companies are doing the same to smokers as well as over weight. Giving them 2 year to stop smoking and show significant weight loss or your rates will be increased. In my view probably not a bad idea due to the cost of medical care and all the bad effects excess weight has.

One thing, keep in mind this thread could get very contentious.....as well as political. I'm only saying this to prevent it's being moved to P&R, guys and gals. Let's do try to keep it very civil and apolitical.

One thing, keep in mind this thread could get very contentious.....as well as political. I'm only saying this to prevent it's being moved to P&R, guys and gals. Let's do try to keep it very civil and apolitical.

It should be for at least 24 hours. I'm leaving on tour in a few minutes. :)

Ride safe and get LOTS of pics, Neil! :D Have some fun!


It should be for at least 24 hours. I'm leaving on tour in a few minutes. :)

Ride safe and get LOTS of pics, Neil! :D Have some fun!

I had to fix a minor mechanical. Darn trailer. :(

I expect these folks will tell old Neil that a Southern man don't need him around anyhow.


Wow, I never had you peged for a classic rocker.
Have a good tour and post pics.

"...Alabama, you got a weight on your shoulders that's breakin' your back..." Neil Young

I saw 2 highway signs in sequence yesterday. The first: "Click it or Ticket".

The next sign, showing food at the exit: "Wendy's, Steak N' Shake, Waffle House...".

It begs the question, which is more dangerous, eating french fries or driving unbuckled? I don't want the state to mandate choices, but if they do, shouldn't they start with the worst? Forget the tax, I'd just like to see the same kind of warning on the fries as a pack of cigarettes. Same level of danger, so why not?

Wow, I never had you peged for a classic rocker.
Have a good tour and post pics.

Will do. Mechanical fixed. I'm off!

Honestly, I wish the company I worked 24 years for would have done that, rather than moving our business to Mexico. I would rather see our workers still have jobs and also have to maintain a somewhat healthy lifestyle. I am still overweight, but I have gone from extremely obese to overweight.

I don't know if any business or government agency is doing this, but it wouild be in their best interest to look into something like this. As a YMCA employee now, I have met with some businesses and we have had employee meetings discussing health and wellness and how it can really make a difference. There are actually many people who have great retirement benefits, but will never get to use them, as they will not make it to 65 or older before dying or not have the energy to enjoy it with their current lifestyle.

Just my opinion.

I think this is a terrible idea. IMO, while companies should be concerned about employee health, and be willing to help folks improve their health, doing it this way is way too intrusive.

It's irrelevant whether this is a good idea or a bad idea from a health perspective. Remember, this is about health insurance, not health care. When you put the health insurance companies in charge, as they are in charge in the USA, you are going to dance to their tune, like it or not. An idea like this doesn't have to make any sense from the perspective of enhancing people's health; if it makes money or saves money for the insurance companies -- and it does, by enabling the insurance company to tack on a surcharge -- it's what's gonna happen.

I have really mixed feelings on this subject. I believe that if our health care system in this country has any hope of survival, some personal responsibility must be introduced. People waste vasts amount of money on health care because the employer/insurance combination is footing most of the bill. On the other hand, I have been denied individual health insurance because of weight. This insurance companies requirement was that at 6' 1" I needed to weigh less than 250 pounds. There was no effort on the part of the insurance company to determine if I was healthy or not. Weight was the only reason. I currently have individual insurance because my company is so small as to not be able to effectively get group insurance. I pay a hefty premium because of my weight. With that being said, the example cited ave did not use weight as the sole factor. "Those who are considered obese -- along with exhibiting other negative health factors -- will have a year to get in shape." I think that is fair.

I think this is a terrible idea. IMO, while companies should be concerned about employee health, and be willing to help folks improve their health, doing it this way is way too intrusive.

+1 to that thought. It worries me to see businesses attempting to control private behavior... even if it is "for our own good". Perhaps visits to the home to assist in healthy choices is next. (An Alabama epatriate incidentally.)

Weight and tobacco use are factored into rates for life insurance so I don't know that doing the same for health insurance is that out of line. Insurance is shared risk. When factors, especially controllable factors, increase the risk for some it increases the cost for all. If this helps make health insurance more affordable so more people can be convered, I'm for it.

Weight and tobacco use are factored into rates for life insurance so I don't know that doing the same for health insurance is that out of line. Insurance is shared risk. When factors, especially controllable factors, increase the risk for some it increases the cost for all. If this helps make health insurance more affordable so more people can be convered, I'm for it.

The article mentions BMI, cholesterol, and blood pressure as criteria- but NOT tobacco use. Also it can be argued that the $25/month penalty is both age discrimination and highly regressive in nature. It is regressive in that it is a greater penalty for lower paid employees. And excessive weight becomes a problem as we age, since the average adult gains about two lbs a year as s/he ages.

I find this discussion interesting, given my position as a Director in a small company (28 Full-time employees). Our staff is decidedly older, overweight, and most have at least two of the following issues: obesity, smokers, heavy drinkers, sedentary lifestyles. As a result we've had 2 heart bypass operations, 4 joint/back related surgeries, and a higher than average number of people on permanent drug regiments for some chronic illness. So I've been struggling with how we can address these issues with impact as our premiums are going to go up at least 25% in our next contract. This is manageable if we forgo normal wage increases for a 1 or 2 year period (not desirable since we're below market wage wise). But its not sustainable.

Given that difficult situation in these economic times, its a huge issue if we were to not try something. But how do you positively impact wellness when only 5 of your 28 employees are under the age of 40, and over half are over 50?

So I go back and forth- should we do a YMCA membership incentive (expensive short term), mandate a wellness program as a condition of employment (not likely), or give up on paying adequately until the remaining employees who are driving the insurance premiums either are forced to retire due to health issues (none of them really can afford to retire even at the right age), or have to take disability do to inability to perform job duties due to health problems.

Any way, this whole discussing got a whole lot less academic for me since I obtained my current position this year. Previously, I thought it beyond the role of employers to try and push employees to change lifestyles. But now that I'm having to face these costs in my budgets, the trade offs are real and not desirable either at a personal level or a company level.

Well, I'm a clyde from Alabama, and my employer is based out of Minnesota (a little sandpaper making business that's grown a bit). They offer us discounts on health club memberships, incentives several times a year via plant wide weight-loss competitions, health fairs, etc. They also have charged a premium on health insurance for smokers for several years now. I don't care for the big brother attitude on telling us what to do or how to look, but a little prodding us towards a healthier lifestyle (with TLC) doesn't seem to be that offensive. Pass the fried pies please.

Something they need to look at in enacting this policy is putting some type of bariatric treatment into their ins. policies. Alot of ins. won't pay for weightloss treatments and this doesn't just mean 'the surgery'. My ins. won't pay for anything weight loss related, I went to the dr. to discuss my options, just talking, nothing set in stone and they refused to pay for the office visit! I agree that obesity is a growing epidemic in this country but I hate that things like this are being mandated and forced down our throats, I have guns and a rottweiler, is my home owners ins. going to up because of this? I guess though that it could be worse, they could just deny you coverage at all.

Wow, I never had you pegged for a classic rocker.


I surprise many people. :)

Something they need to look at in enacting this policy is putting some type of bariatric treatment into their ins. policies. Alot of ins. won't pay for weightloss treatments and this doesn't just mean 'the surgery'. My ins. won't pay for anything weight loss related, I went to the dr. to discuss my options, just talking, nothing set in stone and they refused to pay for the office visit! I agree that obesity is a growing epidemic in this country but I hate that things like this are being mandated and forced down our throats, I have guns and a rottweiler, is my home owners ins. going to up because of this? I guess though that it could be worse, they could just deny you coverage at all.

One reason many insurance companies don't cover bariatric surgery is that in some cases it's not medically necessary.

Given that difficult situation in these economic times, its a huge issue if we were to not try something. But how do you positively impact wellness when only 5 of your 28 employees are under the age of 40, and over half are over 50?

Start passing the costs on to employees, across the board, and tell them why. If they make a collective decision to continue to be obese and smoke, well, that's their call.

Yes, incentives are much better than punishment. Overeating is a problem because of old, old instincts: I'm convinced that we top off the tanks when we can, to make up for times that there's no food available. It's tough to counter instinct.

A reckless driver's auto insurance bill is higher than a safe driver's premium. Since being overweight is often a choice, I don't see any problem with a "fat tax" except for one: People with genuine medical conditions that make it difficult if not impossible to lose weight.

Charging extra to insure someone with a medical reason for overeating is analogous to your auto insurance rates going up when someone rearends you at a red light.

If there were an effort made to qualify this, I'd have no problem with it. The problem here is I don't see any such effort - yet.

There is no denying that smoking and being overweight are bad for you and contribute to a higher risk of developing heart conditions or cancer. It can't be refuted. So insurance companies charging a higher premium for people who don't make an effort to change a documented unhealthy lifestyle just makes sense. I used to pay a higher premium for smoking but at the time I still chose to smoke.

Along with the higher premiums, employers should pay for employees to go to doctors for treatment to help them lose weight or quit smoking and to provide health club memberships for employees that desire them. It needs to be result driven as well. If a person expects a company to fork out a lot of money in medicines and other expenses to help an employee, then the employee should be liable for those expenses if they don't lose weight or quit smoking.

I am bound to get flamed from someone but it really is all about self control and rising to meet a challenge. All of the support in the world cannot make anyone change their behavior.

I'm 6'-2". When I was 240, I felt bad a lot of the time. My BP was up, my cholesterol was up, and I could tell I was not a well person. If someone had said my health insurance had to go up $25 a month to compensate for that, my reply would be, "Only $25?" This is when I was 240; the extra charge kicks in at a BMI of 35, which would be 275 for me (more or less). I would think if my body weighed that much it wouldn't be self-sustaining in that I would have major health issues and would be on a downward spiral toward a premature death.

If you look at it as an incentive to lose weight, it's not a great idea; people shouldn't interfere with personal stuff like that. If you look at it as refelective of actual cost to the insurer, it probably isn't near enough of a surcharge. I do think that they should wave the fee if a person can demonstrate a healthier lifestyle- like maybe regular weigh-ins and losing more than x pounds every month or whatever.

Also, is BMI really a reliable measure for insurance purposes? Can't a person be fit and have a high BMI?

Im all for it. Personally, I think companies doing this, state run or otherwise, need to offer a time period to get under it, medical exemptions (thyroid conditions, etc.), and gym memberships or like reimbursement to assist with it.

NY Times - Asia Pacific
By NORIMITSU ONISHI
Published: June 13, 2008

Japan, Seeking Trim Waists, Measures Millions (http://www.nytimes.com/2008/06/13/world/asia/13fat.html?_r=1&no_interstitial&oref=slogin)
Under a national law that came into effect two months ago, companies and local governments must now measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups. That represents more than 56 million waistlines, or about 44 percent of the entire population.

Those exceeding government limits — 33.5 inches for men and 35.4 inches for women, which are identical to thresholds established in 2005 for Japan by the International Diabetes Federation as an easy guideline for identifying health risks — and having a weight-related ailment will be given dieting guidance if after three months they do not lose weight. If necessary, those people will be steered toward further re-education after six more months.

To reach its goals of shrinking the overweight population by 10 percent over the next four years and 25 percent over the next seven years, the government will impose financial penalties on companies and local governments that fail to meet specific targets. The country’s Ministry of Health argues that the campaign will keep the spread of diseases like diabetes and strokes in check.

As an example my old employer (before closing our facility and shipping all the business to Mexico), paid $1.00 for each visit to our YMCA for an employee per year. I was able to get my entire membership paid for because of my lifestyle change a few years ago. Very few people took advantage of the opportunity out of a 500 plus employee company.

Also, is BMI really a reliable measure for insurance purposes? Can't a person be fit and have a high BMI?

Well, I guess since I can cycle 80 miles, but I am significantly over weight, I have a high BMI and am fit.

Where it gets tricky is if they even bother to use a reliable method of checking the true BMI of a person. Two men 6', one weighs 185 pounds, the other weighs 220, but the extra weight is solid muscle. Punish the heavier guy with greater muscle mass just because a little chart on paper says he MUST weigh 185?

Sounds like slippery slope.

But 220 is still less than a 30 BMI. I thought they said the extra cost doesn't kick in until a BMI of 35?

The other thing is that a lot of people hide behind that "but I have a muscular build" line. I think this exception to the rule applies to very few people in actuality. I think even a lot of serious cyclists like to think of themselves as muscular, but bicycle muscles are high-repetition muscles and aren't particularly bulky (compared to, say, a power lifter or football player). Insurance is just a big statistical game anyway; it all boils down to numbers. Numbers aren't always representative of reality, but they can be shown to have strong statistical correlation.

According to the BMI charts, at 6'-2" if I'm over 195, I'm overweight. That's just about what I weigh right now and I agree. I feel fit if I lose a few pounds, I feel overweight (and my blood pressure starts to go up and all that other bad stuff) if I gain a few. I'm sorry, but I can't claim to be muscular. I wasn't a high school athelete and never bulked up with muscles. I'm just a skinny guy. If I gain some weight, I'm a fat skinny guy.

BMI is a statistical game more useful for raising insurance ratesthan an actual health metric. Body composition is more useful, and measures of composition are similar to BMI in result, but adjusted for lean muscle mass v. Fat. This allows a more accurate determination as to the type, rather than the Q(mass).


Well, I guess since I can cycle 80 miles, but I am significantly over weight, I have a high BMI and am fit.

Where it gets tricky is if they even bother to use a reliable method of checking the true BMI of a person. Two men 6', one weighs 185 pounds, the other weighs 220, but the extra weight is solid muscle. Punish the heavier guy with greater muscle mass just because a little chart on paper says he MUST weigh 185?

Sounds like slippery slope.

Oops. Yeah. Sorry. Getting BMI confused with LBM (Lean Body Mass), which would seem to be a much better rating for health. After all, two women 5'6" can weigh 140. One a couch potato, the other a swim champion, but by the chart, they have the same BMI.

I am on both sides here, it would be nice if ins. could lower if you have a healthier lifestyle. If you could prove,in some fashion, that you are being responsible with your body (biking, gym, hiking etc) and rates lowered that would be great. But to just charge more based on BMI isn't the best IMO. If you have a lot of health issues due to your weight and you CAN do something about it (meaning it's not genetic or in some way medically not your fault in any way) then charging extra may not be so bad. If you can change and you do then the rates will lower right? that's how I see this. Also if the ins company can send out a warning with something like, effective 2010 blah blah blah, then you have time to start and maybe it's what's needed to help this country.

Now with all of that being said I am 5'7" and 266, I work out, I commute, I am often outdoors being active(at least 6 days a week) I have been overweight since I can remember, but not because I was a couch Potato. so I do wonder how this is going to work.

Insurance companies are out for profit plain and simple and they want you to keep paying but hopefully never really use the system much

I'm 5'10 and 215 pounds.... when I had my body fat tested a few years ago I was told I had 185 pounds of muscle on my frame. This would still put me into the category of overweight since my ideal weight is like 149-183. The issue I have is that a BMI measurement like others have said is not exactly accurate

it doesnt account for someone who has been bodybuilding or powerlifting and ading more muscle to their frame than the average person.

a much better way would be getting a body fat test and experts deciding what is not a safe level of fat on your system. But I've also met obver wight people who are in better cardiovascualr shape than many skinny people.

But 220 is still less than a 30 BMI. I thought they said the extra cost doesn't kick in until a BMI of 35?

The other thing is that a lot of people hide behind that "but I have a muscular build" line. I think this exception to the rule applies to very few people in actuality. I think even a lot of serious cyclists like to think of themselves as muscular, but bicycle muscles are high-repetition muscles and aren't particularly bulky (compared to, say, a power lifter or football player). Insurance is just a big statistical game anyway; it all boils down to numbers. Numbers aren't always representative of reality, but they can be shown to have strong statistical correlation.

According to the BMI charts, at 6'-2" if I'm over 195, I'm overweight. That's just about what I weigh right now and I agree. I feel fit if I lose a few pounds, I feel overweight (and my blood pressure starts to go up and all that other bad stuff) if I gain a few. I'm sorry, but I can't claim to be muscular. I wasn't a high school athelete and never bulked up with muscles. I'm just a skinny guy. If I gain some weight, I'm a fat skinny guy.

A statistician can use numbers to prove to you that 2 = 3, they will use lots of Greek symbols and statistical jargon, but in the end, they will prove to you that something mathematically impossible is in fact true enough for evidence in a court of law. Insurance companies deal in risk, and any time they perceive that there is a .5% increase in risk, they will increase premiums by 5%.

So here it goes, the insurance company needs a quick way to determine how healthy you are, without needing a doctor to examine you (that cost's money, and any fixed cost like a doctor exam cuts into profits). BMI fits that perfectly, in that any idiot can read off a chart. The nominal range for BMI is 18.5 to 25, so anything outside this range has an increased risk. How much outside this range determines the amount of risk.

What I think BMI was originally intended for, is generalization over a large population size, for example there are over 8 million people in Ontario, probably less then 5,000 of those are muscular enough to have a significantly skewed BMI, so if you said X% of the population are over weight (BMI higher then 25) the skewing factor is small enough to be statistically insignificant. However if an individual doctor uses solely the BMI to determine whether that person is healthy, they should not be allowed to practise medicine.

Personally my doctor did a number of blood tests, cholesterol normal, blood pressure low normal, blood sugar normal, told me I could probably stand to lose a little weight (tell me something I don't know doc.), but didn't push it. I think doctors here at least are determining that if everything else is okay, that a little extra weight isn't something to worry about. Then again at 1.7m and 93kg, i do have a BMI of 32..... :eek:

I hope everyone will read carefully all three pages of the Historian's link to the WebMD article. The following section seems pretty important to me:

"A report released this month by The Archives of Internal Medicine, which weighed cardiometabolic risk factors vs. weight, revealed that among the 5,440 participants -- U.S. adults 20 years old and older -- 23.5% of "normal weight" adults were metabolically abnormal. Conversely, 51.3% of adults deemed overweight and 31.7% classified as obese were declared "metabolically healthy."(Italics added)


Lifestyle and activity levels certainly vary between individuals, but the link between weight and health doesn't appear to be absolute. And unlike many conditions which remain discrete, obesity is on full display."

So the Alabama penalty to workers focuses solely on weight, an relatively unreliable indicator of health risk. And there appears to be no penalty to Alabama workers for smoking, which is a much stronger risk factor to health than being overweight.

OK a little off topic...but I clicked on the BMI calculator ont he site ..and the bee is only slightly overweight!!! MY good ness that is exciting...

My April weight had me severley obese with a BMI of 35.4 and now I am slighly overweight. BMI 28.5.. I think we should recommend biking to the Bamas...

Alos I noticed one option was for a low calorie diet.. I think the Bee plan is the moderate calorie diet...

A statistician can use numbers to prove to you that 2 = 3, they will use lots of Greek symbols and statistical jargon, but in the end, they will prove to you that something mathematically impossible is in fact true enough for evidence in a court of law.

If memory serves, that proof involves dividing by zero. :rolleyes:

My April weight had me severley obese with a BMI of 35.4 and now I am slighly overweight. BMI 28.5..

Personally, I find that most women who are less than 25 are a little too skinny looking anyway... ;)

This flickr group (http://flickr.com/photos/77367764@N00/1457574885/in/set-72157602199008819/) may be of interest...

personally, i find that most women who are less than 25 are a little too skinny looking anyway... ;)

this flickr group (http://flickr.com/photos/77367764@n00/1457574885/in/set-72157602199008819/) may be of interest...

+1

If memory serves, that proof involves dividing by zero. :rolleyes:

I'm not sure, I took statistics 20 years ago and barely passed, did learn one thing though, a statistic is about as truthful as a politician.... :D

HI,
Many of us anglo/english/german people went thru long periods of fasting during the ice age, potato famine and other disasters many people starved to death , Now for some reason the people who were a little plumper seemed to make it thru many of the problem times.
So if your were skinny your dead, this caused a increase in larger,bigger people in certian gene pools groups.
Now if you feed a large person and a thin person the same amount of food for some reason the large person may gain weight and the smaller thin person will not.
This maybe due to a metabolic problem thats seen in large over weight people until we understand the problem dieting maynot work. It may be insulin resistance thats the problem.

Doug
http://en.wikipedia.org/wiki/Metabolic_syndrome