The People's Perspective on Medicine

Should People with a High BMI Be Penalized on Health Insurance?

A high BMI of 30 or above may classify a person as obese, but it does not tell enough about their state of health.

Just how risky is obesity for long-term health?

Charging More for Health Coverage:

The Affordable Care Act permits employers to charge their unhealthy employees more for health care coverage. But the measures used to determine who has an unhealthy lifestyle include BMI, or body-mass index, as the standard measure of weight for height.

The BMI is used to determine who is considered obese, but it does not actually distinguish those who are out of shape or headed for diabetes from those who are physically fit and metabolically healthy.

Will a High BMI That Qualifies as Obese Tell Who Is Unhealthy?

According to psychologists at UCLA, using a BMI of 30 as the criterion for obesity could misclassify 54 million Americans as unhealthy. What is more, 20.7 percent of those found to have a BMI in the normal range actually had disturbed metabolic markers. As a result, the researchers say, BMI alone should not be used to determine who should pay more for health insurance.

International Journal of Obesity, Feb. 4, 2016

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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to me this is discrimination. I am not a smoker, but on the Obamacare health insurance, that is an allowable question and if you are a smoker, you pay higher rates for insurance. To me this is also discrimination. They don’t ask do you drink alcohol. They don’t ask if you eat fast food or processed foods all day long. They don’t ask if you are overweight or underweight. Smoking is legal, so why do they get to ask that question? Granted smokers are more prone to health issues, but so are people who drink excessively or eat excessively — we could go on and on. I am just shocked that it is allowable to ask that question.

Perhaps it’s a bit cruel, but I do feel that obese people should be held to task in some way or other for the fact that they are obese! We all know by now that obesity practically guarantees serious health problems — which must be paid for by either government programs like Medicare, or the hospital’s charity care, or private insurance. Bottom line, we all pay for it. Certainly some obese people are otherwise fairly healthy, and of course some obesity is the result of glandular dysfunction or some other health problem. But the vast majority of obese people are that way because they gorge themselves on too much fattening, unhealthy food! In my opinion, obesity says “stupid” even more loudly than smoking does. Nicotine is strongly addictive, but anyone can learn to eat healthier if they want to, without that much trauma. Thanks.

Would like to tell you that I have never been overweight yet suffer from more health problems than a close relative who has always been heavy ,who eats whatever he wants, who does not exercise. I eat “right” and exercise and do not drink or smoke. It would be nice if the answers were easy but the body is complex.

My BMI February 2016 is 33.3% down from 35.2% in September 2015. I consider myself overweight but would not consider myself as obese. Over a week’s time, I walk an average of 5 miles a day in addition to other exercise. My BMI does not show my entire health.

Putting aside this particular health issue, doesn’t patient privacy preclude employers being told of employees health status, good or bad?

Can employers really be told private health information?

If so, do they get it from doctors or from the insurance company?

Everything I’ve heard about the problems with BMI as a measure have focused on metabolism and who’s having glucose problems. But having a high BMI also increases your chances of various cancers and I think also Alzheimer’s, so I don’t think it should be all about who’s headed for diabetes and who’s not.

BMI does not take into account that for some people there is more muscle mass relative to the amount of fat. BMI assume that the extra weight is fat and so the weight indicates an unhealthy situation. Until there is a way to include percentage of body fat into the BMI calculation BMI alone should not be used by insurance companies to set prices.

BMI is based on one’s height. If – like many people – you lose an inch or two as you age yet your body weight remains the same, your BMI will increase – – hardly seems fair to be penalized for that!

I have a BMI that puts me in the “overweight” range, however, since I exercise and eat a healthy diet, my waist to height and and waist to hip ratios put me in the “normal” outcome. My cardiologist is happy with this result. I am 70 years old and had surgery a year ago to replace a defective aortic valve.

I remember reading that during his playing career Michael Jordan ‘s BMI was in the over weight range. So much for that being an accurate gauge of fitness.

There really is no such thing as a “healthy obese” person–it’s going to catch up to them. Exercise only goes so far. Weight control is the most important thing to do.

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