Can your BMI affect your health insurance premium?

I wanted to write about this topic, not only because health care is all anyone is talking about lately, but also because BMI seems to be the new “trend” in regulation. Many areas seem to be now using BMI as cut off for numerous things. First, let’s take the example of Lincoln University in Pennsylvania. I’m sure many of you have heard about this college that will not let students graduate with a BMI over 30 unless they take a required fitness course, meeting 3 hours a week. Should colleges have the right to impose this restriction? Will other colleges start to follow suit? And what about high schools? Do public schools have the right to enforce restrictions like this?

The health care regulation that I mentioned earlier is along the same lines. There are currently two states that have imposed a penalty for being obese in terms of insurance rates. Starting in July 2011, state workers in North Carolina who have a BMI higher than 40 will be placed in the more expensive insurance plan (along with tobacco users). Alabama was the first state to impose extra fees for state workers with a BMI of 35 and higher. Using these two examples, it is easy to see how more and more states might adopt something like this (and how it maycould lead to similar regulations in private businesses).

Why impose this in the first place? Health care costs are rising and it seems that those who are obese cost more in terms of health care. In a study released by the CDC (http://www.cdc.gov/media/pressrel/2009/r090727.htm), health care costs from obesity may be close to $147 billion per year. It Results also showed that the proportion of health care costs from obesity is also rising (6.5% in 1998 to 9.1% in 2006). So these states do have some justification in trying to reduce health care costs.

But is BMI the right indicator to use to judge obesity levels? In most cases BMI (weight in kg / height in Mm²) is a fairly accurate measure of overweight and obesity, but it does not work in all cases. Most notably is that of the body builder, where someone with high muscle density is going to have a high BMI, but not be “overfat”. Another example is that of someone who has a BMI in the normal range, but has a higher fat percentage (as often happens in the elderly). Will there be any special regulation for these cases?

These are just some starting points to think about. I am not sure I agree with using BMI to “punish” people. I think a more effective strategy might be to offer a positive incentive to lose weight. Whole Foods just announced a new program for its employees in offering them an increase from their 20% in-store discount to 30% for those employees who maintain a healthy profile, using measures such as blood pressure, cholesterol, and BMI, as well as nicotine use. In this case it is not one factor, like BMI, but a host of measures that will judge an employee’s’ overall health. This seems more encouraging to me than using just BMI as well as using it as a punishment.

What does everyone think about this new trend? Will it help to lower obesity rates? Will it help with controlling health care costs? As runners, most of us probably feel we are healthy as well as have BMIs in the normal range. However, I believe it is important for everyone to be aware of policy debates affecting the general population. Just something to think about…

(Illustration by Inna Komarovsky)