WSJ: “When Your Boss Makes You Pay for Being Fat”
Going along with the theme of shaming which I took up yesterday, there was a recent Wall Street Journal article called “When Your Boss Makes You Pay for Being Fat” about new ways employers are trying to “encourage healthy living”, or otherwise described, “save money on benefits”. From the article:
Until recently, Michelin awarded workers automatic $600 credits toward deductibles, along with extra money for completing health-assessment surveys or participating in a nonbinding “action plan” for wellness. It adopted its stricter policy after its health costs spiked in 2012.
Now, the company will reward only those workers who meet healthy standards for blood pressure, glucose, cholesterol, triglycerides and waist size—under 35 inches for women and 40 inches for men. Employees who hit baseline requirements in three or more categories will receive up to $1,000 to reduce their annual deductibles. Those who don’t qualify must sign up for a health-coaching program in order to earn a smaller credit.
A few comments:
- This policy combines the critical characteristics of shaming, namely 1) a complete lack of empathy and 2) the shifting of blame for a problem entirely onto one segment of the population even though the “obesity epidemic” is a poorly understood cultural phenomenon.
- To the extent that there may be push-back against this or similar policies inside the workplace, there will be very little to stop employers from not hiring fat people in the first place.
- Or for that matter, what’s going to stop employers from using people’s full medical profiles (note: by this I mean the unregulated online profile that Acxiom and other companies collect about you and then sell to employers or advertisers for medical stuff – not the official medical records which are regulated) against them in the hiring process? Who owns the new-fangled health analytics models anyway?
- We do that already to poor people by basing their acceptance on credit scores.
mathbabe 
A few more comments on the comments :
– it is by no means a given that the obesity epidemic is a cultural phenomenon, sugar intake and how it affects the brain is one of many physiological explanations ;
– of all the health standards quoted above, only one is linked to being fat (the waist size). One can be super fat with adequate blood pressure, glucose, cholesterol and triglycerides. Just look at sumotoris who are outstanding athletes !
– the real problem is linking health coverage to employment. A job is supposed to get you cash and you buy what you want with it, including health insurance.
LikeLike
Waist size is not neccesarily related to fat, says the 6’7″ man.
LikeLike
My guess is that some (most) of these metrics are a rough justice tradeoff between actuarial/medical accuracy and administrability/cost to implement. There’s some research on waist size being as or more important than BMI as an indicator for health risks and there’s a vocal minority of bodybuilders who have high BMI by the simple hight-weight ratio but are at low risk for health impacts (an immersion tank gives their true BMI but is costly to implement). You’re on the short end of that particular decision because a height-to-weight BMI would give a good answer for your height.
FoW
LikeLike
Employers’ access to and use of people’s “full medical profiles”, whether in the hiring process or subsequently, is pretty much forbidden under the Americans with Disabilities Act (ADA) and the Genetic Information Non-Discrimination Act (GINA). There are also state and local employment laws that may apply, and many of them prohibit discrimination not only on the basis of an actual medical condition, but also a perceived medical condition, or even association with someone with a medical condition. “Obesity” is sometimes ruled to be a disability under New York law, and, if memory serves, D.C. law prohibits employment discrimination on the basis of “appearance.”
This is not to claim that these statutes completely solve the problem. But I regularly advise employers on fair employment practices, including medical leave issues and accommodation of disabilities (and I defend those decisions in court). In my experience, employers tend to be pretty careful about getting these things right.
LikeLike
Sorry, I didn’t mean the actual medical records, I meant the online profile collected by Acxiom and other companies regarding your google searches etc. – I’ll update the post, thanks.
LikeLike
Interesting; thanks for the clarification. Although an argument can be made for collecting limited data from current employees on a voluntary basis in connection with a employee wellness program, which is usually lawful under the ADA and might be what the Michelin plan is, an employer should still steer clear of informal “online medical profiles” in making employment decisions. Not only do you have the problem of discrimination on the basis of perceived disability, but there’s a presumption under the ADA that if employee medical information was included in a personnel file, it was relied on in making employment decisions, and that’s rarely defensible. I can’t think of any situation where a company’s gathering covert medical data on its job applicants would be legally permitted. If you’re aware of any employer that currently does this, I’d be very interested to hear about it.
LikeLike
If legal counsel for that company has 1/2 a brain they’ve completely firewalled the information at their benefits provider so HR has no access whatsoever to the data on whether you qualified for the $1k discount or not. Any other answer is a lawsuit waiting to happen.
FoW
LikeLike
I have struggled with my weight for most of my adult life. I also understand the employers’ motivations. It is about the math… And getting people to take some ownership of the costs produced by lifestyle choices.
Federal regulations only permit companies over a certain number of employees to charge for health care as single, two person, or family coverage. They cannot discriminate based upon age or lifestyle/health issues. Yet the employers pay individual actuarial rates when they purchase insurance or pay the full cost of the individual care when self insured. These costs have been rising much faster than profit margin for most employers and certainly much faster than wages. Consider the rise in obesity related illness, for example Type-II (adult onset) diabetes. This is a gateway to far worse medical issues that are quite costly to treat. Someone foots that bill – and increasingly it is someone other than the patient. Note that smoking, like obesity, has an association with higher medical costs. These costs, and those arising from the lost time/productivity that accompany their treatment are driving these approaches. This is far better than the alternative: being told “the cost of employing you has risen higher than the value you produce, so we have decided to terminate your employment.” Note that a single-payer system doesn’t solve the problem either.
LikeLike
Due to neurophysiological limitations on our ability to compute the broad scope of reality, the brain itself uses heuristics to associate incoming stimuli with plans for action. Is it any wonder societies do this? In the west, the bottom line is money. All heuristics act to serve cash. It is ruthless, but often human social heuristics are quite ruthless for the individual.
LikeLike
Dear Cathy,
I recently attended an educational session on liver transplantation by an esteemed transplant surgeon. He talked about how obesity is becoming the number one reason for liver transplants in the United States. It was stated with compassion and no judgement, but I couldn’t help but think about the costs incurred by hospitals, health care systems, etc., at a time when health care is in such disarray. I am not trying to evoke anger in anyone. I don’t agree with anyone being targeted for exclusion or shaming. This is a real issue that hospitals are dealing with across the board-not just in the field of transplantation. Are there ways to discuss the negative ramifications, not only on the individual, but in other areas as well. Having viable answers or even rational discussions, to what is in the words of the surgeon quickly becoming a national epidemic, are important. It is an issue that cannot be ignored. Yet, obesity seems to also be an area where people can face discrimination – which is wrong on so many levels. It is complex. Answers? Ideas?
LikeLike
One idea is to tackle it as a community rather than trying to place the blame on the victims. Another idea is to think about why we’re letting the food companies use science to make junk food more addictive and then we’re surprised when people can’t stop eating junk food. It’s a systemic problem, it needs to be dealt with in a systemic way.
LikeLike
Apparently Safeway has a(n optional) program whereby employees are given financial incentives to adapt healthy behaviors. Focusing on behavior rather than a particular result metric sounds like a healthy and kind approach.
LikeLike
Naked Capitalism had a post on this today which indicates there is pressure to “fire” unhealthy patients:
http://www.nakedcapitalism.com/2013/05/coming-corporate-control-of-medicine-certain-to-make-socialized-medicine-look-even-better.html
which links to this post:
http://www.wholehealthchicago.com/5673/you-the-patient-fired/
LikeLike
One of the more intriguing lines of research on this subject, if still in its early stages, is looking at a possible connection between antibiotic use and obesity.
Part of the reason farmers (read, “the food industry”) use antibiotics in animal feed is that they’ve been shown to speed up weight gain and hence aid in maximizing profits. The question of whether trace antibiotics in the food system have had a similar effect on at least some of us carnivores is tantalizing. Again it looks like we are to be part of yet another uncontrolled experiment visited upon us by the captains of industry. All the more reason, if it was needed, to forbid weight and health information being placed in personnel files.
There was a discussion of this question on NPR last year [http://www.npr.org/blogs/health/2012/08/22/159743999/could-antibiotics-be-a-factor-in-childhood-obesity] with links to original articles in Nature and The International Journal of Obesity (a Nature publication).
LikeLike
Opinion:
One of the interesting thing about this so called obesity epidemic is that it only seemed to start gaining momentum since the introduction of fat free salt free snack foods and cooking. Is it simply a coincidence that they take the fat out of milk and kids start getting fat?
The fat free., lite, salt free diets are all attributed to the intense concerns people have about image a marketeer’s dream come true. Obesity epidemic is fueled by the desire to market a new product range of anti- obesity products. Capitalizing on vanity!
LikeLike
If it isn’t obesity it’s being sedentary and so on. I feel education is still be best as you yourself have to be motivated and do it for yourself in the long run. I get tired of the reports of the “evil twin” type that show numbers way out of whack and it seems like we all need to lose some weight so the insurers can make their profits too. I am not not overweight nor am I perfect by any means either with everything in my lifestyle, who can be?
I do believe the focus is good to keep it going but for goodness sakes let’s stop trying to put the weight on the US budget on obesity as there’s a lot more in that pot that contributes and the over weight folks are not putting us in the poor house, as I think its the models and subsequent algorithms, really:) Again education and awareness are good but let’s stop tipping it over to where we get this “evil twin” effect with studies and reports that are way out of whack:)
LikeLike
Somewhat relevant: http://www.pharmalive.com/fired-exec-claims-cro-violated-privacy-practices-in-hiring
LikeLike
The WSJ quotes and your remarks today have less to do with shame, in my view, than with the mis-aligned dependencies that we encourage in this economy / society. The entire healthcare debate comes down to the idea that an employee should be as dependent on their employer as possible. To really understand this system we have to establish two points upfront. There isn’t such thing as health insurance. Everyone gets sick and dies, so really we are talking about a programmatic sharing/spreading of costs. The cost of health programs are NEVER paid for by an employer. They are always paid by the employed. Basic Business 101. What you get in benefits you give up in salary. When employed by the Catholic Church and they are telling you whether to use birth control – they are using YOUR money to control you. Of course the twisting of health benefits into a compensation package gives advantages to larger employers over smaller employers and allows for employer dictated changes in compensation that are very hard for the employed to see or understand.
Of course ALL of the dependencies in this relationship are not bad. If an employer is made to value healthy employees by being in the role of managing the healthcare program to reduce costs, then it might look like a win. And if loyalty and a sense of shared community values could be engendered in employees AND employers – in the pursuit of reasonable healthcare costs – that would be a win. But the cracks in these ideas show up quickly as we inevitably fall into factionalism and bottom-lining. I personally favor universal, non-employer-based healthcare programs. But of course – for any cost we share, however we determine to share it – there will then be what you are calling ‘shame’ for those who choose to live a cost-intensive (in this case, unhealthy) lifestyle. Statistically, obesity is a marker for higher healthcare costs. To the extent that we accept our inter-dependency, we also find ourselves judging each other and imposing some form of correctness – an aspect of liberalism that those on the right don’t like.
LikeLike
Cathy–I think you need to justify that this is shaming to begin with. There’s an alternate explanation: obesity and smoking are the two highest controllable cost indicators (mathematically) for health costs and this company has provided an incentive system to reward people for getting to a more healthy weight which, as a classic example of enlightened self interest, also saves costs for the company at the same time.
Also, in keeping with the theme of this blog to roll up your sleeves and look at the data, notice where they actually set the one standard where we see the cutoff. “waist size—under 35 inches for women and 40 inches for men”. That standard is set out there where (I suspect) the actuarial incidence of high-cost/high-intervention medical issues spikes up–i.e., more than just a few pounds overweight but at the point where your doctor starts to really worry about you. Any health-care data wonks want to weigh in on this one?
I was thinking about your last post and trying to determine what differentiates “shaming” from “encouraging”. My first-swing thesis is that shaming is indicating that you are a bad person because of the behavior in contrast with indicating that the behavior is bad (or just has bad consequences) and you would be happier/have better results if you as a person shed the bad behavior. that’s impacting you Reminds me of that old Twisted Sister music video where the dad comes in and shouts at the kid “You’re worthless and weak!”–that’s classic shaming (and not productive).
FoW
LikeLike
What makes you think this is controllable? That’s a myth, debunked for example in this article: http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=2007-04834-008
People in the dieting industry consistently spread the rumor that it’s controllable because it makes them tons of money. But if you think large-scale, which people who care about Medicare costs need to, you realize that it’s expensive and pointless to try to make people diet.
LikeLike
I’m 100% with you on the fad diet industry–most of that stuff is crap. However, I don’t think you can jump from there to the much stronger claim that “weight is not controllable”.
Here’s what the squib says: “The authors review studies of the long-term outcomes of calorie-restricting diets”. That’s actually pretty narrow and not really a ground-breaking result. Simply trying to eat less on its own is not the best approach, but there are a number of other pathways out there.
My personal opinion is that weight loss and quitting smoking are really really fucking hard to do, and I certainly agree with your original point that we should be supporting people who are taking on the mountain, not shaming them for being bad people.
Also that there’s a real danger of using the word “just” in these discussions, like “well these people just need to lose weight”–that’s trivializing the whole thing. Sometimes the “just” is implied, so let me be 100% clear that I never think one “just” loses weight or “just” quits smoking. Ever.
FoW
LikeLike
There is a neurotrophin called brain-derived neurotrophic factor (BDNF). It is the hub gene for a cascade of functions involving cellular metabolism, level of depression, and exercise-induced nervous system plasticity. For example, if you have a certain allele of BDNF, you may tend to gain more weight — may is the operative word. Many have run ANOVA interactions on the factors we know affect adipose tissue in the human body. As you can guess, they are many: genetic profile, VO2max, activity level, gender, socio-economic status, educational level. Of course they all interaction. Studies to tease out the purple squirrel of variables which does control all the others are probably doomed to failure. It will most likely be a combination of factors whose interactions must be controlled. This is the area of my research btw. At the end of the day, it is good that companies are molding their employees’ minds in the direction of chronic health regimens. Its just that there isn’t one body type or fat/lean ratio that is best applied to everyone.
LikeLike
strange considering Michelin’s logo is a twisted fat guy
LikeLike
Fairly or unfairly, it would seem that in his case Mark Rosenthal’s union members decided to make the boss pay for being fat [1,2].
1) http://nypost.com/2013/05/28/labor-big-a-real-heavy-sleeper/
2) http://nypost.com/2013/06/06/fat-cat-union-president-mark-rosenthal-voted-out-by-rank-and-file-after-sleeping-too-long-on-the-job/
LikeLike