Taking a step back and thinking about the real story

Compulsory medication and monitoring of diets and lifestyles by the State is now a reality for workers in Alabama who are older or have certain genetic physical characteristics.

Despite efforts to paint this in rosy euphemisms, under a new plan just approved by Alabama’s State Employees’ Insurance Board, if workers don’t agree to be subjected to lifestyle and health screening and blood tests for specific hereditary characteristics, they will be penalized $25 a month or be denied health insurance coverage.

Healthcare decisions will no longer be those for individuals and their personal healthcare providers to make. Workers found to have high BMIs, cholesterol levels, glucose levels, or blood pressures will be required to enroll into wellness programs with their integrated disease management, along with weight loss targeting those with BMIs ≥35, and be given one year to improve, or be penalized $25/month. Those who are thin and have approved numbers will be exempt.

According to the State Employee’s Insurance Board, the program, which will cost taxpayers $1.6 million next year alone, is about improving health and saving insurance costs for the State.

Those tempted to believe this plan is warranted and money well spent, ignore the facts that the medical literature shows these indices are not reliable or appreciable measures of risk for future disease or premature death [see the difference between those with ideal numbers compared to those with 'metabolic syndrome' above], or significantly malleable with diet and lifestyle. They are not measures of those “taking responsibility to eat right, exercise and have a healthy lifestyle,” as is popularly cited as justification.

They are based more on myths, than medical evidence, such as of healthy eating, like low-salt lowers everyone's blood pressure, that cutting sugar prevents diabetes, that fruits and vegetables prevent cancers, that a ‘heart-healthy’ diet lowers cholesterol or heart disease risks, that healthy diet or exercise can prevent osteoporosis, or that any special diet or lifestyle behavior can forestall aging or premature death. We’ve exaggerated the role of food from preventing basic nutritional deficiencies and providing fuel and pleasure, to believing that perfect healthy eating can prevent the major causes of death and make us all slim, while “bad” food makes everyone diseased and fat.

The requisite employee “wellness” and weight loss programs have not proven long-term effectiveness, but to put employees at increased risks. Nor do they actually lower healthcare costs. Achieving ideal numbers invariably requires prescription medications and other invasive measures, especially, as has been shown, for those over age 50.

In reality, these health risk factors are primarily measures of genetics and aging, and hence, using them is discriminatory, but hiding behind euphemisms of being about promoting healthy lifestyles. By targeting the fattest, those with BMIs ≥35, this surcharge discriminates because those at the most extremes of size in our culture also tend to be older, female, minority and lower social-economic class. Yet, the naturally fattest in our culture also have no one advocating for them. The belief has become widespread that true obesity and body fat, itself, is unhealthy because it correlates with health and social disadvantage, while thinness is automatically healthier. While using fat to sell the plan, in reality, those at the highest BMIs also make up a small percentage of the population — meaning, most affected by this penalty will be those whose age puts their cholesterol, blood glucose and blood pressures in the range normal for their age, or whose heredity lend them higher numbers.

That reality hasn’t yet reached most Babyboomers, either.

Associated Press reports that the state worker lobbying group has voiced no objection to the new policy. Despite the obvious discriminatory basis for this penalty and its unsound mandatory wellness interventions, no healthcare professional organization, or organization advocating for seniors, minorities or civil rights, has spoken on behalf of those who will be affected by this plan.

To think this is just about fat people, and not also those who are aging, minority, disadvantaged, or with undesirable hereditary characteristics, is to miss the full story. As long as people are convinced that certain physical measurements define desirable characteristics, while other measures earmark those seen as too costly, there seems little hope in helping to direct healthcare resources most effectively.

© 2008 Sandy Szwarc

Wellness, a few posts: here, here, here, here, here,
here, here, here, here, here, and here.