Higher Insurance For Fat People?

      72 Comments on Higher Insurance For Fat People?

Two news article landed in my inbox recently that aren’t directly related to each other, but ought to be.  The first was about a company that’s going to start charging “unhealthy” employees more for health insurance:

Like a lot of companies, Veridian Credit Union wants its employees to be healthier. In January, the Waterloo, Iowa-company rolled out a wellness program and voluntary screenings. It also gave workers a mandate – quit smoking, curb obesity, or you’ll be paying higher healthcare costs in 2013. It doesn’t yet know by how much, but one thing’s for certain – the unhealthy will pay more.

In recent years, a growing number of companies have been encouraging workers to voluntarily improve their health to control escalating insurance costs. And while workers mostly like to see an employer offer smoking cessation classes and weight loss programs, too few are signing up or showing signs of improvement.

So now more employers are trying a different strategy – they’re replacing the carrot with a stick and raising costs for workers who can’t seem to lower their cholesterol or tackle obesity.  They’re also coming down hard on smokers. For example, discount store giant Wal-Mart says that starting in 2012 it will charge tobacco users higher premiums but also offer free smoking cessation programs.

I’m sure MeMe Roth would love the idea of punishing fat people for not being born naturally skinny like she was, but I don’t like seeing smoking and obesity lumped together.

Yes, quitting smoking is notoriously difficult, but people do it all the time.  Once the dangers of smoking were well-known and well-publicized, the rate of smoking in the U.S. dropped by half over the next decade or so.  Both of my parents – neither known for their iron wills – quit smoking in middle age.  That’s because, difficult as it was, they knew exactly what to do:  stop putting cigarettes in their mouths and lighting up.  (Like most people who quit, they quit cold turkey.)

You don’t quit smoking cigarettes only to find that two packs per day of Marlboro smoke is somehow finding its way into your lungs anyway.  But people go on calorie-restricted diets all the time and find (much to their chagrin) that they can’t seem to lose more than a few pounds … which brings me to the second article:

For years, studies of obesity have found that soon after fat people lost weight, their metabolism slowed and they experienced hormonal changes that increased their appetites. Scientists hypothesized that these biological changes could explain why most obese dieters quickly gained back much of what they had so painfully lost.

But now a group of Australian researchers have taken those investigations a step further to see if the changes persist over a longer time frame. They recruited healthy people who were either overweight or obese and put them on a highly restricted diet that led them to lose at least 10 percent of their body weight. They then kept them on a diet to maintain that weight loss. A year later, the researchers found that the participants’ metabolism and hormone levels had not returned to the levels before the study started.

Wait, you mean losing weight isn’t just a simple matter of cutting 3500 calories from your diet to lose a pound of fat?

No, of course it isn’t.  The body adjusts to try to become fatter again.  Hormones drive people to accumulate body fat in the first place, and hormones drive them to regain the weight they lose.  Look at what happened to the people in this study:

In the study, Joseph Proietto and his colleagues at the University of Melbourne recruited people who weighed an average of 209 pounds. At the start of the study, his team measured the participants’ hormone levels and assessed their hunger and appetites after they ate a boiled egg, toast, margarine, orange juice and crackers for breakfast. The dieters then spent 10 weeks on a very low calorie regimen of 500 to 550 calories a day intended to makes them lose 10 percent of their body weight. In fact, their weight loss averaged 14 percent, or 29 pounds. As expected, their hormone levels changed in a way that increased their appetites, and indeed they were hungrier than when they started the study.

Okay, no big deal so far, right?  They were eating less than before, so we’d expect them to be hungry.  But by gosh, if they’d just stick to that maintenance diet …

They were then given diets intended to maintain their weight loss. A year after the subjects had lost the weight, the researchers repeated their measurements. The subjects were gaining the weight back despite the maintenance diet — on average, gaining back half of what they had lost [emphasis mine].

That’s not character at work.  It’s biochemistry.  Their bodies were slowing their metabolisms in an attempt to regain the weight and reacquire a state of energy balance.

One hormone, leptin, which tells the brain how much body fat is present, fell by two-thirds immediately after the subjects lost weight. When leptin falls, appetite increases and metabolism slows. A year after the weight loss diet, leptin levels were still one-third lower than they were at the start of the study, and leptin levels increased as subjects regained their weight.

Other hormones that stimulate hunger, in particular ghrelin, whose levels increased, and peptide YY, whose levels decreased, were also changed a year later in a way that made the subjects’ appetites stronger than at the start of the study.

Your body doesn’t kick up your appetite because it wants to torture you.  It kicks your appetite because it senses a fuel shortage at the cellular level.

The results show, once again, Dr. Leibel said, that losing weight “is not a neutral event,” and that it is no accident that more than 90 percent of people who lose a lot of weight gain it back. “You are putting your body into a circumstance it will resist,” he said. “You are, in a sense, more metabolically normal when you are at a higher body weight.”

Bingo.  It’s like I said in my Big Fat Fiasco speech:  from a biochemical standpoint, you’re as fat as you need to be.  Your body defends a higher fat mass as long as it needs that fat mass to supply your cells with fatty acids for fuel.  To lose weight and keep it off, you need to be able to tap your stored body fat more efficiently – and that requires a change in your hormonal balance.  It’s not just a matter of cutting calories.

Months ago, I bookmarked an article on similar study that looked at the biochemical changes among former contestants on The Biggest Loser.  Here’s what the researchers found:

In an abstract presented at the most recent Obesity Society Annual Scientific Assembly, Darcy Johannsen and friends reported that by week 6 participants had lost 13% of their body weight and by week 30, 39%. More interestingly they reported that by week 6 participants metabolisms had slowed by 244 more calories per day than would have been expected by their weight loss and by week 30, by 504 more calories

That’s basically a meal’s worth of calories a day that Biggest Loser contestants no longer burn as a consequence of their involvement. Effectively that means they’re eating an extra meal a day.

Is it any surprise that so many contestants from The Biggest Loser – including the season two overall winner – have gained back all the weight?  All the “eat less, move more” theory did for them in practice was slow their metabolisms – again, beyond what the weight loss alone would predict.

I’m sure the companies threatening fat employees with higher insurance rates expect those employees to become motivated, eat less, and lose weight.  Without understanding of what drives fat accumulation, I think it’s more likely those employees will become motivated, go on a diet, lose a few pounds, stall, regain, give up … and end up paying the higher insurance rates.

If the bigwigs at these companies knew better and truly wanted to encourage (or coerce, to be more accurate) their employees into making positive changes, they’d base their insurance premiums on their fasting glucose levels – then teach them how to bring those levels down.  If I’m looking at a fat guy with normal blood sugar and a skinny guy with high blood sugar and had to bet which one will run up more in future medical expenses, I’d pick the skinny guy to cost me more every time.


72 thoughts on “Higher Insurance For Fat People?

  1. Peggy Holloway

    Story on the news tonight: New drug turns off fat cells and makes monkeys eat less and exercise more; of course we know that must have happened because that’s the only way to lose weight. When the drug was withdrawn, the monkeys became “couch potatoes” again. Seriously. That is exactly how the news report presented it.

    Apparently the drug works by killing fat cells. Not that I’d take a drug like that.

  2. C

    Ah, blood sugar. i’m doing my science project on that. My teacher wants us to have 3 topics (one preferred one, and then two back-ups) so I chose the affects of foods on different-sized people to emphasize how much metabolisms count in weight and blood sugar, and also to toss in those blood sugar readings as a side note. my two back-ups are either simply testing the blood sugar affects of different foods on one person, or testing how different diets affect a person’s hair’s ability to hold style (bet my teacher would be shocked to find someone on a “healthy, whole-grain-filled diet” would have limp and weak hair. My friend’s hair already goes much wavier than mine after flatironing it in the morning.

  3. Nowhereman

    “At least you wouldn’t have women coming out of the closet claiming sexual harrassment……(errrr….would you??).

    None that I know of … but keep in mind I was a heavy drinker for a chunk of my 30s. There may be episodes I don’t remember.”

    Given the current sorry state of affairs in modern journalism and politics, if Tom were running for president he would wind up being ignored as if he did not exist, as is the case with poor Ron Paul. Or if he became a front runner in spite of everything, they would pay some hos to “speak out” and say he did something he did not.


  4. The Older Brother

    “Story on the news tonight: New drug turns off fat cells and makes monkeys eat less and exercise more…”

    “Apparently the drug works by killing fat cells. Not that I’d take a drug like that.”

    Anyone else wonder how the body would then handle high blood-sugar, since this seems to kill off the physiological coping mechanism?

    From the Yahoo news writer-up:

    “Another promising sign was that monkeys treated with the drug showed an improvement in their resistance to insulin…”

    Improvement? Or body’s last-gasp attempt to save itself by blasting pancreas?

    “However, it was seen to have some damaging effects to the kidneys, which could be lessened by administering the drug in smaller doses.”

    Hey, what’s a little kidney failure if you can look good in a swimsuit without say, cutting back on bread.

    At least we can rest assured that this is solid, unbiased research. Or not:

    “The journal noted that Arap, Pasqualini and some other researchers involved in the project own equity positions in two drug-development companies working on the research.”

    Freakin’ liars.


    My thoughts exactly. Your body makes fat for a reason. If you can eliminate the reason your body is making fat, great. If not, just killing off the fat cells is going to create a problem somewhere else in the system.

  5. Debbie C.

    @The Older Brother

    Thanks, I’m actually looking into opening an HSA. My company retiree health plan does offer a “High Deductible with HSA” insurance option. This one DOES offer a basically unlimited drug prescription plan once you satisfy the annual deductible. But it costs a lot of money each month which would pretty much eat up the amount I would have to *contribute* to the HSA, and other employees and former employees say our company’s HSA plan is a major rip-off. But I’m just trying to get the plan that is lowest cost for the “catastrophic” drug coverage. And if I opened an HSA elsewhere I’d still have no catastrophic drug coverage. One of my fellow employees said when his wife got cancer the *drug* cost alone came to $90,000 or more just for the FIRST YEAR. No matter how much I socked into an HSA I could never afford anything like that if I got cancer. Eeek!

  6. Ricardo

    Hi i was just wondering what do you think of People like Caldwell Esselyton, Dr.Oz, and Dean Ornish? Do you think they are promoting good advice. Dean says on reason people have heart disease is because there bodies are not very good at getting rid of fat and cholesterol.

    Also what would be wrong with a drug that turns of fat cells?

    I think they mean well but are misguided. Ornish, for example, has his patients eliminate sugar, white flour and processed vegetable oils in addition to meat, then cites their improvements as proof that saturated fat is bad for us. He should try the same treatments without eliminating the meat, then show us the results.

    I wouldn’t take a drug that kills fat cells because there are bound to be side effects.

  7. Katy

    Ricardo, Oz and Ornish are on the wrong train, believing that it’s the sat fat that’s causing the problem. As Tom said, they also advise banning sugar and refined grains, but then turn around and blame the fat. But what kind of fat? They do not distinguish between trans fats and natural saturated fat. And they don’t take into account the effects when people eat saturated fat along with a load of sugar and carbs. They seem to oversimplify what they see– Oz “sees” patients’ arteries clogged with “fat” and sees fat on meat, then assumes they are the same! More than likely, his patients’ arteries became clogged as a result of their bodies trying to protect against the rampant inflammation caused by sugar and industrial oils. And Oz has since come out in favor of consuming coconut oil!

    Amazing how many doctors don’t know our bodies can make fat from carbohydrates. How do you fatten up cattle? Feed them grains.

  8. Auntie M

    This annoys me on so many levels. When I was discharged from the hospital after having my baby (Not that you probably wondered or remembered that I was pregnant, but I had her on October 13 at 36 weeks, her heart surgery went perfectly, and she’s home and doing well. Knock on wood….), the discharge papers listed “obesity” as a diagnosis for my problems more than once.

    I’m just over the line to “obese” according to the BMI scale. I have Polycystic Ovarian Syndrome, which often CAUSES you to be insulin resistant and overweight and have difficulty losing weight. PCOS is part of the Metabolic Syndrome which includes actual medical problems I have: Type II Diabetes and hypertension (both symptoms of the PCOS), plus I was diagnosed with severe preeclampsia at 34 weeks. My being fat isn’t really the issue; it’s a side effect of my metabolic problems.

    Oh, and I ate paleo-ish/lower carb/high fat the whole pregnancy, only gained 10 pounds, and lost it all within a week of her birth. The doctors and nurses couldn’t believe that the baby of a diabetic DIDN’T have a huge abdomen or blood sugar problems after birth. She was small (4 lbs, 14.9 oz), but she wasn’t typical of a diabetic mom. But obesity was the issue, of course. Give me a break. I’m surprised they aren’t charging me extra just for daring to bring my fatness near their hospital.

    The good news is that you know your daughter can avoid the same health issues.

  9. Angel

    Given that it seems to be easier for men to lose weight than women, penalizing people for being overweight would tend to penalize women more than men – and women of childbearing age, who choose insurance coverage that includes maternity expenses, already can have some pretty high premiums. I don’t have any data offhand to back up the “men lose weight more easily” assertion, but I seem to remember seeing that usually the men lose more weight in diet trials that have both men and women. I also have my own experience, with changing my diet to low carb, improving my health tremendously, and losing a little weight, but not nearly enough – I am still obese (body fat greater than 33%). I started doing a Slow Burn exercise routine a few months ago, and again lost a few pounds, but nothing significant. It will be a miracle if I ever manage to get below the magic 33% body fat number.

    I’d probably do fine on a fasting blood glucose test, though. I *know* I am not going to end up with diabetes and heart disease like my grandmothers and my dad. That’s what keeps me on low-carb when I get discouraged about still being overweight.

    It various among individuals of course — my wife stays lean effortlessly while I have to work at it — but yes, men typically lose weight more easily than women, partly because we have more muscle mass and fewer fat cells to begin with.

  10. Paul L in MA

    What, Oz favors (tasty tasty tasty) COCONUT OIL now??

    Oh, no, hasn’t anyone told him it’s a solid grease at room temperature, and therefore solidifies in your arteries too?

    I’m not sure if the Great Oz knows what he believes these days. Perhaps that’s a positive sign.

  11. Dennis

    My mom did a heath deal for her work but then she has to put what she eats and when she says almost all meat they freak out even though her tests come out great. And they don’t realize woman with higher col live longer and can’t even read the tests right since total col means nothing. Im afraid she would get charged for that bad science and she isn’t even obese.

    That’s my concern as well. They’re measuring the wrong markers.

  12. Paul L in MA

    I buy the coconut oil in jars now.

    I also got coconuts and made my very own coconut cream in the blender (with plain water, not the sweet coconut water), and toasted the strained coconut flesh.

    The cream separates in the fridge. There is a nice part that rises and solidifies but the thick goo that sinks is just lipid heaven, especially with the toasties added back. I wonder if you could whip it. You could make good “ice cream” in the freezer, just adding a little fruit maybe.

    Do it wrong, though, and it tastes like soap. Anybody know exactly what causes that?

    But learning to prepare coconuts in the kitchen was part of the fun of changing my eating habits. Still learning. There is an entire book by Enig & Fallon about the uses of coconut.

    And I can keep some manly tools in the kitchen now — a power drill and a hammer.

  13. Paul L in MA

    @Dennis, et al

    Yeah, all about getting the insurance companies to get the actuarial science right. You would THINK they would have even better motivation than the scientists to do so.

    Could it be that non-competition is a reason this doesn’t happen? I mean, the well-known barriers to cross-state purchase create fifty little local oligopolies, and lazy big companies LIKE regulation when it means barriers to competitors.

    I wonder why some insurance company can’t sue states in federal courts for unconstitutional restraint of inter-state commerce! Can’t, or just don’t? For reasons above stated.

  14. Auntie M

    Thanks, The Older Brother. It’s been a long, tough road, but she’s worth it. Tom’s right, too, that I’m going to do everything in my power to make her healthier than me and her grandparents. 🙂

    Because she had major surgery at six days old, and because of her feeding tube and the fact that they measured all of her food intake, I had to pump and they fed her my milk. One of the nurses at the hospital commented to my husband at how nice my milk looked, because it had a good layer of fat on it. I guess all the low-fat healthywholegrain diet women have anemic looking milk? He gave a brief explanation about how I eat, including telling her about all the bacon I consumed for breakfast. The nurse seemed a little nonplussed, but accepting. As a crazy good bonus, the lactation consultant at the hospital RECOMMENDED a gluten-free diet to me! She lamented the fact that most people won’t listen to her about it, and was amazed that I was aware of the benefits. We had a great discussion, and I told her about Fat Head and Wheat Belly. She claims that she’s the only lactation consultant she knows who knows about and supports gluten free. Progress!!!!! This is at a major teaching hospital on the East Coast.

    The docs/nurse practitioners kept talking about how they “always” fortify breastmilk with formula to help the babies gain weight. They didn’t fortify mine until her last 24 hours in the hospital, and I stopped it when I got home. She’s gaining weight just fine, thank you.

    I thought you’d be interested in this article telling people how weird it is that skinny people are now getting Type II DIabetes. It quotes Dr. Bernstein. So, yeah. charging the fat people more may not make sense. Duh.

    People who develop type 2 diabetes are more likely as a group to be overweight than not, but of course that doesn’t mean being fat is what makes them diabetic. A lousy diet can cause both.

  15. Jordan

    Wow, whodathunk that eating 500 calories a day would make people hungry? Those pesky hormones!

    And whodathunk that people would have trouble maintaining their weight loss a year after a crash diet- err, I mean, a “study”- that they’re probably not emotionally invested in. After all, it’s not like people ever underestimate their calorie intake by as much as 50%. Those pesky hormones make it so hard to commit a full year to a weight loss study! Or count calories accurately!

  16. Paige

    I think the problem here is that we assume being hungry means you have to eat, making hunger a medical condition (?). Smokers crave cigarettes just like dieters crave food, but it is their fault for becoming addicted to cigarettes or food in the first place!

    There’s a big difference. If you’re hungry, it means you’re low on fuel at the cellular level. People assume the obese could simply ignore the hunger and burn stored body fat instead, but if they can’t release fatty acids quickly enough to make up for the fuel shortage (which is often the case with obese people), their bodies will respond by burning lean tissue (i.e., muscle), slowing the metabolism, or both. That’s exactly what obese people don’t need to do.


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