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Charlotte Doc: Adjust Insurance Premiums Based On Health and Habit

By Candice Leigh Helfand
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File photo of fast food. (Photo by Jeff J Mitchell/Getty Images)

File photo of fast food. (Photo by Jeff J Mitchell/Getty Images)

CHARLOTTE, N.C. (CBS Charlotte) — A Charlotte doctor feels that obesity caused by habit is weighing down the American health care system, and that one possible solution to the problem is to require that portion of the obese population to pay higher health insurance premiums.

Dr. John Cleek, who presently serves as medical director at Carolinas Weight Management & Wellness, feels that this potential solution could address both the crippling shared costs of treating weight-related diseases, and more important, the crippling effects of being dangerously overweight.

“I think we all know people who say ‘We’re gonna die anyway, why not eat what I want?'” he said to CBS Charlotte. “Why should the rest of … the insured population pay for their choices?”

He added that some life and health insurance providers implement a similar pay rubric for smokers.

Dr. Steven Heymsfield, executive director for the Pennington Biomedical Research Center in Louisiana and an on-call expert for the Obesity Society, told CBS Charlotte that the concept of what he called “incentives or disincentives” may work in smaller settings, but could be problematic on a national scale.

Ted Kyle, the volunteer chair for the Obesity Society Advocacy Committee, also noted that negative motivational tools could potentially serve to reward persons who did nothing more than inheret good genes.

“Incentives are great if they focus on healthy behaviors,” he said to CBS Charlotte. “They are not productive, however, if they are focused on rigid biological goals, because everybody’s biologies are so different.”

The process of assessing obese individuals – to differentiate between those whose actions dictate their weight and those with medical or psychological reasoning – may also simply be too time-consuming, due to the staggering number of individuals involved in the obesity epidemic.

According to a report issued by the Centers for Disease Control and Prevention, roughly one-third of American adults are obese, as well as 17 percent of children 2 to 19 years of age.

The CDC categorizes weight based on body mass index or BMI, calculated by factoring height and weight into an equation. An adult with a BMI of 30 or higher is considered obese.

Cleek also noted the difficulty of offering detailed, personalized assessments to such a significant portion of the population, and offered an alternative.

“If a person meets certain medical criteria … maybe they should be getting a reimbursement, or a reduction in rate,” Cleek said. “It’s more about rewarding [positive] changes in lifestyle – going from not being active to being active? That’s a huge plus.”

Heymsfield noted the inherent merits of such a plan.

“That’s a pathway that might lead to more success, and have more plausibility,” he said of behavior-focused health initiatives. “It’s best stay away from something like weight, which is very hard to move in a big way. [Otherwise] you’re drawing attention to it, and stigmatizing people.”

In addition to health insurance premiums tailored to weight, Cleek also laments the staggering lack of healthy foods for significant portions of the American populace – namely the poor and the urban – and asserted that the government should do more to make healthy foods affordable and available.

“Weight issues in America in particular are multi-factorial … a perfect storm of lack of activity … and the availability of high-fat, high-calorie food at a very low-cost,” he said, noting that desk jobs and public safety, in tandem with food deserts, especially contribute to a dearth of fitness opportunities. “Even if farmer’s markets [come to these areas], many don’t accept WIC funds, so you still have [isolated] a segment of the population.”

Heymsfield agreed, noting that, while it may be difficult to nail down a standardized definition for healthy foods across the board, habitat all the same contributes to a person’s chances at being healthy in a significant way.

“My sense from where I live … is that there’s a strong regional impetus to support [healthy] activities locally,” he observed. “Whenever people become obese, it’s generally due to a combination of genetics and environment, and we can’t erase environment.”

The trickle-down effect may be taking root in some areas, but for other areas still saddled with limited access to fresh produce or exercise opportunities, the solution to their ongoing health struggles seems elusive at best, and impossible at worst.

As Cleek rhetorically concluded, “How do we expect those people to be healthy?”

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