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History Reclaimed: Part of The [Missing] HAES Files Series

Obamacare’s Misfire on Weight

By Lindo Bacon, PhD

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New Workplace Provisions that Deserve a Pink Slip

Formerly published on “The HAES files” blog, the Association for Size Diversity and Health. May be slightly edited since original publication.

The Supreme Court’s decision to uphold President Obama’s Affordable Healthcare Act is good news for Americans in many ways, but not without significant problems. It’s a big coup for the diet industry, for example, but less settling for a populace already suffering from weight anxiety and misinformed advice.

The Act enforces the recent recommendation from the U.S. Preventive Services Task Force that all doctors warn “obese” patients that their weight puts them at high risk for disease, but that weight loss and lifestyle changes can help – and then direct them to intensive weight-loss counseling. Currently, few insurance companies pay for such programs. Under “Obamacare,” however, insurers will be required to cover most medically advised weight-loss expenses and employers will almost surely intensify their anti-obesity campaigns. Weight Watchers’ stock has already surged in anticipation of the bounty to come.

If this made Americans healthier, it would be all to the good. But it won’t. Before Jenny Craig counts more millions, before more doctors mete out bad diet advice, and before more well-intentioned American executives mandate disordered eating as a condition of employment, here’s what they (and all of us) need to know…

Dear Boss: It’s Time to Give Anti-Obesity Programs the Pink Slip

An  absence of results in our national war on obesity hasn’t dimmed enthusiasm in the private sector for a spate of workplace “wellness” initiatives aimed at weight loss. As discouraging as it is to see the government wasting its efforts and spreading fat stigma without effect, the workplace trend is far worse. That it won’t work is only the start of the problem.

When fat prejudice comes from government, disgusted citizens at least can walk away or change the channel (and maybe even vote its authors from office). When it comes from a boss, though – or, more commonly, a human resources department – employees have little recourse. That’s when anti-obesity initiatives cross the line from merely offensive and ineffectual to something worse: They become hostile and coercive.

I leave to lawyers the technical arguments against discrimination and when this constitutes a hostile work environment – not an easy case to make, given that just one state (Michigan) has outlawed discrimination based on size. But whether it’s benefits like health insurance at stake or “only” the insult and prejudice of a workplace “educational campaign” stressing the dangers of obesity, workplace obesity initiatives induce stress, anxiety, and bad feelings while increasing the likelihood of disordered eating and other maladies.  On top of all that, they make it seem okay to discriminate against colleagues and subordinates based on externalities unrelated to job performance.

This is not to demonize the people behind these efforts. Given today’s general misunderstanding at all levels about the roles of fat in disease, it’s easy to imagine that most HR and health professionals have only good intentions in trying to induce colleagues to get thinner. If that worked – and if it didn’t induce harm – this blog post might be unnecessary. 

But evidence so far shows that hardly anyone can lose weight and keep it off long term, despite widely touted claims by some scientists. Which shouldn’t be so surprising, given well established evidence that the body’s regulatory mechanisms resist weight loss. So we are left with anti-obesity messages that wield no practical impact while shaming the larger members of a community (and causing their colleagues to fear becoming like them). 

As I ask in my online form letter opposing such campaigns (paraphrased here), “What does our organization gain by shaming some of us for how we look? Is there any evidence to suggest it will stimulate improved health behaviors?”

Yes, evidence. It’s surprising, really, that corporate employers, who have their own or shareholders’ money at stake, are undeterred by the abysmal return on investment of pretty much every obesity-education measure ever tried. If measured by the yardsticks applied to other commercial efforts – in marketing, say, or research and development – weight-loss “health” initiatives would be history, so the hate question would be moot.

But when it comes to the obesity bogeyman, even MBAs quail and comptrollers quake. Cost-benefit ratios fly out the window along with reasonableness itself. No one seems to care or calculate whether a campaign will make workers healthier, only whether it will slim them down and, in that case, only in the short term. 

Some companies incentivize thinness, without regard to health, by providing better benefits for thinner employees. Whole Foods, for example, has a “health incentive” program which allows  a higher discount for in-store purchases for employees with lower body mass indexes (BMI). 

Other companies penalize fatness, also regardless of employees’ health status or habits, as in this example from a correspondent on the West Coast who faces a frightening bind (and therefore remains anonymous). “I work in an outpatient medical clinic,” she wrote, “and heard that, come open enrollment time, employees are going to be screened and face either insurance premium raises or a requirement to enroll in Weight Watchers” or an in-house weight-management class. (Again, this is absent any evidence that such programs offer any lasting health benefits for most people.)

Government workplaces make the same error, as another correspondent has just reported: “The Navy now has policy that ensures members are separated without compensation because they do not fall within Navy [BMI] standards. What bothers me the most is the fact that the Navy is discharging personnel who do not weigh/measure up to their standard without even allowing them to take a physical fitness test. I know many people who are very unhealthy and are within standards only because they weigh less than others.”

As an exercise physiologist and nutritionist and an avid athlete myself, I’m as eager as anyone to see more people caring for themselves by enjoying movement and eating well. It makes sense – and dollars, too – to refocus the energy behind our anti-obesity campaigns into promoting good health behaviors for everyone, regardless of what they weigh. That philosophy is at the heart of my book, Health at Every Size: The Surprising Truth About Your Weight. I just know that fat shaming will never get us where we want to be, and it’s time corporate America learns that, too.