Usually I find The Jillian a pretty good source of information and entertainment, but I disagreed with her rant on the latest episode of the podcast (Overweight to pay?) that insurance companies should charge overweight people more for health and life insurance (or the seemingly nicer tactic of charging less for people in a "healthy" weight range). Or, more accurately, I disagree that doing so would result in truly lower premiums for healthier people or provide incentive for people to lose weight in a healthy way.
First of all, any time you decide to test people for anything, there are costs involved. Florida's legislature found that out when they decided to require drug tests for welfare recipients. There are the costs for the tests themselves, plus the costs of tracking the results, and the cost to defend against lawsuits resulting from the law. Plus, they were only able to deny welfare benefits to a small percentage of the people who applied (a percentage lower than the suspected drug use rate among the general population), and though the legislature might derive some satisfaction from starving those people's children (who presumably have no control over whether their parents use drugs), the actual savings were not that great because of the other costs.
I think this is a pretty good parallel to Jillian's insurance proposal. Insurance companies (unlike state legislators) are pretty good assessors of risk. That's how they make their money. If charging more for health insurance for overweight people was really worth the costs, they would already be doing it. Unlike the Florida legislature, they also have to compete for customers, and they probably know that most customers would not want to have to weigh-in regularly with their insurance company. Plus, of course, there would be administrative costs associated with the weigh-ins, and possible discrimination lawsuits.
Assuming that such an initiative passed, it might not have the desired effect. Presumably, overweight and obese people already want to lose their excess weight even more than insurance companies would want them to, and they have not managed to do so not for lack of trying, but because healthy weight loss is slow and difficult. (I speak from experience here) and there is a lot of conflicting information about what kind of diet and exercise is most effective. Imposing a financial penalty for excess weight might encourage customers to try dangerous and drastic weight-loss measures that could result in excess costs from, say, extreme diets or harmful supplements. Or more of them might ask their insurance companies to pay for costly weight loss surgeries. The kind of moderate behavioral modifications that would result in the healthiest weight losses might take years to bring an obese person into a healthy BMI range.
Finally, there is some evidence to suggest that weight is not a highly accurate predictor of health. The simplest method of determining who is overweight or obese, BMI, has been shown to inaccurately predict body fat percentage in many adults.There is some evidence that suggests that excess weight is not a health risk for some obese people, especially those who exercise regularly. One study even found that people who fell into the "overweight" BMI range had the lowest risk of dying from all causes. It may be that excess weight is just a marker for the real risk factors: A sedentary lifestyle and a poor-quality diet. For people who have addressed those factors, excess weight might be more of a cosmetic issue than a health problem (or at least that's what I'm hoping).
Ideally, any incentive would be attached to behavior, rather than weight. I know of quite a few employers who provide free or reduced-price gym memberships to employees, and even cover the costs of some weight-loss programs and smoking-cessation interventions, in an attempt to address the behavioral side of the problem and reduce their health insurance premiums. These companies are creating a win/win situation: happier, healthier employees and lower absenteeism and health care costs. These incentives also probably increase their competitiveness for good potential employees.
I would like to know how much those incentive programs pay off for companies, if at all. I would also like to know what the costs/benefits of the pay-to-weigh program that Jillian is proposing. Somehow, I think the insurance companies have analyzed the situation more than Jillian has and probably already have the answer.