soap obesity
Image: Paul Blow

MY MOM MUST resent what my older sister and I did to her figure. Until we came along, she had a smoking body—I’ve seen the pictures. Long shapely legs, tiny waist, buns the shape of two perfect French batards. But 18 months of pregnancy left my mom carrying an extra 20 or so pounds; 18 years of grabbing meals on the go as she ferried us from school to piano lessons and volleyball tournaments turned that 20 into, well, a lot more. Today, my 59-year-old mother is part of the 66 percent of American adults who are considered overweight.

Which is part of why I find myself struggling with this quandary: Should obese individuals pay more for health insurance? After all, obesity-related illnesses like heart disease, high blood pressure, diabetes and high cholesterol cost Americans more than $75 billion in 2004; the obese also accrue average lifetime medical costs $10,000 higher than those of non-obese folks, according to a 2004 report by researchers at Stanford University and the RAND Corporation, a California think tank. It’s a question the Oregon Health Fund Board, which was established by the state legislature in 2007, should have the guts to consider—as some private companies already have—when it makes recommendations for reforming Oregon’s health care system to stem rising costs in October. Because if we weren’t so jiggly in the middle, we might not pay so much for our insurance in the first place.

“A large part of rising health care costs is related to chronic disease,” says Susan Pisano, vice president of communications for America’s Health Insurance Plans, “and many of our major chronic diseases are related to obesity.”

The problem is particularly prevalent in Oregon, where nearly 25 percent of the population is obese—a figure that officially makes us the fattest of the West Coast states. According to the Center for Disease Control, a person is “obese” when they hit a Body Mass Index (or BMI) of more than 30, a number that corresponds to a basic calculation of weight and height. (For example, someone who is 5 feet 4 inches and 175 pounds just sneaks into the CDC’s obese category.) To accommodate our burgeoning girths, Portland now has hospital beds and ambulances specially designed for plus-size people. You can even supersize your coffin upon passing. So widespread is the problem that last year’s Oregon legislature declared obesity a state emergency, and established a separate task force to develop a plan for reducing obesity and its attendant diseases.

Our weight problem is eating away at our wallets, too: Obesity-related diseases cost the state an estimated $781 million in 2003. Those costs get passed on to insurance companies, then to employers and eventually to employees. In some places, the private sector is looking to trim the fat from the system on its own. Last summer, the Indianapolis-based hospital system Clarian Health announced plans to charge obese employees up to $60 more per month if they didn’t meet certain wellness goals by 2009, like a BMI of less than 30 (though the company reverted to a voluntary wellness plan amid cries of “fattist” discrimination).

This isn’t the first time employers have scrutinized employees’ lifestyles outside the office: In the ’20s, Henry Ford’s employees faced dismissal if they didn’t conform to company ideals about alcohol and nicotine consumption, something his “Sociological Department” monitored with home visits.
“It’s a slippery slope when you get into the idea of social policy,” says Mike Bonetto, a member of the Federal Laws Subcommittee of the Oregon Health Fund Board. “People are sensitive when you start talking about charging more for health conditions.”