In a growing trend of incentivizing fitness (and/or disincentivizing obesity) to cut down on health insurance costs, a hospital chain based in Indiana said last month it would implement one of the boldest strategies yet.

In 2009, if employees don’t meet certain weight-to-height ratios, blood pressure and cholesterol levels, they could be charged up to $30 every two weeks until they meet those levels the company deems healthy.

The L.A. Times took a look at the program yesterday, and reported the L.A. Unified School District is researching similar financial incentives and disincentives.

The concept raises significant questions. To many people, it seems fair that overweight employees, those with higher health costs and risks would have to work to shape up, or pay up.

But here’s the other side:

Critics of the lose-it-or-pay trend say that companies that charge overweight employees more for their medical coverage are turning the healthcare system into a police state and, just as worrisome, are working off of a false assumption that it’s easy for people who are obese and have other health issues to change their situations. …

“It’s reprehensible to punish and emasculate someone for having a disease like obesity,” said Walter Lindstrom, director of the Obesity Law and Advocacy Center in Chula Vista, Calif. “Anyone who penalizes workers for being overweight should brace themselves for a backlash.”

I gave Lindstrom a call this afternoon. He said he hasn’t yet heard of any local employers pursuing such rigorous policies. But he said he wouldn’t be surprised to see it soon in San Diego County: “It’s somewhat the flavor of the month in many areas,” he said.

He said the quote in the L.A. Times didn’t capture the caveat that he believes wellness programs should be encouraged, though he opposes the program that targets visible health problems.

“‘Reprehensible’ is the right word when you try to punish someone for having a health condition,” he said.

“When you see someone who’s morbidly obese, that’s someone dealing with a complex, multi-factorial disease,” he said, comparing treating that problem to chemotherapy or dialysis for cancer and organ failure.

“The only difference is that you can see when someone is a person of size,” he said. Often, obesity results from many complex medical factors, he said, but is misunderstood much the way depression once was. You wouldn’t tell someone who’s depressed just to clench their fists and presto! change their mindset, he said. So you can’t just tell an obese person to lose weight and expect that to be enough to change the situation.

But if that’s the rock, context from the Times story shows the hard place employers are up against.

As the number of obese Americans continues to soar — it’s now 1 in 3 — employer healthcare premiums are growing twice as fast as inflation to nearly double their cost at the beginning of the decade. Employers have been struggling with how to hold down costs without offending or pushing away workers.

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