NPR ran a piece this morning on Safeway's health insurance plan using reduced premiums to encourage, among other things, weight loss.

http://www.npr.org/templates/story/...oryId=113549864

I was hoping someone would catch this. I heard part of it while driving to work this morning but missed some of it as well.

I would like to see my insurance company incorporate a BMI incentive. I would definitely qualify for it. Instead I pay as much in premiums as my 300 pound neighbor who thinks sitting in a duck blind all day is exercise.

BMI is a very inaccurate measure of health. If they based it on triglyceride and A1C levels it might make sense.

Exactly. There are a lot of assumptions that Burd is making here.



The BMI thing we know is inaccurate (I wont be sending any of my bodybuilder friends to the Safeway job application desk...)

But lowering cholesterol? So Safeway will be slowly acquiring employees who are more prone to cancer and depression...

They are charging people less for health insurance based on a failed hypothesis. Let's check back with them in a few years to see how this brilliant plan is working out. The proof is in the pudding.
However, any incentives for quitting smoking are good I'll admit. But how to gauge which health outcomes are a direct result of quitting smoking as opposed to lowering cholesterol?

I don't think the there is any particularly valid way to do this. On the other hand appropriate copays might do some of it.

There are markers for good health. Cholesterol, inflammation, A1C, blood pressure, etc

They could ask for a standard health exam and give discounts for each health marker is in the "normal" range. I agree that BMI would be a stupid one to use. Better to use a caliper and measure body fat.

BMI may not work for those at the extremes of either end, meaning too fat or too muscled or too skinny. But for the 90% that fall within a normal bell curve, it's a simple and practical tool.

Nope on the cholesterol...

" In a finding that appears to stand a basic health recommendation on its ear, researchers who have been tracking a group of old men for decades now say low blood cholesterol is associated with an increased death rate.

A study of more than 3,500 Japanese-American men over the age of 70 found a steadily increasing death rate from all causes when cholesterol levels drop, reports a group led by Dr. Irwin J. Schatz, a professor of medicine at the University of Hawaii.

“We have been unable to explain our results,” they write in the Aug. 4 issue of The Lancet."
http://weeksmd.com/?p=494

"Dr. Uffe Ravnskov, MD, PhD, who wrote the book The Cholesterol Myths, goes through study after study destroying the idea that high cholesterol levels are the cause of heart disease. In the Framingham heart study done near Boston that spanned 30 years , the researchers concluded that high cholesterol was a risk factor for heart disease, but when one really dissects the data, one must question how they came to that conclusion. For example, when the participants of the study are plotted on a graph it clearly shows that those with cholesterol levels between 182 and 222 did not survive as long as those with higher cholesterol levels of between 222 and 261. The study shows that about half the people with heart disease had low cholesterol, and half the people without heart disease had high cholesterol.

Most studies have found that for women, high cholesterol is not a risk factor for heart disease at all - in fact, the death rate for women is five times higher in those with very low cholesterol. In a Canadian study that followed 5000 healthy middle-aged men for 12 years, they found that high cholesterol was not associated with heart disease at all. And in another study done at the University Hospital in Toronto that looked at cholesterol levels in 120 men that previously had heart attacks, they found that just as many men that had second heart attacks had low cholesterol levels as those that had high. The Maoris of New Zealand die of heart attacks frequently, irrespective of their cholesterol levels. In Russia, it is low cholesterol levels that are associated with increased heart disease. The Japanese are often cited as an example of a population that eat very little cholesterol and have a very low risk of heart disease. But the Japanese that moved to the US and continued to eat the traditional Japanese diet had heart disease twice as often as those that maintained the Japanese traditions but ate the fatty American diet. This suggests that it is something else, like stress perhaps, that is causing the heart disease.

Dr. Malcolm Kendrick noticed that in the MONICA study that has been going on for about 40 years, there is no association between high cholesterol levels and heart disease"
http://trusted.md/blog/vreni_gurd/2...e_heart_disease

As for BMI....
"Kenneth Devlin of National Public Radio recently took on the issue of the many flaws of the body mass index, and in fact came up with a bunch of good reasons why BMI is bogus.

We’ll cover them quickly for people who can’t take the time to listen to the original piece.

1. The formula was developed by a mathematician, not a doctor, and he explicitly said it shouldn’t be used to rate individual fatness.
2. It makes no sense scientifically (why is height squared, for instance?).
3. It makes no accounting for relative differences in bone mass, muscle mass and fat, and the differing weights of each.
4. High BMI doesn’t logically mean that a person is overweight or obese.
5. It assumes people are sedentary, with high fat and low muscle mass, so those who don’t fit the mold look unhealthy.
6. It sounds scientific but really isn’t.
7. It suggests hard and fast boundaries for the different weight categories, which clearly don’t exist in reality.
8. BMI gives insurance companies a handy way to charge people more without really evaluating their health.
9. It’s actually embarrassing to the United States to base such important health decisions on such a dumb model."
http://calorielab.com/news/2009/07/...ss-index-flaws/

" in 1998, the NIH changed the rules: They consolidated the threshold for men and women, even though the relationship between BMI and body fat is different for each sex, and added another category, "overweight." The new cutoffs—25 for overweight, 30 for obesity—were nice, round numbers that could be easily remembered by doctors and patients.

Keys had never intended for the BMI to be used in this way. His original paper warned against using the body mass index for individual diagnoses, since the equation ignores variables like a patient's gender or age, which affect how BMI relates to health. It's one thing to estimate the average percent body fat for large groups with diverse builds, Keys argued, but quite another to slap a number and label on someone without regard for these factors. "
http://www.slate.com/id/2223095/pagenum/2

And study after study find that the lower weight people seem to die earlier than the overweight or moderately obese. Could this be an artifact of BMI?

For obese people, their fat cells are removing a poison from the blood. Those that do not become obese will develop other nastier issues because of this poison. So we might say that the obese are the lucky ones.

Patrick

I know that cholesterol levels aren't really a good marker but it's widely accepted, that's why i mentioned it. If the insurance companies knew their business, they would look for triglycerides levels and the particle size of your HDL. But since they are talking about BMI, they obviously have no clue.

Really. Every single other health marker besides BMI is perfect in my records. I haven't been sick in...3 or 4 years, I can't remember. No health conditions, no medications. Yet I'm still considered at deaths door just because my BMI is still sky high. That's just silly.

That was my reaction too, Bat Spit. I have some lean coworkers who are far less healthy than I am. Grrrr!

Actually nearly everybody I know is less healthy than I am. I once got in a debate in a family get together and finally pointed out that while I was greatly fat, I was the ONLY person in that room who had not had surgery to remove body parts or who wasn't on some endless-prescription chronic medication. At this point, with a couple rare exceptions (like my natural bodybuilder cousin TJ) (yes, TJ and PJ, how cute eh) it seems to be the 'norm' for people to have health issues younger and younger, be on medications ranging from coumadin to prozac to statins, to be missing gall bladders and wombs and so on, and people seem to think this is NORMAL. I tell my dad, "It is NOT normal for people to be sick!!" But everyone thinks I am unrealistic, that of course it's normal. Sheesh!

Since I quit eating gluten, my severe acid reflux, severe allergies, severe asthma -- all of which arrived late in life -- vanished. I was born with a mild heart murmur that is no big deal. Cleaning up my food resolved the only health issues I had "besides obesity". Which in my case is severe enough to be a health issue but, IMO, not nearly the health issue that my stepmom's diabetes is (she's thin), etc.

Nah, people don't need another reason to feel entitled and better than the sick, old or fat.