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Overweight but won’t exercise. Who should pay?

Overweight but won’t exercise. Who should pay?

A new study says that the overweight live longer. Economists say that may be true, but the overweight have higher health costs.


A higher body mass index — a standard measure for determining whether people are overweight or obese — is associated with a number of chronic illnesses, including diabetes, heart disease and hypertension. These chronic illnesses are expensive to treat. If, as it now turns out, overweight people are living longer in addition to racking up more chronic illnesses, that means Medicare is on the hook for paying for more expensive people for more years….

In other words, your spare tire might help you live longer, but it is also accelerating the country’s debt problems.

[Prof. Goldman] gave as an example a doctor he knows who has an obese patient taking expensive drugs for various health problems related to being overweight. The doctor told Professor Goldman: “The best thing I could do for this patient would be to take him for a walk. But I don’t get paid for that.”

Across the pond, Savitri Hensman writing at Ekklesia, points to a proposal in the UK to cut benefits for people who don’t exercise:

As the NHS Choices website explains, GPs can help people to lose weight in various ways, including “exercise on prescription” and other physical activity opportunities. In addition “Many GP surgeries across the country prescribe exercise as a treatment for a range of conditions, including depression”. People with a family history of heart disease, at risk of osteoporosis, with diabetes, high blood pressure, arthritis or who have had a stroke are among those who can benefit.

A Dose of Localism recommends punishing those on such schemes who do not turn up to exercise sessions: “Relocalisation of council tax benefit and housing benefit combined with new technologies provide an opportunity for councils to embed financial incentives for behaviours that promote public health. The increasing use of smart cards for access to leisure facilities, for instance, provides councils with a significant amount of data on usage patterns. Where an exercise package is prescribed to a resident, housing and council tax benefit payments could be varied to reward or incentivise residents.”

Is it wrong to require those on Medicare to pay for their healthcare if there is a cheaper and superior alternative, i.e. exercise? If we can ban supersized sodas or kids meals with toys (as some cities do) why not mandate exercise by taxing your Medicare benefits if exercise is prescribed and you don’t do it?


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Savi Hensman

As those who have read the articles cited – or my follow-up piece on – will have gathered, though I am in favour of promoting exercise, I am certainly not arguing for the proposal.


JCF–did you read any of the links I provided? The point is that obesity is not the “problem” that it has been painted to be.

If you would kindly re-read my post, I never said obesity was a problem, Paige. [FWIW, as someone who does muscle-building exercise, I have never trusted the BMI. Muscle weighs more than fat!]

…but I do think we need a conversation about health, and how what (quality/quantity) we eat/how we don’t exercise (enough, inc myself) contributes to ill health.

JC Fisher

Gary Paul Gilbert

Marion Nestle, Professor of Nutrition at NYU, on her blog Food Politics, says that in the real world being overweight increases the incidence of disease in some individuals. It is definitely a factor. In health as in nutrition one has to know many different factors.

Her general advice remains to eat less and move more. She is critical of both the food and diet industries.

We have a food industry which persuades Americans that it is a good idea to snack throughout the day and a diet industry which further helps to make people obsess about food. I was once pleasantly surprised to find a nutrition web sponsored by the French government which stressed “le plaisir de la table” ‘the pleasure of the table.’ In Europe people spend more time at table having conversations. There are many variables to health.

Gary Paul Gilbert

Gary Paul Gilbert


What about other risky behaviors?


Drinking to excess

Diabetics eating too many sugary foods

Motorcycle riders

Owners of guns

I could go on. How will the behaviors be monitored? Another large bureaucracy to monitor risky behavior?

Gary’s right. Education, not stygmatization is the answer. As has been mentioned, poor people all too often have fewer choices about food and exercise than those who are better off. And better public transit would get more of us out of our cars.

Does anyone think that seriously obese people who find it difficult to get around and difficult to lose weight are happy with their condition?

June Butler

Paige Baker

JCF–did you read any of the links I provided? The point is that obesity is not the “problem” that it has been painted to be. We hear over and over and over that fat people are unhealthy, per se, and that they are a drain on the healthcare system.

The evidence does not support those claims.

Rather than shaming fat people and discussing punitive measures against them, THAT’s the thing we need to be having a conversation about. We have been convinced that the world is flat. Why is that? And who has benefited from convincing us to completely ignore all the scientific evidence to the contrary?

I’ll be happy to have a conversation about the fact that our obsession with weight has nothing to do with health. It may have to do with aesthetics, or a multi-billion dollar diet industry, or with our Puritan desire to declare other people as “less than” and to control them through shame and social policy–but not with health.

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