I made a similar comment on a similar slate article a few weeks ago that was probably written much better than this will be, but but there are so many problems with the idea of taxing people because they are "fat."

First, what determines "fat"? Everyone knows the standard BMI scales are just guidelines and cannot be applied to every individual. Regardless of how hard or easy it is for people to lose weight, every person is different in terms of what they "should" weigh and it has more variables than just height. I hate to use myself as an example, but I weigh 165lbs, but the standards suggest as a 5'4" female in my 30s I should weigh something like 135 lbs. If you look at the circumfrances of my arms and legs, you would know instantly that I could NEVER weigh 135 lbs. In fact, I think I weighed that when I was 12. I am a size 12, I'm extremely muscular, and I've always just been a bigger, denser person. I could maybe stand to lose about 5 lbs right now. I have extremely healthy habits, I'm obsessed with fitness, and I am perfect health given my blood glucose levels, my cholesterol levels, my blood pressure, etc. I'll be damned if I'm paying extra for anything just because I have more mass than some standard. On the reverse, people can weigh very little and be "fat" just because they are small. Haven't you ever seen fat skinny people?

Second, once you determine someone is "overweight" where do you draw the line for how much overweight they have to be to effect health care costs? If someone is 10 lbs overweight, how much extra costs are they imposing on society relative to someone who's 100 lbs overweight? Should they have to pay the premium? Someone could be 10 lbs over whatever is supposedly their ideal weight, but still be perfectly healthy. Someone who's 100 lbs overweight is probably causing significantly more costs. And then, this could vary from person to person. 10 or 20 lbs is a lot more significant in very small framed person than it is for an NFL player.

Third, "fat" no matter how it is measured is NOT a disease. I cannot for the life of me understand why "obesity" is considered a disease- isn't it a symptom? Obesity is not a cause of health problems, it's an effect. A person eats a lot of sugar, develops insulin resistance, and their body converts carbohydrates directly to fat. In that case a behavior (eating too much sugar) was the cause of a disease (insulin resistance) a symptom of which is getting fat. Even if you cut out the disease part here, and say, a person eats a lot of calories and their body stores the extra as fat, fat is still the effect, not the cause. In this case, the person might still be perfectly healthy- say they ate all those calories in apples, broccoli, and lean fish? They might not have any health problems, they're just fat.

Which brings me to four, fat people can be healthy. AND fat people can have healthy habits. Just has some people have trouble losing weight due to biology, they might more easily gain weight due to biology. Take women with PCOS for example (which is estimated to be 10% of the population). You can be exercising like a psycho and eating nothing if you have PCOS, and your body just holds onto that fat, it's chemical. As I said above, you can get fat just from eating too many calories. What's wrong with eating too many calories if it doesn't result in any health problems? If you don't develop insulin resistance or high cholesterol from the calories you're eating, you might be fat, but you don't have a disease.

Fourth, skinny people can be decidedly unhealthy. I know a TINY (actually underweight) woman who exhibits poor eating and exercising behavior and as a result has a whole host of health problems in her early 30s. For whatever reason though, this behavior and the resulting health problems do not manifest themselves as fat in this individual. Why should a healthy fat person subsidize the cost of this skinny person's poor behavior? And, as I mentioned above, a person could be "skinny" and have poor behavior, and just never pay the cost of it because they're small.

Let's look at an example: Person A, Person B, and Person C, Person D all eat an entire chocolate cake. Person A develops insulin resistance from the sugar and gets fat as a result. Person B gets fat because he doesn't exercise and his body just stores the extra calories from the cake. Person C develops insulin resistance from the sugar, but due to good genes doesn't gain much weight and stays below the cut off BMI. Person D has a high metabolism and the cake has no effect on him. All 4 people have the same behaviors, but only 2 of them have an illness are adding to health care costs, and only *1* of them is paying extra for it.

Does this make any sense?

Actually, in my example, 2 people A and B are paying for the poor behavior, but only A and C have a disease.

If you have read the many posts below you would see that many people believe that insurance premiums can be based on health factors but that weight would only be one of them and only in conjunction with other factors.

e.g. LDL is a good factor and as you noted one can have a high (poor) LDL level regardless of whether of their weight. Blood Preasure, HDL, ACL, etc.. can all be factors. Now if one has problems with any of these AND they are also obese (not just overweight), then this combination of factors could impact their premiums.

My view is that only factors that relate to behaviors that one can change should impact premiums. So age and gender wouldn't count.

"My view is that only factors that relate to behaviors that one can change should impact premiums. So age and gender wouldn't count."

Human physiology is much more complicated than that. There is nothing in the human body that is always, 100% of the time responsive to changes in behaviors..

The belief that, if people just did x,y & z and had a,b & c results on lab tests that they would never get sick is ridiculous. There is no consistent indicator that guarantees a low risk in regards to health insurance. Therefore, charging people simply because they look fat to someone is simple bigotry.

Being fat is not a sin. Being fat is not something that everyone needs to be 'cured' of.

Doc Holliday:

"My view is that only factors that relate to behaviors that one can change should impact premiums. So age and gender wouldn't count."

Human physiology is much more complicated than that. There is nothing in the human body that is always, 100% of the time responsive to changes in behaviors..

The belief that, if people just did x,y & z and had a,b & c results on lab tests that they would never get sick is ridiculous. There is no consistent indicator that guarantees a low risk in regards to health insurance. Therefore, charging people simply because they look fat to someone is simple bigotry.

Being fat is not a sin. Being fat is not something that everyone needs to be 'cured' of.

I completely agree. That's basically my main point: taxing fat is profiling. It's no different than police officers arresting people of a certain race. It's a statistical shortcut doctors take to determine health that isn't accurate.

And the "behaviors" that people want to tax is a huge oversimplification. I gained weight once in grad school and at my doctor's appointment, two points were made. First, the doctor asked me why I gained weight. I said I wasn't sure but it seemed to start when I was training for a half-marathon and running more than I normally did ("normally" meaning I previously had a more varied workout, not that I didn't have a workout). She said this is common- when you train for performance you tend to eat more, but not necessarily burn it all, and my muscle mass had probably decreased as a result of reducing weight training in favor of running. If that is taxable behavior, fine tax me. Second, the doctor said, "but you should lose weight. the key is simply to eat less calories than you burn." I said, "come on, you're a doctor, you can't possibly believe it's that simple." She said, "I don't. But no one really knows anything else about it, so as a doctor, that's what I have to tell you."

First premiums are NOT a tax and second I never supported a fat premium but instead risk factors that can be measured like LDL, HDL, etc... Most people can change their levels from 'good' to 'bad' by changing their behavior. Thus it is still 100% up to the individual; Want a discount on your premiem change your behavior.

Note that for a small percent of people they will change their behavior and their factors will still be 'bad'. Hey, no system is perfect.

Again, I'm NOT talking about a tax on sode or other taxes but how health insurance premiums are set. So PLEASE get off the tax bandwagon. A tax is something the government does and I do NOT support that.

Of course people can be fat just like someone can own a house that doesn't have smoke alarms, but they cannot get fire insurance.

Private insurance companies have a right to adjust premiums using sound and fair methods. This occurs in all other lines of insurance, why should health insurance be any different? Really THAT is the debate here not the right to be fat or not.

Of course people can be fat just like someone can own a house that doesn't have smoke alarms, but they cannot get fire insurance.

Being 'fat' is an entirely subjective criteria with no real basis. Not having smoke alarms is an objective criteria. The former is not, necessarily, a choice and later is, always, a choice.

Adjusting premiums on subjective criteria is not "using sound and fair methods." It's profiling.

While that's better than a fat tax, you're still punishing a small segment of the population for their genetic inheritance. Is that really ok>