From the article:

A 2008 study from the Archives of Internal Medicine found that a full one-third of all obese patients were "metabolically healthy" in terms of their blood pressure, cholesterol levels, and other measures. Meanwhile, one-fourth of the patients whose BMI was in the normal range showed abnormal metabolic signs. So a policy that varies its premiums as a function of body size is guaranteed to punish a bunch of people who are perfectly healthy and reward a bunch of people who are at risk.

I'm assuming the study is scientifically sound. That being said I would love to play a betting game with the author. We both bet the same amount of money (the higher the better) on whether a patient is "metabollicaly healthy." The author can bet on the obese patients while I get the people with a normal BMI. Of course we want this to be fair so we each both bet on the same number of people. If the author is reading this post please skip ahead to the bold font.

....... Is he gone? Good. Now hopefully everyone else can see that he will lose money while I win money. The longer this game goes on the more I will win from him. As long as you, the general public can see this then I have faith you aren't all mentally handicapped and can see through the idiocy that is Daniel's article. Health insurance companies make money by charging more money than they will pay for treatment. If there can be no discrimination then high-risk people such as obese people will actually statistically profit versus low risk people.

Hi Daniel. Welcome back. This is where you should resume reading. If you're interested in playing this game please respond and we can work out specifics.

Of course the person betting on the fatties would lose most of the time if this game was played repeatedly. You are just stating the obvious.

However, the whole problem with insurance and risk selection is that- what makes financial sense to the insurance company may be grossly unfair to an individual. Let's say you have a body builder whose muscle mass causes him to fall in the 'obese' side of the BMI. He is penalized with a fattie surcharge, even though he is more fit and healthier than 99.9% of the population. Now this makes perfect financial sense for the insurance company- they deal with 100 of 1000's of people everyday. They just don't have time or money to verify every case for every overweight person. For every Mr. Universe they wrongly surcharged, there are probably 20 couch potatoes that they correctly surcharged. It's simply cheaper for them to err on the side of penalizing all 'overweight' people.

In short- it makes perfect financial sense for the insurance company, but you cannot deny that this is grossly unfair for Mr. Universe here.

I agree wholeheartedly with you concerning the unfairness of using BMI. It was never meant to be used for evaluating individual's health, and to do so is absolutely indefensible.

That doesn't change the fact that fat people cost more to insure and should be required to pay higher premiums.

So use an index that is valid - such as waist-to-hips, or an accurately assessed body fat %. Waist-to-hips costs very little, and can be measured nearly as quickly as weight and hight... but you won't find literally 25+% of the population in which waist-to-hips is completely invalid for. If you have a waist-to-hips ratio of greater than 1, you're less healthy. If you have greater than 1.1, you're fat... and if you have 1.25 or more, you're fatter.

The only exceptions are pregnent women, and that condition (for which they could be allowed an exemption from the fat surcharge) only lasts ~10 months (5 months where the tummy swells, and 5 months to lose the weight... the first 4 months of pregnacy doesn't change a woman's waist-to-hips ratio.)