How would you feel if your employer was thinking about making you reduce your waistline as a way to reduce the company's bottom line?
Some advocates for the rights of overweight people say that may be what is happening as debate over a broad public health approach to the obesity epidemic in this country comes face to face with a recession that is forcing companies to look at bottom lines.
The U.S. Centers for Disease Control and Prevention unveiled a free Web site application last week called LEANWorks designed to motivate employers to start healthy living programs and weight loss measures for their employees.
Yet, a keystone to the LEANWorks program, the "obesity cost calculator" for companies to estimate how much their obese and overweight employees cost them each year, has started a debate between some public health experts and size discrimination activists.
"They are my employer. They are paying for my time to work for them. They are not my owner. They do not have a right to my personal information such as my height, my weight or my BMI," said Peggy Howell, member and public relations director of the National Association to Advance Fat Acceptance.
The obesity cost calculator lets employers enter their employees' age, gender and Body Mass Index numbers and get an estimate of how much their obese and overweight employees cost in insurance and missed work days each year.
While some public health officials see this as a growing trend and the cost assessment as a necessary stick and carrot to get preventive programs off the ground, some size advocates say the calculator is fuel for needless size discrimination.
"We believe that this kind of practice would be discriminatory to all sorts of people, particularly to women and minority women because of the difference of body makeup and body composition," said Howell, who cited government statistics that a greater proportion of overweight people are female and of certain ethnicities.
For example, 23 percent of white men and 26 percent of white women are obese in the United States while 32 percent of black men and 39 percent of black women are obese.
"And, you cannot tell by looking at a person's physical appearance whether or not they are healthy," she said.
Is Obesity Always Unhealthy?
Joanne Ikeda, nutritionist emeritus at the University of California at Berkeley and member of NAAFA, supported the claim that not all obese people are necessarily unhealthy.
"I think we need to distinguish between the metabolically healthy obese person and the metabolic unhealthy obese person," Ikeda said. "There has been no attempt to look at the difference in terms of the physical fitness of people who are not meant to be a large size and their poor exercise and eating habits as opposed to the obese people whose genetics engineered them to be big people, and they are otherwise healthy."
Ikeda pointed to numbers from the National Health and Nutritional Examination Survey that showed while 68 percent of obese adults are metabolically unhealthy, 24 percent of normal-weight adults are also metabolically unhealthy.
Ikeda said she thought the focus on obesity alone unfairly targets people of size for being costly.
"For employers having a choice of spending money on a health promotion programs versus letting go or not hiring any more of them, which do you think an employer is going to choose?" Ikeda said.
But the engineers of the LEANWorks program said they disagree.
"It's no secret that obesity is a big risk factor for chronic diseases. Employers understand that," said Dr. Bill Dietz, director of the Division of Nutrition, Physical Activity and Obesity at the CDC.
While Dietz agreed that some obese patients are metabolically normal, he pointed out that those estimates do not take into account other health problems such as arthritis, nor do they look at the larger picture across the nation.
"Obesity has accounted for over 25 percent of the rise in medical costs between 1987 and 2001," Dietz said, who added that the LEANWorks program took two years to develop through numbers from national surveys, including the Medical Expenditure Panel Survey.
"The reason why we think employers are so important is employers are to adults what schools are for kids," Dietz said. "We think that work sites can be a very healthy place to work if employers pay attention to nutrition activities for their workforce."
The Business of Obesity Prevention
The LEANWorks Web site does not encourage employers to ask for BMIs employee by employee. If a company does not have BMI information on hand, the site can generate estimates based on regional statistics and numbers gathered from similar companies.
Regardless of whether the government provides the numbers, a growing private sector is capitalizing on employers concerned with obesity and company costs.
"Essentially I think this is really the direction the whole country is going in," said Kathy Fleming, vice president of corporate communications for U.S. Preventive Medicine. "Our field is growing exponentially. It's so interesting that with the economy the way it is, our business is taking off."
Fleming's company is one of many taking private-based, health insurance-based and now government-based approaches to estimating the cost of chronic diseases and helping companies implement preventive measures.
U.S. Preventive Medicine goes much further than just looking at BMIs. Fleming said participating employees go through blood tests, biometric measurements and lifestyle surveys, all of which remain anonymous to the employer.
The biggest hurdle to participation, Fleming said, are employees who worried that their health information will be used against them.
"Privacy is an obvious concern and it's one of the first questions," Fleming said. "Our research has shown us people are scared to give this sort of information if they think their employer would know their information."