Increasingly, weight bias has gone underground. Explicit fat shaming has become socially unacceptable. But the human impulse behind it has not disappeared. So it pops up in diverse new ways. Like a school district that covers metabolic and bariatric surgery for employees, but requires a $5,000 copay that it refunds to employees only if they suffer no weight regain for five years. Let’s be clear. This is a $5,000 penalty for obesity relapse.
Can we imagine a financial penalty for someone who suffers a relapse of breast cancer? Of course not. But then, we have little impulse to blame people for breast cancer. For obesity, the common (and false) bias is that you must have done this to yourself. Thus, even if we reject explicit bias, many people can rationalize a penalty like this. Just call it an “incentive” for healthy habits.
Wellness “Incentives” Don’t Work
That rationalization has a serious problem. Wellness incentives don’t work. The notion that an employer has to pay people to want to be healthy is inherently flawed. It’s condescending because it presumes that people are too stupid to want to be healthy themselves.
In fact, health problems generally, and obesity in particular, are punishing enough. Adding financial stress does not help.
Obesity Is Chronic
More to the point, a penalty for relapse of a chronic disease is ridiculous. Obesity is a chronic disease because treatment, including surgery, doesn’t make it go away forever. It simply helps control it, make it better. But some weight regain is almost inevitable. Heaping blame on people for weight regain is ignorant and cruel. It also gets in the way of more constructive approaches.
So calling this program a health “benefit” is an oxymoron.
Click here for reporting on this program and here for perspective on the role of stigma in weight regain after bariatric surgery.
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