Employers, Stop Oversimplifying Your Employees’ Body Mass Index

Conference season is exciting when you hear a solid debate, learn more about a topic you care about or discover a speaker who is a promising resource.

But it also means coming across speakers who sling dangerous or overly simplistic ideas to their audience, in this case employers. I want to take this opportunity to gripe about my biggest pet peeve(s) in the employer health and benefits space. These are ideas I’ve heard at several conferences over several years and/or have read in a good number of articles about.

Here’s the biggie: Workplace weight loss or nutrition programs that hinge on body mass index on an individual level, especially outcomes-based programs whose “rewards” rely on reaching a certain BMI or losing a designated amount of weight.

“BMI is useful when studying populations and trends,” according to Medical News Today. But it can only give a rough idea of an individual’s health and weight status. There are flaws in the formula.

This is important to point out because if employers want to continue to micromanage employees’ health, they should know the nuance behind certain health measures instead of blindly trusting wellness companies.

To be clear, I understand that obesity is a considerable public health issue in America. I understand that there can be health risks.

But it’s also an issue I feel employees should feel safe dealing with in the privacy of their doctor’s office rather than having to share private medical information with their employer. Also, I’m aware of the fact that people and organizations have misconceptions about BMI and weight that are important acknowledge. Here are some important facts to know:

1. There’s a misconception that thinner people are healthier. This is not always the case, as weight is only one of many measures for health. (Northwestern Medicine)
2. Using BMI gives us a false idea about who has weight issues and who doesn’t. (Northwestern Medicine)
3. “It’s important to recognize that BMI itself is not measuring “health” or a physiological state (such as resting blood pressure) that indicates the presence (or absence) of disease.” (Harvard Health Blog)
4. Plenty of people have a high or low BMI and are healthy and, conversely, plenty of folks with a normal BMI are unhealthy (Harvard Health Blog). [This fact might not be considered in certain settings. For example, the New York Times recently reported about how, even though women can still be healthy with a high BMI, fertility clinics often refuse to treat them.]

I don’t know if employers in general understand the limitations of BMI.

The American Journal of Managed Care published an interesting research paper in November 2015 called “U.S. Employee Wellness Programs and Access to Obesity Treatment in Employer-Sponsored Health Insurance.” Its primary results were that 16 percent of employers required wellness program participation in order to receive full health benefits (how employers do not realize that this is coercion and does NOT make the program voluntary is beyond me!). Further, while most wellness programs set targets for weight and for other health indicators, most organizations health plans did not provide coverage for evidence-based obesity treatments.

The paper concluded:

For people seriously affected by obesity, the coverage gap described here is problematic because substantial improvement in their condition is unlikely without evidence-based treatment. This is true because obesity and its complications are typically chronic and progressive. Wellness programs may have little impact on costs driven by severe obesity in the absence of access to effective treatment for this chronic disease.

This is one of my major issues with wellness programs: They should be treated as secondary to real, HIPAA-protected medical benefits. Adequate health care is important. A wellness program should not be a replacement for certain coverage areas in a health plan. Also, if an employee would rather deal with health issues (any health issue, not just weight) through their doctor rather than a wellness program, they should not have to lose the opportunity to get hundreds of dollars in “rewards” like wellness program participants do.

I enjoyed this Consumer Reports story about privacy issues on wellness program. Its basic argument is that wellness programs often pose major privacy problems and that people should have a choice on whether they want to participate. Financial incentives or insurance discounts muddy the waters and may coerce people into sharing medical information.

Why is the free choice to participate necessary? The goals and recommendations of a wellness program may not align with your personal health care decisions, the article noted.

“If something you’re being asked to achieve in your workplace wellness program is unhealthy in your doctor’s opinion, you shouldn’t be required to do it,” said one source, Dr. Anna Kirkland, professor of women’s studies at the University of Michigan. “Wellness programs should never replace or supersede your doctor’s advice.”

The final point I want to make is that bias against people who are seen as overweight or unhealthy does exist. This is more so for women than for men, unsurprisingly; women tend to experience higher levels of weight stigmatization than men, “even at lower levels of excess weight.” Some negative stereotypes against seemingly overweight people include that they are “weak-willed, lazy, unintelligent and gluttonous.”

Further, a research report about this, “The Impact of Workplace Health Promotion Programs Emphasizing Individual Responsibility on Weight Stigma and Discrimination,” was released in November 2018. The research identified workplace health promotion programs as “potent catalysts of weight stigma and weight-based discrimination, especially when they emphasize individual responsibility for health outcomes.”

This is a lot of information, but my main argument here is that employers shouldn’t look at employee weight and BMI in such a black-and-white capacity. Also, I want to stress the point that health plans (covered under HIPAA, unlike wellness programs) should cover evidence-based obesity treatments. Finally, as employers focus more and more on employee health, be aware that weight discrimination is serious and should never be tolerated.

Also read: Some Constructive Criticism on Wellness