Looking for new ways to trim the fat and boost workers' health, some employers are starting to make overweight employees pay if they don't slim down.
Others, citing growing medical costs tied to obesity, are offering fit workers lucrative incentives that shave thousands of dollars a year off health care premiums.
In one of the boldest moves yet, an Indiana-based hospital chain said last month that it had decided on the stick rather than the carrot. Starting in 2009, Clarian Health Partners said it will charge employees up to $30 every two weeks unless they meet weight, cholesterol and blood pressure guidelines the company deems healthy.
"At first, I was mad when I thought I would be charged $30 for being overweight," said Courtney Jackson, 28, a customer service representative at Clarian. "But when I found out it was going to be broken into segments - like just $10 for being overweight - it sounded better."
Jackson said she was going to try to slim down before the plan took effect. "If I still have weight to lose when it starts," she said, "I'll deserve to pay the $10."
Employers are serious about penalizing workers "because they've run out of other options" said Joe Marlowe, senior vice president with Aon Consulting, a national benefits consulting firm.
UnitedHealthcare, a national insurer, introduced a plan this month that, for a typical family, includes a $5,000 yearly deductible that can be reduced to $1,000 if an employee isn't obese and doesn't smoke.
Last summer, a similar plan was offered to county workers in Benton County, Ark., location of the headquarters of Wal-Mart Stores Inc. The $2,500-a-year deductible can be reduced to $500 if a worker meets low height/weight ratios during yearly on-site physicals.
According to federal guidelines, a man who is 6 feet 1 inch tall is considered obese if he weighs 221 pounds or more. A 5-foot-6-inch woman is obese if she weighs more than 185 pounds.
Thomas Dunlap, Benton County's benefits administrator, said the plan had witnessed a nearly 30 percent drop in claims - and led to changes in the workplace.
Workers can attend free weight-reduction classes, and there are now regular competitions between departments to see who can lose the most weight.
"When we have birthday parties now," he said, "people don't want sugar-laced cake and candy - they want fruit and deli trays."
Acknowledging that it could be partially the result of the new deductible, he noted that the county didn't have to raise its insurance premiums this year and likely won't next year.
Critics of the lose-it-or-pay trend say that companies that charge heavier employees more for their medical coverage are turning the health care system into a police state and, just as worrisome, are working off a false assumption: that it's easy for people who are obese and have other health issues to change their situations.
According to a 2005 Stanford University study, obese people with health coverage might already be punished on the job. Those surveyed were paid an average of $1.20 less per hour than thin workers, perhaps because employers intentionally adjust their wages to account for health costs.
"It's reprehensible to punish and emasculate someone for having a disease like obesity," said Walter Lindstrom, director of the Obesity Law and Advocacy Center in Chula Vista, Calif. "Anyone who penalizes workers for being overweight should brace themselves for a backlash."
Lewis Maltby, president of the National Workrights Institute, a Princeton, N.J.-based employees rights group, called the trend "a very dangerous road that could lead to employers controlling everything we do in our private lives."
"To penalize for things that are beyond some people's control is just wrong," he said. "Some people are fat because that's how God made them."
As the number of obese Americans continues to soar - it's now 1 in 3 - employer health care premiums are growing twice as fast as inflation, to nearly double their cost at the beginning of the decade. Employers have been struggling with how to hold down costs without offending or pushing away workers.
Sixty-two percent of 135 executives responding to a PricewaterhouseCoopers survey this spring said unhealthy workers such as those who smoke or are obese should pay higher benefit costs, compared with 48 percent who said so in 2005.
Employers might be motivated by new federal regulations.
In January, the U.S. Department of Labor released final clarifications on the Health Insurance Portability and Accountability Act (HIPAA) of 1996, which ruled that employers can use financial incentives in wellness programs to motivate workers to get healthy.
Still, some lawyers say weight-based compensation plans might run afoul of other employment laws.