>> Tuesday, January 26, 2010
Union-busting, health care reform-opposing, global-warming denying John Mackey, CEO of Whole Foods, has come up with a super idea for cutting his health insurance costs: giving his employees extra discounts on their company store purchases if they maintain or achieve a "healthy" (sic) weight.
The details: employees with a Body Mass Index of between 28 and 29.9 will get a 22% discount on their purchases; those with a BMI of 26-28.9 will get a 25% discount; those with a BMI of 24-25.9 will get a 27% discount; and those below 24 will get a 30% discount (employees must also meet blood pressure and cholesterol criteria and not use nicotine).
How crazy is this? Let me count the ways:
(1) In terms of BMI, the Whole Foods discounts correlate with increasing mortality risk. The most sophisticated study on this subject, published in 2005 in JAMA by Katherine Flegal et. al., used a BMI of 23-24.9 as its referent category for baseline risk of mortality. (This corresponds with the higher end of the government's "normal/recommended" weight range of 18.5-24.9. The lower one goes in the "normal" weight range, the greater the mortality risk becomes, so using the top of the "normal" range as the referent category actually minimizes the risks associated with "normal" weight). It found 86,000 excess deaths per year in the United States associated with "normal" weight when compared to the mortality risk among people with BMIs in the 25-29.9 range.
You're reading that right: Whole Foods' employee discounts based on weight are inversely related to mortality risk. So you have a policy that's not merely discriminatory on its face, but completely irrational on its own terms.
(2) The highest employee discount has no floor, only a ceiling. In the Flegal study, underweight (BMI <18.5) was associated with a stratospheric increase in mortality risk. (This remains true even when the data is controlled for smoking and pre-existing disease). But if you're an underweight college student suffering from an eating disorder and working as a checker at the Boulder Whole Foods (not a hypothetical as anyone who has ever shopped there can attest) you get a 30% discount for maintaining the "healthiest" weight.
(3) Even if one decides to enter John Mackey's Epidemiological Fantasyland, where good health is achieved by purchasing $27 a pound Ahi tuna in order to achieve Optimal Thinness, how much sense does it make to make it more expensive for your non-thin employees to purchase said tuna?
All this is a classic example how the habitus of upper class people in America ends up getting projected onto the broader culture, under the rubric of "a healthy lifestyle." It's also an example of how healthism and junk science are powerful weapons in the fight to avoid that most dreaded thing, a fair and efficient health care system for all Americans. Few myths in that fight are more pernicious than the idea that if you get sick it's your fault, because you didn't make healthy choices, such as searing that Ahi tuna you bought at Whole Foods after lightly coating it in $30 a bottle olive oil.
Relatedly, here's a talk I gave last week on the general topic. The first link is the talk; the second is the Q&A.