The Fat Tax Comes to North Carolina

North Carolina is poised to become only the second state (after Alabama) to impose a fat fee on its state employees by placing them in a more expensive health insurance plan if they're obese. I predict we won’t be the last, and I know that such plans for private business employers will soon be popping up everywhere.

Smokers will feel the drag of higher costs, too, as North Carolina state employees who use tobacco are slated to pay more for health insurance next year.

North Carolina officials, coping with a steady uptick in health-care costs for state employees each year, are aiming to improve state workers' health, which saves money in medical expenses.

"Tobacco use and poor nutrition and inactivity are the leading causes of preventable deaths in our state," said Anne Rogers, director of integrated health management with the N.C. State Employees Health Plan. "We need a healthy workforce in this state. We're trying to encourage individuals to adopt healthy lifestyles."

State workers who don't cut out the Marlboros and Big Macs will end up paying more for health care. Tobacco users get placed in a more expensive insurance plan starting in July of 2010 and, for those who qualify as obese, in July 2011.

Some state employees, though, are criticizing the planned changes. The State Employees Association of North Carolina opposes the tobacco and obesity differentials as invasive steps. "It's my understanding they're talking about testing [for tobacco use] in the workplace which, to me, would create a hostile environment," said Kim Martin, a sergeant at Piedmont Correctional Institution in Salisbury. "And it's an invasion of privacy. This is America, the land of the free. I don't think [body mass index is] a very good measure. I know some folks who would have a high body mass index because they're muscular." It’s interesting to note here that North Carolina will at the same time ban ALL smoking in prisons - even by inmates! I guess you’re out of luck Sarge.

The health plan covers more than 600,000 state employees, retirees and teachers at a total cost last year of $2.6 billion. Last spring, the legislature bailed out the plan with an infusion of $250million to pay the bills after rising costs and inaccurate projections left little money for claims. Over the next two years, the state general fund will pump about $408 million into the health plan.

Although officials have not yet estimated any potential savings from the obesity requirement, the higher costs for smokers could save $13million in the 2010-2011 budget year, Rogers said, emphasizing that the plan's priority is to improve health and save money in the process.

The idea of penalizing unhealthy lifestyles and rewarding healthy conduct is hardly new among insurance plans. Public health insurance plans in other states already penalize smokers or reward nonsmokers in insurance costs. South Carolina's state employees health plan is scheduled to add a $25-per-month surcharge on smokers in January. Elsewhere in the Southeast, Kentucky and Georgia impose surcharges, and Alabama gives nonsmokers a discount.

Weight checks

Alabama was out front on weight testing. Starting in January, state workers will have their blood pressure, cholesterol, glucose and body mass index checked by a nurse. If they're in a risk category, such as a body mass index of 35 or greater or a blood pressure of 160/100 or greater, they are charged an extra $25 per month on their insurance premium. If they go to a health screening, either offered by the state or by their personal physician, then the $25 is subtracted, according to Gary Matthews, chief operating officer for the Alabama State Employees Insurance Board.

North Carolina will allow state workers with a BMI of up to 40 to keep the discount, although some experts consider anyone with a BMI of 30 to be obese.

Private sector employers appear to have been targeting tobacco and weight in their insurance pricing ahead of state health plans.

Two risk factors

"We're beginning to see a lot of employers extremely interested in this," said Tim Smith, president of BioSignia, in Durham, which provides for private employers a system of measuring employees' risk factors for the onset of chronic disease. The company presents only aggregate data to the employers and does not disclose information about individuals, Smith said.

Tobacco and obesity are leading risk factors for ailments such as heart disease, stroke, type 2 diabetes and chronic breathing disorders. BioSignia is not under contract with the state health plan, but Smith said that employers like the state are trying to catch employees who are in pre-disease stages to save both lives and money.

Only a fraction of employers, though, offer financial incentives for healthy behavior or wellness programs, such as gym memberships or smoking cessation, according to a Kaiser Family Foundation study last year. Differences in employees' education, health literacy and access to basic health care could affect the usefulness of financial incentives in reducing health-care costs over time, the study said.

The results are not yet in. The higher costs for smokers and the obese don't appear to have been in place long enough for any state to boast of a healthier workforce yet, according to officials in several states.

Where is the data?

"I don't know that any states have a lot of hard data on this," Rogers said.

The policies have generated a backlash among at least a portion of state workers. Some workers are anxious about the idea of tests for smoking. The tests involve examining a saliva sample for cotinine, a derivative of nicotine found in the system of tobacco users. Health plan officials recognize those concerns and are getting ready to take bids from companies that will perform the tests. The state plan has not yet developed a procedure to monitor members for the obesity standard due to take effect in 2011.

"We're going to have to work out those logistics," Rogers said, “…but the plan is hear to stay.”

More Ways to Look Foolish While Trying to Look Good

Chances are someone you know has tried a weird weight loss product. From the 1990s' ThighMaster to the 1950s' vibrating belts, entrepreneurs have long known that the public is willing to look stupid if promised an easy way to lose weight.

Now, with 21st-century technology, people have only found more mesmerizing and ridiculous weight loss products.

Weird Weight Loss Product 1: The Hula Chair

Dance-exercise classes, such as Kukuwa dance, or Zumba, have gained traction in recent years. But one company hopes people who don't want to haul themselves down to the gym may want to sit in the Hawaii Chair for an exotic dance workout.

The Hawaii Chair, also popularly known as the hula chair, made its debut in comedy programs such as "The Ellen DeGeneres Show" in early 2008. DeGeneres tried to pour a drink of water and conduct an interview while using the Hawaii Chair on its highest setting.

A person has two choices once they're sitting on top of the patented 2,800 RPM Hula motor made by T&L Perfect USA. They can either be thrashed around in an amusement park ride fashion or attempt to keep their head straight while the chair swivels their hips about.

Dr. Steven Blair, a professor of exercise science at the University of South Carolina, admitted he hasn't tried the Hawaii Chair, but he had some doubts.

"Obviously, it is possible to sit in a recliner and scarcely move at all. It's also possible to sit in a regular office chair and twirl around and around and you'd be burning calories, too, for free," Blair said.

Blair thought the chair might burn more calories than lying down, but he wasn't quite impressed and pointed out there are cheaper ways to burn calories while working.

"Standing, you'd be burning even more calories, and standing on one leg, you'd be burning even more calories than before," he said.

Instead of buying specially designed chairs, Blair recommended going out for a walk.

Weird Weight Loss Product 2: Vibration Plates

This is my personal favorite and gets my award for "exercise product most likely to detach a retina." Don't be deceived by the static appearance of this most curious of fitness machines -- it moves enough to make most users nauseous in about 15 minutes..

The Power Plate is priced at $4,500 (or a mere $2,499 for home models) and its manufacturers assure customers that the platforms only look like they're stationary. In fact, the plates are vibrating millimeters in distance back and forth under your feet.

"A person can stand on it and do a simple squat and still get a benefit from the vibration," said Julie Devin, marketing coordinator for Power Plate. "But it's intended for people to do exercises on it."

Devin explained the vibrations force the body's muscles to contract in order to keep the person's balance -- adding another level of work in addition to the muscles required to do a pushup, squat or stretch on the machine.

Standing on a whole body vibration platform as a way to shorten workouts is a scam that has already spread through Europe and now is hitting California (much like the H1N1 flu).

But Blair, the exercise science professor from South Carolina, remains skeptical (he's more tactful than me).

"I don't demean sitting less and standing more," said Blair. "But you'd spend a lot more calories, I think, even going for a walk than by standing on the vibration platform."

You'd also be a lot less likely to throw up on the walk.

Weird Weight Loss Product 3: Thermal Suits

Here's a blast from the 70's past. For better or worse, the "Rocky" movies brought mainstream America boxing fitness "secrets" such as eating raw eggs or jogging up stairs decades ago.

However, it took much longer for the public to glom onto the vinyl suits used by boxers and wrestlers to lose weight.

Makes and models vary from flashy silver suits to more subdued colors, but the point of every suit is to lose weight quickly.

What the buyer may not understand, or care to understand, is that they're really losing water weight through sweat.

"But they've been used forever. A lot of wrestlers use them in order to make weight, and I think that's how it filtered down to where the general public has seen it in athletes," said Richard Davis, co-founder of GoFit, maker of the GoFit Thermal Training Suit.

The vinyl suits make for great insulation, and little evaporation, when worn. Exercise long enough in the suit, and one might take off several pounds in water sweat.

"The premise and purpose behind it is weight loss, and the primary weight loss a user would experience would be water weight loss," said Davis. "Then again, if you go back and drink some water, you may gain it back."

Now, I can see some use in the suits for warming up muscles in very limited circumstances. For example, a relief pitcher might sometimes wear these things if they're trying to warm up quickly. As for weight loss, it would all be water weight. Once you start drinking it would come back, and the suits certainly don't speed up losing body fat.

Overall though these things are actually DANGEROUS!

People have DIED from heat stroke wearing these things, and the suits are counterproductive during a strength training workout. You're going to have more difficulty regulating your body heat, you're going to get tired sooner, and you're not going to get as far.

Weird Weight Loss Product 4: The Tongue Patch

Some people still take the "no pain, no gain" slogan to the gym. But it takes a certain type of bravery to take the theory all the way into the doctor's chair as he stitches a prolene patch to your tongue.

Dr. Nikolas Chugay, a plastic surgeon in private practice in Beverly Hills, Calif., (of course) developed the tongue patch as a temporary way to lose "20 to 40 pounds."

"The tongue patch is a prolene mesh [the] size of [a] stamp," Chugay said. "All you need is about four stitches to attach it to the tongue."

The prolene patch makes it uncomfortable, if not painful, to chew solid food. Chugay has implanted the patch in more than 10 patients, and sells a liquid drink mix (just protein powder meal replacement, but at a really high price) to the dieters to ensure more calories are cut.

Chugay said his drink is "about 700 calories per day, so it's a low caloric intake. It has carbs, proteins, fat, vitamins and minerals.

"Some people still manage to eat solid foods even despite of the patch, but it's a good way of helping people not to cheat," he said.

After a month-long liquid diet, Chugay will snip off the patch, releasing his patients into the world of solid food again.

Of course, who's not going to loose weigh on only 700 calories a day? Dr. Blair thought the approach seemed short-sighted for a person's general health, or even as an attempt to lose weight and he's right.

"If you make it painful to eat, maybe people won't eat so much -- in the short-term," he said.

"But it won't work long-term, unless somewhere in this world there is a crazy person who would wear this for their whole life," Blair said.

If you're that person, please email me now.