Money Talk Makes You Walk
May 9, 2013 2:24 PM Subscribe
Exercise or pay 20% higher health insurance premiums. 'It was a controversial move when a health insurer began requiring people who were obese to literally pay the price of not doing anything about their weight – but it worked, a new study finds.' 'Faced with a choice between higher insurance prices or exercising, people who were obese enrolled in and stuck with Internet-tracked walking program for a year.'
'After one year, nearly 97 percent of the enrollees had met or exceeded the average goal of 5,000 steps a day – including the most resistant participants who disagreed with the financial incentives and found the program “coercive.”'
'“There are ethical debates around the idea of forcing someone to be personally responsible for health care costs related to not exercising, but we expect to see more of these approaches to financially motivate healthier behaviors,” says senior author Caroline R. Richardson, M.D., assistant professor in the U-M Department of Family Medicine, investigator with the VA Center for Clinical Management Research and member of the U-M Institute for Healthcare Policy and Innovation.'
In contrast, self-motivated wellness programs even when provided free of charge, resulted in some people actually faring worse:
Providing Workplace Wellness Centers Could Backfire
'After one year, nearly 97 percent of the enrollees had met or exceeded the average goal of 5,000 steps a day – including the most resistant participants who disagreed with the financial incentives and found the program “coercive.”'
'“There are ethical debates around the idea of forcing someone to be personally responsible for health care costs related to not exercising, but we expect to see more of these approaches to financially motivate healthier behaviors,” says senior author Caroline R. Richardson, M.D., assistant professor in the U-M Department of Family Medicine, investigator with the VA Center for Clinical Management Research and member of the U-M Institute for Healthcare Policy and Innovation.'
In contrast, self-motivated wellness programs even when provided free of charge, resulted in some people actually faring worse:
Providing Workplace Wellness Centers Could Backfire
Researchers evaluated a group of people insured by Blue Care Network who were enrolled in a pedometer-based program as a requirement to receive insurance discounts.If I put the damn thing on a neighborhood cat would it work?
Friend. If a friend put it on a cat.
posted by Foci for Analysis at 2:31 PM on May 9, 2013 [11 favorites]
'After one year, nearly 97 percent of the enrollees had met or exceeded the average goal of 5,000 steps a day
...and? This is sort of a meaningless metric, no? Did the obese employees lose weight? Did they get healthier? Did they actually save the insurance companies any money?
posted by muddgirl at 2:31 PM on May 9, 2013 [29 favorites]
...and? This is sort of a meaningless metric, no? Did the obese employees lose weight? Did they get healthier? Did they actually save the insurance companies any money?
posted by muddgirl at 2:31 PM on May 9, 2013 [29 favorites]
They had a program like this at my old job. I think it did motivate people to exercise, but eventually they started letting people with a low BMI opt out. It felt discriminatory to me and was the focus of my exit interview, but not the reason I left.
posted by Big_B at 2:33 PM on May 9, 2013
posted by Big_B at 2:33 PM on May 9, 2013
If I put the damn thing on a neighborhood cat would it work?
It works. Sadly, you then test positive for catnip abuse, which causes your rates to rise by 20%.
posted by Behemoth at 2:34 PM on May 9, 2013 [6 favorites]
It works. Sadly, you then test positive for catnip abuse, which causes your rates to rise by 20%.
posted by Behemoth at 2:34 PM on May 9, 2013 [6 favorites]
And in this thread we will passionately debate whether physical exercise is beneficial to people.
posted by Argyle at 2:34 PM on May 9, 2013 [36 favorites]
posted by Argyle at 2:34 PM on May 9, 2013 [36 favorites]
What happened to fat people who were disabled, I wonder?
From TFA:
"Those with medical conditions were exempt if they had waivers from their doctors."
posted by VikingSword at 2:34 PM on May 9, 2013 [5 favorites]
From TFA:
"Those with medical conditions were exempt if they had waivers from their doctors."
posted by VikingSword at 2:34 PM on May 9, 2013 [5 favorites]
This is of course absolutely breaking the fundamental premise of insurance of which is risk pooling. The ever shrinking pools of risk created by this and things like in car monitors for car insurance is taking us to the point where insurance will be nothing more than a prepayment plan where a company gets to hold and invest your money for a profit until you need it for a claim and then you can try and get some of it back.
That and I wonder if any of their participants died. Today I watched a gasping morbidly obese woman reach the fourth floor of a building by stairs - part of me thought - good for you - while another part of me wondered if the building had a portable defibrillator.
posted by srboisvert at 2:34 PM on May 9, 2013 [21 favorites]
That and I wonder if any of their participants died. Today I watched a gasping morbidly obese woman reach the fourth floor of a building by stairs - part of me thought - good for you - while another part of me wondered if the building had a portable defibrillator.
posted by srboisvert at 2:34 PM on May 9, 2013 [21 favorites]
Did they get healthier?
By this I mean firstly, were any of the employees actually exercising more than they did before they enrolled in the program?
"People will do shit to save money" doesn't seem like a revolutionary hypothesis.
posted by muddgirl at 2:36 PM on May 9, 2013 [1 favorite]
By this I mean firstly, were any of the employees actually exercising more than they did before they enrolled in the program?
"People will do shit to save money" doesn't seem like a revolutionary hypothesis.
posted by muddgirl at 2:36 PM on May 9, 2013 [1 favorite]
A paternalistic and policing rhetoric of "health" - treating real, living, individual bodies as things that must be brought into healthy conformity in order to be patriotic, deserving citizens, treating "noncompliant" bodies as threats to an imagined national body - that's just going, so to speak, to bite us all in the ass.
I agreed with Frowner at the time - but I have to say, I thought it would take more than a day to implement. Jesus Christ.
posted by Joey Buttafoucault at 2:39 PM on May 9, 2013 [14 favorites]
I agreed with Frowner at the time - but I have to say, I thought it would take more than a day to implement. Jesus Christ.
posted by Joey Buttafoucault at 2:39 PM on May 9, 2013 [14 favorites]
So this means the ACA "Obamacare" is going to restore funding to all the community athletic centers, and build/staff new ones in underserved areas with larger percentages of ACA-insured peeps?
In my dreams. Due to a state legislature-required coverage change I haven't been able to get my required physical therapy for 6 months. Who needs to walk or use both arms, anyway?
posted by Dreidl at 2:40 PM on May 9, 2013 [6 favorites]
In my dreams. Due to a state legislature-required coverage change I haven't been able to get my required physical therapy for 6 months. Who needs to walk or use both arms, anyway?
posted by Dreidl at 2:40 PM on May 9, 2013 [6 favorites]
The accompanying (copyright-free?) photo of people showing how They're Lovin' It makes me never want to engage in any form of physical activity ever again.
posted by foxy_hedgehog at 2:40 PM on May 9, 2013 [1 favorite]
posted by foxy_hedgehog at 2:40 PM on May 9, 2013 [1 favorite]
This is of course absolutely breaking the fundamental premise of insurance of which is risk pooling.
That would seem to be an emerging trend in all forms of insurance, especially as more and more people are moved off employer-based group plans and into the individual market.
posted by Thorzdad at 2:40 PM on May 9, 2013
That would seem to be an emerging trend in all forms of insurance, especially as more and more people are moved off employer-based group plans and into the individual market.
posted by Thorzdad at 2:40 PM on May 9, 2013
And in this thread we will passionately debate whether physical exercise is beneficial to people.
If the insurer was primarily motivated by the fact that physical exercise is beneficial to people, why were only obese insurees targetted for enrollment? If you are thin, are you not a person?
posted by muddgirl at 2:41 PM on May 9, 2013 [3 favorites]
If the insurer was primarily motivated by the fact that physical exercise is beneficial to people, why were only obese insurees targetted for enrollment? If you are thin, are you not a person?
posted by muddgirl at 2:41 PM on May 9, 2013 [3 favorites]
Well, I'm super fat, and I work out all the time, because I like it. My insurance makes me wear a pedometer and it's no big deal -- I average around 8,500 a day because of my lazy day (Wednesday!). I have never lost any weight exercising, no matter how intense or how many times I work out. But you know, my health is good, so yay exercise.
The BMI thing makes me crazy, however. My doctor is like, "here is your number!" and I'm all "what about my muscles?"
posted by Malla at 2:42 PM on May 9, 2013 [11 favorites]
The BMI thing makes me crazy, however. My doctor is like, "here is your number!" and I'm all "what about my muscles?"
posted by Malla at 2:42 PM on May 9, 2013 [11 favorites]
It was very easy to cheat the devices - a piece of string and simple twirling gave you points.
posted by Big_B at 2:42 PM on May 9, 2013 [2 favorites]
posted by Big_B at 2:42 PM on May 9, 2013 [2 favorites]
So this means the ACA "Obamacare" is going to restore funding to all the community athletic centers, and build/staff new ones in underserved areas with larger percentages of ACA-insured peeps?
I wondered about this too. Walking is a form of exercise that has relatively few barriers to entry (in terms of equipment and expertise) but some of the more inhumane aspects American city planning (or lack thereof) make it actually rather difficult to find somewhere to do your walking.
posted by foxy_hedgehog at 2:42 PM on May 9, 2013 [3 favorites]
I wondered about this too. Walking is a form of exercise that has relatively few barriers to entry (in terms of equipment and expertise) but some of the more inhumane aspects American city planning (or lack thereof) make it actually rather difficult to find somewhere to do your walking.
posted by foxy_hedgehog at 2:42 PM on May 9, 2013 [3 favorites]
If the insurer was primarily motivated by the fact that physical exercise is beneficial to people, why were only obese insurees targetted for enrollment? If you are thin, are you not a person?
Exactly. Exercise is good for all people, lowers disease rates across the board. The cynical part of me thinks that they can only get away with this when it involves scapegoating fat people.
posted by lunasol at 2:43 PM on May 9, 2013 [21 favorites]
Exactly. Exercise is good for all people, lowers disease rates across the board. The cynical part of me thinks that they can only get away with this when it involves scapegoating fat people.
posted by lunasol at 2:43 PM on May 9, 2013 [21 favorites]
I am okay with this if it is done in the opposite way that isn't douchey, I guess? Like if my insurance company was like "yo liz i see you go to the gym every single day, so we're gonna give you a discount for being a sweaty goatbeast". That would be rad.
Otherwise this is just more bullshit to make people feel shitty about themselves.
posted by elizardbits at 2:43 PM on May 9, 2013 [21 favorites]
Otherwise this is just more bullshit to make people feel shitty about themselves.
posted by elizardbits at 2:43 PM on May 9, 2013 [21 favorites]
Were these some kind of fancypants wireless pedometers that the company could track, or just good-old-fashioned clicky ones, that you can up the number on by casually shaking back and forth?
In fact..does anyone even check the pedometers? Or is it all just self-reported?
If they find that people do cheat, what's next? Mandatory weight loss as proof you exercised? Or just to get that 20.00/off? And who determines how much it is safe for you to weigh? The insurer or your doctor?
posted by emjaybee at 2:46 PM on May 9, 2013
In fact..does anyone even check the pedometers? Or is it all just self-reported?
If they find that people do cheat, what's next? Mandatory weight loss as proof you exercised? Or just to get that 20.00/off? And who determines how much it is safe for you to weigh? The insurer or your doctor?
posted by emjaybee at 2:46 PM on May 9, 2013
A penalty for not exercising is effectively the same as a bonus for exercising. It does have better optics in the latter case I will grant.
posted by Justinian at 2:46 PM on May 9, 2013 [1 favorite]
posted by Justinian at 2:46 PM on May 9, 2013 [1 favorite]
Excellent point about exercise being good for all sizes of people. Heart disease is the leading killer of thin women, too.
posted by Malla at 2:47 PM on May 9, 2013
posted by Malla at 2:47 PM on May 9, 2013
I've surprised the threshold was 5000 steps; I was expecting something crazy onerous.
posted by Mitheral at 2:47 PM on May 9, 2013
posted by Mitheral at 2:47 PM on May 9, 2013
This has nothing to do with employee welfare and everything to do with a business lowering the cost of coverage.
My company decided this year that all employees needed to give a blood sample to prove they weren't smokers. Forget peeing for a drug screen, now they want literal as well as metaphorical blood from folks.
Much cheaper to by some pedometers and scapegoat a few people than to take holistic steps to improving employee health. And gods forbid tackling how inefficient it is for individual companies to cover health care is in the first place. No amount of walking is going to make up for the fact that we have an idiotic system with ever-rising premiums and most everyone in America is just one healthcare crisis away from bankruptcy.
posted by fifteen schnitzengruben is my limit at 2:49 PM on May 9, 2013 [6 favorites]
My company decided this year that all employees needed to give a blood sample to prove they weren't smokers. Forget peeing for a drug screen, now they want literal as well as metaphorical blood from folks.
Much cheaper to by some pedometers and scapegoat a few people than to take holistic steps to improving employee health. And gods forbid tackling how inefficient it is for individual companies to cover health care is in the first place. No amount of walking is going to make up for the fact that we have an idiotic system with ever-rising premiums and most everyone in America is just one healthcare crisis away from bankruptcy.
posted by fifteen schnitzengruben is my limit at 2:49 PM on May 9, 2013 [6 favorites]
Is the program only for people who are obese, or for anyone who enrolls?
posted by Cram-It Chris at 2:50 PM on May 9, 2013
posted by Cram-It Chris at 2:50 PM on May 9, 2013
I would actually prefer this over my husband's employers insurance, which makes us go through rounds of "heath assessments" (including blood tests and other evaluations performed by personnel at his work - no going to your own doctor to get them done) and then makes us talk to non-HIPAA "wellness coaches" about our "health concerns" at least twice a year.
posted by anastasiav at 2:52 PM on May 9, 2013
posted by anastasiav at 2:52 PM on May 9, 2013
If the insurer was primarily motivated by the fact that physical exercise is beneficial to people, why were only obese insurees targetted for enrollment? If you are thin, are you not a person?
Valid point.
IMHO, taking positive action toward your health should reward you with an incentive. Doing it as a way to avoid punishment is less effective as a motivator.
I'd like everyone to be more active because a) I want people to be healthier and have more fun b) Lowers health care costs for all of us in the pool
My old work offered $100 for each of these objectives: Take a health survey, get a physical check-up, and get under BMI 25 or lose x% in weight.
I think this kind of discount/reward for taking positive action toward your health will gain more and more traction.
posted by Argyle at 2:52 PM on May 9, 2013
Valid point.
IMHO, taking positive action toward your health should reward you with an incentive. Doing it as a way to avoid punishment is less effective as a motivator.
I'd like everyone to be more active because a) I want people to be healthier and have more fun b) Lowers health care costs for all of us in the pool
My old work offered $100 for each of these objectives: Take a health survey, get a physical check-up, and get under BMI 25 or lose x% in weight.
I think this kind of discount/reward for taking positive action toward your health will gain more and more traction.
posted by Argyle at 2:52 PM on May 9, 2013
LOL. My wife made me count the steps from my computer to the fridge. 55 x2 for a round trip of 110 steps. She estimates I make 20 trips a day. So if they put me on this program (not really a candidate) I would log 2200 steps just back and forth to the fridge. Don't know where I am going with this but don't know where they are going either.
posted by notreally at 2:53 PM on May 9, 2013 [1 favorite]
posted by notreally at 2:53 PM on May 9, 2013 [1 favorite]
So what if a guy joined crossfit and just lifted heavy weights all day? He'd be in great shape but would have walked fewer than 5,000 steps.
posted by dfriedman at 2:53 PM on May 9, 2013 [3 favorites]
posted by dfriedman at 2:53 PM on May 9, 2013 [3 favorites]
Note to self: If forming a band, name it "Sweaty Goatbeast"
elizardbits: I declare you winner of this thread!
posted by Argyle at 2:55 PM on May 9, 2013
elizardbits: I declare you winner of this thread!
posted by Argyle at 2:55 PM on May 9, 2013
This is of course absolutely breaking the fundamental premise of insurance of which is risk pooling.
One of the things about insurance, though, is that risk pooling was designed because assessing the overall level of risk in society was easier than assessing it, at a distance, for an individual.
In a world where that just isn't as true - when your scale can upload your weight to an insurance company server and pedometers talk directly to your doctor - it's inevitable that the returns to risk pooling decrease.
posted by downing street memo at 2:56 PM on May 9, 2013 [5 favorites]
One of the things about insurance, though, is that risk pooling was designed because assessing the overall level of risk in society was easier than assessing it, at a distance, for an individual.
In a world where that just isn't as true - when your scale can upload your weight to an insurance company server and pedometers talk directly to your doctor - it's inevitable that the returns to risk pooling decrease.
posted by downing street memo at 2:56 PM on May 9, 2013 [5 favorites]
Walking is a form of exercise that has relatively few barriers to entry (in terms of equipment and expertise) but some of the more inhumane aspects American city planning (or lack thereof) make it actually rather difficult to find somewhere to do your walking.
For 11 years I used to walk for 45 minutes during my lunch hour....slap my Walkman on, listen to tunes, and explore different side streets in the area. I got so used to it that I went out in the rain and snow, no matter what the weather. I was lucky in that our office was located in a relatively nice suburban area and my boss didn't mind if I munched on my lunch at my desk after I got back while I worked (i.e. eating was not restricted solely to lunch hour).
Sadly, my next job was in a very, very sketchy neighborhood, so walking anywhere other than from the fenced-in parking lot to the office door was out of the question. The job after that was a pretentious "dress for success" place that actually requested that I did not walk at lunch time because it made me perspire (I didn't think I smelled, and I washed up in the sink afterward, but oh well...)
If you don't have a gym membership or home treadmill and live in an area where it's not recommended to walk alone (especially after the sun sets), what is a person supposed to do?
posted by Oriole Adams at 2:58 PM on May 9, 2013 [2 favorites]
For 11 years I used to walk for 45 minutes during my lunch hour....slap my Walkman on, listen to tunes, and explore different side streets in the area. I got so used to it that I went out in the rain and snow, no matter what the weather. I was lucky in that our office was located in a relatively nice suburban area and my boss didn't mind if I munched on my lunch at my desk after I got back while I worked (i.e. eating was not restricted solely to lunch hour).
Sadly, my next job was in a very, very sketchy neighborhood, so walking anywhere other than from the fenced-in parking lot to the office door was out of the question. The job after that was a pretentious "dress for success" place that actually requested that I did not walk at lunch time because it made me perspire (I didn't think I smelled, and I washed up in the sink afterward, but oh well...)
If you don't have a gym membership or home treadmill and live in an area where it's not recommended to walk alone (especially after the sun sets), what is a person supposed to do?
posted by Oriole Adams at 2:58 PM on May 9, 2013 [2 favorites]
This seems to fit the trend in which all societal problems are blamed on bad-acting individuals and bad apples and we fix it with blanket solutions that are dumped on everyone from the top down. YOU MUST TAKE X # STEPS PER DAY OR PAY MORE instead of just paying for what people need and assuming that if people don't like __ they are already suffering and doing the best they can so let's support them instead of dictating to them.
posted by bleep at 2:59 PM on May 9, 2013 [4 favorites]
posted by bleep at 2:59 PM on May 9, 2013 [4 favorites]
No black president is going to spy on how much I exercise or pay for my dialysis.
posted by fraxil at 3:00 PM on May 9, 2013 [2 favorites]
posted by fraxil at 3:00 PM on May 9, 2013 [2 favorites]
We had a voluntary program like this at my workplace, albeit for all employees, with prizes like apples and squeezable stress balls awarded in lieu of cash or insurance discounts. The pedometers they gave us were indeed the sort that would tick up steps if you just held them in your hand and shook them. According to my Fitbit, 5,000 steps is equivalent to walking about two miles.
How on earth is demanding that a specific fraction of insurance beneficiaries -- only insurance beneficiaries who are deemed obese, mind -- must walk approximately two miles per day any sort of guarantee that those beneficiaries will lose even a fraction of an ounce of weight? How is this program anything but yet another reinforcement of the neverending myth that the only reason anyone can ever be "obese" is because they're just slothful layabouts?
The article directly equates a given person's failure to walk two miles a day with "not doing anything about their weight" -- indirectly calling them lazy and irresponsible, and specifically shaming them due to their size rather than encouraging a simple, scalable, basic level of physical activity for any and everyone who is healthy enough to be able to maintain one, regardless of weight, height, etc.
I have an overwhelmingly stationary desk job, and usually only manage to squeeze in about 2,500 steps before I leave the office... but I'm chronically underweight, so under this program, I wouldn't even need to worry about getting that extra mile in anyway -- being underweight automatically means that it's just fine for me to sit around for the rest of the day "not doing anything about [my] weight." Nope, that's not problematic at all!
posted by divined by radio at 3:02 PM on May 9, 2013 [10 favorites]
How on earth is demanding that a specific fraction of insurance beneficiaries -- only insurance beneficiaries who are deemed obese, mind -- must walk approximately two miles per day any sort of guarantee that those beneficiaries will lose even a fraction of an ounce of weight? How is this program anything but yet another reinforcement of the neverending myth that the only reason anyone can ever be "obese" is because they're just slothful layabouts?
The article directly equates a given person's failure to walk two miles a day with "not doing anything about their weight" -- indirectly calling them lazy and irresponsible, and specifically shaming them due to their size rather than encouraging a simple, scalable, basic level of physical activity for any and everyone who is healthy enough to be able to maintain one, regardless of weight, height, etc.
I have an overwhelmingly stationary desk job, and usually only manage to squeeze in about 2,500 steps before I leave the office... but I'm chronically underweight, so under this program, I wouldn't even need to worry about getting that extra mile in anyway -- being underweight automatically means that it's just fine for me to sit around for the rest of the day "not doing anything about [my] weight." Nope, that's not problematic at all!
posted by divined by radio at 3:02 PM on May 9, 2013 [10 favorites]
If they find that people do cheat, what's next? Mandatory weight loss as proof you exercised?
Promotion to management, presumably.
posted by indubitable at 3:02 PM on May 9, 2013 [3 favorites]
Promotion to management, presumably.
posted by indubitable at 3:02 PM on May 9, 2013 [3 favorites]
Also I think at the point that everyone has to wear wireless pedometer that's constantly reporting how many steps we are taking I think we can agree that the health care system has reached rock-bottom and requires an intervention. Talk about your nanny states..
posted by bleep at 3:02 PM on May 9, 2013 [4 favorites]
posted by bleep at 3:02 PM on May 9, 2013 [4 favorites]
So this means the ACA "Obamacare" is going to restore funding to all the community athletic centers, and build/staff new ones in underserved areas with larger percentages of ACA-insured peeps?
No, but I supposed the sequel could do that by individually-mandating that everyone buy gym memberships.
Also I think at the point that everyone has to wear wireless pedometer that's constantly reporting how many steps we are taking I think we can agree that the health care system has reached rock-bottom and requires an intervention. Talk about your nanny states.
I don't think we've hit rock bottom, yet. They still haven't put voice-synthesizers on the pedometers to automatically dispense health advice: "I've detected that you're still overweight. You should walk instead of drive!"
posted by cosmic.osmo at 3:03 PM on May 9, 2013
No, but I supposed the sequel could do that by individually-mandating that everyone buy gym memberships.
Also I think at the point that everyone has to wear wireless pedometer that's constantly reporting how many steps we are taking I think we can agree that the health care system has reached rock-bottom and requires an intervention. Talk about your nanny states.
I don't think we've hit rock bottom, yet. They still haven't put voice-synthesizers on the pedometers to automatically dispense health advice: "I've detected that you're still overweight. You should walk instead of drive!"
posted by cosmic.osmo at 3:03 PM on May 9, 2013
@downing street memo: I agree, these are attempts to better access individual risks and make each individual pay a premium closer in line with their actual risk. However, that does break down in the limit: if you had a perfect predictor of individual risk and make everyone pay their exact risk premuum, "insurance" just degenerates into a savings plan from which you deduct your costs when they arise. No-one else pays your expenses and you pay no-one else (except, maybe, some money shuffling so some other people give you loans if your costs come earlier than theirs). We are very far from that, but at some point, society would have to decide whether the healthy should subsidize the sick or not.
Of course, currently we do exactly that, but the reason is unclear. It could be because we actually want that, or because have no perfect (or even flawed) predictors of future health costs per person.
posted by dlg at 3:04 PM on May 9, 2013 [1 favorite]
Of course, currently we do exactly that, but the reason is unclear. It could be because we actually want that, or because have no perfect (or even flawed) predictors of future health costs per person.
posted by dlg at 3:04 PM on May 9, 2013 [1 favorite]
A penalty for not exercising is effectively the same as a bonus for exercising.
Humans aren't actually rational actors, so the two aren't effectively the same. This study demonstrates that people will engage in behavior they disapprove of (enrolling for a pedometer program) in order to avoid a penalty. It doesn't actually show that such a penalty is a good idea for insurance companies.
posted by muddgirl at 3:05 PM on May 9, 2013 [1 favorite]
Humans aren't actually rational actors, so the two aren't effectively the same. This study demonstrates that people will engage in behavior they disapprove of (enrolling for a pedometer program) in order to avoid a penalty. It doesn't actually show that such a penalty is a good idea for insurance companies.
posted by muddgirl at 3:05 PM on May 9, 2013 [1 favorite]
My old work offered $100 for each of these objectives
MeFi insurance offers $50. My other job has a workplace wellness program that offered smallish incentives (a points-based program but you could cash in points at the end of the year, up to $150 total) to do things like fill out a health survey, do little crossword puzzles about things like heatstroke and frostbite, and chart your flexibility/stress/sleep/walking (differed every year). Just this past year they stopped the incentives and tried to get people to just do the stuff because it was "fun" and participation plummeted to nearly zero.
posted by jessamyn at 3:09 PM on May 9, 2013 [4 favorites]
MeFi insurance offers $50. My other job has a workplace wellness program that offered smallish incentives (a points-based program but you could cash in points at the end of the year, up to $150 total) to do things like fill out a health survey, do little crossword puzzles about things like heatstroke and frostbite, and chart your flexibility/stress/sleep/walking (differed every year). Just this past year they stopped the incentives and tried to get people to just do the stuff because it was "fun" and participation plummeted to nearly zero.
posted by jessamyn at 3:09 PM on May 9, 2013 [4 favorites]
I think my over-arching theory is about this global sweeping assumption of bad faith on the part of individuals. And that the only way to fix it is sticks, never carrots. I encounter this attitude a lot. Like the complaint that "Unions let people get away with too much and people take advantage of it." Well, someone's got to take advantage of something. Would it rather your boss taking advantage of you, or your co-worker taking advantage of the system in a way that hurts no one? People don't identify with individuals, they identify with the system. The system must tell us how to behave or we never, ever will. Ugh, wake up, sheeple. Seriously.
posted by bleep at 3:09 PM on May 9, 2013 [1 favorite]
posted by bleep at 3:09 PM on May 9, 2013 [1 favorite]
The idea that what exercise activities I do during the day should be decided upon and tracked by people who lack any kind of imagination or common sense (e.g. actuaries and HR) just makes me want to fucking puke.
I can't wait for the the requirement that we send in pictures of the food we eat...
posted by smidgen at 3:12 PM on May 9, 2013 [2 favorites]
I can't wait for the the requirement that we send in pictures of the food we eat...
posted by smidgen at 3:12 PM on May 9, 2013 [2 favorites]
Welcome to UnFascist America.
posted by MartinWisse at 3:13 PM on May 9, 2013
posted by MartinWisse at 3:13 PM on May 9, 2013
What happened to "abs aren't made in the gym, they're made in the kitchen"?
This is dopey and Big Brother-y.
posted by potsmokinghippieoverlord at 3:18 PM on May 9, 2013 [1 favorite]
This is dopey and Big Brother-y.
posted by potsmokinghippieoverlord at 3:18 PM on May 9, 2013 [1 favorite]
Just this past year they stopped the incentives and tried to get people to just do the stuff because it was "fun" and participation plummeted to nearly zero.
This is the most interesting aspect of the story: incentives. I was hoping we wouldn't get too far afield with analyzing the ethics of this or the healthcare system, but rather focus on how incentives work.
There is an endless debate about what is the optimal ratio of sticks to carrots, and one thing is abundantly clear, that positive incentives of making money (or other material rewards), or pain of losing money (paying more) is much more effective than merely information and even awareness about the benefits of behavioral change (see my second link).
You could make all gyms free of charge, and you'd get very few people utilizing them. But pay people money to exercise, and you'd pack them.
Not far from where I live, there's a great little park with a track and field and exercise machines. Free of charge. This is in the middle of the city, densely populated. The only part of the park that sees regular usage are the basketball courts and a bit of the baseball/football field (and the paid tennis courts). But the vast majority of time, my wife and I are the only people jogging around the track - and we go 5 times a week at all sorts of hours. It's stunning. People will do "fun" things like play team sports, but pure exercise...
Before you can make rational health policy, you must figure out what actually works for people and adjust your policies to that. Merely dispensing information is never going to be enough.
posted by VikingSword at 3:21 PM on May 9, 2013 [5 favorites]
This is the most interesting aspect of the story: incentives. I was hoping we wouldn't get too far afield with analyzing the ethics of this or the healthcare system, but rather focus on how incentives work.
There is an endless debate about what is the optimal ratio of sticks to carrots, and one thing is abundantly clear, that positive incentives of making money (or other material rewards), or pain of losing money (paying more) is much more effective than merely information and even awareness about the benefits of behavioral change (see my second link).
You could make all gyms free of charge, and you'd get very few people utilizing them. But pay people money to exercise, and you'd pack them.
Not far from where I live, there's a great little park with a track and field and exercise machines. Free of charge. This is in the middle of the city, densely populated. The only part of the park that sees regular usage are the basketball courts and a bit of the baseball/football field (and the paid tennis courts). But the vast majority of time, my wife and I are the only people jogging around the track - and we go 5 times a week at all sorts of hours. It's stunning. People will do "fun" things like play team sports, but pure exercise...
Before you can make rational health policy, you must figure out what actually works for people and adjust your policies to that. Merely dispensing information is never going to be enough.
posted by VikingSword at 3:21 PM on May 9, 2013 [5 favorites]
self-motivated wellness programs even when provided free of charge, resulted in some people actually faring worse
Does anyone have access to the study mentioned in this article? I don't think it's at all clear that the people who were the low users of the wellness centers mentioned in the article that fared worse did so as a result of the centers' implementation.
posted by jessamyn at 3:23 PM on May 9, 2013
Does anyone have access to the study mentioned in this article? I don't think it's at all clear that the people who were the low users of the wellness centers mentioned in the article that fared worse did so as a result of the centers' implementation.
The authors suggest that one way to improve the quality-of-life benefits of wellness programs might be to provide a wider range of features, such as those that reduce stress. Furthermore, they say, participants in wellness programs often have unrealistic expectations and become discouraged when they don't immediately reach their goals. If participants understand that motivation can fluctuate due to life circumstances, it could help.It just seems like the usual things you find with people who can't keep with fitness/nutrition/health programs. The people who can't keep with it wind up feeling bad emotionally even if they're not doing any more poorly physically which is what this article actually seems to be saying. Which comes back to your incentives question: the money I got from our wellness program I spent directly on gym membership so it felt more like "free money" and I felt freer to go or not go without feeling bad about it. I think a lot of people tie money spent on a thing to wanting to get value out of it and there is a lot of negative mojo that goes along with "wasting" money in that way. You see it a lot with technology users as well. It's not so much that they are slow adopters, it's that they have sunk costs that weigh on them in a bad way.
posted by jessamyn at 3:23 PM on May 9, 2013
My wife made me count the steps from my computer to the fridge. 55 x2 for a round trip of 110 steps. She estimates I make 20 trips a day. So if they put me on this program (not really a candidate) I would log 2200 steps just back and forth to the fridge.
Last time I was ionvolved in a printer scope project (IT/Management would prefer one monsterous printer that serves every employee in a building and employees all want rapid colour lasers on each desk) one of the pro bullets for centralized printing (every 10-20 employees served by a MFP printer/copier was that the couple hundred steps the average employee needed to take for each print run would increase health and reduce stress, eye strain and fatigue. Those little things like not parking as close as possible to the building can really add up over the course of a month.
posted by Mitheral at 3:27 PM on May 9, 2013
Last time I was ionvolved in a printer scope project (IT/Management would prefer one monsterous printer that serves every employee in a building and employees all want rapid colour lasers on each desk) one of the pro bullets for centralized printing (every 10-20 employees served by a MFP printer/copier was that the couple hundred steps the average employee needed to take for each print run would increase health and reduce stress, eye strain and fatigue. Those little things like not parking as close as possible to the building can really add up over the course of a month.
posted by Mitheral at 3:27 PM on May 9, 2013
I would be proud to tell the insurance company how far I'll walk to drink a beer.
posted by RobotVoodooPower at 3:32 PM on May 9, 2013
posted by RobotVoodooPower at 3:32 PM on May 9, 2013
I'm not sure what is so much better about running in a circle vs playing basketball, but...
posted by smidgen at 3:42 PM on May 9, 2013 [2 favorites]
posted by smidgen at 3:42 PM on May 9, 2013 [2 favorites]
I'm fat as a prime sow but I work out ten hours a week. Peasant stock - you can see women who look just like me in any photos of Irish immigrant women who weren't actually starving. If I eat only about a thousand calories a day and work out that much I can lose weight, but that's not particularly sustainable in the long run.
I knew this kind of 'fat people pay more' policy was coming, but it still makes me angry. Especially since we make less than skinny people, too.
posted by winna at 3:42 PM on May 9, 2013 [4 favorites]
I knew this kind of 'fat people pay more' policy was coming, but it still makes me angry. Especially since we make less than skinny people, too.
posted by winna at 3:42 PM on May 9, 2013 [4 favorites]
I wouldn't mind being incentivized to exercise. But, I think it's the bigger picture aspects that make it sort of annoying. Like, the state of our system of healthcare is bloated and unsustainable. For those people who are lucky enough to have jobs with health insurance, making that insurance more and more nosy certainly makes it less of a perk. I just feel like working people are getting battered at all sides and it's really quite a horror-show. My father-in-law has all sorts of folksy sayings about the working world (and he was quite a successful executive in high-tech), here's one: "They pay me enough money that they could stick pins in me... and so they do."
I would be proud to tell the insurance company how far I'll walk to drink a beer.
They'll just keep putting that beer further and further away.
posted by amanda at 3:43 PM on May 9, 2013 [3 favorites]
I would be proud to tell the insurance company how far I'll walk to drink a beer.
They'll just keep putting that beer further and further away.
posted by amanda at 3:43 PM on May 9, 2013 [3 favorites]
Wait, Mefi has an insurance plan? I'm going out on disability from a beanplating injury.
posted by dr_dank at 3:48 PM on May 9, 2013 [3 favorites]
posted by dr_dank at 3:48 PM on May 9, 2013 [3 favorites]
The thing that makes me really angry about this -- and I've been wearing my Christmas FitBit all year now, I know how much I walk -- is that no matter how well I eat, no matter how much I work out, no matter what I do, the weight is not coming off.
And so what happens is that I get treated like a child -- you should see this thing my husband's work (our health insurance is through them) did last year. It was insulting. Multiple weeks of logging/questionnaires. One whole week was "log how many glasses of water you had today... now log how many sodas." One week was salads and fried foods. Etc etc etc. I'm not a jackass, people. I know which things are good and bad. Forcing me to waste hour upon hour of time doing these idiot logbooks is not helping any.
Now they're forcing everyone with a certain BMI to do them...and to get under the BMI they want I would have to weigh less than I did as a competitive athlete freshman year of high school. This is "healthy"?
posted by bitter-girl.com at 3:49 PM on May 9, 2013 [4 favorites]
And so what happens is that I get treated like a child -- you should see this thing my husband's work (our health insurance is through them) did last year. It was insulting. Multiple weeks of logging/questionnaires. One whole week was "log how many glasses of water you had today... now log how many sodas." One week was salads and fried foods. Etc etc etc. I'm not a jackass, people. I know which things are good and bad. Forcing me to waste hour upon hour of time doing these idiot logbooks is not helping any.
Now they're forcing everyone with a certain BMI to do them...and to get under the BMI they want I would have to weigh less than I did as a competitive athlete freshman year of high school. This is "healthy"?
posted by bitter-girl.com at 3:49 PM on May 9, 2013 [4 favorites]
You could make all gyms free of charge, and you'd get very few people utilizing them. But pay people money to exercise, and you'd pack them.
I guess I don't see why this is an interesting observation or finding. We see this all the time - would I really come into the office every day from 8 to 5 if I wasn't getting paid to do so? No I would not (this isn't to say I wouldn't do any work at all, but I would not perform the exact tasks my employer asked of me).
However, the downsides to using extrinsic motivation (which is what this program is) to enable a desired behavior are well-known. It is not easy to convert extrinsic motivation to intrinsic motivation, so you have to keep applying the carrot or the stick for as long as you want the behavior. Additionally, over time the motivator (whether good or bad) starts to lose its power. Eventually some people who aren't internally motivated to walk 5,000 steps will inevitably decide that they'd rather take the stick. Even worse, some people who WERE internally motivated to do the behavior may find that getting rewarded for it (or punished for not doing it) lessens some of their own motivation. I'd like to see more longitudinal studies of insurance motivation programs, but I doubt there's much industry funding in that.
posted by muddgirl at 3:51 PM on May 9, 2013 [3 favorites]
I guess I don't see why this is an interesting observation or finding. We see this all the time - would I really come into the office every day from 8 to 5 if I wasn't getting paid to do so? No I would not (this isn't to say I wouldn't do any work at all, but I would not perform the exact tasks my employer asked of me).
However, the downsides to using extrinsic motivation (which is what this program is) to enable a desired behavior are well-known. It is not easy to convert extrinsic motivation to intrinsic motivation, so you have to keep applying the carrot or the stick for as long as you want the behavior. Additionally, over time the motivator (whether good or bad) starts to lose its power. Eventually some people who aren't internally motivated to walk 5,000 steps will inevitably decide that they'd rather take the stick. Even worse, some people who WERE internally motivated to do the behavior may find that getting rewarded for it (or punished for not doing it) lessens some of their own motivation. I'd like to see more longitudinal studies of insurance motivation programs, but I doubt there's much industry funding in that.
posted by muddgirl at 3:51 PM on May 9, 2013 [3 favorites]
Most exercise in a gym is dead boring, and gyms are smelly. I need holodecks, dammit.
posted by emjaybee at 4:01 PM on May 9, 2013 [3 favorites]
posted by emjaybee at 4:01 PM on May 9, 2013 [3 favorites]
You could make all gyms free of charge, and you'd get very few people utilizing them. But pay people money to exercise, and you'd pack them.
muddgirl:
"I guess I don't see why this is an interesting observation or finding. We see this all the time - would I really come into the office every day from 8 to 5 if I wasn't getting paid to do so? No I would not (this isn't to say I wouldn't do any work at all, but I would not perform the exact tasks my employer asked of me)."
I hate to state the obvious, but I guess it's this kind of thread, where if you try hard enough you can miss the very obvious.
The difference between you going to work for 8+ hours to get paid, vs exercising is pretty fundamental: there is no other motivation to go to work, other than get paid, whereas exercising is supposed to provide you with health benefits, so that should be enough by itself... you are doing it for your health. You know the saying: "I'm not doing it for my health", about a task you doing for some kind of specific reward? That's what you say, to distinguish it from doing it for yourself. "Why do you do all that hard work for 8+ hours a day?" "Well, I'm not doing it for my health, I can tell you that!". See? Very on-point. Coincidentally I just had reason to use that expression - see below:
I'm not sure what is so much better about running in a circle vs playing basketball, but...
To again, state the obvious: it's not about better or worse - it's about the fact that people exercise when there is an additional motivation beyond health... the folks who exercise through basketball play are mostly doing it less for the benefits of exercise and more for the fun of a teamplay; you don't see women or older people on basketball courts, partially because of social issues and partially because of an additional skill required; meanwhile anyone can walk or jog (unless medically proscribed).
In connection to this, my wife and I were recently again marveling about how the basketball courts were packed and here we are alone, jogging. Yes, we acknowledged, it was fun to play basketball, and frankly we both happen to hate exercise - we only do it because of the health benefits, to which I quipped "Of course I hate jogging, what do you think, I'm doing it for my health?".
posted by VikingSword at 4:07 PM on May 9, 2013
muddgirl:
"I guess I don't see why this is an interesting observation or finding. We see this all the time - would I really come into the office every day from 8 to 5 if I wasn't getting paid to do so? No I would not (this isn't to say I wouldn't do any work at all, but I would not perform the exact tasks my employer asked of me)."
I hate to state the obvious, but I guess it's this kind of thread, where if you try hard enough you can miss the very obvious.
The difference between you going to work for 8+ hours to get paid, vs exercising is pretty fundamental: there is no other motivation to go to work, other than get paid, whereas exercising is supposed to provide you with health benefits, so that should be enough by itself... you are doing it for your health. You know the saying: "I'm not doing it for my health", about a task you doing for some kind of specific reward? That's what you say, to distinguish it from doing it for yourself. "Why do you do all that hard work for 8+ hours a day?" "Well, I'm not doing it for my health, I can tell you that!". See? Very on-point. Coincidentally I just had reason to use that expression - see below:
I'm not sure what is so much better about running in a circle vs playing basketball, but...
To again, state the obvious: it's not about better or worse - it's about the fact that people exercise when there is an additional motivation beyond health... the folks who exercise through basketball play are mostly doing it less for the benefits of exercise and more for the fun of a teamplay; you don't see women or older people on basketball courts, partially because of social issues and partially because of an additional skill required; meanwhile anyone can walk or jog (unless medically proscribed).
In connection to this, my wife and I were recently again marveling about how the basketball courts were packed and here we are alone, jogging. Yes, we acknowledged, it was fun to play basketball, and frankly we both happen to hate exercise - we only do it because of the health benefits, to which I quipped "Of course I hate jogging, what do you think, I'm doing it for my health?".
posted by VikingSword at 4:07 PM on May 9, 2013
srboisvert: "This is of course absolutely breaking the fundamental premise of insurance of which is risk pooling. "
The fundamental premise of insurance is that there are events and outcomes in life, that are unpredictable and negative. We call that risk. By pooling our risk, we can convert a large uncertain event into a small one that it's possible to budget for.
I want to emphasize that it's risk pooling, not outcome pooling. It's folly to expect outcome pooling from competitive insurance markets. In a competitive market, your customers and competition will take advantage of your inability insure only unpredictable risks. Your low probability customers will underinsure, or find a competitor that specializes in low risk pools. Your high probability customers will stick around for the premiums you're now undercharging for. So you end up raising premiums to avoid selling insurance at a loss, and the market ends up shifting closer to charging participants their outcomes.
Basically, by improving our ability to predict outcomes, we're reducing risks and the need for insurance, but crucially, not the ability for people to afford it. That's where insurers and employers offering incentives for preventative steps comes in.
posted by pwnguin at 4:11 PM on May 9, 2013 [2 favorites]
The fundamental premise of insurance is that there are events and outcomes in life, that are unpredictable and negative. We call that risk. By pooling our risk, we can convert a large uncertain event into a small one that it's possible to budget for.
I want to emphasize that it's risk pooling, not outcome pooling. It's folly to expect outcome pooling from competitive insurance markets. In a competitive market, your customers and competition will take advantage of your inability insure only unpredictable risks. Your low probability customers will underinsure, or find a competitor that specializes in low risk pools. Your high probability customers will stick around for the premiums you're now undercharging for. So you end up raising premiums to avoid selling insurance at a loss, and the market ends up shifting closer to charging participants their outcomes.
Basically, by improving our ability to predict outcomes, we're reducing risks and the need for insurance, but crucially, not the ability for people to afford it. That's where insurers and employers offering incentives for preventative steps comes in.
posted by pwnguin at 4:11 PM on May 9, 2013 [2 favorites]
VikingSword: "The difference between you going to work for 8+ hours to get paid, vs exercising is pretty fundamental: there is no other motivation to go to work,"
Not true! Work is where I go to slack off and read MeFi!
posted by pwnguin at 4:11 PM on May 9, 2013
Not true! Work is where I go to slack off and read MeFi!
posted by pwnguin at 4:11 PM on May 9, 2013
"I am okay with this if it is done in the opposite way that isn't douchey, I guess? Like if my insurance company was like "yo liz i see you go to the gym every single day, so we're gonna give you a discount for being a sweaty goatbeast". That would be rad. "
Yeah, it was interesting that this was U of M — when my girlfriend worked there, they had an incentive program where there was (she'll correct me if I'm wrong) a gift card for everyone in the office if everyone in the office hit some number of health goals out of a passel of options (e.g. dropping BMI or doing a daily number of steps or whatever). It was something that got everyone involved through social pressure — you didn't want to be the dipshit who cost the whole office gift cards — but gave people options on how to achieve the goals and it seemed to work pretty well.
I think there are ways to design these programs so that you're incentivizing doing them rather than punishing people for not, which seems less voluntary and less fair.
posted by klangklangston at 4:12 PM on May 9, 2013
Yeah, it was interesting that this was U of M — when my girlfriend worked there, they had an incentive program where there was (she'll correct me if I'm wrong) a gift card for everyone in the office if everyone in the office hit some number of health goals out of a passel of options (e.g. dropping BMI or doing a daily number of steps or whatever). It was something that got everyone involved through social pressure — you didn't want to be the dipshit who cost the whole office gift cards — but gave people options on how to achieve the goals and it seemed to work pretty well.
I think there are ways to design these programs so that you're incentivizing doing them rather than punishing people for not, which seems less voluntary and less fair.
posted by klangklangston at 4:12 PM on May 9, 2013
"there is no other motivation to go to work, other than get paid, whereas exercising is supposed to provide you with health benefits, so that should be enough by itself"
I actually like my job right now — beyond getting paid, my motivation is to win protections for a disadvantaged minority. I could probably be making more money elsewhere, but that's not as important to me as making the world a better place.
posted by klangklangston at 4:14 PM on May 9, 2013 [1 favorite]
I actually like my job right now — beyond getting paid, my motivation is to win protections for a disadvantaged minority. I could probably be making more money elsewhere, but that's not as important to me as making the world a better place.
posted by klangklangston at 4:14 PM on May 9, 2013 [1 favorite]
I imagine 50 years from now everyone hovering around in drone chairs like in Wall-E, still arguing on MeFi that weight loss is metaphysically impossible and morbid obesity is unrelated to overall health.
Weight loss threads on MeFi: You got data? We got anecdata!
posted by crayz at 4:20 PM on May 9, 2013 [4 favorites]
Weight loss threads on MeFi: You got data? We got anecdata!
posted by crayz at 4:20 PM on May 9, 2013 [4 favorites]
I actually like my job right now — beyond getting paid,
Naturally. But I was responding to muddgirl's specific example. Obviously, many people love their jobs or get other rewards quite apart from money. There are also plenty of people who exercise because they love it, and would do so even if it hurt their health (medical evidence seems to say you can overdo it, and many people state that it would not dissuade them). To state the obvious.
posted by VikingSword at 4:23 PM on May 9, 2013
Naturally. But I was responding to muddgirl's specific example. Obviously, many people love their jobs or get other rewards quite apart from money. There are also plenty of people who exercise because they love it, and would do so even if it hurt their health (medical evidence seems to say you can overdo it, and many people state that it would not dissuade them). To state the obvious.
posted by VikingSword at 4:23 PM on May 9, 2013
I think the motivation problem is that health in the abstract is a very delayed and usually subtle reward. My wage is very different -- in fact it's both a strong carrot (spending money) and a stick (rent money). They aren't really comparable.
The benefit from exercise is less obvious unless I'm trying to reach a particular concrete goal quickly (e.g. beating the other guy or mastering a skill). Which is not to say that you can't create that kind of incentive for any particular exercise, just that "health benefits" doesn't really do the trick. Even if I loose weight, it's temporary -- the motivation is gone once you reach the desired goal.
posted by smidgen at 4:29 PM on May 9, 2013
I am all about people doing more exercise. I don't go to the gym because I think it will make me a lithe and beautiful size zero, I go because it makes me feel, however deludedly, that I am strong and awesome.
I just don't think that slapping people with a 20% tax because they're fat is particularly likely to be a motivating way to help them exercise. For one thing, gyms are expensive and that 20% tax makes it harder to afford a membership.
That is one good thing my company does - my gym membership is subsidized. If it weren't for that, someone who wasn't motivated to scrimp to pay for it (as I did when I didn't have the subsidy) is not going to spend the extra money.
The other problem is that it's hard to budget time for exercise when they've let so many staff go you're all working sixty hour weeks. I really don't know how people with kids manage at all, other than the ones who drag the kids to the gym and make them sit in the corner while their mom or dad works out.
posted by winna at 4:31 PM on May 9, 2013 [1 favorite]
I just don't think that slapping people with a 20% tax because they're fat is particularly likely to be a motivating way to help them exercise. For one thing, gyms are expensive and that 20% tax makes it harder to afford a membership.
That is one good thing my company does - my gym membership is subsidized. If it weren't for that, someone who wasn't motivated to scrimp to pay for it (as I did when I didn't have the subsidy) is not going to spend the extra money.
The other problem is that it's hard to budget time for exercise when they've let so many staff go you're all working sixty hour weeks. I really don't know how people with kids manage at all, other than the ones who drag the kids to the gym and make them sit in the corner while their mom or dad works out.
posted by winna at 4:31 PM on May 9, 2013 [1 favorite]
I just don't think that slapping people with a 20% tax because they're fat is particularly likely to be a motivating way to help them exercise.
It's not a question of think or not think, the data suggests that it is a motivating way to get them to exercise. The question being raised isn't whether it works... it did... it's whether it is appropriate.
posted by Justinian at 4:41 PM on May 9, 2013 [1 favorite]
It's not a question of think or not think, the data suggests that it is a motivating way to get them to exercise. The question being raised isn't whether it works... it did... it's whether it is appropriate.
posted by Justinian at 4:41 PM on May 9, 2013 [1 favorite]
If I put the damn thing on a neighborhood cat would it work?
Maybe, but then they think you take 10 naps a day.
posted by RobotHero at 4:55 PM on May 9, 2013 [1 favorite]
Maybe, but then they think you take 10 naps a day.
posted by RobotHero at 4:55 PM on May 9, 2013 [1 favorite]
My brother in law works for Nike. They have a gym on-site, and workers are allowed to spend up to 90 minutes of their paid work day at the gym, every day. They literally get paid to exercise.
Their gym utilization is staggering. When they did one of those fitness-goal everyone-wear-a-pedometer things, something like 88% of the office hit the goal. I don't know how it works out for them from an actuarial standpoint, but from the goal of having people move more, it works great.
Since those results are so great, and so much better than other incentive programs like these that you hear about, I can only conclude that any employer who DOESN'T do stuff like this isn't really interested in what they claim to be interested in.
posted by KathrynT at 5:10 PM on May 9, 2013 [14 favorites]
Their gym utilization is staggering. When they did one of those fitness-goal everyone-wear-a-pedometer things, something like 88% of the office hit the goal. I don't know how it works out for them from an actuarial standpoint, but from the goal of having people move more, it works great.
Since those results are so great, and so much better than other incentive programs like these that you hear about, I can only conclude that any employer who DOESN'T do stuff like this isn't really interested in what they claim to be interested in.
posted by KathrynT at 5:10 PM on May 9, 2013 [14 favorites]
Well on the Nike campus, I've heard Nike does it to keep their employees doing the things they make products for. Like the lead designers of basketball shoes should play basketball a lot, even as they get older.
posted by mathowie at 5:12 PM on May 9, 2013
posted by mathowie at 5:12 PM on May 9, 2013
True, but my brother in law designs shirts, and he still gets the benefit.
posted by KathrynT at 5:15 PM on May 9, 2013
posted by KathrynT at 5:15 PM on May 9, 2013
I mean regular old cotton t-shirts, not High Performance Wicking Ab Enhancing Action XTreme Wear.
posted by KathrynT at 5:15 PM on May 9, 2013
posted by KathrynT at 5:15 PM on May 9, 2013
dfriedman: So what if a guy joined crossfit and just lifted heavy weights all day? He'd be in great shape but would have walked fewer than 5,000 steps.
Right on. Yesterday was squat day. I can't walk 5000 steps to save my life, motherfuckers.
Also this was all no doubt based on that marvel of mechanical-minded idiocy, the BMI, which puts anybody with more muscle mass than the average Belsen survivor deep in the obese category. Try to conceive of a physical metric that actually takes account of the existence of lean mass in the human body?! Why that's a concept so ridiculous it makes me want to laugh out loud and chortle.
posted by Kandarp Von Bontee at 5:16 PM on May 9, 2013 [3 favorites]
Right on. Yesterday was squat day. I can't walk 5000 steps to save my life, motherfuckers.
Also this was all no doubt based on that marvel of mechanical-minded idiocy, the BMI, which puts anybody with more muscle mass than the average Belsen survivor deep in the obese category. Try to conceive of a physical metric that actually takes account of the existence of lean mass in the human body?! Why that's a concept so ridiculous it makes me want to laugh out loud and chortle.
posted by Kandarp Von Bontee at 5:16 PM on May 9, 2013 [3 favorites]
Then you're in terrible shape no matter how big your muscles are.
posted by Justinian at 5:22 PM on May 9, 2013 [2 favorites]
posted by Justinian at 5:22 PM on May 9, 2013 [2 favorites]
OK, I'm on this plan, I carry one of these pedometers, and my data was probably used in the study. I can see how it could be effective for some people, and I don't feel that it's any more or less inherently shitty or greedy than our entire fucked-up system. So, if it changes some behaviors, that's a net plus. Here's my experience:
While you can say it's just optics, everyone on the plan gets the standard coverage. If you don't meet the health goals (which aren't just BMI, also blood pressure, depression, smoking, and blood sugar) and you agree to work on it, you get the "enhanced" coverage which was in my case no deductible instead of a $500 family deductible. So far, you don't actually need to make progress to keep the enhanced coverage. Given that no-deductible plans are pretty rare these days I do feel it's a positive bonus and not a fat tax.
The pedometer is not wireless, you have to upload it at least once a month, and the damn driver still doesn't support Lion (let alone Mountain Lion!) so I need a VM to upload my pedometer to keep my deductible low, which is crazy, but again, not really any less crazy than anything else in american health care.
That said, I already walked a lot, and I've never walked more because of the pedometer. I do like seeing how many steps I've taken and feel good about the numbers. But it hasn't changed my habits or my BMI.
I agree that BMI is a pretty dumb nail to hang this on, but I think it's overall not such a bad deal and it's nice to see some economic incentives for being healthier to offset all the incentives that work the other way.
posted by ulotrichous at 5:31 PM on May 9, 2013 [5 favorites]
While you can say it's just optics, everyone on the plan gets the standard coverage. If you don't meet the health goals (which aren't just BMI, also blood pressure, depression, smoking, and blood sugar) and you agree to work on it, you get the "enhanced" coverage which was in my case no deductible instead of a $500 family deductible. So far, you don't actually need to make progress to keep the enhanced coverage. Given that no-deductible plans are pretty rare these days I do feel it's a positive bonus and not a fat tax.
The pedometer is not wireless, you have to upload it at least once a month, and the damn driver still doesn't support Lion (let alone Mountain Lion!) so I need a VM to upload my pedometer to keep my deductible low, which is crazy, but again, not really any less crazy than anything else in american health care.
That said, I already walked a lot, and I've never walked more because of the pedometer. I do like seeing how many steps I've taken and feel good about the numbers. But it hasn't changed my habits or my BMI.
I agree that BMI is a pretty dumb nail to hang this on, but I think it's overall not such a bad deal and it's nice to see some economic incentives for being healthier to offset all the incentives that work the other way.
posted by ulotrichous at 5:31 PM on May 9, 2013 [5 favorites]
And in this thread we will passionately debate whether physical exercise is beneficial to people.
posted by Argyle at 2:34 PM on May 9 [16 favorites +] [!]
Actually I recently read that about 15% of us are exercise-resistant, and get none of the health benefits, including weight loss, that exercise is supposed to bring. I can't find a citation for that though.
posted by bq at 5:47 PM on May 9, 2013
posted by Argyle at 2:34 PM on May 9 [16 favorites +] [!]
Actually I recently read that about 15% of us are exercise-resistant, and get none of the health benefits, including weight loss, that exercise is supposed to bring. I can't find a citation for that though.
posted by bq at 5:47 PM on May 9, 2013
If I put the damn thing on a neighborhood cat would it work?
Maybe, but then they think you take 10 naps a day.
You mean that you don't?
posted by His thoughts were red thoughts at 6:21 PM on May 9, 2013 [1 favorite]
Maybe, but then they think you take 10 naps a day.
You mean that you don't?
posted by His thoughts were red thoughts at 6:21 PM on May 9, 2013 [1 favorite]
Also this was all no doubt based on that marvel of mechanical-minded idiocy, the BMI, which puts anybody with more muscle mass than the average Belsen survivor deep in the obese category.
I want to see all these people who aren't professional weightlifters whose pounds whose muscle mass are seriously fucking up their BMI calculations; not just inching over 25.
I have a mid/large frame, more muscle than most people and a few extra pounds of fat, and I'm 6'/175lbs, about 24 BMI. To get to the "obese" BMI weight would mean adding an extra 50lbs, which I have in the past, but the idea I could get there with primarily muscle weight is just laughable. If I add another 10 lbs of muscle I start looking like a complete block-head.
I'm really skeptical of the idea MeFites are all on roid rages and just sadface about their BMI #s.
posted by crayz at 6:58 PM on May 9, 2013 [9 favorites]
I want to see all these people who aren't professional weightlifters whose pounds whose muscle mass are seriously fucking up their BMI calculations; not just inching over 25.
I have a mid/large frame, more muscle than most people and a few extra pounds of fat, and I'm 6'/175lbs, about 24 BMI. To get to the "obese" BMI weight would mean adding an extra 50lbs, which I have in the past, but the idea I could get there with primarily muscle weight is just laughable. If I add another 10 lbs of muscle I start looking like a complete block-head.
I'm really skeptical of the idea MeFites are all on roid rages and just sadface about their BMI #s.
posted by crayz at 6:58 PM on May 9, 2013 [9 favorites]
Well, I am. Excuse me I need to go professionally weightlift to stave off a roid rage.
posted by Kandarp Von Bontee at 7:40 PM on May 9, 2013 [1 favorite]
posted by Kandarp Von Bontee at 7:40 PM on May 9, 2013 [1 favorite]
...everyone on the plan gets the standard coverage. If you don't meet the health goals (which aren't just BMI, also blood pressure, depression, smoking, and blood sugar)...
Depression? WTF? Talk about screwed up. You just go out and walk it off or something? Yup, gonna penalize you for depression, why not.
posted by BlueHorse at 8:06 PM on May 9, 2013 [3 favorites]
Depression? WTF? Talk about screwed up. You just go out and walk it off or something? Yup, gonna penalize you for depression, why not.
posted by BlueHorse at 8:06 PM on May 9, 2013 [3 favorites]
At the other end of the spectrum, I always wonder how those who have eating disorders and the like are treated by this type of program. I would guess that people who have diagnosed eating disorders can be medically exempted, just as others with disabilities - but what about those with undiagnosed eating disorders, disordered eating patterns, exercise obsessions, etc?
Perhaps it's because of my own history, but it's very easy for me to see how exercise and weight loss incentives can be very harmful to those in a vulnerable position.
posted by insectosaurus at 8:09 PM on May 9, 2013 [2 favorites]
Perhaps it's because of my own history, but it's very easy for me to see how exercise and weight loss incentives can be very harmful to those in a vulnerable position.
posted by insectosaurus at 8:09 PM on May 9, 2013 [2 favorites]
I want to see all these people who aren't professional weightlifters whose pounds whose muscle mass are seriously fucking up their BMI calculations; not just inching over 25.
My brother-in-law (different BIL than the one who works at Nike) is 6' and 215, which makes his BMI 29.2. I promise you, he is mostly muscle. He's just HUGE. He doesn't look like a bodybuilder, either, he just looks like a fit, muscular guy. Until he starts doing pullups, then he looks like a gorilla.
posted by KathrynT at 8:26 PM on May 9, 2013
My brother-in-law (different BIL than the one who works at Nike) is 6' and 215, which makes his BMI 29.2. I promise you, he is mostly muscle. He's just HUGE. He doesn't look like a bodybuilder, either, he just looks like a fit, muscular guy. Until he starts doing pullups, then he looks like a gorilla.
posted by KathrynT at 8:26 PM on May 9, 2013
My BMI is 19, my blood pressure, cholesterol, glucose etc are all good, and I am one lazy son of a bitch. I can't remember the last time I walked further than a mile or up more than two flights of stairs.
posted by desjardins at 8:29 PM on May 9, 2013 [1 favorite]
posted by desjardins at 8:29 PM on May 9, 2013 [1 favorite]
Carrot, stick, whatever - so long as you recognize that you're somebody's stupid draft animal.
posted by codswallop at 8:49 PM on May 9, 2013 [1 favorite]
posted by codswallop at 8:49 PM on May 9, 2013 [1 favorite]
Actually I recently read that about 15% of us are exercise-resistant, and get none of the health benefits, including weight loss, that exercise is supposed to bring.
If your weight-loss plan is based solely on exercise, you have a terrible weight-loss plan. I can personally attest to this.
posted by ob at 9:11 PM on May 9, 2013 [1 favorite]
If your weight-loss plan is based solely on exercise, you have a terrible weight-loss plan. I can personally attest to this.
posted by ob at 9:11 PM on May 9, 2013 [1 favorite]
taking positive action toward your health should reward you with an incentive. Doing it as a way to avoid punishment is less effective as a motivator.
Unfortunately (?) there are a lot of studies showing just the opposite, that people are much more likely to take action to avoid a perceived loss than to achieve a perceived gain, even if the only real difference is the framing.
You can see that effect in this very thread, where several people seem to think that using a "stick" is terrible, drastic, inhumane, while offering people a "carrot" would be fine or no big deal, when we all know that in practice it would end up being the exact same amounts of money whether you call it a discount for exercising or a penalty for not exercising.
posted by straight at 9:12 PM on May 9, 2013 [3 favorites]
Unfortunately (?) there are a lot of studies showing just the opposite, that people are much more likely to take action to avoid a perceived loss than to achieve a perceived gain, even if the only real difference is the framing.
You can see that effect in this very thread, where several people seem to think that using a "stick" is terrible, drastic, inhumane, while offering people a "carrot" would be fine or no big deal, when we all know that in practice it would end up being the exact same amounts of money whether you call it a discount for exercising or a penalty for not exercising.
posted by straight at 9:12 PM on May 9, 2013 [3 favorites]
He's just HUGE. He doesn't look like a bodybuilder, either, he just looks like a fit, muscular guy. Until he starts doing pullups, then he looks like a gorilla.
OK, and if people who look like the hulk are withering in the face of the undue burdens of proving their fitness to nanny-state bureaucrats, I will fight that fight with you.
My gut feeling is hulk-discrimination is probably not quite up there on the scale of social crisis with the meteoric rise in American obesity, in terms of say a death toll of a hundred or few thousand citizens per year, widespread crippling disability, heart disease, strokes, ulcers, amputations ...
posted by crayz at 9:56 PM on May 9, 2013 [1 favorite]
OK, and if people who look like the hulk are withering in the face of the undue burdens of proving their fitness to nanny-state bureaucrats, I will fight that fight with you.
My gut feeling is hulk-discrimination is probably not quite up there on the scale of social crisis with the meteoric rise in American obesity, in terms of say a death toll of a hundred or few thousand citizens per year, widespread crippling disability, heart disease, strokes, ulcers, amputations ...
posted by crayz at 9:56 PM on May 9, 2013 [1 favorite]
I was just at a talk at this evening at the United Health Group HQ where higher copays and negative reinforcement in wellness programs were cited as their two key "innovative" approaches to behavior change and the health care crisis in the US.
Meanwhile ADM continues to churn out High Fructose Corn Syrup while ADM and United Health board members do as board members do (via they rule) and stay quiet about the real issues.
posted by specialk420 at 9:59 PM on May 9, 2013 [2 favorites]
Meanwhile ADM continues to churn out High Fructose Corn Syrup while ADM and United Health board members do as board members do (via they rule) and stay quiet about the real issues.
posted by specialk420 at 9:59 PM on May 9, 2013 [2 favorites]
My gut feeling is hulk-discrimination is probably not quite up there on the scale of social crisis with the meteoric rise in American obesity, in terms of say a death toll of a hundred or few thousand citizens per year, widespread crippling disability, heart disease, strokes, ulcers, amputations ...
--crayz
Except that long term, large scale studies (such as the Framingham and Harvard Nurse studies) show something that goes against this popular belief: it is exercise, not obesity, that is the primary determinant for getting these health problems (with the exception of extreme obesity).
So, as many people here have said, they should have offered it to everyone, not just the obese.
(I bet they even used the BMI to measure obesity).
Which means if dfriedman did crossfit and lifted weights all day, he might get penalized at Argyle's old place of employment.
posted by eye of newt at 10:16 PM on May 9, 2013
--crayz
Except that long term, large scale studies (such as the Framingham and Harvard Nurse studies) show something that goes against this popular belief: it is exercise, not obesity, that is the primary determinant for getting these health problems (with the exception of extreme obesity).
So, as many people here have said, they should have offered it to everyone, not just the obese.
(I bet they even used the BMI to measure obesity).
Which means if dfriedman did crossfit and lifted weights all day, he might get penalized at Argyle's old place of employment.
posted by eye of newt at 10:16 PM on May 9, 2013
I finally gifted out the right keywords. It's non responders to exercise.
A Finnish study of 175 adults found that some didn’t improve their strength or fitness level at all after a 5-month exercise program.
link
posted by bq at 10:45 PM on May 9, 2013
A Finnish study of 175 adults found that some didn’t improve their strength or fitness level at all after a 5-month exercise program.
link
posted by bq at 10:45 PM on May 9, 2013
If you don't meet the health goals (which aren't just BMI, also blood pressure, depression, smoking, and blood sugar) and you agree to work on it, you get the "enhanced" coverageIn other words, the insurance company is now your doctor. Plus, if you happen to be deficient in any of these areas, well, it must be entirely your fault if the plan *they* prescribe does not work.
No.
It isn't about making you healthier, it's about cutting costs. This is a load of crock (e.g. "BMI" and "Depression", really?) based on what they can get away with. They do not have your best interests at heart. They are doing this because it is illegal to change coverage on the fly based on the ICD codes and prescription drugs they see in your records. If they suddenly added $500 to someones deductible because they saw a blood pressure med, they would be in trouble.
posted by smidgen at 11:04 PM on May 9, 2013 [2 favorites]
Except that long term, large scale studies (such as the Framingham and Harvard Nurse studies) show something that goes against this popular belief
Harvard Nurses: Obesity increases risks of heart disease, stroke, breast and colon cancer. Decreases risk of hip fracture because you're cushioned.
Framingham: "Recent observations of disease occurrence over 26 years indicate that obesity, measured by Metropolitan Relative Weight, was a significant independent predictor of CVD, particularly among women. Multiple logistic regression analyses showed that Metropolitan Relative Weight, or percentage of desirable weight, on initial examination predicted 26-year incidence of coronary disease (both angina and coronary disease other than angina), coronary death and congestive heart failure in men independent of age, cholesterol, systolic blood pressure, cigarettes, left ventricular hypertrophy and glucose intolerance. Relative weight in women was also positively and independently associated with coronary disease, stroke, congestive failure, and coronary and CVD death."
posted by crayz at 11:35 PM on May 9, 2013 [1 favorite]
Harvard Nurses: Obesity increases risks of heart disease, stroke, breast and colon cancer. Decreases risk of hip fracture because you're cushioned.
Framingham: "Recent observations of disease occurrence over 26 years indicate that obesity, measured by Metropolitan Relative Weight, was a significant independent predictor of CVD, particularly among women. Multiple logistic regression analyses showed that Metropolitan Relative Weight, or percentage of desirable weight, on initial examination predicted 26-year incidence of coronary disease (both angina and coronary disease other than angina), coronary death and congestive heart failure in men independent of age, cholesterol, systolic blood pressure, cigarettes, left ventricular hypertrophy and glucose intolerance. Relative weight in women was also positively and independently associated with coronary disease, stroke, congestive failure, and coronary and CVD death."
posted by crayz at 11:35 PM on May 9, 2013 [1 favorite]
When you take into account that people who are not obese are often exercising, the predominant effect becomes apparent.
Harvard Nurses:
And nurses in the mid-range overweight category who were physically active (as little as one hour a week counted) had a lower risk of death than lean nurses who were inactive (exercising less than an hour per week). Being a little active and a little fat wasn’t such a bad combination.
posted by eye of newt at 11:55 PM on May 9, 2013 [1 favorite]
Harvard Nurses:
And nurses in the mid-range overweight category who were physically active (as little as one hour a week counted) had a lower risk of death than lean nurses who were inactive (exercising less than an hour per week). Being a little active and a little fat wasn’t such a bad combination.
posted by eye of newt at 11:55 PM on May 9, 2013 [1 favorite]
From the study linked by bq: “Finnish researchers asked these previously sedentary adults to work out regularly for 21 weeks. Some walk or jogged while others trained with weights. Some did both...
Does this imply the exercise regimen was self-directed? Because if that's the case it's not terribly surprising that 20% of people achieved fuck-all by the end of the study. Go into chain gyms the world over and at least 20% of people in there could be tagged as non-responders: it's nothing to do with genetics, they've just got no clue what they're doing, with dietary and lifestyle habits that preclude the slightest progress.
posted by Kandarp Von Bontee at 12:12 AM on May 10, 2013
Does this imply the exercise regimen was self-directed? Because if that's the case it's not terribly surprising that 20% of people achieved fuck-all by the end of the study. Go into chain gyms the world over and at least 20% of people in there could be tagged as non-responders: it's nothing to do with genetics, they've just got no clue what they're doing, with dietary and lifestyle habits that preclude the slightest progress.
posted by Kandarp Von Bontee at 12:12 AM on May 10, 2013
Insurance companies will penalize you for being fat but deems a yearly physical an unnecessary procedure and won't pay for it. This seems fair.
posted by Foam Pants at 1:53 AM on May 10, 2013 [2 favorites]
posted by Foam Pants at 1:53 AM on May 10, 2013 [2 favorites]
This is of course absolutely breaking the fundamental premise of insurance of which is risk pooling.
Yes, but health insurance fundamentally breaks the premise of insurance, because it's less a true insurance product and more a pre-paid services product. "Real" insurance products are written under the largely justified assumption that most policies will not have a claim during any particular policy term. Health "insurance" products are written under the largely justified assumption that there are going to be a shit-ton of very expensive claims in any particular policy term.
True, it does start acting more like a proper insurance policy once you've hit your deductible and/or out-of-pocket maximums, and most people don't do that. But that means you need to spend something north of $15,000 in some combination of deductible, co-insurance, and premiums* before you start getting your claims paid completely.
*Mustn't forget premiums, as they're coming out of your salary, if not your checking account. Want to know where all of our wage increases have gone for the past twenty years? Health insurance, that's where.
posted by valkyryn at 2:45 AM on May 10, 2013
Yes, but health insurance fundamentally breaks the premise of insurance, because it's less a true insurance product and more a pre-paid services product. "Real" insurance products are written under the largely justified assumption that most policies will not have a claim during any particular policy term. Health "insurance" products are written under the largely justified assumption that there are going to be a shit-ton of very expensive claims in any particular policy term.
True, it does start acting more like a proper insurance policy once you've hit your deductible and/or out-of-pocket maximums, and most people don't do that. But that means you need to spend something north of $15,000 in some combination of deductible, co-insurance, and premiums* before you start getting your claims paid completely.
*Mustn't forget premiums, as they're coming out of your salary, if not your checking account. Want to know where all of our wage increases have gone for the past twenty years? Health insurance, that's where.
posted by valkyryn at 2:45 AM on May 10, 2013
Can one person wear ten of them and walk all day?
Business opportunity
posted by DanCall at 3:19 AM on May 10, 2013 [1 favorite]
Business opportunity
posted by DanCall at 3:19 AM on May 10, 2013 [1 favorite]
I'm confused as to why people are surprised by the concept that removing incentives reduces participation. I mean, the whole concept of insurance is that you do something now (pay the irrationally escalating fees) with the intention of financial benefits down the line. (Namely the fact that you don't go bankrupt for that one procedure that had to be done because of the thing that you had never heard of before.)
The incentive is that you don't spend your entire life savings just because you get sick. If they were to take away the incentives entirely there would be no reason to participate at all. Why does this surprise anybody?
Caveat: I'm an employee of the health care industry, but loathe the healthcare insurance industry. Put simply: I hate the fact that some corporation profits off of things like non-payment for cancer treatments.
posted by Blue_Villain at 4:45 AM on May 10, 2013 [1 favorite]
The incentive is that you don't spend your entire life savings just because you get sick. If they were to take away the incentives entirely there would be no reason to participate at all. Why does this surprise anybody?
Caveat: I'm an employee of the health care industry, but loathe the healthcare insurance industry. Put simply: I hate the fact that some corporation profits off of things like non-payment for cancer treatments.
posted by Blue_Villain at 4:45 AM on May 10, 2013 [1 favorite]
Actually I recently read that about 15% of us are exercise-resistant, and get none of the health benefits, including weight loss, that exercise is supposed to bring. I can't find a citation for that though.
This is not quite correct. What they didn't get were as much fitness improvements - increased lung capacity or physical strength.
I can't recall if they measured anything to do with health benefits though they surely burned calories (physics being physics and all).
posted by srboisvert at 8:34 AM on May 10, 2013
This is not quite correct. What they didn't get were as much fitness improvements - increased lung capacity or physical strength.
I can't recall if they measured anything to do with health benefits though they surely burned calories (physics being physics and all).
posted by srboisvert at 8:34 AM on May 10, 2013
I'll toss in my anecdata:
I weigh 156 lbs. I am 5 feet, 0 inches tall. I am obese according to my BMI (30.5). I also bicycled over 650 miles in April alone. My waist to hip ratio is .76, which is in the healthy range. I run often, I like doing adventure runs with obstacles and shit. I am not an unhealthy person.
posted by domo at 9:40 AM on May 10, 2013
I weigh 156 lbs. I am 5 feet, 0 inches tall. I am obese according to my BMI (30.5). I also bicycled over 650 miles in April alone. My waist to hip ratio is .76, which is in the healthy range. I run often, I like doing adventure runs with obstacles and shit. I am not an unhealthy person.
posted by domo at 9:40 AM on May 10, 2013
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And how did they weed out all the thin people who didn't exercise either?
It's almost as if they treat weight as a proxy for exercise or lack thereof, and then take the further step of assuming that the inactivity, which they have determined to exist by proxy, is voluntary and optional.
In other words, fuck this all to hell, this should be illegal and everyone involved should die in a fire.
posted by edheil at 2:30 PM on May 9, 2013 [40 favorites]