Mandatory Fitness Programs for Employees: A Logical Result of the ACA

Obesity is an increasingly prevalent issue in the United States.  As the overweight and obese are now in the majority and the trends suggest that ratio will not be going down any time soon, the implications for this health concern extend into every facet of life.  The workplace is one area where weight concerns must be taken into account in all the various ways they manifest, both for the sake of the employer and employees.  The impending Affordable Care Act makes health issues very much the domain of employers and the advocates for mandatory fitness programs, as a means to combat weight problems and provide healthcare for employees, can pose a very compelling argument.  If employers are to be held accountable for the health of their employees, which they are already are in that a healthy employee is a productive employee, then they should have some means of ensuring the continuing health of those employees.

Many employers already provide healthcare for their employees, with policy changes implementing coverage for fitness programs.  They do this voluntarily as a benefit to attract and keep the employees they want; it also provides some tax advantages.  The ACA, however, will change this from an option to a legal requirement for certain employers, “The recent health reform legislation requires larger employers to share the responsibility for assuring that their employees have health coverage” (Van de Water, 2010).  Of course, there are qualifications and stipulations, but at the heart of this legislation is the concept that employers, who are able, must be held accountable for the health of their employees.  A popular adage claims that power must come with responsibility, but then it should also hold true that responsibility bestows power.  And the responsibility is not insignificant.  On average, employers who provide health insurance cover 75% of the cost, a proportion that will almost necessarily be maintained by the ACA (Mandelbaum, 2011). Health insurance is seldom cheap, even for the healthy, and providing 75% of the health insurance costs for a workforce is a very significant investment, a tremendous responsibility.

While the ACA will likely protect overweight and obese people from increased insurance costs based on their weight, there are other costs of obesity that affect employers as well.  Employees injured in the workplace cost the company money both in compensation and in time lost.  While this is a risk that is managed exhaustively by OSHA, there are some dangers that necessarily remain a part of the workplace and it was found that, “Having a body mass index (BMI) in the overweight or obese range increases the risk of traumatic workplace injury, according to researchers at the Johns Hopkins Bloomberg School of Public Health’s Center for Injury Research and Policy” (Pollack et al., 2007).  If employees are held responsible by OSHA for maintaining a safe working environment and are required by law to compensate workers who are injured in the workplace, then it would only be fair for some responsibility to fall on the employees to protect themselves against injury.  Safety equipment is provided and expected to be used, so it would not be unreasonable for physical fitness training to be provided and expected to be used as well, in the interest of protecting the health of workers.

Injury is not the only kind of weight-related health problem that affects employers.  Illness also results in reduced efficiency and time lost.  A review of studies by the  National Institute for Occupational Safety and Health found that, “There is some evidence that obesity may increase the risk of some occupational diseases, including musculoskeletal disorders, asthma, and vibration-induced injury. Obesity may also alter the way the body responds to potentially neurotoxic chemicals, and to challenges to the immune system” (NIOSH, 2007).  If being overweight makes a person more vulnerable to health issues and an employer has the responsibility to protect employees against those health issues as well as help pay for treatment when those issues arise, then the employee should be held responsible to the employer for doing everything possible to avert health problems.

 There is of course a question of fairness.  Would it be fair to require overweight employees to participate in fitness programs?  If so, what would the standard be, BMI or bodyfat percentage or perhaps how easily they fit in a restroom stall, and would there be exceptions with irregular body types or medical conditions that alter their weight irrevocably?  Discrimination based on weight is already a recognized issue in many parts of society, including the workplace, and such a policy would certainly appear to be a continuation of that.  It would not be far removed from the, so far, unsuccessful efforts of places like Lincoln University who wanted to restrict the graduation of obese students until they lost weight or took fitness classes or the state of Mississippi that wanted to make it legal for restaurants to turn away customers based on their weight (Jameson, 2010).  Targeting overweight and obese people is a sure way get slapped with accusations of discrimination.  And those claims would probably be rightful.  Opening a legal door that allows people to be singled out based on their appearance would be a significant backwards step for the United States.

But the risks of being overweight and the degree to which those risks fall on employers cannot be ignored.  If the responsibility for maintaining employee health is to be theirs, then they must also have power to influence it.  An understanding of the facts is the best way to approach a reasonable and fair method for enforcing fitness in employees.  It would be impractical and unfair for employers to expect all employees to fit a certain body type.  In fact, studies found that, “while it is possible to lose weight through changes in diet and exercise, research shows that most people are only able to lose 5 to 10 percent of their weight by these means” (Tsai, 2012).  Such a limitation would keep most overweight people and all obese people from achieving normal weight through conventional means and so a requirement of being ‘normal’ weight is impractical.  This issue has been considered, however, and mandatory fitness programs would likely be aimed toward healthy habits, not any particular goals.  The ACA was designed with this in mind; it stipulated, “employers should incentivize individuals for healthy behaviors per se, not for the outcomes of those behaviors” (Tsai, 2012).  However, even with the objective of the health programs clarified, there is still the matter of who is required to participate.

The question of whether participation should be mandatory at all is largely answered by the issue of responsibility.  Employees who benefit from employers who are required to provide health insurance should be required to participate in health programs that are a part of that insurance.  Logically these programs would not be abusive or intense, they would be at worst inconvenient, as were restrictions on smoking areas, and more likely would have a positive effect on the lives of those who participate.  Nor should they focus on overweight and obese employees.  It would only be fair for all employees to participate in the fitness programs or provide reasonable proof that their own fitness regimen matches or exceeds that required by the employer provided insurance.  Good health is important for people of all weights and it has been shown that, “Low fitness levels were an independent predictor of mortality in all body mass index groups after adjustment for other mortality predictors such as high cholesterol and smoking” (“Study finds that”, 1999).  Employers are no less liable for their normal weight employees who encounter health issues and these employees should be just as responsible for maintaining a reasonable level of fitness to enjoy employer provided health benefits.

It would certainly not be fair or reasonable to single out overweight and obese employees for mandatory weight loss.  The message behind that is corrupt on several levels.  But a mandatory fitness program for all recipients of employer provided healthcare would be entirely fair and reasonable.  The obligation to care for the health of their employees should confer a certain amount of power to enforce that health on employers.  It just so happens that overweight and obese employees are significantly more vulnerable to injury and disease because of their weight, and so would likely benefit more from mandatory programs.  Employers should not be allowed to persecute the overweight, but they should be allowed to enforce healthy practices, to a reasonable degree, in all their employees, so long as they are subject to the ACA.

References

Jameson, M. (2010, February 1). Fed up with fat and saying something about it. The Los Angeles Times. Retrieved March 15, 2013, from http://articles.latimes.com/2010/feb/01/health/la-he-fat-fatigue1-2010feb01

Mandelbaum, R. (2011, July 13). Doing the math on employer health insurance. The New York Times. Retrieved March 15, 2013, from http://boss.blogs.nytimes.com/2011/07/13/doing-the-math-on-employer-health-insurance/

NIOSH. (2007, April 11). Research challenges in work, obesity, and health examined by NIOSH scientists, colleague in journal paper. Centers for Disease Control and Prevention. Retrieved March 15, 2013, from http://www.cdc.gov/niosh/updates/upd-04-11-07.html

Pollack, K. M., Sorock, G. S., Slade, M. D., Cantley, L., Sircar, K., Taiwo, O., et al. (2007, May 16). Obesity increases risk of injury on the job. Medical News Today. Retrieved March 15, 2013, from http://www.medicalnewstoday.com/releases/71053.php

Study finds that even modest weight loss yields significant health and economic benefits. (1999, November 3). Safety Online. Retrieved March 15, 2013, from http://www.safetyonline.com/doc.mvc/Study-Finds-That-Even-Modest-Weight-Loss-Yiel-0001

Tsai, A. G., & Bessesen, D. (2012, June 3). Obesity and health care: Prevention and support, not penalties. The Denver Post. Retrieved March 15, 2013, from http://www.denverpost.com/opinion/ci_20754953/obesity-and-health-care-prevention-and-support-not

Van de Water, P. N. (2010, May 14). Employer responsibility in health reform. Center on Budget and Policy Priorities. Retrieved March 15, 2013, from http://www.cbpp.org/cms/index.cfm?fa=view&id=3163