Paying Our Way to Better Health?

The state of North Carolina announced recently that it was considering a change to how much its employees will pay for health insurance premiums, and the potential change has caused quite an outcry. The basic problem with the state employees' health insurance plan is that it's losing money, and the primary reason is that it is insuring too many sick employees. The costs are high enough that younger, healthy employees can often find cheaper insurance for themselves and their dependents by opting for private insurance.

The solution, according to the state: charge higher premiums for those employees who are smokers and those who are overweight. Not surprisingly, the suggestion met with almost immediate opposition. How could the state know which employees smoke on their own time? And how would they determine if an employee was overweight, without raising enormous privacy concerns? I'll leave the debate about insurance costs for smokers for others, but I am curious about the notion of making people pay more for insurance because they weigh too much.

Obviously, I've had my own struggles with my weight, and my bias would generally be in sympathy with the overweight. It is an interesting conundrum, though. The reality is that for the most part, people who weigh more also have more health problems, including issues like diabetes, heart disease, and breathing problems. Those health issues often translate into higher health costs, so the insurance companies and those who provide insurance (both government agencies and private employers) have a vested interest in how the health of their employees translates to the bottom line. At the same time, it's hard to avoid the sense that people are being punished for something that may or may not be within their control. In this particular case, the standard for being "overweight" which would trigger higher premiums equated to weighing 35% more than normal (and I recognize that "normal" can be difficult to define). The state would also provide a method of exemption for those who are medically unable to lose weight. Still, it does raise the specter of a clash between our public and private lives, where our employers would be interested in the number on the scale, and would be able to, in essence, reach into our pocketbooks to make us pay the price for our unhealthy choices.

And that right there is the main issue, as far as I'm concerned. What is the right approach to encourage people to strive for a healthy, active lifestyle? It seems to me like this is basically a "stick" approach; in other words, punishing people for not eating good things or being physically fit by making them pay more money for health insurance. But I have to wonder whether a "carrot" approach might be more helpful. I'm not sure if I want to advocate for paying people for good behavior. But I also might be more motivated to lose weight if I knew that doing so meant a financial payoff in the form of perhaps a cash bonus or a rebate on my health care expenses. Maybe that's greedy or mercenary of me, but I'd prefer to think of it as being practical. If there's a tangible benefit to staying on the straight and narrow when it comes to eating healthy - money, in this case - then I'm much more likely to stick with it. The end result is the same: I'm healthier and don't need to visit the doctor as often, and that's what will make me and my health insurance provider happier - and maybe even for some of the same reasons.

Out of Hibernation

While fall is my favorite time of year, spring is probably a close second. This year in particular, I'm really looking forward to the weather changing. The winters here are generally pretty mild; we're lucky to see snow once or twice during the season. (And when I say "see snow," I mean that we'll get a couple of inches at a time, maybe.) The weather this year, though, has been a little worse than normal. It's been colder and wetter than the past several years. We've certainly had a few warmer spells, but for the most part, winter has hung on and made it highly undesirable to be outside for any length of time.

In spite of the fact that I walk outdoors most days, I tend to be a wimp when it comes to walking in the rain. And because this winter has been wetter than usual, that means I haven't been walking as much as I'd like. Sometimes that means I do an exercise video indoors, and other days I just won't walk as far. The result is that my weekly mileage is suffering, and I'm eager to get more miles in. The weather, unfortunately, has not been cooperating lately. We've been having stretches of 3-4 days in a row of rain, and it's been colder rain at that, with temps in the 30s and low 40s. Ick. The upshot is that I've been holed up this winter, not getting out nearly as much as I should. I feel a lot like a bear that's been hibernating, and it's time to wake up from my long winter's nap.

Lately I've been pondering the old saying about March coming in like a lion, and it sure does seem as if that's true this year. Supposedly spring starts on Friday, and I for one can't wait. Now I realize that it's not like Mother Nature is going to flip a switch on March 20 and suddenly the birds will be singing, flowers blooming, and sun shining. (I can still imagine it, though, can't I?) Still, when I see March on the calendar, I know that warmer weather can't be too far behind. This year in particular, I'm hoping that will translate into more and longer walks. I've been struggling to walk over 15 miles a week, and by usual goal is 20. I definitely have some ground to make up. But if the weather gets better, you'd better believe I'll be out enjoying it. So here's hoping that March will be going out like a lamb this year.

The Next Big (Diet) Thing

We hear all the time about the latest, very best plan to lose weight. A new craze, guaranteed to bring results, presented with lots of exclamation points on the covers of magazines prominently displayed in the supermarket checkout line. "Amazing Results! Lose Pounds While You Sleep! The Latest Celebrity Diet - Guaranteed to Help You Lose Those Thunder Thighs!!!" And on and on it goes.

And now, the biggest news of all on the weight loss scene: there really is a perfect diet, and you're almost certain to lose weight. There must be a catch, right. Well, sort of. Research recently reported in The New England Journal of Medicine shows this stunning result: any diet works - if you stick with it.

Well, there's really only one thing to say about that big announcement: duh! And yet, I think that sometimes, in our haste to find the next big diet thing, we overlook the very obvious idea that success in losing and keeping off weight comes when we commit for the long term. I'll admit it: I'm impatient. I want fast results, and I'd prefer to get them without making sacrifices. I want to - quite literally - have my cake and eat it, too. But if I'm honest with myself, I know that the way to lose weight in a way that means I won't put the pounds right back on is to find a diet I can live with.

Diet is one of those 4 letter words that gets a rise out of us every time. Who really wants to go on a diet? But we do it again and again and again. The long term strategy that these researchers are advocating, though, is more than a quick fix. They're talking about permanent lifestyle changes, ones we can live with for a long time to come. So while it may seem obvious, it also works. And I think deep down we all know it.

There is one part of this study that seems to get lost in the news reports, and that's the benefit of group support for weight loss success. One of the reasons why Weight Watchers works for many people is not so much the points and the programs (although I'm sure those matter, too); instead, it's about the accountability and encouragement that comes from enlisting others in your lifestyle changes. I don't think it necessarily means we all need to go to a meeting every week in order to be successful at losing weight. But I do believe that there are huge benefits to finding a friend or family member who knows what you're trying to do and who will help you along the way. Plus you'll get a nice bonus benefit: you'll have someone to celebrate with you when you reach your weight loss goals, someone who appreciates what it took to get there.

The Dangerous Things We Do

We hear a lot - and talk a lot - about distracted drivers. We see them all the time: putting on makeup in the car; talking or texting on cell phones; blasting the radio while doing their best impressions of Jay-Z or Beyonce. Pedestrians, cyclists, and even other drivers complain about these drivers who are so engaged in other activities that they don't pay full attention to their driving, and sometimes the result is an accident.

For pedestrians, the shoe is now on the other foot (pun intended). NPR reported recently about a group of Ohio State researchers who are studying the effects of electronic devices on pedestrian safety - except this time, the pedestrians are the one causing the problems. It's probably no surprise to hear that there's evidence that injuries are on the rise as more and more people walk while distracted by iPods or cell phones. Some have worn headphones and turned up the music so loud that they didn't hear a train approaching and were struck and killed. Others have stepped into the path of an oncoming car while talking or texting on a cell phone and were seriously injured.

It saddens me to hear of incidents like these. For obvious reasons, of course, as no one wants to imagine the sadness of those left behind after an entirely preventable accident. But I'm also worried about the problems we pedestrians can create through our inattention. Those of us who walk share responsibility for our safety with our fellow citizens on the roads and sidewalks. It's easy to point fingers at those drivers who pay more attention to changing the radio station than on operating a several ton vehicle. But when we pedestrians step off the curb and into traffic without looking because we're distracted by a text message we have to send right that minute, we too are responsible for creating a dangerous situation.

So what's the answer? I've certainly used an iPod on my walks, and I'm not eager to give it up. But it's also true that it probably prevents me from paying full attention to my surroundings. Some answers are relatively easy: if you can't hear a car or pedestrian approaching, turn down the volume. As for the cell phones, that's easier for me than for others, I'd guess, because I rarely use one and haven't yet entered the brave new world of texting. Honestly, though, if you're walking for exercise, I can't see a lot of benefit in talking on the phone the whole time. I certainly understand the desire of some to carry a phone for emergencies, and I don't think most would have a problem with that. But is it really necessary to give your BFF the blow-by-blow about your disastrous blind date while walking around town? if it is, I won't judge (but I will reserve the right to shoot you a dirty look if your story interrupts my peaceful morning walk). But I beg you, put the phone down for the 15 seconds it takes to look both ways and cross the street. You owe it to the drivers, cyclists, other pedestrians, and mostly to yourself. You're doing a good thing for your body by walking, so you might as well do what you can to keep that body safe while you're at it.

A Bump in the Road

Month 2 of my renewed commitment to healthy eating has been a little tougher than the first month. I've struggled to be consistent with my eating habits, and have made some less than stellar food choices over the past few weeks. That's partly the result of life stress, which is understandable. But I think I've taken advantage of that and allowed myself to eat things I know aren't good for me just because I feel like I deserve it somehow. I did get back in the groove toward the end of the month, so it wasn't a total bust, and I lost a total of 2 pounds in the last 4 weeks. That's nowhere near my goal of 5, so I've got some work to do in March to turn things around.

I don't have any big, profound lessons I've learned, except that I need to stay focused and motivated. Weekends continue to be a struggle, and will be unless I really work to develop a plan for eating on those days. In the past it's been helpful for me to write down what I'm eating, and I may do that again for a while on Saturdays and Sundays to see if it helps this time.

Here's hoping for a better March.