Whole Foods to Base Employee Discounts on BMI

[leleboo]

Apparently, Whole Foods is starting an optional program that will give employees with lower BMIs higher employee discounts.

In fairness, they're also rewarding those who don't smoke, have low blood pressure, and low cholesterol. There is apparently an indication in the letter that went out to employees (note: source of link is Jezebel.com, whose commentary is pretty snarky) that the company understands BMI is only a general approximation of overall health. I worry at the implication that the system will be purely numerical; incredibly low (<19) BMIs (for those severely underweight due to malnutrition or eating disorders, for example) are also unhealthy, while professional or high-level amateur athletes often have BMIs in the "obese" range due to sheer muscle mass. (Although I suspect not many of those atheletes are working for WF.)

I'm all for companies promoting healthy lifestyles for their employees. I work at the American College of Cardiology; we have an on-site gym and our HR department is always looking for health and wellness classes to offer us free or discounted. Even when I'm on the world's most urgent deadline, the doctors I work for encourage me to take an hour off and work out. This particular implementation of a similar idea, however, strikes me as ... falling short of the mark. Am I wrong?

[Arcturus]

I agree- it is a bit silly. I think one would be surprised at how many people don't fit into the "healthy" category on BMI because of both body build and muscle mass. My level of amateur athletics is probably higher than most due to Brazilian Jiu Jitsu, but the 10 pounds of muscle I've put on since October makes me "obese" when calculating BMI. I think things like being able to run/exercise for a certain period of time, bodyfat %, or being involved with some sort of strenuous activity outside of work would be better approximators of physical fitness, and the discount. I do like the no-nicotine and low blood pressure and cholesterol criteria, though.

[Al Dente]

You might smoke your ass off and live to a ripe old age with limited health problems. Look at Keith Richards.

Point is, BMI is a pretty good indicator of overall health. Yup, there are fatsos (like me) who may not smoke (me not much anyway), have good cholesterol levels (like me), and have healthy blood pressure (more or less like me), and I know there are muscle considerations, but fer chrissakes, what's wrong with WFM offering an incentive to increase the wellness of its employees while lowering health care costs?

[Pat]

People who are fit and have low BMI can also have high cholesterol for hereditary reasons, so that one seems a bit iffy. That doesn't come down too well without medication. There are also people who are average weight and work out who have high blood pressure. What kind of discount does someone get who has a healthy BMI but has high blood pressure and/or high cholesterol?

[Al Dente]

People who are fit and have low BMI can also have high cholesterol for hereditary reasons, so that one seems a bit iffy. That doesn't come down too well without medication. There are also people who are average weight and work out who have high blood pressure. What kind of discount does someone get who has a healthy BMI but has high blood pressure and/or high cholesterol?

They keep the discount they currently get-- 20%.

[monavano]

I agree- it is a bit silly. I think one would be surprised at how many people don't fit into the "healthy" category on BMI because of both body build and muscle mass. My level of amateur athletics is probably higher than most due to Brazilian Jiu Jitsu, but the 10 pounds of muscle I've put on since October makes me "obese" when calculating BMI. I think things like being able to run/exercise for a certain period of time, bodyfat %, or being involved with some sort of strenuous activity outside of work would be better approximators of physical fitness, and the discount. I do like the no-nicotine and low blood pressure and cholesterol criteria, though.

Cholesterol as a criteria leaves me a bit cold; there are genetic factors that make even skinny people struggle with high cholesterol. Additionally, total cholesterol does not tell the real story, whereas HDL and LDL give a truer picture. But, do I want my employer to be privy to my private patient information vis a bis blood test results?

No.

Discrimination is a fine line and a slippery slope, but I'm all for providing incentives for healthy living. Think of the money saved if most employers did things like discounts on gym membership etc.

Come to think of it, why would WF give more discount to "healthy" employees, and less incentive to "unhealthy" employees? Seems counterproductive.

[jparrott]

"Here, buy this cheese. If not I'll eat it and have to pay 6 cents more for my coffee."

[hm212]

Cholesterol as a criteria leaves me a bit cold; there are genetic factors that make even skinny people struggle with high cholesterol. Additionally, total cholesterol does not tell the real story, whereas HDL and LDL give a truer picture. But, do I want my employer to be privy to my private patient information vis a bis blood test results?

No.

I would have a huge issue giving out this information to anyone besides a doctor. What is the company doing with this information? Where are they storing it.

Stupid ideas like this are the reason even stupider HIPPA laws were created (the basic idea was good, but as usual implementation and interpretation are rediculous).

[stickmoon]

Come to think of it, why would WF give more discount to "healthy" employees, and less incentive to "unhealthy" employees? Seems counterproductive.

My guess is because they're trying to encourage a more healthy group of employees, something that will likely save WFM money in health care insurance premiums.

[monavano]

Because a healthier group of employees will likely save WFM money in health care insurance premiums.

But wouldn't you want to give the less healthy employees just as much incentive/discount so that they buy more healthy foods? I presume that's the intent vs. well, exercising your discount on triple cream cheeses

[stickmoon]

But wouldn't you want to give the less healthy employees just as much incentive/discount so that they buy more healthy foods? I presume that's the intent vs. well, exercising your discount on triple cream cheeses

Yeah I see your point...there are many ways WFM could try to create incentives for their employees to be more healthy. I can just imagine the next such policy: "30% employee discount on rice cakes, 10% discount on brie!" What they're trying may not work, and I would be uncomfortable handing over that medical information to my workplace, but I think their motivation is to lower health insurance premiums.

[Keithstg]

Yeah I see your point...there are many ways WFM could try to create incentives for their employees to be more healthy. I can just imagine the next such policy: "30% employee discount on rice cakes, 10% discount on brie!" What they're trying may not work, and I would be uncomfortable handing over that medical information to my workplace, but I think their motivation is to lower health insurance premiums.

WRT the "next such policy", a friend of mine works for a pretty large privately held company. The company's owner / ceo sets bonus targets for a group of employees each year. In the conversation with my friend, the CEO gave out the bonus figure, then added - "but if you quit smoking, your bonus will be 10% more". While my friend's smoking status isn't medical information per se, I thought the situation more than a little odd.

I agree that least one of WFM's aims seems to be lowering health insurance premiums - but that's nothing new. In fact, my employer has all types of health related incentives for employees in terms of free yearly physicals for officers, health questionnaires that provide a monthly discount on the premium, etc. The food discount is similar, but based on more invasive criteria (depending on your personality, I guess). I'd be interested to know what effect the policy has a year from now.

[DanCole42]

As with any policy designed to do anything, this will be unfair to certain individuals.

For the population as a whole, it will likely improve health and save the company money.

Percentage-wise, everyone wins.

I do not have a problem with this.

[Waitman]

But wouldn't you want to give the less healthy employees just as much incentive/discount so that they buy more healthy foods? I presume that's the intent vs. well, exercising your discount on triple cream cheeses

I think the idea is that you put the carrot in front of the horse, so that the horse moves in that direction, rather than giving them the carrot where they're standing and trusting them to cantor onwards.

I don't have too much of a problem with this. It would see that someone about their BMI would be more worried about snarky co-workers than a number on a hard drive.

The real problem, of course is, is that it's a step towards employment discrimination based on insurance costs. "I can't hire you, because your BMI/blood pressure/ noctine hobby/affection for gin will throw off the cost curve."

Given that BMI is probably less accurate as a predictor -- high blood pressure is high blood pressure, but high BMI can be the result of a couple of different things -- you'd think there'd be a company doctor somewhere to certify that so-and-so is cool despite the high BMI.

[jayandstacey]

This doesn't seem problematic. Not perfect on either side (the criteria or employee reward) but generally pretty good and obviously vetted by the insurance co.

As for becoming a part of the hiring decision, the law protects against hiring decisions based on factors other than a person's ability to perform the job. Of course the law is often skirted, but I don't think this becomes any kind of systemic hiring problem.

[KMango]

...the law protects against hiring decisions based on factors other than a person's ability to perform the job...

Protected classes don't include the overweight or obese. Thus far, anyway.

(kmango is not an eeo attorney)

(and does not play one on tv)

[deangold]

According to my cardiologists and endocrinologists (remember I had a heart attack while living on a solcely Whole Foods Diet} BMI has little explanatory value after controlling for BP, HLD/LDL ratios, diabetic status and past cardiac history. I have seen no evidence tothe contrary and even the CDC who pimps BMI says that is is powerful because it is easy to compute and cheap. It also skews across ethnicities so it seems to be a proxy for racial discrimination.

So the simplistic notion seems to be wrong headed.

[Heather]

What about type 1 diabetics? People with autoimmune diseases? Cancer survivors? There are people whose health relies on medical care, not just diet & exercise. As Waitman said, this looks like a step towards employment discrimination based on health care costs.

[jayandstacey]

Protected classes don't include the overweight or obese. Thus far, anyway.

(kmango is not an eeo attorney)

(and does not play one on tv)

I'm not an attorney either, but spend way too much time in their vicinity. Agreed - I should have been more clear - that the law generally protects against such practices. While not named, it isn't a big leap to pull BMI into a protected class violation claim, say via race or disability ("My high BMI is due to thyroid issues...or my American Indian heritage"). And while the claim may not be valid and may not win, that doesn't matter - the hiring company isn't mainly concerned with losing such a case, rather the concern is the expense and negative media exposure (both of which can happen win or lose). So in this way, the law provides the defacto protection, if not the stated protection. To that end, I've always thought that the best corporate attorneys aren't ones that simply know the precise law very well, rather ones that know how to run a business within the real-life bounds the law places upon it.

Of course with WF this isn't a hiring decision, rather an employee discount - thus not a regulated perk. I haven't looked at the policy, but I'm quite sure WF considered how this might play out in the press and how defenisble the policy would be in the court of public opinion. I'd bet that a big part of the defense would be to point to the insurance company and say "they are making us pay more or less based on BMI and other related factors. Where we can save, we're merely passing on the savings to our employees."

I'd be much more impressed if WF passed along the savings in the form of a reduced health insurance premium, with WF picking up the difference based on what it saved. "You helped reduce our health insurance costs - now go buy more of our stuff, and THEN we'll give you a little back. But only if you buy stuff." Big whoopdie-frickin-do.

[jayandstacey]

What about type 1 diabetics? People with autoimmune diseases? Cancer survivors? There are people whose health relies on medical care, not just diet & exercise. As Waitman said, this looks like a step towards employment discrimination based on health care costs.

Yes, I'd agree that it is heading that direction - but it isn't there. I think WF would say two things:

1. We are not making any distinction based on medical need.

2. Even with those needs, we believe (more precisely, our insurers believe) that such diseases are best fought with a body that is otherwise healthy and maintained. And we feel that a mix of factors as we've laid out, to include BMI and others, are a simple indication of such baseline health. We undertand it isn't perfect and that only a thorough examination of all health factors by the family doctor can provide an indication of the best health for each individual. We are simply using this as a quick and easy rule of thumb to act as an encouragement for our employees to take an active part in their health. (or some other similar corporatese)

Don't get me wrong - I'm not a huge fan of it, but its not like this is the first health-related perk a company has ever given out. And I suspect the insurance company is partially hoping that a handful of people will take the screening test and use the results to drive to a better discount. They can pretty much only do that through diet and exercise - thus resulting in a person less likely to incur a big health expense.

[Waitman]

It's all part of the Rollerball scenario. Large corporations get to fund elections, sink their mosquito-like proboscises into the federal treasury, continuously merge into larger and more powerful entities and tell you what you can and cannot eat, drink or weigh, on and off the job. It's not Big Brother. It's Big Shift Boss.

[Al Dente]

and i thought i was a cynic....

[lperry]

It seems to me that this move is part of an overall trend toward putting obesity into the same category as tobacco use now is: a health issue that is under personal control, and that costs us all a great deal of money. I think the fear is that fat people, who already face discrimination, will become demonized. There are also the very personal and culturally important aspects of food to consider, and the fact that people just don't want to be told what to do. As an anthropologist who studies food, I find the discussion fascinating.

[jayandstacey]

It's all part of the Rollerball scenario. Large corporations get to fund elections, sink their mosquito-like proboscises into the federal treasury, continuously merge into larger and more powerful entities and tell you what you can and cannot eat, drink or weigh, on and off the job. It's not Big Brother. It's Big Shift Boss.

Didn't he used to be called The Man?

I suspect this is limited to just an extra 10% off more nom-nom. However, proboscises can be tricky, and you can never be 100% that one isn't in mid-sinkage at any moment.

[Anna Phor]

If I ever shopped at WF, this would make me stop immediately. I don't, so I guess it's a moot point.

[jayandstacey]

If I ever shopped at WF, this would make me stop immediately. I don't, so I guess it's a moot point.

Really? Each company I've worked for in the last 15 years has had some version of reward for health. Some were simple weight-loss competitions. Most aren't publicly announced. I suppose this one made the paper for the "low BMI = a discount on food" angle. What in particular about this would make you an ex-patron?

[Pat]

Really? Each company I've worked for in the last 15 years has had some version of reward for health. Some were simple weight-loss competitions. Most aren't publicly announced. I suppose this one made the paper for the "low BMI = a discount on food" angle. What in particular about this would make you an ex-patron?

It probably made the paper because it was Whole Foods. Mackey's previous comments on related matters are a bonus.

[Anna Phor]

Really? Each company I've worked for in the last 15 years has had some version of reward for health. Some were simple weight-loss competitions. Most aren't publicly announced. I suppose this one made the paper for the "low BMI = a discount on food" angle. What in particular about this would make you an ex-patron?

I don't think I've ever worked anywhere that had a policy like this, but 3 major reasons:

1. it's discriminatory in a way that might be legal but that I believe is unethical;

2. I don't think employers have the right to get that deep into their employees' personal lives;

3. I'm not sure it even correlates well with the stated goal--the link between BMI and health is fairly hotly contested.

[jayandstacey]

I don't think I've ever worked anywhere that had a policy like this, but 3 major reasons:

1. it's discriminatory in a way that might be legal but that I believe is unethical;

2. I don't think employers have the right to get that deep into their employees' personal lives;

3. I'm not sure it even correlates well with the stated goal--the link between BMI and health is fairly hotly contested.

OK, but I think it runs a little deeper than that and thus isn't so cut-and-dry.

The goal of the program is for WF to reduce their health insuance costs. To do that, they worked with their ensurer to determine what numbers would be needed. And then set up a measurement program for all that - using smoking, BMI, cholesterol and blood pressure to combine into a tiered level of overall health. BMI alone does not determine the discount level.

To that end, it would seem:

- that this is only as discriminatory as heath care is. If an employee has an issue with it, they can simply forego the WF offer and either get their own health insurance, or just not get measured.

- that WF doesn't seem particularly interested in any more details of employee personal business than can save them some money. And it seems all that WF sees is some 'net health score like platinum, gold, silver...and they may not even see that connected to an employee's name. The service conducting the tests may only give WF generic data, as WF wants no part of HIPAA or other complications.

- BMI may not correlate to health, but it's hard to argue that the combination of the four factors isn't an OK representation. And while even that is debatable, what isn't debatable is that WF will save some money if the numbers look good - which accomplishes their goal of reducing heath related costs.

[deangold]

Th elinl to mortality and health care of BP, Cholesterol and smoking are all well known and pretty strong. But there are myriad studies that show no effect of BMI when these others and waist circumference are put in. Its just that BMI is not a very good measure of anything when you have other measures available. BMI has well know biases against prople with high percentages of body mass {athletes} and preople with certain genetic dispositions. When I was in my best shape and regularly lifting weights, my sedical team said that BMI was BS in my case as other measurements indicated I was not overweight yet BMI said I was.

Bad science is bad science. Whole Foods should be able to do better. They should also be able to do better than to peddle industrial milk greenwashed as Horizon, which is part of Dean Foods.

[Anna Phor]

- this is only as discriminatory as heath care is. If an employee has an issue with it, they can simply forego the WF offer and either get their own health insurance, or just not get measured.

But it's about the employee discount program, no? The insurance premiums that employees pay aren't affected. So I don't think there really is a viable opt-out here; also, the difference between the cost of individual & group healthcare means that opting out of your employer's insurance for reasons of principle is really a luxury, not a choice.

- that WF doesn't seem particularly interested in any more details of employee personal business than can save them some money.

Sure. Would it be okay if they extended discounts only to those employees who didn't drive in cars? Or to be even more pointed, what about if they only extended discounts to employees who practiced safe sex?

(Sorry if this is terse; I don't mean to be short--I'm wrangling an infant as I type.)

[mdt]

Am I missing something? Is this really that big a deal? All they are doing is something to possibly get employees to think about their personal health and well being by providing a carrot in the form of a larger discount on items they decide to buy. If this in turn saves the company money is that bad?

[Waitman]

Am I missing something? Is this really that big a deal? All they are doing is something to possibly get employees to think about their personal health and well being by providing a carrot in the form of a larger discount on items they decide to buy. If this in turn saves the company money is that bad?

I fear you are unaware of the emotion and controversy anything having to do with body weight arouses in some circles, particularly among new wave (third wave? fourth wave? I've lost track) feminists (check out leleboo's link to the Jezebel site). Quite a touchy subject.

[Heather]

Is the discount only offered on "healthy" products, or do the low-BMI employees get to use it on ice cream, slab bacon, and lasagna?

[Michael Landrum]

Is the discount only offered on "healthy" products, or do the low-BMI employees get to use it on ice cream, slab bacon, and lasagna?

Only if they own a cat named "Garfield."

[jayandstacey]

- this is only as discriminatory as heath care is. If an employee has an issue with it, they can simply forego the WF offer and either get their own health insurance, or just not get measured.

But it's about the employee discount program, no? The insurance premiums that employees pay aren't affected. So I don't think there really is a viable opt-out here; also, the difference between the cost of individual & group healthcare means that opting out of your employer's insurance for reasons of principle is really a luxury, not a choice.

When a company offers health insurance, they typically cover a large portion of the premiums. So you might have $50 deducted from a paycheck and the company is kicking in $200 each pay - this is especially true in larger companies like WF. So yes, on the surface, WF is offering discounts to their employees for this health info. But what they are REALLY doing is finding a way to respond to their insurance company, who presented them with some form of a simple request - show us evidence that YOUR pool of employees is better than the average pool of employees with unknown health, and we'll give you a discount on every policy. This is a discount on the $200 WF pays, not the $50 the employee pays. I don't know if the discount unique to each individual policy or a blanket reduction in premiums - but an insurance company finds great value in simply having this basic information - and even more value if the numbers are good.

So WF wants this discount, it is likely quite large over such a large employee pool. They do NOT want the info - they want the insurance company to get it, so they get their discount. They have to find some carrot to encourage people just to get measured - and have determined that an extra 10% employee discount is enough to incent, but not enough out of their pocket to outweigh the savings in insurance premiums,

This is very much about what WF pays to insure its employees.

- that WF doesn't seem particularly interested in any more details of employee personal business than can save them some money.

Sure. Would it be okay if they extended discounts only to those employees who didn't drive in cars? Or to be even more pointed, what about if they only extended discounts to employees who practiced safe sex?

(Sorry if this is terse; I don't mean to be short--I'm wrangling an infant as I type.)

NP.

The rules around what can and can't be calculated into insurance actuarial tables are pretty clear. And WF will only ask those questions that are directly related to saving money on their insurance premiums, those dictated by their insurance company. They really don't care about the actual health (except to the extent of missed work days and other performance impacts) and would not ask these questions unless deemed OK by the insurance co.

[jayandstacey]

Am I missing something? Is this really that big a deal? All they are doing is something to possibly get employees to think about their personal health and well being by providing a carrot in the form of a larger discount on items they decide to buy. If this in turn saves the company money is that bad?

Nope.

The article is pretty misleading though, with the poll asking something like "Should only WF reward employees with a low BMI?" That's not what's happening.

[jayandstacey]

Th elinl to mortality and health care of BP, Cholesterol and smoking are all well known and pretty strong. But there are myriad studies that show no effect of BMI when these others and waist circumference are put in. Its just that BMI is not a very good measure of anything when you have other measures available. BMI has well know biases against prople with high percentages of body mass {athletes} and preople with certain genetic dispositions. When I was in my best shape and regularly lifting weights, my sedical team said that BMI was BS in my case as other measurements indicated I was not overweight yet BMI said I was.

Bad science is bad science. Whole Foods should be able to do better. They should also be able to do better than to peddle industrial milk greenwashed as Horizon, which is part of Dean Foods.

Well, but this is

- Driven by the insurance co

- Is about cost, not health.

- And we don't know where the BMI line is. I have to believe there's a line in BMI where the ratio is so high, call it morbidly obese, that circumstances like athletes are not up in that range. For all we know, BMI only factors in if an employee measures some "way off the chart" number, and only then moves them from platinum to gold status.

On another point - is it fair to say WF is generally greenwashed? There's a guy not far from here raising goats and making cheese. It is good and available in my locally owned, small, green grocer. If that guy walks in the door at the local WF, is there any opportunity for him? I guess WF seems better than Giant, sort of...

[jayandstacey]

I fear you are unaware of the emotion and controversy anything having to do with body weight arouses in some circles, particularly among new wave (third wave? fourth wave? I've lost track) feminists (check out leleboo's link to the Jezebel site). Quite a touchy subject.

As in WF touching their employees?

Sorry, couldn't resist. But I can't add any more to this thread.

[deangold]

Well, but this is

- Driven by the insurance co

- Is about cost, not health.

- And we don't know where the BMI line is. I have to believe there's a line in BMI where the ratio is so high, call it morbidly obese, that circumstances like athletes are not up in that range. For all we know, BMI only factors in if an employee measures some "way off the chart" number, and only then moves them from platinum to gold status.

On another point - is it fair to say WF is generally greenwashed? There's a guy not far from here raising goats and making cheese. It is good and available in my locally owned, small, green grocer. If that guy walks in the door at the local WF, is there any opportunity for him? I guess WF seems better than Giant, sort of...

Again

There is significant evidence that health care cost are not driven by BMI once Waist circumfrence. BP, and cholesterol is brogught in. Read what I have posted. I am not arguing against WF taking action about things that matter. But BMI does not matter once the proper variables are accounted for. Thats all.

My link

By the way, WFM self insures.

Whole Foods is green washed when their primary dairy is Horizon, their meat supplier is Meyer {who used a simply atrocious abbatoir, did not have proper handling guidelines on their meats etc}. Yes they have a smattering of local product, but walk their produce section. Earthbound farms and Calo organics are the big guns and that is greenwashing. Is better than Giant is the standard to be held to? Because that standard seems to be fairly low. Their fish selection contains much that is red listed by Monterrey Bar Aquarium and Blue Oceans Institute.

Whole foods does a much better job at supporting artisan production than they do at sustainable.

[zoramargolis]

from a follow-up article on the Jezebel site:

Yes, there's a place in our society for encouraging healthy eating and exercise — walkable cities and an end to corn subsidies would be a start. But one reason we need universal health care so badly is so that those who control our jobs don't also control our bodies. Whole Foods's program could be a lot worse, but it still illustrates the way in which employer-based health care can turn bosses into amateur doctors and actuaries — and sick employees into liabilities to be managed or even eliminated.

click

[jayandstacey]

Again

There is significant evidence that health care cost are not driven by BMI once Waist circumfrence. BP, and cholesterol is brogught in. Read what I have posted. I am not arguing against WF taking action about things that matter. But BMI does not matter once the proper variables are accounted for. Thats all.

My link

By the way, WFM self insures.

OK, I get it. Waist size should have been used instead, or just the other factors. But not BMI. Maybe they could get the employees to sit in a bucket filled with water, then measure how much spills out. Call it BMD - butt mass displacement.

[jayandstacey]

click

You know, the article points out the key distinction that has me re-thinking this whole thing. They are rewarding a person's state, not their actions. I mentioned that each of the places I've worked the last 15 years (3 fortune 500s) has had some kind of incentive for health - but now that I think about it, ech of those incentives was for a healthy action, not the state. For instance, one was simply Get a checkup and get a discount (or a gift card or something). That's sound advice for anyone, and only divided the employees into two classes - those that went and those that didn't. And sometimes a person's state can't be helped, and that may be protected under the law. Seems obvious now, seemed inocuous a minute ago.

Hmmmm

[jayandstacey]

By the way, WFM self insures.

WFM uses UnitedHealthCare PPO. By self-insure, do you mean they pay 100% of the premium?

[DanielK]

WFM uses UnitedHealthCare PPO. By self-insure, do you mean they pay 100% of the premium?

No, that means WFM pays UntedHealthCare to administer the program, but the actual costs of claims are born by WFM. WFM is betting that the claims made will be less than the premium they would pay to UHC.

[jayandstacey]

No, that means WFM pays UntedHealthCare to administer the program, but the actual costs of claims are born by WFM. WFM is betting that the claims made will be less than the premium they would pay to UHC.

Cool, makes sense. Thanks.