Li J, Linnan L, Finkelstein EA, Tate D, Carolyn Naseer, M.A.,c and Kelly R. Evenson,, N C Med J. 72(3):183–190., 2011 May 01
Background: We investigated overweight state employees’ perceptions about health insurance benefit changes designed to reduce the scope of health benefits for employees who were obese or smoked.
Methods: Prior to implementation of health benefit plan changes, 658 overweight [body mass index (BMI) ≥25 kg/m2] state employees enrolled in a weight loss intervention study were asked about their attitudes and beliefs of the new benefit plan changes.
Results: Thirty-one percent of employees with a BMI≥40 kg/ m2 were unaware that their current BMI would place them in a higher risk benefit plan. More than half reported that the new benefit change would motivate them to make behavioral changes, but less than half felt confident in making changes. Respondents with a BMI≥40 kg/m2 were more likely to oppose the new changes focused on BMI categories compared to respondents in lower BMI categories (P<0.0001). Current smokers were more likely to oppose the new benefit change focused on tobacco use than former smokers and non-smokers (P<0.01).
Limitations: Participants represented a sample of employees enrolled in a weight loss study, limiting generalizability to the larger population of state employees.
Conclusions: Benefit plan changes that require employees who are obese or smoke to pay more for health care may motivate some, but not all, individuals to change their behaviors. Since confidence to lose weight was lowest among those in the highest weight categories, health plan benefit modifications may be required to achieve desired health behavior changes.