Food for Thought

The idea that “you are what you eat” in terms of influencing one’s overall health may soon be tested in a unique way. Increasingly, employers seeking to reduce health care expenses are targeting employees’ unhealthy lifestyle practices. But will these programs cross the line and invade employees’ privacy?

In a January/February article in Health Affairs, Paul Ginsburg, PhD, noted that while employers’ interest in wellness and health promotion has increased sharply, “whether employers will pursue programs that may be distasteful to employees has not yet been tested.” With ever-rising health care costs, driven in part by increasing prevalence of obesity, that may soon change.

Many of us participate in supermarket customer loyalty award programs in which we receive periodic discounts in exchange for sharing information on the specific items we purchase.

Safeway, which operates 17,380 supermarkets, is looking to combine the concepts of promoting employee wellness with tracking of food purchases in order to reward its employees for making healthful food choices and lower the company’s health care costs.

Participating employees would be asked to provide details about family members, how active their lifestyles are, and whether they have specific health issues. A nutritional analysis of food purchases would be rated using recommended consumption levels of 25 nutrients and vitamins compiled by the US Department of Agriculture (USDA). Employees who made healthful food choices (as defined by the USDA) would receive discounts on health insurance premiums.

Implementation is planned for 2009. “If someone wants to opt in to demonstrate a nutritious lifestyle, I think we will be the first company to grant premium reductions for that. I think other companies will follow,” said Steven Burd, Safeway’s chief executive, in the January 21 edition of the Financial Times.

Burd added that while such initiatives could be considered intrusive, he is using automobile insurance as a model. “If you have a lot of accidents, you pay more for your insurance. . . . Healthy behavior gets rewarded. Less healthy behaviors should bear their fair share.”

While “distasteful” could describe a company’s plan to monitor employees’ food choices, one can hardly blame employers for exploring novel ways to influence employee health habits in order to contain rising health care costs. Health care costs increased 6.7% in 2006. Even more disconcerting would be a government-run health care system that seeks to monitor and reward (or penalize) individual health-related behavior.

However, if individual responsibility is the goal, Safeway’s program may not go far enough. Another approach increasingly being talked about is to make it easier for individuals to purchase health insurance outside the employment-based system by providing the same tax benefits to individuals. Employment-based coverage may not be the most practical or cost-effective option for everyone. Insurance companies are beginning to offer more reasonably priced individual products. The incentives for cost containment and responsible behavior are best aligned when individuals can make and accept consequences for choices they make themselves, including food and lifestyle choices. Now, where is that cookie aisle?