There can be little doubt or dispute that Americans are getting fatter. By some estimates, in the near future 40% of Americans will be obese, and the trend keeps rising. Obesity is the breeding ground for ill health, as it can cause high blood pressure, type II diabetes in adults, heart disease, and stroke. It also reduces the quality of life due to the inability to accomplish physical tasks leaner people can do with ease. Obesity in children is especially alarming, and is growing at an especially high rate. Increased ill health means increased medical costs and increased claims on health insurance policies. The situation has spurred government, private industry, and the insurance companies to begin implementing health insurance programs designed to entice people to lose weight, as well as make healthier lifestyle choices.

Some of these programs take the road of using the proverbial carrot, and some are designed to use the stick. On the carrot side, some companies are paying closer attention to employee's health, and in one example, offered a flat $120 bonus to anyone who filled out a health evaluation questionnaire. Another implemented a contest between divisions as to which one would fill out the most health risk assessment forms, with the winner receiving a free healthy lunch. Another has set up a support system for anyone identified as being in a higher risk category who decides to exercise more or use a company healthy lifestyles coach.

Of course, positive incentives go along with punitive consequences, even in the same company. The firm that paid its employees to fill out health risk assessment questionnaires may decide the next year that anyone who didn't fill one out would be required to pay more every month into the insurance pool. Some states are requiring public employees to undergo testing for tobacco use (under fire from public employee unions), and establishing the employees' BMI or body mass index, with the result that those who smoke or whose BMI is past a certain level must pay more for health insurance premiums. In fact, increased insurance premiums and co-pays are the main stick used to prod people into making healthier lifestyle choices.

Childhood obesity is being targeted on several fronts. State governments are funding pilot programs aimed at reducing the rate of childhood obesity, and in-school education programs have been established to try to wean the kids from unhealthy food alternatives. In addition, the recently passed health care bill mandates the establishment of programs aimed specifically to try to reverse the trend towards fatter kids.

It's clear that health insurance programs are increasingly concerned with reducing the obesity epidemic, and will continue to be for the foreseeable future.