Alabama will be the first state to charge overweight state workers who don't work on slimming down, while a handful of other states reward employees who adopt healthy behaviors.
Alabama already charges workers who smoke - and has seen some success in getting them to quit - but now has turned its attention to a problem that plagues many in the Deep South: obesity.
The State Employees' Insurance Board this week approved a plan to charge state workers starting in January 2010 if they don't have free health screenings.
If the screenings turn up serious problems with blood pressure, cholesterol, glucose or obesity, employees will have a year to see a doctor at no cost, enroll in a wellness program, or take steps on their own to improve their health. If they show progress in a follow-up screening, they won't be charged. But if they don't, they must pay starting in January 2011.
"We are trying to get individuals to become more aware of their health," said state worker Robert Wagstaff, who serves on the insurance board.
Not all state employees see it that way.
"It's terrible," said health department employee Chequla Motley. "Some people come into this world big."
Computer technician Tim Colley already pays $24 a month for being a smoker and doesn't like the idea of another charge.
"It's too Big Brotherish," he said.
The board will apply the obesity charge to anyone with a body mass index of 35 or higher who is not making progress. A person 5 feet 6 inches tall weighing 220 pounds, for example, would have a BMI of 35.5. A BMI of 30 is considered the threshold for obesity.
The board has not yet determined how much progress a person would have to show and is uncertain how many people might be affected because everyone could avoid the charge by working to lose weight.
But that's unlikely - government statistics show Alabamians have a big weight problem. According to the Centers for Disease Control and Prevention, 30.3 percent are now obese, ranking the state behind only Mississippi.
E-K. Daufin of Montgomery, a college professor and founder of Love Your Body, Love Yourself, which holds body acceptance workshops, said the new policy will be stressful for people like her.
"I'm big and beautiful and doing my best to keep my stress levels down so I can stay healthy," Daufin said. "That's big, not lazy, not a glutton and certainly not deserving of the pompous, poisonous disrespect served up daily to those of us with more bounce to the ounce."
A recent study suggested that about half of overweight people and nearly a third of obese people have normal blood pressure and cholesterol levels, while about a quarter of people considered to be normal weight suffer from the ills associated with obesity.
Walter Lindstrom, founder of the Obesity Law and Advocacy Center in California, said he's concerned that all overweight Alabama employees will get is advice to walk more and broil their chicken.
"The state will feel good about itself for offering something and the person of size will end up paying $300 a year for the bad luck of having a chronic disease his/her state-sponsored insurance program failed to cover in an appropriate and meaningful fashion," he said.
William Ashmore, executive director of the State Employees' Insurance Board, said the state will spend an extra $1.6 million next year on screenings and wellness programs, but should see significant long-term savings.
Ashmore said research shows someone with a body mass index of 35 to 39 generates $1,748 more in annual medical expenses than someone with a BMI less than 25, considered normal.
According to the National Conference of State Legislatures, a few states offer one-time financial incentives for pursuing healthy lifestyles. Ohio workers, for instance, get $50 for having health assessments and another $50 for following through with the advice.
Arkansas and Missouri go a step further, offering monthly discounts on premiums for employees who take health risk assessments and participate in wellness programs to reduce obesity, stress and other health problems.
Alabama's new policy is drawing no objection from the lobbying group representing state workers.
Mac McArthur, executive director of Alabama State Employees Association, said the plan is not designed to punish employees.
"It's a positive," he said.