by Iain Roberts on 3 January, 2013
The media is carrying a story about proposals to force obese people on benefits to go to the gym – or lose money.
Obese who refuse to exercise “could face benefits cut” says the BBC.
Obese and unhealthy people could face benefit cuts says the Guardian.
I need to say two things about these proposals.
First, despite the misleading headlines, these are not Government proposals. It seems to be some piece of work jointly between Westminster Council and the Local Government Information Unit, which has probably got more prominence that it should in the relatively quiet first few days of January.
Second, the proposals as reported are – in my opinion – utter nonsense.
The suggestion is that, as councils take over responsibility for public health (which is generally a positive development), they can force obese people on benefits to exercise or risk losing some of their benefits.
Let’s look a just a few of the reasons why this is a really, really bad idea that should swiftly be consigned to the dustbin.
1. The evidence that being overweight or obese leads to poorer health outcomes is surprisingly mixed. There’s actually strong evidence that being “overweight” (BMI 25-30) is healthier than having a “normal” BMI of 18.5-25. Being underweight (BMI less than 18.5) is almost certainly worse for your health than being obese. If you were taking an evidence-based approach, you’re main priority would be to focus on underweight people. Studies vary on health outcomes for obese people (BMI 30+) but the totality of evidence seems to suggest that being obese (as opposed to morbidly obese) is no worse for your health than being normal weight. See for example this 2009 study and this new meta-study looking at 2.88 million people.
2. Offering financial bribes/punishments alone is quite a bad way to encourage people to change behaviour. How many people sign up to attend a gym and then rarely, if ever, attend, despite a sizable chunk of money leaving their bank account each month?
3. Councils can monitor their own facilities, and perhaps penalise people for not using them, but what if (like me) you hate gyms but really enjoy cycling or walking? What if you want to play some other sport? Building a fair system to monitor people’s exercise would be almost impossible (and certainly very expensive and intrusive).
4. People on benefits are an easy group to punish, and you might think this is also the group with the problem. Actually, it isn’t – and neither are children – to a large extent. Middle aged men – regardless of income or class – are by far the most likely to be overweight or obese. If this is really about improving the health of the population, getting the target group right would be a good start.
5. If you’re going to attack one group – obese people – and threaten to remove their benefits, why not others who indulge in “risky” behaviour? Smokers, drinkers, skiers and rugby players should logically be targetted. Is that the society we want to live in? I know I don’t.
6. Where people are worried about their own weight and actively want to change (and many do) there are already tools we can use to help. Doctors can prescribe Weightwatchers membership, for example. In Stockport we have a sports centre (Avondale) specially designed to help people who want to get back into exercising. Equipment is designed for larger people, a section of the gym can be screened off and special classes and help are available.
Please note that I am criticising this one idea, which is the one that’s caught the media’s imagination and got a lot of coverage. As is often the way, there are many other ideas in the paper and a lot of them are very good.
You can read the LGiU paper here (pdf) – it’s readable and only nine pages long. The actual text relating to this idea in the paper is short and reads:
Linking welfare measures to behaviours that promote public health. Relocalisation of council tax benefit and housing benefit combined with new technologies provide an opportunity for councils to embed financial incentives for behaviours that promote public health. The increasing use of smart cards for access to leisure facilities, for instance, provides councils with a significant amount of data on usage patterns. Where an exercise package is prescribed to a resident, housing and council tax benefit payments could be varied to reward or incentivise residents.