Fat people in Arizona told: ‘Diet or be fined’

Overweight welfare claimants in the US state of Arizona face paying fines if they don't follow diets laid down by their doctor. Is that fair?

In this global recession, with everyone cutting costs, the state of Arizona is proposing a radical idea.

It wants to impose a $50 (£31) annual fine for overweight Medicaid recipients who don't follow a health regime developed with their doctor.

Medicaid – the programme which provides healthcare for the poor – is expensive. It costs the US federal and state governments $339bn (£209bn) a year, and this figure is climbing 8% annually.

Something has to be done and Arizona believes the overweight – who comprise 25% of the state's population – can help out.

Monica Coury, assistant director at Arizona's Medicaid programme is clear: 'If your doctor believes you can do something about your weight and prescribes a regime for you and you choose not to follow it, your treatment – for heart problems in later life, for example – is costing more and we're asking you to put something back to the system.'

In the UK, with our National Health Service, medical treatment is free whenever we need it. In the US, however, people need health insurance to cover the costs. Those who can't afford insurance rely on Medicaid, so this move to fine obesity will only affect the poor.

But is poverty itself part of the problem? Ziporah Janowski, from Camp Shane weight loss camp in Arizona believes it is

'The reason people are obese is complicated and saying 'eat less' is not enough. People don't have access to grocery stores that carry healthy foods, don't have the funds to buy them and don't have the education to know what to buy.'

Wes Benedict of the Libertarian Party has other issues with the scheme, believing it's just another example of nanny-state interference.
'If you want to save the state money,' he says, 'which libertarians do, cut Medicaid across the board, but don't single out overweight people and smokers.'

But Arizona, with the second-highest proportion of Medicaid recipients in the US, is keen to act and will do if it gets the thumbs up from Washington.

Feeling fine
The US Center for Disease Control and Prevention has named obesity as the number one health risk facing America.

It estimates that obesity – being 30% over the ideal body weight for your height – causes 400,000 deaths a year in the US and costs the economy $123bn (£76bn) per annum.

Expanding waistlines bring expanding costs, and with states across the country facing huge budget cuts, the Arizona experiment is being closely watched.

Is a 'Fat Fine' the future for America's poor?

You Decide

  1. 'Obese people should be educated - not fined.' Discuss.
  2. Only 5% of people lose weight and keep it off for five years. Is obesity an unsolvable problem?


  1. Draw up a five point 'Health plan for Humans'. What will it include?
  2. An Arizona resident is furious at discovering they might be fined for obesity. Write a letter to them. What do you want to say?

Some People Say...

“If you get ill and it's your own fault, you should pay for your treatment.”

What do you think?

Q & A

What causes obesity?
Essentially, excess weight is caused by an imbalance between energy in – what's consumed through eating – and energy used by the body, over a prolonged period.
Didn't President Obama want to increase funding for healthcare?
He did. He wanted to extend health cover, increasing costs to states by billions of dollars. But the Republicans opposed him and their budget proposal caps the government contribution. This saves central government an estimated $750bn (£463bn) over 10 years – but forces states to make cuts.
Why is obesity so expensive for healthcare systems?
There are many obesity-related conditions such as heart diseases, diabetes and polycystic ovary syndrome. While obesity in pregnancy brings higher risks of still birth, foetal abnormalities or the mother suffering pre-eclampsia.


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