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Pay as you weigh an unfair pricing strategy
Playing a game of blame and shame is not a const ruct ive solut ion t o t he obesit y problem
A version of this commentary appeared in the Globe and Mail, Vancouver Sun and the Edmonton Journal T his week the wires were active with suggestions that people with obesity pay more f or airline travel. T his discussion was prompted by a Samoan airline announcing that they would begin charging passengers by the pound. It was also stimulated by Bharat Bhatta, an economist f rom Norway suggesting that heavier passengers pay a surcharge while lighter passengers are of f ered discounts. T he logical argument of course is that larger individuals take up more space and use up more jet f uel. T his line of reasoning is sure to f ind ample supporters, as people who “choose” to be f at must clearly bear the consequences of their gluttony and sloth. But why stop at airline travel? Here are some additional ideas f or where businesses could charge larger individuals more: 1. Cab rides: T his is not just to cover additional f uel costs but also to pay f or wearing out the suspensions (assuming that these actually exist in cabs); 2. Hotel rooms: Not only will this cover the mattress surcharge but also cover the cost of the increased consumption of water, soap and extra towel required to “service” the greater body surf ace; 3. Gym memberships: To cover the additional wear and tear on the treadmills and other exercise equipment; 4. Amusement park rides: To pay f or taking up more space, using more electricity and taking longer to load and of f -load; 5. Ball games: For occupying an extra seat and obstructing the view. Why not add all of these to the list of things that obese people are already paying more f or like health and lif e insurance, oversized clothing, bigger cars and sturdier home f urniture? T hat will certainly teach them to f inally see the light and begin shedding those pounds. But wait — did anyone mention that obesity rates are already markedly higher in poor income neighbourhoods, and that being obese already reduces an individual’s chances of employment and promotion despite ability? T he assumption underlying the “pay as you weigh” pricing strategies is that body size is a matter of choice and responsibility. Unf ortunately, f or most this is not the case. Let me state it clearly: Obesity is not simply a matter of laziness, overindulgence or lack of will power. It is a result of complex and diverse drivers of weight gain, including genetics, medications, stress, depression, addictions, eating and sleeping disorders and gut bugs — to name just a f ew.

T he f act that obesity is f ar less under individual control than generally assumed is f urther evident f rom the f act that f ewer than one in 20 individuals embarking on a weight loss attempt are likely to keep any of the weight of f . T he jury is still out on whether such f ailed attempts at weight loss are detrimental to health — they certainly are to the ego. T here could also be a number of unintended consequences of such a “pay as you weigh” policy, such as people starving themselves and abusing diuretics, laxatives and anorexic agents (including tobacco) to lose weight prior to boarding a f light. Such unhealthy weight-control practices are already widespread amongst competitive athletes who participate in sports that involve weight categories (e.g., boxers and wrestlers). T his could be lif e threatening when it involves patients who are on medications f or blood pressure or diabetes, where even short term attempts at weight loss can result in increase health risks, such as stroke and hypoglycaemic shock, f or example. A single emergency landing because of a diabetic patient skipping breakf ast bef ore weighing in f or a f light would by f ar outweigh any potential savings to the airline (not to mention the inconvenience to other passengers). Ultimately, however, it is a matter of f airness. If airlines wish to treat their passengers like cargo, then a pay-as-you-weigh policy may appear justif iable. But if an airline sees itself as providing a service, namely, transporting human passengers, then the average price of a ticket (and the average size of a seat) should increase. T his is the only f air distribution of costs, and the only f air way to accommodate everyone. Playing a game of blame and shame is not a constructive solution to the obesity problem. Arya M. Sharma, MD, is an expert advisor with, Professor and Chair in Obesity at the University of Alberta and Scientific Director of the Canadian Obesity Network.

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