A minor controversy ignited when President Obama nominated Regina Benjamin, who is slightly overweight, for Surgeon General back in 2009. This controversy illustrates a cardinal idea for healthcare reform, putting aside the politics of fat. Obesity costs the healthcare industry billions each year, but prejudice towards the overweight, and ignoring the dangers of being underweight compounds the damage.

The healthcare bill will likely fail to penalize those that engage in risky or unhealthy behavior, in contrast to many insurance programs. Most health insurance companies charge those seen as high risk factors with higher premiums. Smokers and the overweight take the brunt of this policy, which makes sense, to a point.

Being overweight can lead to a litany of problems, from diabetes, to heart disease, and countless pains of the body. These ailments would lead to higher healthcare costs and should thus be compensated through higher premiums. This is not a foolproof concept, however, and needs to be reformed.

To begin with, while the overweight pay more in premiums, not all health problems are caused by weight. For issues such as disease, accidents, and other ailments not related to being overweight, compensation needs to be provided. If being overweight isn’t the reason for a claim, why pay extra?

Deductibles for claims not related to being overweight should be significantly reduced in order to compensate. Regulations will be needed; otherwise the compensation could be rejected for reasons as absurd as “the car wouldn’t have hit her if she was thinner.” Such arguments sadly do occur, but are unique to the government and big business.

The concept of what constitutes a healthy weight needs to be reevaluated, as well. A study by the CDC suggests that being slightly overweight will reduce the risk of death, as opposed to being obese or underweight. That is why the criteria for judging optimal weight should be based on health, not societal norms.

Despite the underweight having a higher risk of death than those slightly overweight or normal weights, they do not pay a higher premium. Societal prejudice towards the overweight is a likely cause, as well as a disposition to think of thinner as healthier. This is not always the case, as lack of body fat can reduce resilience to diseases. The insured who severely deviate from their healthiest bodyweight should be penalized with higher premiums, the over and underweight.

Two 2003 journals from Obesity research suggest that doctors are prejudiced towards overweight patients, blaming their weight for any ailment. This prejudice adds to healthcare costs for two reasons. The first reason is because those who are overweight often postpone regular checkups because of poor treatment by doctors. This causes preventable diseases to fester and worsen.

The second reason is misdiagnosis. Skin rashes, car accident induced leg pain, and other problems are often blamed on a person’s weight. Such perfunctory analysis means the real source of a patient’s illness might not be diagnosed until much later. By then, her condition may have deteriorated, because of societal prejudice.

All pronouns that have been used so far have been she, this is not an accident. A report for the Rudd Center for Food Policy & Obesity shows that the aforementioned prejudices are more pronounced for women. Whereas a man won’t see a decline in the quality of treatment until he’s at least 65 pounds overweight, for a woman it’s only 13 pounds. Even accounting for gender related body differences; this is still a large gap.

The politics of fat have been sapping healthcare funds for too long now. Reforms need to be made to adequately address costs from being overweight, but also underweight. The concept of healthy weight should be based on how it impacts the body, not a knee-jerk belief that being a little overweight is automatically bad.  If prejudices towards the overweight continue, it’ll continue to drive up healthcare costs, and that means higher costs for everyone.