by Marilyn Wann

So you're in perfectly good health, but you say to yourself, "I should get some health insurance."

If you're fat, most insurers will turn you down.

"That's illegal, isn't it?" you say. "Can they do that?" Well, they can and they do. It happened to me. And it's happening to lots of people. So I decided to investigate.

But is it discrimination?

"Fat people are discriminated against; let's face it," said Alan Diskin, a financial planner who has worked in the insurance industry for 20 years. He was also insurance committee chairman for NAAFA, the National Association to Advance Fat Acceptance. Up to 50 people contact NAAFA each year because they have been denied health insurance. Their weights did not fit on insurance industry height/weight tables.

"Discrimination by the insurance industry is a rampant and really serious problem," said Sally Smith, executive director of NAAFA. "It's just such a ridiculous issue. The whole concept of insurance is pooled risk. How can they exclude anyone?" she said.

One of Diskin's clients, a woman about 5'5" tall and 240 pounds, was turned down by eight companies in her search for disability insurance, despite the fact that she worked in a low-risk occupation, had a good income, and no health history to speak of Ñ the three main criteria insurers consider for that type of insurance. "They said she was overweight, that she was going to get a bad back and bad knees," Diskin said. "Why should this woman be turned down on the presumption that she'll develop a problem? You can presume that about everybody. I'm sure there are plenty of skinny people with bad backs and bad knees." In fact, he said very few people are denied health insurance because their weight is below the height/weight charts.

Are you really in good hands?

There are no federal laws or regulations that govern how insurers determine a person's eligibility. New York state passed a law prohibiting insurers from denying coverage for pre-existing conditions. Florida guarantees access to health insurance. But states make no guarantees that the premiums for such coverage will be affordable.

In this writer's experience, weighing five pounds more than the allowable amount meant the difference between the normal, $40/month policy and a $200/month policy for high-risk individuals. When asked why fat people had to pay more, a Blue Cross of California customer service representative said, "We don't publicly disclose our reasons for doing what we do." Most of the insurance company spokespeople contacted for this article claimed not to know about weight limits.

"We do have standard weights for eligibility," Blue Cross of California spokesperson Cam Freedlund admitted. People who get group insurance with Blue Cross (through work, for instance) are not screened, she said, but individuals, and those who enroll late in group plans, are. "Late enrollees need to fill out a health questionnaire. If their weight is at such a point, it may be a factor in whether their applications are rejected. But you have to be very, very overweight. For example, if someone is 5'6" tall and is 50 percent over what the medical community has said is the ideal weight, that person would have to weigh something like 231 pounds, and we could decline them," she said.

One wonders how the average football player would get health insurance if he were dropped from the team.

HMO's (health maintenance organizations) are no haven, either. Federally qualified HMOs cannot screen members of their group plans. But they can screen individual buyers. An HMO industry insider said this practice is probably very common.

What do those numbers mean?

How reliable are the tables that decide your healthcare fate? Most insurance charts are based on the Metropolitan Life Insurance Company (MLIC) Height and Weight tables, first published in 1942. The charts claim to list the weights at which people live the longest. Updated in 1959 and in 1983, the MLIC tables are based on data from more than four million life insurance policies.

Critics of the tables point out that since most policyholders are white men who can afford insurance, there is no way to tell whether the suggested weights result in long life for women, people of color, or poor people.

"Height/weight charts have been highly criticized over the years, because weight is not a very good predictor of death, except at the extremes," said C. Wayne Callaway, M.D., a researcher who helped formulate the federal government's recommended weight tables. "It's not as useful as family history or blood pressure levels, for example." "The Metropolitan Life Insurance Company said they want to get out of the business of making the charts. And the health insurance trade organization has said the charts are more of an embarrassment than a help," he explained. As a result, Callaway said insurers don't base eligibility on weight "except in the extreme."

The problem is that 60 percent of Americans weigh more than the height/weight tables allow. With so many people "in the extreme," it would be unfortunate if the tables were wrong.

The MLIC tables suggest different weight ranges for people with small, medium, or large frames. But the source data had no information about frame size, Callaway said. "Some clever fiction writer created frame sizes. I think they [insurers] were embarrassed the weight ranges were so wide," Callaway said. Without frame categories, a 5'5" tall woman could weigh between 117 and 155 pounds.

However, the government's height/weight tables indulge in a similar fiction, he admitted. Callaway's research committee found that optimal weight ranges were the same for both men and women. But the U.S. Department of Agriculture and the U.S. Department of Health and Human Services published the chart in 1990 with a footnote to the contrary. It reads, "The higher weights in the ranges generally apply to men, who tend to have more muscle and bone; the lower weights more often apply to women, who have less muscle and bone." This advice has no basis in scientific research, Callaway explained. Instead, it reveals cultural comfort levels relating to gender and weight; i.e., men are big and strong. The government's weight tables are widely available in pamphlet form as an adjunct to the familiar, nutrition pyramid literature.

Even if these height/weight tables are a little flawed, you're thinking, it's still unhealthy to be fat, right?

Fat has gotten a bad rap

Fat people are also less prone to such diseases as cancer, tuberculosis, osteoporosis, anemia, and peptic ulcers, wrote Paul Ernsberger, M.D., and Paul Haskew, M.D., in a 1987 issue of "The Journal of Obesity and Weight Regulation." And fat women are less likely to have premature babies.

In a study of 1.8 million Norwegians, the women who lived the longest are overweight according to insurance tables. Even women who were twice the suggested weight had a better chance of surviving to retirement age than the leanest women, who were about the size of fashion models.

The Seven Countries Study, a review of 16 major studies, found that being fat was not a major risk factor for death or coronary heart disease in any of the studies.

Other research suggests that it's not as unhealthy to be fat as it is to lose weight or to yoyo diet. A 1992 review of 10 major studies found the data "do not support the idea that losing weight will increase longevity. The available evidence supports the opposite conclusion," wrote Reubin Andres, M.D., clinical director of the National Institute on Aging Gerontology Research Center in Baltimore. That is, dieting, not fat, may shorten your life. The study found that the risk of heart disease and death increased steadily the more weight people lost and the more times they lost and regained it. Meanwhile, gaining weight only slightly increased these risks. For men, each 10 percent loss of weight was associated with a 14 percent increase in risk of death from any cause, the study estimated.

In the Framingham Heart Study, which tracked more than 3,000 people for 32 years, those whose weight fluctuated many times or by large amounts were 25 to 100 percent more likely to suffer heart disease or die than those whose weight remained stable. These results were reported in "Healthy Weight Journal."

What can you do?

"There are over 2,000 life and health insurance companies in the U.S. I've tried high and low to find a specialty company that will insure fat people. If you know of one, please tell me about it," said Diskin. NAAFA tried to offer group coverage for its fat members, but could only find one insurer willing to develop a package, and even that would have excluded people who weighed more than about 300 pounds, Smith said. To maintain a unified political front, NAAFA leaders decided not to adopt the plan.

A national health plan may not be the answer, either, Smith warned. While healthcare reform would offer coverage to people regardless of pre-existing conditions, it could still exclude people who are "deemed to have unhealthy lifestyles," she said. Fatsos might fall into this group thanks to the myth that people get fat by eating too many donuts rather than by genetic predisposition.

Insurers turn down fat people, "but they will still take people who smoke five packs a day and had cancer a few years ago," Diskin said.

"The reality of it is that height/weight charts are prejudicial," agreed Joe McVoy, Ph.D., a family therapist. He is director of AHELP, the Association for the Health Enrichment of Large People, a group that seeks to dissuade doctors and other healthcare providers of their anti-fat bias.

Fatsos also have to fight bias directly. That means questioning institutions like the insurance industry, when assumptions about fat are inaccurate and discriminatory. File a complaint with your state's insurance commission. Write your legislator. Write to FAT!SO? Don't be a victim.