Should people who are overweight pay more for their health insurance? Yes, says Alabama, the first state prepared to charge the large heftier fees: 37,527 state workers have one year to get in shape or they will have to pay $25 for health insurance that would usually be free. The charge will be applied to anyone with a body mass index (BMI) of 35 or higher who is not making progress—a normal BMI is considered to be around 20.

The state hopes that by pushing a healthier lifestyle, the costs for doctor visits, prescriptions and other medical needs that it pays will decrease. Alabama ranks second in obesity after Mississippi with 30 percent of its residents overweight.

Numerous health advocates complain that BMI does not accurately calculate weight. A 2007 study pointed out that by using this standard, professional basketball players would be considered obese, and a more recent study found that people who are overweight, as defined by the BMI, are not necessarily unhealthy.