A small number of companies have linked health factors to what employees pay for benefits, but the practice is expected to grow now that some federal rules have been finalized, spelling out what's allowed by law.
Employee advocates worry that other antidiscrimination laws such as the Americans with Disabilities Act won't cover the person who is 20 or 30 pounds overweight.
The businesses are deducting from employees' paychecks, adding insurance surcharges, or offering insurance discounts or rebates only to low-risk workers.
"Employers know they have to do something," said Garry Mathiason, a senior partner at the national employment and labor law firm Littler Mendelson, based in Boston. "I believe that in just the next two years more employers will turn to penalties to change employee behavior."
Mathiason said more than 300 companies have sought advice on creating more aggressive wellness programs since the firm released a study in April on legal issues and trends associated with requiring healthy practices.
Healthcare spending in the United States is estimated to reach $2.2 trillion this year, with at least 54 percent of spending in the private sector, and is expected to nearly double by 2016, according to the National Coalition on Health Care.
A 2003-2004 National Health and Nutrition Examination Survey showed about two-thirds of adults in the United States were overweight and almost one-third were obese. A US surgeon general's report said healthcare costs of obesity totaled more than $117 billion in 2000.
More employers have charged higher insurance premiums the past few years for tobacco-using employees. Otherwise, wellness programs had been primarily voluntary, offering in-house fitness centers and free health screenings, for instance.
But many employees of Indianapolis-based Clarian Health didn't use the programs, hospital spokesman James Wide said.
