Alabama—which has the second highest obesity rates in the country—will soon become the first to charge overweight government employees extra for their insurance if they don't take steps to improve their health. According to the Associated Press:

The state has given its 37,527 employees a year to start getting fit - or they'll pay $25 a month for insurance that otherwise is free.

Alabama will be the first state to charge overweight state workers who don't work on slimming down, while a handful of other states reward employees who adopt healthy behaviors.

Alabama already charges workers who smoke—and has seen some success in getting them to quit-but now has turned its attention to a problem that plagues many in the Deep South: obesity.

The State Employees' Insurance Board this week approved a plan to charge state workers starting in January 2010 if they don't have free health screenings.

If the screenings turn up serious problems with blood pressure, cholesterol, glucose or obesity, employees will have a year to see a doctor at no cost, enroll in a wellness program, or take steps on their own to improve their health. If they show progress in a follow-up screening, they won't be charged. But if they don't, they must pay starting in January 2011.

Some of the thinking behind Alabama's decision is evident in the State Employees' Insurance Board's July/August newsletter to its members, highlighting a recent board study which found 18 percent of the state's workers were morbidly obese (body mass index over 35 with one or more co-morbid conditions). In trying to make the case for an insurance surcharge, the article illustrates the tensions between individual and shared responsibility, that come from trying to deal with issue like obesity.

Striking the right balance is a difficult. It's good to see Alabama taking steps to address the challenge of obesity, but the approach raises several issues.

First, as the AP article notes, how do you measure progress? BMI is an imperfect measure for assessing a person's health. There are a variety of factors—such as person's income, family, environment, education, etc.—that influence obesity, none of which are easily addressed by a single policy or an individual person.

Second, is the question of penalties versus incentives. Assuming, for the moment, that the state collected money from all of its morbidly obese employees (that is, no one made an effort to lose weight or changed behavior), the new surcharge would bring in around $2 million. It's a significant amount, but still much less than the estimated savings for reducing the level of obesity among its workers.

The key to saving money is changing behavior. States such Missouri, Ohio, Arkansas, have launched similar programs, but instead of penalties, they provide workers financial incentives for taking steps to improve their health and wellness. That may be a more palatable option for states and workers alike.