From ancient times to the first mortality statistics related to build published in the United States in 1903, abnormal build (both under and overweight) has been recognized as a contributor to a higher death rate. Whereas when communicable disease such as tuberculosis and chronic fungal infections showed underweight to be a significant predictor of earlier mortality, later in the century overweight was recognized as a contributor to earlier mortality as well. Subsequent studies began to link conditions such as diabetes, hypertension, vascular disease and heart disease to obesity, and a better grasp of excess weight was added to the overall concept of impaired health.
The first set of insurance tables on ideal height and weight were published by Metropolitan Life, first in 1942 and then revised in 1959 to a “desirable weight table.” Eventually the tables evolved by the 1980s to height and weight measurements stratified to small, medium and large build. The definition of who was which build was quite arbitrary, and anyone approaching the upper limits of the table or beyond were quite naturally “large build” or “big boned.” Looking retrospectively at the tables, designed to express which range of weight for a particular height afforded the greatest longevity, the ranges are by today’s standards quite slim, and a significant percentage of adults (particularly middle aged and older males) would overwhelmingly qualify as outside the desired build.
Rather than using height and weight on their own, most physicians have turned to a calculation called a body mass index (BMI). It is measured as weight/height squared where weight is measured in kilograms (most of the world is on the metric system) and height in meters. The BMI is used by the World Health Organization as the basis for calculation of build. When using build as an underwriting measure however, most underwriting tables in the United States still are calibrated for height and weight.
Most insurers publish (or at least allow agents to be aware of) maximum weight for height that would fall into a standard category, and many also allow knowledge of which builds qualify for preferred or best class rates. Significant overweight has been widely shown to correlate with increased mortality, as has significant underweight. The gray zones really are where build combines with other health impairments. For instance, in type 2 diabetes significant overweight not only has its own health impairment consequences but the diabetes is additive to the risk rather than independent. Sometimes the diabetes itself is worsened by the increased weight. Other conditions including but not limited to cardiovascular disease, high blood pressure, stroke, fatty liver, gallstones, sleep apnea and certain cancers are related to increased body weight either by cause or effect.
When build is the only ratable factor in an underwriting application, there are credits which may lessen the effect of any rating imposed. With favorable blood pressure, normal cholesterol values, a negative treadmill test, good blood sugars and other testing showing a normal cardiovascular system, higher build may qualify for standard and even best class consideration. However the bets are off when there is coincident diabetes, abnormal blood pressure, known heart disease or kidney impairment as just a few examples, and the debits imposed may not only be a sum of rating debits but in certain cases worse—where each contributor makes the next problem even more significant. One other significant factor to mention is smoking, which severely worsens the consequences of abnormal build (both underweight and overweight) and may add up to more than just the sum of the parts. On the opposite end of the spectrum, underweight may be a marker for disease, and unexplained recent weight loss and underweight may be associated (particularly in the elderly) with cancer or other significant and as yet undiagnosed disease.
Abnormal build on either end of the table is often a subject of debate by broker, agent and insurer, as “only a couple of pounds” may influence premium significantly—particularly when considering better than standard rates. While insurers often bend over backwards to keep that from making or breaking a policy, rest assured that the published limits are very liberal, and what falls into standard category is very often considered as overweight by the lay public or the client himself. A good percentage of preferred policies are issued to applicants who would not be considered “trim.” Likewise when adverse action is taken on underweight it would be noticeable to most people as not the norm. Remember also that build has less consequence in the absence of other disease and more significance when it is contributory or caused by another condition which has added mortality in and of itself.
