A health insurer in the US has given its customers the choice of exercising or facing a 20% increase in their premiums. While this can be seen as “coercion” or “arm twisting”, it could also denote the general direction of travel for the health economy. In Samoa where obesity runs at approximately 70% of the population, the national air carrier has started charging individuals by weight, with higher air fares for obese individuals.

It remains to be seen whether countries with free healthcare can incentivise exercise in the same way.