Illustration: Liu Rui

One of the most popular nicknames for people in China is "fatty." Almost everyone living in China knows someone who is called that name, be it classmates, friends, neighbors or colleagues. Often it is a term of endearment, and the "fatties" don't really mind, or at least, they have to pretend they don't. 

This would be appalling to Americans. In the US, it is a taboo to joke about someone's appearance or disabilities. At school, taunting students based on their weight is specifically listed as an offense in many disciplinary codes. In the work place, you can face a serious complaint for mocking overweight colleagues. On the subway, if an overweight passenger tries to squeeze into the middle of a three-person seating area, the other two passengers can't protest without risking the outrage of others.

So apart from New Jersey Governor Chris Christie, whose waistline became a butt of jokes on late night comedy shows earlier this year when he was being touted as a possible Republican nominee for the Presidential election, overweight people can basically enjoy an amiable environment where prejudice is curbed, equal opportunities are provided and their weight is the 800 pound elephant in the room.

But this is only up to a point. Given the increasingly brutal nature of the health insurance industry in the US, more and more overweight employees are being labeled "fatty" by their employers. 

According to a recent report by Reuters, 40 percent of large and mid-sized companies are planning to punish high health-risk employees, including smokers and overweight people, by charging them higher premiums and deductibles next year. This is up from 8 percent of companies two years ago.

The employers have plenty of reasons to do so. Health insurance premiums in the US have been skyrocketing. Employers, big and small, are struggling to cope with the costs and are trying to pass on increasing charges to their staff.

According to recent surveys, the average premium employers pay for the families of their employees is $15,073 this year, more than double the amount in 2001.  And less than 60 percent of big companies and less than 48 percent of small companies still provide health insurance to employees, compared to 68 percent and 58 percent a decade ago.

Across the board, employees are paying more out of their own pockets for insurance policies that often cover less and less.

In 2006, only 10 percent of employees of big companies and 16 percent of those at small companies were paying more than $1,000 a year for their employer-sponsored health insurance and now more than 30 percent and 50 percent employees respectively are doing so.

But it is the high-risk people who raise the costs of insurance companies and, therefore, the premiums. So, rather than having healthy people share the burden, it may seem like a logical approach to have the high-risk people pay more, especially when many companies have already provided weight-lose or anti-smoking programs but found that participation rates are low.

However, unlike smokers who arguably have few other than themselves to blame for their addiction and could perhaps quit with enough willpower, not all overweight people are responsible for their own hefty natures.

Some of them have been pre-selected by their genes. And although exercise and salads might help them get fitter, it may not help enough for the health police.

We are quickly heading to the time that only healthy people can afford to have health insurance and only wealthy families can afford to have fat babies. 

One more black joke in an already ridiculous world.

The author is a New York-based journalist. rong_xiaoqing@hotmail.com