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I think it is time to apply the same standards to health insurance that auto insurers use in order to provide an economic insentive for people to lose weight. For example, if you stay trim you might pay $50 per month for health insurance but if you are fat (like a bad driver) you would pay $500 per month for health insurance.
Also, doctor should simply start saying, okay, if you don't want to lose weight then we are not going to give you any medicine. The fear of death would also serve as a good motivator to lose weight.