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I don't think this is any reason to not treat people, or grounds to criticise the obese as some have (probably only jokingly) suggested.
First up, the point of medicine seems to be treatment the sick. If you rule out a treatment for the highly obese you are on a slippery slope. What about those with lung cancer? Those with AIDs, others with heart disease? Liver damage from alcohol etc. What if we are presented with a repentant druggie? What about a motorcyclist with trauma/spinal? A skateboarder with a broken arm? Where to stop?
The second point is that health care is a business, at least as far as I see it. Unless I'm mistaken - this is not government funded on the whole in the US. Treatment cost must influence insurance costs though, and yep, I can agree with differential costs for various categories. Maybe.
But once again, if you are not careful - you start heading towards a system where only the healthy get covered and those with a genetic precondition, high weight, and so on will be cast adrift, left without cover.
And we should remember I think that many highly productive people (intellectually and economically) do not look after their health, either due to focus on work, family care and/or hobbies... It's easy to laugh at the fat person at the shopping centre - but their contribution to society may be much greater than the nearby pretty-young-thing in tights.
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