More evidence on the cost of obesity

ACOEM study shows work costs

Yet another study shows obesity increasingly is common in American workers, and it suggests being overweight is associated with sharply increased cardiovascular risk factors and work limitations. The latest study, reported in the December 2004 Journal of Occupational and Environmental Medicine, suggests being obese adds the equivalent of 20 years of age in terms of increased cardiovascular risks and decreased productivity.

The study was conducted by a research group led by Robin P. Hertz, PhD, of Pfizer Global Pharmaceuticals, NY, and published in the journal of the American College of Occupational and Environmental Medicine (ACOEM).

Hertz and colleagues analyzed data on nearly 2,400 American workers drawn from a 1999-2000 health survey. Twenty-nine percent of workers were classified as obese, a substantial increase over the 20% obesity rate reported in a 1988-1994 survey. Obesity was defined as a body mass index of 30 or higher.

Thirty-four percent of workers were classified as overweight, having a body mass index of 25 to 29.9. Compared with the obese group, overweight workers had a similar but less pronounced pattern of increased cardiovascular risk factors.

Cost to productivity

The research team reported that the health and productivity impact of obesity has the same effect as adding 20 years of age.

Several studies have tried to estimate the costs of the obesity epidemic to employers, focusing on outcomes such as medical claims. A 2004 study on work-based weight loss programs, conducted by the American Association of Occupational Health Nurses (AAOHN), estimated employers’ dollar costs due to obesity at $13 billion annually in health care costs and productivity. The Hertz study is the first specifically to examine the health status and work limitations associated with obesity in the working population.

Hertz’ team reports that, based on their study and others, nearly two-thirds of workers are now classified as either overweight or obese. But AAOHN’s study found that only 2% of the working population claims to have participated in an employer-sponsored weight-management program.

However, of those who have participated, nearly 50% reached and maintained their weight-loss goals, AAOHN reported.

Over the last several decades, researchers have provided many estimates of the costs of overweight and obesity. These estimates differ according to their scope (e.g., the individual person, a particular company or health plan, or the nation as a whole), the timeliness of the data, and the methods used to derive them, including how obesity is defined, how the prevalence of obesity is determined, what associated disorders are included, the degree to which these disorders and obesity are considered to be associated, how costs are defined, and the assumptions used in calculating those costs.

As with other chronic conditions, estimates may focus on direct costs to the community, including the costs of health care services, physicians and other health care professionals, hospital admissions, and medicines; indirect costs, such as loss of productivity caused by absenteeism, disability, and premature death; or personal costs, such as reduced earnings, higher insurance costs, reduced quality of life, and out-of-pocket expenses for individuals. These cost estimates are approximations, and it becomes even more difficult to estimate the costs of the effects of obesity over very long periods of time, according to the U.S. Department of Health and Human Services’ (HHS) 2003 report on preventive wellness initiatives, Prevention Makes Common Cents (go to www.aspe.hhs.gov/health/prevention/prevention.pdf).

The costs to U.S. businesses of obesity-related health problems in 1994 added up to almost $13 billion, according to the HHS report, with approximately $8 billion of this paying for health insurance expenditures, $2.4 billion for sick leave, $1.8 billion for life insurance, and close to $1 billion for disability insurance.

The direct health care costs of overweight and obesity represent a significant portion of total annual U.S. health care expenditures, the HHS report states, with estimates ranging from 4.3% of total expenditures to as much as 9.1%. Moreover, Medicare and Medicaid may finance as much as half of these costs, with Medicare covering the larger share due to the more substantial medical problems associated with obesity in the elderly.

Researchers have found that obese people who live to age 65 have much larger annual Medicare expenditures than nonobese people. For the period between 1996 and 1998, the latest HHS data analyzed, a 15% increase in annual per capita Medicare spending is attributable to being overweight, and a 37% increase is attributed to being obese.

Battling the bulge

AAOHN developed some guidelines to help companies develop and implement work-based weight management programs:

Involve management — Management support contributes to the success of the program. Management should promote the program at meetings and take an interest in success and outcomes.

Recruit employees — Getting employees involved at the very beginning is crucial to making the program successful. Setting up a committee and having representation from a diverse group of individuals (fit employees, overweight employees, and obese employees) is key.

Promote often — Promote the programs as often as possible. Visibility and repeated communications help ensure consistent participation.

Enlist trained professionals — Enlist a trained health and wellness professional to help implement and lead the program. This brings credibility to the program and helps to ensure that all employees are participating in a healthy manner.

Encourage a team atmosphere — Encourage employees to participate in the programs together and to check in on each other’s progress to help with overall encouragement and support.

Share successes — Seeing results is a proven motivator. Proving the program works keeps employees and management excited and participation levels high.