Fat and fired!

June 22, 2008
The New York Times: Waistlines Expand Into a Workplace Issue

TAKE a look around your office tomorrow and see if you can identify a condition that’s quietly costing employers billions of dollars a year.
Give up? Here’s a clue: waistlines.

Nearly two-thirds of American adults are overweight or obese, according to the Centers for Disease Control and Prevention, and the percentage of adults classified as obese doubled from 1980 to 2000 to 31 percent of the population. (To see how obesity has spread, take a look at some startling maps from the Centers for Disease Control and Prevention: on cdc.gov, search with “Obesity Trends 1985-2006.”)

In their capacity as health insurance providers, employers pay heavily for obesity’s spread. Obesity accounted for 27 percent of the rise in medical costs from 1987 to 2001, according to research by Kenneth Thorpe, a professor of public health at Emory University, and three colleagues. Obesity costs companies $45 billion a year, according to a report by the Conference Board and RTI International, a research institute.

Obese people tend to miss work more often and tend to be less mobile on the job than their thinner counterparts. Obesity is also a more powerful trigger for chronic health problems than either smoking or heavy drinking, according to research by Roland Sturm, a senior economist at the RAND Corporation.

And it is increasingly being treated as a disease in its own right, with therapy, bariatric surgery and drugs, all of which propel insurance costs higher.

But here is where the situation becomes confusing. Corporate leaders often speak out on issues that cost them tens of billions of dollars annually. Numerous executives have called for a plan for providing health insurance to the uninsured, for example. So why aren’t they making more noise about obesity?

“People in charge of benefits plans completely, 100 percent get it,” said LuAnn Heinen, director of the Institute on the Costs and Health Effects of Obesity, an offshoot of the National Business Group on Health. It is also clear, she said, that top executives are very interested in health benefit costs. But, she added, “their perception of obesity as a driver of costs – they may not understand that as well.”

Or maybe they are generally aware of obesity’s cost – almost 14 percent of United States chief executives counted it as a top health care benefits concern in the Conference Board-RTI report – but, as Ms. Heinen said, “It’s a sensitive issue to address head-on.” (It’s quite a contrast to Japan, where employers are actually measuring workers’ waists and doling out dieting guidance.)

American employers may also believe that obesity is not their problem to solve, particularly in industries with high employee turnover. After all, workers’ health care costs do not rise the minute they gain weight. And people tend to change jobs every four or five years, taking their health care costs with them.

“For most companies, it’s not a smart business move,” said Eric Finkelstein, director of the public health economics program at RTI. “Putting on a public health hat, you might say it’s unfortunate that companies don’t do more for employees. But it doesn’t make sense from an employer’s point of view.”

Still, companies can – and a few do – take cost-effective steps to encourage employees to lose weight and keep it off. Several studies indicate that simple cash incentives, like payments to employees for completing questionnaires assessing their health, discounts at health clubs, reduced health insurance premiums, can all help.

In addition, changing the habits of a few workers may affect the behavior of many more. Nicholas A. Christakis, a doctor and a sociology professor at Harvard, has studied the effects of social networks on obesity. When one friend gains or loses a lot of weight, he found, the odds improve that another will, as well. “You can take advantage of this multiplicative power of networks, so my behavior influences you, and you influence the next guy, and so on,” he said.

PSEG, the utility company based in Newark, recognizes in its wellness and weight-management programs the power of employees to influence one another. Several years ago, it began analyzing which illnesses and injuries were most common among employees. Not surprisingly for a company with workers who carry heavy equipment and operate jackhammers, musculoskeletal injuries were the most common cause of disabilities and absences. Digging deeper, the company found that obese employees were far more likely to get hurt.

One lineman who weighed 350 pounds could not ride in a bucket to elevated wires and other equipment, recalled Dr. Ronald Mack, PSEG’s medical director. Dr. Mack had long been generally aware that obesity was an issue for many workers, but “that was an aha moment,” he said.

Over the last few years, PSEG has revamped its wellness programs to emphasize weight and nutrition. It has also added some modest financial incentives for participation, like payments for filling out personal health evaluations.

The programs have not yet changed overall injury rates, but the employees who used all the services have 18 percent fewer missed days than their counterparts.
“Engagement, engagement, engagement,” Dr. Mack said. “That’s the

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