Are Chubby Workers Eating You Out of Profits?

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OSHA recordkeeping and reporting requirements appear straightforward, but the devil is in the details. Pound for pound, obese workers cost you plenty. Here are some facts that should disturb you.

 Which employee health issue costs employers more, obesity or smoking?

If you guessed obesity, you guessed right. A study in the Journal of Occupational and Environmental Medicine analyzed the additional costs of smoking and obesity among more than 30,000 Mayo Clinic employees and retirees. All had continuous health insurance coverage between 2001 and 2007.

Both obesity and smoking were associated with excess health costs. Compared to nonsmokers, average health costs were $1,275 higher for smokers. And obese people averaged an additional $1,850 more than normal-weight individuals. For those with morbid obesity, costs were up to $5,500 per year.

Clearly obesity is an issue that most employers will need to deal with in the future. Americans are becoming fatter every year, and that means increasing health problems and increasing health costs. Since many of these obese people work, employers will be impacted by increasing medical costs and lost productivity.

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Facts and Figures

Here are some other statistics that paint a worrisome picture:

•    Annual healthcare cost of obesity in the U.S. is estimated to be $147 billion per year.

•    Annual medical burden of obesity increased to 9.1 percent in 2006 compared to 6.5 percent in 1998.

•    Medical expenses for an obese employee are estimated to be 42 percent higher than for employees with a healthy weight.

•    Three major conditions related to obesity (heart disease, diabetes and arthritis) cost employers $220 billion annually in medical cost and lost productivity, according to CDC and MetLife research.

•    An American Journal of Health Behavior study showed that the annual medical cost increased from $119 for normal-weight employees to $573 for overweight employees and to $620 for obese employees.

•    A MetLife study found that the average absence for employee who filed an obesity-related short-term disability claim was 45 days.

•    A 1998 study found obesity resulted in approximately 39 million lost work days, 239 million restricted-activity days, 90 million bed days and 63 million physician visits.

•    Obese employees have double workers’ compensation claims, 7 times higher medical claims, and lost 10 times more working days from illness or injury compared to non-obese employees, according to the Duke University Medical Center.

Who's Obese?

Obesity is defined as at least 30 to 40 pounds overweight, severely obese is at least 60 pounds overweight, and morbidly obese is at least 100 pounds overweight.

Obesity can increase the risk for many adverse health effects, including:

·    Type-2 diabetes

·    Hypertension

·    Heart failure

·    High cholesterol

·    Kidney failure

·    Degenerative joint disease and arthritis

·    Gallstones and gall bladder disease

·    Cancer

·    Lung and breathing problems (asthma)

·    Faster aging

 


New Guidelines On Obesity Treatment Herald Changes In Coverage

By Michelle Andrews
July 10, 2012
Source: Kaiser Health News

Eat less, exercise more. Simple? Yes. Easy? No. If weight loss were easy, obesity rates among adults in the United States probably wouldn't have reached the current 36 percent.

Recently revised guidelines from the U.S. Preventive Services Task Force acknowledge that fact. They recommend that clinicians screen patients for obesity, which is defined as having a body mass index of 30 or higher. Further, they say patients who meet or exceed that level should be offered or referred to "intensive, multicomponent behavioral interventions" to help them lose weight.

The revised guidelines strengthen the previous recommendations, says David Grossman, a senior investigator at Group Health Research Institute in Seattle and a member of the task force.

For the millions of people who struggle to lose weight, the new guidelines offer much-needed support. It's unclear whether employers and insurers will welcome the change, though.

Under the 2010 health-care law, new health plans and those whose benefits change enough to lose their grandfathered status must provide services recommended by the Preventive Services Task Force at no cost to members. For the 70 percent of employers that already offer weight management programs, that may mean just supplementing what they already offer, says Russell Robbins, a senior clinical consultant at Mercer, a human resources consulting firm.

But some employers are concerned they may be on the hook for ongoing treatment as employees make repeated attempts to lose weight.

"From a financial standpoint, the guidelines are pretty broad and pretty extensive," says Helen Darling, president of the National Business Group on Health, which represents the interests of large firms. "Does this mean that employers and the government will be paying for up to 26 intense visits every year for every obese person for the rest of their lives?"

An HHS official said the department is evaluating whether to issue additional guidance on the new rules.

Insurers will be working to determine how best to satisfy the recommendations, says Susan Pisano, a spokeswoman for America's Health Insurance Plans, an industry group.

"I think the real question is making sure there are programs that fulfill these requirements," she says.

According to the task force, effective weight-loss programs involve 12 to 26 group or individual sessions over the course of a year that cover multiple behavioral management techniques. These may include setting weight-loss goals and strategizing about how to maintain lifestyle changes, incorporating exercise and eating a more healthful diet, and learning to address the psychological and other barriers that create roadblocks to weight loss. The task force found that people in these programs generally lost nine to 15 pounds in the first year.

The task force said there wasn't enough evidence to determine whether such interventions worked for people who were overweight but not obese.

A number of existing programs provide the kind of care that the guidelines recommend, say experts.

Weight Watchers, for example, runs 20,000 meetings a week around the country where people discuss their weight-loss challenges and successes and get pointers on losing weight and keeping it off.

At $42.95 a month for access to group meetings and online food tracking and other tools, however, it's not an option for many people with limited incomes, who make up a disproportionate share of the obese. Some employers subsidize their employees' membership in the program. Under the new guidelines, insurers and employers could be responsible for paying 100 percent of the cost.

Other programs have also been successful. Two years ago, the Centers for Disease Control and Prevention, in partnership with UnitedHealth Group and the YMCA, launched the National Diabetes Prevention Program for people at high risk for developing Type 2 diabetes.

The program is based on a study in which participants who learned to eat more healthfully and exercised at least 150 minutes a week lost 5 to 7 percent of their weight and reduced their risk of developing diabetes by 58 percent.

The program is offered by many YMCAs and other groups. It offers each participant 16 weekly group weight-loss sessions followed by six monthly sessions. It's a covered benefit for people with UnitedHealthcare or Medica insurance; others pay based on a sliding scale, says Ann Albright, director of CDC's Division of Diabetes Translation. CDC is working with Medicaid and Medicare to try to get it covered by those programs, says Albright.

John Joseph IV tipped the scales at 203 and had a BMI of 28.3 when he paid $150 to join the program at the YMCA near his Birmingham, Ala., home. In the four months since then, the 34-year-old, who runs a job-coaching business for college grads, has dropped 17 pounds.

At the weekly group meetings, he learned to count the fat grams in food and to make smarter food choices. Now he eats fewer cookies and more flounder. He started an exercise program and runs or lifts weights for 30 minutes three times a week.

"I thought, if I can do this, it will give me the infrastructure and habits so I can get to the mid-170s, which is where I want to be," he says.

Losing weight is hard, but keeping it off may be harder.

In 2009, Gayenell Magwood lost 100 pounds with the help of the weight management center at the Medical University of South Carolina in Charleston.

But after health problems curtailed her exercise routine for a few months, her weight crept up to 170, a gain of nearly 20 pounds. Magwood, 49, who lives in North Charleston and is a researcher in the College of Nursing at MUSC, went through the 15-week program all over again, at a cost of about $600. She lost the weight she had regained.

Before enrolling in the MUSC program, "I'd never once been successful with significant weight loss," she says.


Fitness in Middle Age Lowers Medical Costs Later: Study

By Ellin Holohan
HealthDay Reporter

THURSDAY, May 10 (HealthDay News) -- Subsidizing exercise and fitness-related lifestyles in middle age could significantly reduce the ballooning cost of health care in later years, a new study of more than 20,000 people suggests.

The study, slated for Thursday presentation at an American Heart Association meeting in Atlanta, found that fit middle-aged men and women had significantly lower medical expenses later in life compared to people who failed to stay in shape.

The more-fit study participants had 38 percent lower medical costs many years later, measured by Medicare and other insurance claims from 1999 through 2009.

"We wanted to determine if higher levels of physical fitness in middle age are associated with lower costs later in life," said study author Dr. Justin Bachmann. "We found that fitness confers dividends later in life even when other risk factors such as smoking, high blood pressure and obesity are controlled for."

The implications of the findings give "credence to efforts like Michelle Obama's 'Let's Move' campaign," he said. The First Lady has initiated a project aimed at reducing childhood obesity through exercise and proper nutrition.

Levels of fitness were determined by a treadmill test measuring metabolic equivalents (METs), Bachmann said. The higher the METs, the more fit a person is. People who exercise regularly perform better on the test because they have greater aerobic capacity, which translates into better cardiorespiratory health and lower costs later in life, he said.

The study was a collaboration between the University of Texas-Southwestern Medical Center and the Cooper Institute, both in Dallas.

Researchers screened participants for previous heart attacks, strokes and cancer. Of the 20,489 given a "healthy" designation, 16,186 were men and 4,303 were women, with an average age of 51. When Medicare costs and other insurance payments were compared, the average age was about 72, Bachmann said. The study participants were drawn from the Cooper Center Longitudinal Study, a repository of health-related data from close to 100,000 patients collected over the past four decades.

Many of the study participants were business executives who went to the center for physicals and represent "an unusually healthy cohort," reducing the effect of confounding factors, Bachmann said.

The analysis controlled for health risks, such as smoking, diabetes, high blood pressure, cholesterol levels and body-mass index (BMI). Body-mass index, used to measure the impact of obesity, is based on a combination of height and weight in adults.

Even in the presence of risk factors, better fitness in middle age predicted lower medical costs later.

The least-fit group at the study's onset had higher risk factors across the board. For example, 31 percent of the most out-of-shape men smoked, compared with 9 percent of the most-fit men. About 5 percent of the least fit men had diabetes, vs. less than 2 percent of men in the best condition. A similar pattern existed for women in the study.

Average annual claims for medical costs for the least-fit men, at $5,134, were about 36 percent higher than the average of $3,277 a year for the most-fit men. The average medical claims of $4,565 for the least-fit women were about 40 percent higher than the $2,755 average for the most fit.

Another expert called the study "quite compelling" and connected the results of the treadmill tests to regular exercise, promoting it as a path toward fitness.

"Exercise is the best medicine we have," said Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital in New York City. Noting that exercise has an impact on blood pressure, diabetes and even mood, she said "the positive effect of exercise on the body is powerful and it's empowering."

Exercise affects "so many chronic conditions leading to major health care costs," said Steinbaum, who also is the hospital's director of women and heart disease. "We should have financial support for people to go to gym facilities."

People who are more fit should "get some benefit" from insurers, Steinbaum said. Society should "give them the ability to become fit," and then "give people a reward when they demonstrate" fitness, she added.

Because the new study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.