Battling the Bulge in the Workplace

BROOMFIELD, Colo. - Lisa Bailey labors on the front lines in the ongoing battle against workplace obesity.

Since 1983, her company, Health Promotion Management, Inc., has been in the business of starting up employee-wellness programs for workplaces. These days, Bailey said she and her eight employees are finding it easier to get their feet in the door, as once-skeptical business owners begin to jump on the wellness bandwagon.

“Employers are at a tipping point,” Bailey said. “With double-digit health-care-cost increases every single year, they can’t ignore it any more. They’re fed up with the options they’ve been given, and wellness is the last frontier.”

Consider some research:

* Obese employees cost U.S. private employers an estimated $45 billion yearly in medical expenditures and work loss, concluded a 2008 report by the Conference Board business research group.

*Medical expenses for obese employees in 2006 were 42% higher ($1,429 per employee) than for a person with a healthy weight, according to the Centers for Disease Control.

*Obese adults are 21.7% more likely than healthy counterparts to report having one or more poor physical health days per month, according to a 2009 report by the Colorado Business Group on Health.

* In 2008, only one state – Colorado -- had a prevalence of obesity rates below 20%. Thirty-two states had a prevalence equal to or greater than 25%. Six (Alabama, Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia ) had obesity rates equal to or greater than 30%.

“Employers are saying, ‘We need tools in our toolbox to deal with threat of health-care costs,’” Bailey said. “When I look at our clients today, they wouldn’t be there without a senior-level exec who believed it was right thing to do. But that’s not enough. Fluff money has decreased. We have to convince them that we can impact their bottom line, in either health-care costs or productivity.”

Figuring that an employer spends between $5,000 and $7,000 annually on health-care costs per worker, Bailey argues they should be willing to spend 1-3% of those costs on prevention.

“I tell companies we can affect 25-40% of their employees’ annual health-care claims through health promotion,” Bailey said. “If there are cynics at the top, they won’t put our programs in place. Is health promotion worth it? We on the prevention side are held under the microscope much more than medical testing people. Are MRIs worth it?”

According to the Conference Board report, more than 40% of U.S. companies had implemented obesity-reduction programs by 2007, and 24% more said they plan to do so. Estimates of return-on-investment for wellness programs range from zero to $5 per $1 invested, the report said.

According to the CDC, workplace obesity prevention programs “can be an effective way for employers to reduce obesity and lower their health care costs, lower absenteeism and increase employee productivity.”

What could “sitting on” the issue cost a company?

“If employers want to calculate what physical inactivity is costing their company, I would suggest that they take a look at their total health-care expenditures for a year and take 15% of that,” said Dr. Steve Aldana, a professor of Lifestyle Medicine at Brigham Young University. “In reality, that’s going to be pretty close to the actual expenditures.”

Bailey said HPMI typically begins a contract by assessing employee health, with lifestyle questionnaires and physical measurements. A person’s “body mass index” is computed after height and weight are measured. People are considered obese if their BMI is greater than 30. The overweight range is 25 to 29.9 -- and a normal BMI is considered to be 18.5 to 24.9. For instance, according to a BMI index, if a man is 5’8” and weighs more than 178 pounds, he would be considered obese. A BMI is a serviceable indicator of body fatness and weight categories that may lead to health problems.Obesity is a major risk factor for chronic diseases, including diabetes, high blood pressure, high cholesterol, stroke, heart disease and asthma. Studies show that for employers, poor employee health leads to lower productivity, lower morale, higher absenteeism and higher insurance claims.

What’s to blame for the obesity epidemic in the workplace?

Jobs that have become mostly sedentary. The transition to a “knowledge economy,” in which workers sit in front of a computer all day. People too busy to cook healthy meals. Video games, huge flat-screen, high-def TV screens.

“We’ve basically engineered physical activity out of our lives,” said James Hill, who heads a nutrition and research center at the University of Colorado Health Sciences Center.

Once Bailey’s team has done a health screening of a company’s workforce, they’ll sit down with management to come up with a customized plan of attack.

“We tell them, ‘Based on risks of your employee population, we’d expect this much productivity loss, this much excess cost due to medical claims, this much excess absenteeism,’” she said.The recipe could include wellness classes, one-on-one coaching, group challenges on weight loss or pedometer use and possibly incentive programs. Some companies offer gift cards or other forms of cash reward, such as paying an employee’s health-care-deductible cost if a weight goal is met.

“We used to focus solely on the individual worker,” Bailey said. “But there’s been a gradual realization that the individual has a wife, kids, [and] an office environment. Are they supportive of good health or a barrier?

“Change is brought about most effectively at the policy level, whether it’s corporate or governmental.”

Dr. Eric K. France, chief of preventive medicine for Kaiser Permanente Colorado, agreed. “For some of the issues we face, we need to go upstream and look at policies and plans,” France said.

“Doctors can solve health problems in the clinic, but urban environments can encourage healthy behavior. People have to find that the easy thing for them to do is the healthy thing for them to do. People have to naturally include physical activity in their daily activity.”

“We have designed our cities to serve the automobile,” he added. “That’s why we are 30 years into an obesity epidemic.”

Since HPMI is headquartered in Broomfield, a hilly suburb between Denver and Boulder, Bailey would seem to be in an ideal place. After all, Colorado consistently ranks as the least-obese state in the country, according to the annual CDC Obesity Index. Also, the nonprofit Trust for America's Health says Colorado has some of the lowest rates in the country of overweight residents, physical inactivity, hypertension and childhood obesity. Overall, Colorado ranks as the leanest state in its study.

But there is a growing problem. Over the past 15 years, the percentage of obese Coloradans has grown faster than any other state, except Virginia.

According to a report released last month by the state health department, Colorado’s obesity rate rose 89% from 1995 through 2008, while the national rate rose 67%. The percentage of Coloradans classified as obese went from 10.1% to 19.1%, still lower than the national rate of 26.6%, but discouraging.