The perils of not addressing obesity 

A provocative opinion piece in the Wall Street Journal titled The Economics of Obesity posits that America got fat because of marketplace innovations that led to more sedentary work and an abundance of cheap, high-calorie food – and that American businesses should be more open to treating this unfortunate by-product of our economic success. Here are some meaningful steps that employers can take to address this significant health risk in their populations.

Obesity is a growing epidemic

The epidemic of obesity is a growing global concern. Its impact is seen not just on morbidity and mortality, but on many facets of everyday health and well-being. Obesity is a major risk for chronic conditions including diabetes mellitus, cardiovascular disease, hypertension, stroke and certain forms of cancer. Obesity contributes to and/or complicates musculoskeletal conditions such as low back strain and joint arthritis. Obesity is time sensitive and cumulative; the longer it persists and the higher the severity, the more negative the health impact.

How did we get to this point? The industrial revolution, innovations in agricultural production, and the digital revolution have been hugely beneficial for the US and the rest of the world, but the resulting economic growth and productivity gains have led to a less healthy lifestyle and health status for many. Weight gain and clinical obesity has been an unfortunate by-product of the shift to more sedentary work. We can wish that all the physical activity that used to be a by-product of working can be replaced by dedicating time and money to regular exercise. But behavior change is hard and the reality is that meaningful long-term weight loss isn’t always achievable.

Given that obesity isn’t going away on its own, it may be time for employers to think seriously about their role in helping employees reverse the negative impact of our modern lifestyle.

• Behavioral modification is always the cornerstone – but we need to accept its limitations. We do need to make healthier food choices and regulate calories and, in parallel, find ways to counter our sedentary lifestyle. We can choose to stand periodically while we work and find the time to pursue physical activities. But often there is only so much sustainable weight loss an individual can achieve. When that limit is reached but still falls short of ideal, external interventions are necessary. It isn’t fair – or based in reality – to blame obesity on weakness or lack of discipline. It certainly isn’t a productive view.
• Weight reducing medications. The latest weight reducing medications are demonstrating effectiveness and becoming common standard of care. Certain medications have additional benefit at improving glucose level in those with concurrent type 2 diabetes mellitus, which is common.
• Bariatric surgery may seem like a drastic step, but for some it is the only option that works. There are guidelines that ensure appropriate treatment decisions. When doctors are practicing based on the latest evidence-based medicine, then the best interest of the patient is the center of the treatment choice.

Does your benefit program support obesity treatment?

Employer should refresh their perspective regarding obesity for their employees and plan members. Some health programs are designed to limit access and utilization of costly treatment options for obesity, perhaps reflecting the view that it isn’t the employer’s responsibility to pay for treating a condition stemming from a poor lifestyle. Instead, we should think of obesity as an unfortunate side effect of modern day life and work. There’s a practical argument as well – the cost of not treating obesity is quickly manifested not just for the individual, but for the company in the form of downstream cost impact due to complications or illnesses associated with obesity.

The end result of doing nothing is well known – we’re living with those impacts today. So how does an employer proceed for optimized success?

• Change the mindset that obesity is an issue with poor life choices and lack of discipline and motivation. It’s complicated.
• Re-evaluate and re-affirm the corporate philosophy and value with regards to the organization’s role and the inter-dependency and importance of a healthy workforce in terms of employee health and their contribution and productivity at work.
• Design a health benefit program that aligns to this broader, mission-critical health priority. Every organization is different in terms of population mix. Instead of the benefit plan based on non-precise norms and averages, quantify the true risk within the organization, understand the individuals by their drivers and determinants of health and what will matter to them. Match the plan, the best clinicians and process that make it easy and effective for employees with obesity to achieve a more ideal weight, and a healthier and more productive life.