Observations on Obesity in the Workforce

Heart disease. Hypertension. Diabetes. Cancer. Many corporate wellness programs began as a way to address these four horsemen of the employee health apocalypse. While extending employees’ lives is an admirable goal, employers are finding that it’s more practical to make sure that workers can do their jobs now. New research suggests focusing wellness programs squarely on an underlying nemesis: obesity.

Health insurer Cigna Corp. recently released its analysis of 20 years of short-term disability claims. The study found that from 1993 to 2012 the number of obese Americans doubled. Obesity contributes to “presenteeism,” defined as a sick or distracted employee who chooses to work anyway at a decreased performance level, a study found. Cigna found that presenteeism due to obesity accounts for 39.4 percent of the total cost of obesity for U.S. employers, or an estimated $365,859 per every 1,000 employees in 2013.   

The U.S. Centers for Disease Control and Prevention defines obesity as having a body mass index of 30 or higher. BMI is calculated by dividing a person’s weight in kilograms by height in meters squared.

According to Steve Wojcik, the vice president of public policy at the National Business Group on Health, the workplace weighs heavily on obesity.

“This is something that is related to the current job market and the current economic situation,” Wojcik said. “People spend a lot of time at work. In many cases their work environment is a source of the added weight.”

High stress levels because of workload, in addition to the common complaint of lack of sleep, leads to poor eating habits and lack of exercise that lead to obesity, Wojcik said.

“There could be different ways in which obesity is the underlying cause of the disability,” said Terri Rhodes, executive director for the Disability Management Employer Coalition, an association dedicated to the management of disease and disability in the workplace. “It could be musculoskeletal problems with the knees, joints, back and feet, as well as depression.”

Rhodes said obesity affects employees on both a mental and physical level. As a result, the wellness programs implemented to preemptively combat the disability must address the whole person.

“When someone gets to the point of being morbidly obese, it impacts their psyche,” Rhodes said. “They’re shamed. There’s an underlying issue as to why they have gotten to the point that they are currently.” An individual with a BMI of 40 or higher is considered morbidly obese, according to the CDC.

The problem is that employers often identify a single diagnosis. As a result, they alleviate the physical pain instead of treating its root cause.

Rhodes cites chronic back pain caused by obesity as an example. Wellness programs typically address the lack of physical activity that can lead to obesity. However, if an employee were overeating because of an underlying emotional condition, such as depression, the problem would likely recur and continue to cost the employer in lost workdays.

“Over time they realized that they have to deal with the depression part, and the mental issue in order to get the person on the road to recovery,” Rhodes said.

The majority of large and midsize employers offer wellness programs, but they are overwhelmingly incentive-based. This means they aim to change a physical behavior, such as inactivity, by rewarding increased activity instead of addressing the underlying reason of why an employee doesn’t want to get up and move. 

Effective treatment of obesity and further disease prevention can be accomplished by implementing aspects of behavioral counseling into wellness programs. Wojcik said that the U.S. Preventive Services Task Force requires employers to cover behavioral counseling. Unfortunately, the requirements are so vague that the service is not often used to its full potential.

Rhodes attributes this trend to employees who fear the social stigma of mental illness diagnosis. Regardless of the sentiment, employers should make mental health services available if they want to effectively combat obesity in the workplace.

 “If you don’t get at the root cause of why the problem exists in the first place, it’s probably not going to be long-term successful weight loss,” Wojcik said. “It’s the most difficult part of this.”