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By DAN REYNOLDS, senior editor of Risk & Insurance®

As she considers the landscape of American healthcare, Carol Harnett remembers very well one of her "Ah ha!" moments.

So, what did the large health insurer serve at the kicking off party for the weight-loss program? Doughnuts.

"No doughnuts at the sign-in for a weight-loss program might have been the way to go," said Harnett, laughing at the absurdity of the story.

And the story is absurdly funny. But America's battle with its collective waste line isn't.

There are at least two levels where it is not funny. More Americans getting fatter and fatter means that not only is their quality of life suffering but their very lives are at risk.

The other part is the money. We've all seen the studies and the projections, but here are a couple more to chew on ... scratch that ... consider.

According to a new study by a quartet of researchers, the amount of medical spend that can be connected to obesity in this country in 2008 is $147 billion. The researchers include Eric Finkelstein, the director of the Public Health Economics Program at RTI International, and William Dietz, director of the Division of Nutrition and Physical Activity at the Centers for Disease Control and Prevention in Atlanta.

Compare that figure with where things were 10 years ago, when the annual medical spend connected to obesity was around $78.5 billion, according to those same researchers.

An additional study by Kenneth Thorpe, the chair of the Department of Health Policy and Management at Emory University in Atlanta, and his colleagues found that obesity was responsible for 27 percent of the rise in inflation-adjusted health spending between 1987 and 2001. And that was in 2001, when this seeming runaway train of obesity appeared to be just picking up momentum.

But as bad as the numbers over the last few years look, there are indications that a corner may be on the verge of being turned, according to Harnett.

"There is a modicum of good news, and that is that last year, for the first time as a nation, we didn't get any fatter," Harnett said. "So that is good because that is the first time we appear to have arrested for at least one year a growth in obesity."

DON'T SUPERSIZE ME

Certainly, the big food and beverage chains, the McDonald's and the Starbucks of the world, are doing their bit to help. McDonald's has added calorie counts to its menus, and Starbucks is working on calorie counts and portion control.

Both corporations very well could have been to blame in giving this runway train a push, according to Harnett.

Take Starbucks: "Our genetics haven't changed in the last 20 years. But really what has changed and this not an easy answer, but it is the environment. I don't mean to pick on this one company, but they are an easy example because everybody understands," Harnett said.

When Starbucks set out to dominate coffee-bar culture in America, it came out with its own drink sizes, for instance, calling a small a "tall." That 12-ounce Tall cup at Starbucks, traditionally its smallest size, is at least twice the serving size for a beverage recommended by the USDA. So, right there, you see how people's perceptions of the volume that they are consuming starts to get tweaked.

"So when we look at this cup now our memory of what a small serving is is actually double what a normal serving size is according to the USDA."

Twice the recommended size if you drink your coffee black may not be so bad. But start adding in double and triple shots of syrup, throw on some sweetened whipped cream for your seasonal pumpkin spice latte, and then start jumping sizes to a "Grande" or a "Vente," and you are going to be stoking the engine on that calorie train big time.

Sensing the error of its ways, Harnett reports, Starbucks in some of its locations has started offering a normal-sized cup of coffee that it calls a small. Its semantics might still be off-center, but at least the Seattle-based company is trying. The company has also reduced portion sizes and posted calorie counts on food items.

"And I think that is really wonderful," Harnett said.

And it is.

THE CIANBRO WAY

On the work front, there are some companies that have had so much success with their workplace wellness and weight-loss programs that they have landed themselves on the Web pages of the Centers for Disease Control and Prevention's new Web page devoted to the art of losing weight. Called "LEANworks!" the Web site lists promising practices and recounts the success stories of companies that have made meaningful progress in getting their workers to slim down.

One of those is Cianbro, a construction and fabrication company headquartered in Pittsfield, Maine. As far back as the early 1990s, Cianbro's then-president Peter Vigue saw that some co-workers, including managers in the employee-owned company, were battling serious health problems, including substance abuse and weight gain. Like other companies, Cianbro was also suffering through double-digit annual increases in its healthcare costs.

"It was simply unsustainable, and so we looked for some easy fixes and there weren't any," said Rita Bubar, Cianbro's corporate human resources and wellness manager.

What the company did was build on an existing safety awareness program to launch a pilot program around weight loss.According to Bubar, the initial scheme was launched and involved a voluntary program offered to 150 people, whom the company had determined were at risk due to their weight and other factors. Of those 150, 75 signed up, with the incentive of a $100 gift certificate if they completed the six-month pilot.

Participants met face to face with a nurse every two weeks to work on their wellness goals. Guess what? It worked. At the end of the pilot, all the high-risk employees had been downgraded to medium- or low-risk.

"No one was interested in having smoking cessation as one of the things that they worked on, but we had seven people quite smoking anyway," Bubar said.

The program also involved making nutritional changes in company offices and other work sites.

"You will never see a Twinkie in the office. Bottled water--there is no cola in the office," said company spokesman Alan Grover.

The program has now evolved to where it has 1900 participants, which includes what Cianbro refers to as "team-members" and their spouses.

"We have 80 percent of those team members who are eligible for medical," Bubar said.

Cianbro self-insures for healthcare, and the money the company is saving is bolstering its profit-sharing program. The employee-owned company of 1,960 people plunked down $8 million in profit-sharing proceeds in 2008.

In 2001, when it christened what it now calls its Healthy Lifestyle Program, Cianbro offered cash incentives of $600 to an individual and $1,600 per family to participate. That incentive has since been modified with one-third of that amount being given to every participant and two-thirds held back for participants who can achieve three out of four fitness measurement metrics.

"It would be nice to think that people would join just because there is a coach to help them, but you really need incentives because changing behavior is difficult," Bubar said. "We have a lot of temptations in life."

THE FIVE POINTS

Yes, we do, and before we get too hard on ourselves, remember that changing the behaviors that put weight on may be the hardest thing you can do in the personal health realm, according to another wellness expert. Just look at our history of tobacco use and take some comfort from it.

"Let's be realistic. Changing behavior is up there possibly beyond smoking addiction," said Dr. Paul Berger, a senior vice president and health and benefits chief medical officer for Aon Consulting. "It is about the hardest behavior to change, anything less than a full-court press will disappoint."

Forty years ago, about 43 percent of the adult population smoked. But with the use of sin taxes on cigarettes and smoking bans motivated by the legal ramifications of the impacts of second-hand smoke, that percentage has been taken down to something more like 20 percent.

"Banning smoking had a greater effect than taxes some people believe," Harnett said.

Berger thinks that any wellness program that is going to work is going to have to have at least five elements to it: senior management endorsement, ongoing communications, the incorporation of incentives or disincentives, encouragement of sharing of wellness resources like a good fitness coach and correct contact information.

"You can't really engage someone in a wellness program if you can't find them," Berger said.

Berger said companies need to press hard on wellness and make it a priority. That means that the man or woman at the top has to lead that communication and coordination effort.

He says anything less will fail.

"If you don't year after year have management saying in their address to their employees, right at the top of that address, it can't be just profits, it can't be productivity, it's got to be, 'We value our employees.' "

October 1, 2009

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