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Getting fat is expensive.

A recent analysis from Duke University Medical Center has found that obese workers filed twice the number of workers' comp claims, had seven times higher medical costs from those claims, and had lost 13 times more days of work from work injury or work illness than nonobese workers.

"We all know obesity is bad for the individual, but it isn't solely a personal medical problem. It spills over into the workplace and has concrete economic costs," says Truls Ostbye, professor of community and family medicine at Duke and co-author of a study on obesity and claims. "Given the strong link between obesity and workers' comp costs, maintaining healthy weight is not only important to workers but should also be a high priority for employers."

The study, published in the Archives of Internal Medicine, was supported by a grant from the National Institute for Occupational Safety and Health. Researchers examined the records of 11,728 employees of Duke University who received health risk appraisals between 1997 and 2004.

Ostbye says the university collects this information anonymously in order to identify areas of potential occupational risk and to develop plans to reduce that risk. The analysis covered a diverse group of workers, such as administrative assistants, groundskeepers, nurses and professors.

For the study, researchers looked at the relationship between body mass index, or BMI, and the rate of workers' comp claims. Because the BMI takes into account both a person's height and weight when measuring body fat, Ostbye says it is considered the most accurate measure of obesity. For Americans as a whole, a BMI of 18.5 to 24.9 is considered normal, 25 to 29.9 is considered overweight, and 30 and above is considered obese.

Researchers found that workers with a BMI greater than 40 had 11.65 claims per 100 workers, compared with 5.8 claims per 100 for workers within the recommended BMI range.

In terms of average lost days of work, the obese averaged 183.63 per 100 employees, compared with 14.19 per 100 employees for those in the recommended range. The average medical claims costs per 100 employees were $51,019 for the obese compared with $7,503 for the nonobese.

The body parts most prone to injury among obese workers were the lower extremity, wrist or hand, and back. Researchers say the most common causes of these injuries were falls or slips, and lifting.

The results of the study echo warnings from the insurance community that employers need to develop a plan to contain obesity-related costs.

According to statistics, the total cost of obesity to U.S. companies is estimated at $13 billion per year. Obesity is also a major contributing factor in industrial accidents. Even when obesity is not a factor in causing a traumatic injury, researchers say it can complicate treatment and extend the time necessary for recovery.

John Dement, professor of occupational and environmental medicine and principal investigator for development of the workplace safety surveillance program at Duke University, says he believes the study isn't simply a snapshot of a group of employees but is reflective of society as a whole.

"The findings can be generalized to the community as a whole, since the demographics of Duke closely reflect the local area," he says. "We can use the Duke population to think about the community, so the solutions we come up with can benefit the community as well."

Dement says the primary message from the study is that U.S. employers need to reduce the burden on workers' comp by intervening not only on individual risk factors such as obesity but also within the workplace to reduce the risk of injury.

"By targeting obesity and workplace risks simultaneously, we can reduce absenteeism, increase the overall health of our workers and decrease the cost of healthcare for all employees," he says.

TRAUMATIC INJURY RISK

In a separate study, researchers at the Johns Hopkins Bloomberg School of Public Health's Center for Injury Research and Policy have found that having a BMI in the overweight or obese range increases the risk of traumatic workplace injury.

"Clearly, limited resources for workplace injury prevention and control should target the most prominent and modifiable risk factors, but we cannot neglect the fact that our study and other recently published studies support an association between BMI and the risk, distribution and prevalence of workplace injury," says Keshia M. Pollack, the lead author of the study and an assistant professor in the Bloomberg School of Public Health's Department of Health Policy and Management.

Employer-sponsored weight-loss and maintenance programs should be considered as part of a well-rounded workplace safety plan, according to authors of the Advance Access study recently published in the American Journal of Epidemiology.

The researchers used medical and injury surveillance data on hourly workers employed in eight plants of the same aluminum manufacturer to determine whether increased BMI was a risk factor for workplace injury.

The plants were scattered across the United States. BMI was calculated using National Institutes of Health criteria. Employees were grouped into five categories: underweight, normal, overweight, obesity levels I and II, and obesity level III.

Of the 7,690 workers included in the study, 29 percent were injured at least once between Jan. 2, 2002, and Dec. 31, 2004. Approximately 85 percent of the injured workers were classified as overweight or obese. More than 28 percent of injuries occurred among employees classified as overweight, 30 percent in the obese I and II category, and almost 34 percent in the obese III category.

The severely obese group, which had a BMI of greater than 40, also had the most injuries to the hand/wrist/finger at 22 percent when compared to the same injuries in the other weight categories. Almost 10 percent of all injuries in the obese III group were to the leg/knee, compared to 7 percent of workers classified as overweight, which was the next highest injury rate.

"We know that obesity prevention policies and programs in the workplace are important simply because of likely improvements in employee health," Pollack says. "What we do not know is if obesity prevention in the workplace will also have the added benefit of improving injury rates and reducing lost work time. Evaluations of worksite health promotion and obesity prevention efforts should measure changes not only in employee health, but also traumatic injury."

The researchers say that more work will be needed to test the effectiveness for reducing weight among hourly, nonoffice employees who face a number of barriers to participating in work-site physical activity programs, such as the need to remove protective clothing for midday exercise and a lack of time because of additional employment or home responsibilities.

JOSHUA CLIFTON is editor of the Workers' Compensation Report, a newsletter owned by the parent company of Risk & Insurance®.

December 1, 2007

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