By JULIE LIEDMAN
who writes about healthcare issues.
As American workers' expanding girth continues to have a dramatic, negative impact on corporate bottom lines through increased healthcare costs and decreased productivity, more and more employers are taking steps to promote healthy lifestyles, hoping to reduce overall risk and the cost of employee health plans.
But are they doing enough?
According to a new report by Lockton Inc., a leading independent insurance broker:
-- Some 74 percent of the adult U.S. population, aged 20 years and older, is either overweight or obese.
-- Medical costs associated with obesity are estimated at $168.4 billion per year.
-- The increase in obesity prevalence accounts for 12 percent of the growth in health care spending.
Although employers may institute wellness programs to encourage healthier behaviors among their employees, the Lockton report said traditional wellness programs do not provide enough assistance to all employees, such as the morbidly obese. For such employees, the report said, employers should consider offering benefits that cover more dramatic interventions, particularly bariatric surgery, which limits the amount of food the stomach can hold and therefore limits total calories absorbed.
In an ideal world, the problem of obesity would be addressed simply by eating nutritious foods in moderate portions and exercising regularly. And because the workplace is where employees spend up to a third of their working days, employers can indirectly influence employees with healthy choices in terms of the facility, culture and resources they offer at work. According to the Lockton report, they"can make an impact by ensuring a culture of health and taking steps to establish policies and amenities that are conducive for employees to make healthy choices"--everything from vending machine choices and filtered water to incentives for healthy behaviors.
Indeed, many employers do just that. Joe Miller, managing director of CHC Wellness, a Chicago-based, on-site provider of corporate health and wellness programs, said he sees an increase in obesity awareness and a desire among employers to help their employees address them.
"Weight issues are a continuum," he said. "They start with being overweight and move along the continuum to obesity." Along this continuum is the development of metabolic syndrome, a group of risk factors that raise the risk for heart disease and other health problems such as diabetes, coronary artery disease and stroke.
"Metabolic syndrome is the newest phrase in the wellness industry," Miller said, "and the cost of every step continues to rise in health plan costs." It is the No. 1 focus in wellness programs today, he said.
THE HIGH COST OF OBESITY
The American Society for Metabolic & Bariatric Surgery (ASMBS) reported that obese individuals spend 40 percent more on healthcare than individuals of normal weight, and diseases associated with obesity accounted for 27 percent of the increases in medical costs from 1987 to 2001, the most recent statistics available.
Many employers offer programs with a variety of opportunities for their employees to lose and maintain their weight, from health coaching to incentive programs. One Catholic archdiocese with 4,000 employees in a Midwest town realized a $240,000 medical savings with just a walking program, Miller said.
"Everybody gains weight," he said. "In general, nonparticipants in wellness programs gain over two pounds a year, but people who participate in such programs gain half of that, and a maintenance program can slow the trend."
According to the Lockton report, "Physician-developed clinical guideless recommend prevention of obesity and medically supervised weight loss as the first-line treatments for excess weight." Overweight and obesity also can be treated with behavior modification and pharmacotherapy, it said.
But cultural, lifestyle and psychosocial issues make weight loss difficult for some people no matter what kind of programs are available. For those people, more drastic measures might be called for and, according to Lockton, "for severe obesity, physicians have concluded that bariatric surgery is the most effective intervention."
To be sure, this is never a standalone option. Dr. Robin Blackstone, president of the ASMBS and a surgeon said it is important that employers provide access to "an obesity treatment continuum" that includes everything from counseling and wellness programs to surgery.
"Our society (the ASMBS) is supportive of access to all of the treatments," she said. "The data is clear that weight-loss programs help employers that want to retain their employee base and keep them healthy. It's a good investment."
Nevertheless, she said, it is important to understand that obesity is not simply the result of too much eating and not enough exercising. Genetics, metabolism, culture, illness, environment and psychological issues also are contributing factors to obesity.
And it's a very serious matter. Morbid obesity is associated with more than 30 illnesses and medical conditions, and obese individuals have a 10 to 15 percent increased risk of death compared with individuals of a healthy weight, according to the metabolic and bariatric surgery society.
WHO IS A CANDIDATE, WHO IS COVERED?
Body mass index (BMI), which is calculated by dividing weight in kilograms by height in meters, is the most common measurement of body fat.
A person with a BMI of 25 to 29.9 is considered overweight; a person with BMI of 30 to 39.9 is considered obese and a person with BMI of 40 or more, or a BMI of 35 or more with an obesity-related disease such as diabetes, heart disease or sleep apnea is considered morbidly obese. People with BMI of 40 or more, or 35 or more with an obesity-related disease, are considered candidates for surgery.
According to the metabolic and bariatric surgery society, 15 million Americans have morbid obesity; some 220,000, or just 1 percent of the clinically eligible population, had bariatric surgery in 2009, the latest statistic available. Bariatric surgery costs an average of $11,500 to $26,000; insurance coverage varies by provider. Although some offer coverage to one extent or another, some do not offer it all.
"There is variability in coverage," said Susan Pisano, vice president of communications for America's Health Insurance Plans (AHIP), the national trade association representing the health insurance industry. "Employers purchase insurance, so most providers will provide a benefit if the employer wants it. Some won't. To the extent that an employer believes it's important, he will find an insurer to cover that benefit.
"There is a place for this type of surgery in the treatment of morbid obesity, but at least during the initial years that it became popular there were many concerns about issues of patient safety," she said. "Patient safety is always the backdrop."
The U.S. Agency for Healthcare Research and Quality (AHRQ) and recent clinical studies reported significant improvements in safety, including:
-- Risk of death from bariatric surgery is about .1 percent.
-- Overall likelihood of major complications is about 4 percent.
-- Risks of living with morbid obesity outweigh the risks of bariatric surgery.
Furthermore, the surgery improves and even resolves many obesity-related conditions, including Type 2 diabetes, heart disease, sleep apnea, hypertension and high cholesterol, and it increases lifespan, according to statistics from the metabolic and bariatric surgery society.
At present, bariatric surgery is covered as a standard benefit by all federal health plans, and in health plans offered to state employees in 43 of 50 states. It is covered in 47 of 50 state Medicaid plans.
According to a national survey of employer-sponsored health plans conducted by global administrator Mercer, bariatric surgery is covered by 40 percent of plans with fewer than 500 employees and 76 percent of plans with 20,000 or more employees; the percentage increases as the number of employees increases.
The metabolic and bariatric surgery society is urging Congress and U.S. Secretary of Health, Education and Welfare Kathleen Sebelius to include coverage in the health exchanges that will be created in each state by 2014, as part of the health reform legislation signed into law in March 2010. The exchanges will make health insurance more affordable and easier for small businesses and individuals to purchase.
"I can't imagine that we understand obesity and we have this treatment for it, but not everyone has access to it," Blackstone said.
"I know of a man in New Mexico who was 38 and employed, who had a good employer-based insurance plan but not one that covered bariatric surgery. He had BMI of 58 and everything--Type 2 diabetes, hypertension, two cardiac stents, sleep apnea.
"This man applied to his insurance company to get bariatric surgery covered as a medical necessity. They kept turning him down and he kept appealing.
"He died during the appeal. It was completely tragic," she said. "And that's going on in this country right now. People are waiting for life-saving surgery and dying in the process.
"Broadening the understanding of the problem will help employers think about it carefully and not reject it out of hand. They need to know that covering bariatric surgery, rather than not covering it, is to their advantage; it's more risky for employers not to cover it.
"The most important part of the cost," Blackstone said, "is that it's effective."
October 1, 2011
Copyright 2011© LRP Publications