I’m reading a fascinating book by Erik Finkelstein, PhD, MHA, and Laurie Zuckerman, called The Fattening of America. Finkelstein is an expert in the field of economics and obesity, and the thoroughness of his research is obvious in every page of his book (the bibliography is 25 pages long – I guess they didn’t just wake up one day and write a book).
So far, several points have caught my attention. First is the cost of obesity, both from a health insurance perspective, and the direct cost to employers. The authors write that if we were all at a healthy weight, annual medical expenses in the US would be $90 billion lower. That would represent a 9% decrease in spending. Further, they examined a study that looked at the number of annual sick days taken off work by women of normal size and women who are obese. For the formers, the number was 3.4 days. But for women with a BMI of 40 or higher (about 100 pounds overweight), the number jumped to 8.2 days (the numbers were higher for obese men compared with normal weight men, but not as dramatically so). In another issue for employers, there are ten times as many short term disability claims related to obesity than there were ten years ago. And as far as cost for the employer, obesity-related disabilities run an average of $8,720 per claim. No wonder employers would like to see their workforce slim down.
I’ve written before about wellness programs offered by employers, and about various carrots and sticks that employers use in order to improve the health of their employees. But while being healthy is an obvious benefit to the employees, employers tend to be motivated by a healthier bottom line. And I was interested in Finkelstein’s premise that employer wellness programs might not have such a great return on investment for the employer after all. For starters, employees change jobs much more frequently than they did a generation ago, which means that employer 1 might invest in the health of an employee, only to see him go work for employer 2 a few years down the road. Since health problems related to obesity tend to build gradually, the benefits of a wellness program might not be seen until the employee has moved on. But in addition to this, he points out that many of the studies done on employer-sponsored wellness programs don’t hold up to scientific testing. Often there’s no control group, and the results might be generated by looking at the people who enrolled in the wellness program versus those who did not – but this is not random selection of participants. There’s a good chance that those who enrolled may have been healthier to begin with.
But I’m curious about some of the more intangible benefits to a wellness program. The things you can’t measure directly in dollars and cents, but that do have an indirect impact on productivity. Things like improved morale and less fatigue. Hopefully employers will continue to promote wellness and healthy lifestyles for their employees, even if they don’t see an immediate boost to their bottom line.
In AL, overweight state workers will have to start paying $25/month for their health insurance in 2010 if they don’t take steps towards losing weight (currently they don’t pay anything for their health insurance). The state is offering lots of free help to employees who are looking to slim down. Some people are criticizing the program, but overall the response has been positive. And let’s face it – there are a lot of people who would love to pay only $25/month for their health insurance. In Colorado – as in most states – overweight applicants often pay 25 – 50% more for individual health insurance, and all individual health insurance companies have upper weight limits beyond which an applicant will be declined for coverage at any price. This is a reflection of that $90 billion in health care costs that are attributed to excess weight, and It’s only fair that participants in group health insurance plans also pay a little extra for their coverage. Especially if their employers are willing to offer help and incentives to lose the weight (the AL program is offering free doctor visits and a wellness program to employees trying to lose weight).
I’d like to see a similar program in Colorado. I think positive reinforcement is a better motivator than punishment or negative reinforcement – so the more help an employer or a state provides, the better. But anything that could lower our obesity rates would lessen the amount we’re spending every year to treat obesity-related health problems. And that would in turn have an impact on health insurance premiums, which would benefit all of us.