Tag Archives: obesity

How to Shrink Employees’ Waistlines

A majority of the population of countries in the Organization for Economic Cooperation and Development is now classified as overweight or obese, with weight-related health costs accounting for up to 10% of total healthcare spending. Levels of obesity are also rising in the developing world.

Excess weight can lead to multiple health issues, increasing the number of sick days, as well as health insurance premiums. In addition, poor health costs U.S. companies U.S. $227 billion a year in lost productivity, while U.K. companies are losing £29 billion a year (U.S. $45 billion) through sick leave costs. With lack of physical activity during modern office workdays, a core contributing factor to the sedentary lifestyles that are increasing obesity, encouraging exercise is in everyone’s interests.

The question is no longer so much whether you should invest in employee wellness, but how.

In Depth

Numerous studies have shown benefits from encouraging employees to exercise:

  • Better problem solving: Want your employees to get better at solving problems and innovating? Aerobic exercise has been shown to boost both positivity and creativity.
  • Improved mental health: Physically active employees are significantly less likely to suffer from depression or job burnout.
  • More capable management: Getting managers exercising not only reduces their stress levels but makes them better managers, according to some studies.

There are several approaches companies can take that can help even the most reluctant employee start adopting a more healthy lifestyle. However, it’s important to remember that, to get the benefit, it is important that employees see the exercise as enjoyable and practical, not as a chore. Here are just a few:

  • Calorie-counted staff cafés: Consuming too many calories is the key cause of most weight issues, so helping staff manage their intake by providing healthy yet nutritious meals at an on-site café can be a major boost. In addition, several studies have shown that workplace cafés can act as social hubs that boost employee engagement and motivation.
  • On-site gyms: Employees are more likely to exercise if it is convenient, while time lost traveling to an off-site gym can reduce productivity and increase stress. On-site company gyms can save employees an average of $58 a month in membership fees — and make it easy to get the productivity and health benefits of daytime exercise.
  • Discounts for regular workouts: With the rise of wearable fitness tracking devices come new opportunities to monitor employee lifestyles, and reward the healthy ones. The ability to keep track of employee activity is sparking a fresh wave of apps that could help reduce insurance premiums if adopted at scale.
  • Standing desks: Studies have shown standing desks — a popular alternative in modern workplaces — lead to an increased heart rate, improved energy levels and employees burning as much as 20 additional calories an hour. Long periods of sitting, meanwhile, have been associated with increased mortality across a range of illnesses, with some doctors warning that sitting is the new smoking.
  • Cycle-to-work schemes: As well as saving employees money (as much as $7.3 billion a year in the U.S. alone) and being a great way to burn off excess calories, cycling to work is, on average, associated with one less sick day per year than for non-cycling colleagues.
  • Group calisthenics: One of the oldest workplace wellness programs (still popular in many Asian countries), organized all-company workouts are starting to make a comeback in the West. Though they can be awkward at first, done right they can boost team spirit and employee health.

It has become a truism that employees are businesses’ biggest asset. Just as you would invest in keeping your machinery operating at its best through regular maintenance, investing in maintaining your staff’s health is increasingly vital. Not only could it be good for productivity, but studies have shown that such programs can be vital in both attracting and retaining top talent. With staff turnover rates increasing across the world, if you want to thrive in the long term, investing in employee health and wellness could be an increasingly important strategy to keep your people active, productive and engaged.

Talking Points

“Instead of viewing exercise as something we do for ourselves — a personal indulgence that takes us away from our work — it’s time we started considering physical activity as part of the work itself. The alternative, which involves processing information more slowly, forgetting more often and getting easily frustrated makes us less effective at our jobs and harder to get along with for our colleagues.” – Harvard Business Review

“Workplace wellness and community prevention programs are a win-win way to make a real difference in improving our health and bottom line all at once.” – Jeff Levi, executive director, Trust for America’s Health

“Employees are eight times more likely to be engaged when wellness is a priority in the workplace.” – World Economic Forum

This article originally appeared onTheOneBrief.com, Aon’s weekly guide to the most important issues affecting business, the economy and people’s lives in the world today.”

Further Reading

6 Limitations of Big Data in Healthcare

Claims data captures the services provided to a patient. This information can be grouped into different cohorts—those getting preventive exams, those seeing specific physicians or hospitals for conditions, etc. The data can be grouped by diagnosis. However, all claims data is just a collection of medical bills. Medical bills do not contain a complete look at the patient, such as important information about a patient’s prognosis. That’s a gap. Thus, it is important to set appropriate expectations on the use of the data.

Here are six limitations that should be placed on the expectations:

Number 1 (one of the most important): Avoid the averages
Most claims data sets are not normally distributed, so the averages do not provide relevant information. In most discussions today, employers evaluate the average cost of employees with specific conditions, e.g., diabetes or high blood pressure. This is a flawed approach because spending by employees with various chronic conditions is skewed, thus not really “averageable.” For example, assume 90% of an employee population with diabetes is spending $10,000/year and 10% is spending $250,000/year; the average will be a meaningless $34,000/year. All too often, a wild goose chase ensues, when in fact the focus should be on the $250,000 cohort to understand why they were so much more expensive.

See Also: Why Healthcare Costs Bleed Firms Dry

Number 2: Follow the money
A superior use of claims data is to look at distributions of spending. In most plans today, roughly 8% of enrollees are consuming 80% of plan dollars, and these 8% typically change every 12 to 18 months. (We still run into benefit managers who were unaware of that turnover.) The future belongs to micro-managing these “outliers,” rather than the 92% who spend only 20% of the dollars. If you study those outliers carefully, you will find that only about 7% of their spending possibly would have been preventable, and then only if they faithfully did what their doctors told them to do decades earlier. A cardiologist recently told me that, of the patients he has seen with a significant acute blockage, about 25% had no known health risks of any kind…no high blood pressure, cholesterol, diabetes, obesity, smoking, genetic predisposition, etc. As such, there is a component of randomness in terms of who gets blocked arteries. The same holds true for cancer. For the other 75%, their physicians have usually counseled them on the importance of exercise and nutrition and the dangers of tobacco use, but to no avail.

Number 3: Realize the limitations for quality designations
Yet another big error is trying to use claims data to determine the best-quality doctors. You had better be really, really talented to try that one. Why? We are in an era in which many doctors are making their “quality” and “outcomes” look better by referring their most complex and riskiest patients to someone else. (Much has been written about this.) On the other hand, there are highly effective doctors who take responsibility for their riskiest patients, but as a consequence score poorly on so-called “quality measures.” The real travesty is that the low-scoring doctors may be the most cost-effective and provide the best care.

Number 4: Misdiagnoses are a real cost driver
Another huge shortcoming of claims data is one that readers of Cracking Health Costs know about. Namely, a large number of patients with complex health problems are simply misdiagnosed – today, that’s about 20% of the outliers in benefit plans, accounting for 18% of claim dollars. Thus, you cannot rely on diagnoses in claims data, and you cannot tell who is getting diagnoses right or wrong – this takes detective work beyond claims data. Click here for a good article by the Mayo Clinic on rates of misdiagnoses. We have sent hundreds of people to the Mayo Clinic for second opinions and can verify by personal experience the truth in that article…same for other clinics we have used for employers. Our first rule in selecting a Center of Excellence is its success in correctly diagnosing patients with complex health problems. Huge amounts of claim dollars are spent on treatments or surgeries that are either completely erroneous or clearly suboptimal. An executive at a Fortune 100 company once said to me that the biggest quality failure in healthcare is to misdiagnose a patient…everything that follows harms the patient.

See Also: To Go Big (Data), Try Starting Small

Number 5: Coding can affect the data analysis
During a data analysis for a very larger employer, with more than 250,000 covered lives, executives told me they had not paid for a solid organ transplant in a number of years. Based on their size, they should have been paying for about 25 a year. After further detective work, we discovered their consultant was using a DRG grouper that coded all transplants as ventilator cases…who knows why…but a huge error. The benefit team had no idea they were really paying for about 25 a year at an average cost over five years of about $1.5 million each.

Number 6: Reversion to the mean
One thing we’ve learned from years of claims analysis of big companies’ benefit programs is that if you have enough life years of data, it all looks about the same, i.e., it reverts to the mean. If the workforce is comparatively older, they will have somewhat more high-cost claims.

Obesity as Disease: A Profound Change

The obesity rate in the U.S. has doubled in the past 15 years. More than 50% of the population is overweight, with a BMI (body mass index) between 25 and 30, and 30% have a BMI greater than 30 and are considered obese. Less than 20% of the population is at a healthy weight, with a BMI less than 25.

On June 16, 2013, the American Medical Association voted to declare obesity a disease rather than a comorbidity factor, a decision that will affect 78 million adults. The U.S. Department of Health and Human Services said the costs to U.S. businesses related to obesity exceed $13 billion each year. With the pending implementation of ICD (International Classification of Diseases) 10 codes, the reclassification of obesity is is fast becoming a reality and will dramatically affect workers’ compensation and cases related to the American Disability Act and amendments.

Before the AMA’s obesity reclassification, ICD-9 code 278 related to obesity-related medical complications rather than to obesity. The new ICD-10 coding system now identifies obesity as a disease, which needs to be addressed medically. Obesity can now become a secondary claim, and injured workers will be considered obese if they gain weight because of medications, cannot maintain a level of fitness because of a work-related injury or if their BMI exceeds 30. The conditions are all now considered work-related and must be treated as such.

The problem of obesity for employers is not confined to workers’ compensation. The Americans with Disability Act Amendment of 2008 allows for a broader scope of protection for disabilities. The classification of obesity as a disease now places an injured worker in a protected class pursuant to the ADA amendment. In fact, litigation in this area has already started. A federal district court ruled in April 2014 that obesity itself may be a disability and will be allowed to move forward under the ADA (Joseph Whittaker v. America’s Car-Mart, Eastern District of Missouri).

Obesity as an impairment

Severe obesity is a physical impairment. A sales manager of a used car dealership was terminated for requesting accommodation and won $128,000. He was considered disabled, and the essential function of the job was walking, so he was terminated without reasonable accommodation.

The judge ruled that obesity is an accepted disability and allowed him to pursue his claim against his employer. This could have substantial impact for employers as injured workers could more easily argue that their obesity is a permanent condition that impedes their ability to return to work, as opposed to a temporary life choice that can be reversed.

The Equal Employment Opportunities Commission (EEOC) has recently chimed in on obesity. According to the EEOC, severe [or morbid] obesity body weight, of more than 100% over the norm, qualifies as impairment under the ADA without proof of an underlying physiological disorder. In the last year, we have seen an increasing number of EEOC-driven obesity-related lawsuits. Federal district courts support the EEOC’s position that an employee does not have to prove an underlying condition, especially in cases where there is evidence that the employer perceived the employee’s obesity as a disability or otherwise expressed prejudice against the employee for being obese.

Workers’ compensation claims are automatically reported to CMS Medicare with a diagnosis. When the new ICD-10 codes take effect, an obesity diagnosis will be included in the claim and will require co-digital payments, future medical care or continued treatment by Medicare.

There is good news on the horizon. Reporting of a claim only happens if there is a change in condition not primarily for obesity. It is recommended that baseline testing for musculoskeletal conditions be conducted at the time of hiring and on the existing workforce. In the event of a work-related injury, if a second test is conducted that reveals no change in condition, it results in no reportable claim and no obesity issue. In the event of ADA issues, the baseline can serve to determine pre-injury condition or the need for accommodations.

What does this mean to employers?

Obesity is now considered a physical impairment that may affect an employees’ ability to perform their jobs and receive special accommodations pursuant to the ADA.

An increasingly unhealthy workforce will pose many challenges for employers in the next few years. Those that can effectively improve the health and well-being of their employee population will have a significant advantage in reducing work comp claim costs, health and welfare benefits and retaining skilled workers.

Recent studies

In a four-year study conducted by Johns Hopkins with an N value of 7,690, 85% of the injured workers studied were classified as obese. In a Duke University study involving 11,728 participants, researchers revealed that employees with a BMI greater than 40 had 11.65 claims per 100 workers, and the average claim costs were $51,010. Employees with a BMI less than 25 had 5.8 claims per 100 workers, with average claim costs of $7,503. This study found that disability costs associated with obesity are seven times higher than for those with a BMI less than 30.

A National Institute of Health study with 42,000 participants found that work-related injuries for employees with a BMI between 25 and 30 had a 15% increase in injuries, and those with a BMI higher than 30 had an increase in work-related injuries of 48%.

The connection between obesity and on the job injuries is clear and extremely costly for employers. Many employers have struggled with justifying the cost of instituting wellness programs just on the basic ROI calculations. They were limiting the potential return on investment solely to the reduction in health insurance costs rather than including the costs on the workers’ comp side of the equation and the potential for lost business opportunities because of injury rates that do not meet customer performance expectations. Another key point is that many wellness programs do not include a focus on treating chronic disease that may cause workers to be more likely to be injured and prolong the recovery period.

Customer-driven safety expectations

There are many potential customers (governments, military, energy, construction) who require that their service providers, contractors and business partners meet specific safety performance requirements as measured by OSHA statistics (recordable incident rates) and National Council on Compensation Insurance (NCCI) rating (experience modifiers) and, in some cases, a full review by 3rd party organizations such as ISNet World.

Working for the best customers often requires that your company’s safety record be in the top 25th percentile to even qualify to bid. To be a world-class company with a world-class safety record requires an integrated approach to accident and injury prevention.

Challenges of an aging workforce

The Bureau of Labor Statistics projects that the labor force will increase by 12.8 million by 2020. The number of workers between ages 16 and 24 will decline 14%, and the number of workers ages 25 to 54 will increase by only 1.9%. The overall share of the labor force for 25- to 54-year-olds will decline from 68% to 65%. The number of workers 55 and older is projected to grow by 28%, or 5.5 times the rate of growth in the overall labor force.

Employers must recognize the challenge that an aging workforce will bring and begin to prepare their workforce for longer careers. A healthy and physically fit 55-year-old worker is more capable and less likely to be injured than a 35-year-old worker who is considered obese.

Treating chronic disease

Employers who want a healthy work force must recognize and treat chronic disease. Many companies have biometric testing programs (health risk assessments) and track healthcare expenditures through their various providers (brokers and insurance carriers).

The results are quite disappointing. On average, only 39% of employees participate in biometric screenings even when they are provided free of charge. For those employees who do participate and who are identified with high biometric risk (blood pressure, glucose, BMI, cholesterol), fewer than 20% treat or even manage these diseases.

This makes these employees much more susceptible to injury and significantly lengthens the disability period. The resulting financial impact on employers can be devastating.

Conclusion

Best-in-class safety results will require a combined approach to reduce injuries and to accommodate new classes of disability such as obesity. It is important that employers focus on improving the health and well-being of their workforce while creating well-developed job descriptions, identifying the essential functions, assessing physical assessments and designing job demands to fall within the declining capabilities of the American workers. It is important for an employer to only accept claims that arise out of the course and scope of employment. This is especially true with the reclassification of obesity as a disease. Baseline testing will play an essential role in separating work-related injuries from pre-existing conditions in this changing environment.

Digital Tech to Fight Childhood Obesity

Parenting in the modern world means worrying about how much time your child spends in front of a screen. Pediatricians may recommend only two hours of screen time a day, but kids actually spend as much as seven hours a day looking at TVs, computer monitors, video games, tablets, and cell phones. Study after study has linked those sedentary hours to the skyrocketing rate of childhood obesity in the U.S.

I realize that it’s not realistic in today’s high tech world to restrict screen time to two hours, especially for teenagers. So here’s an alternative: How about harnessing some of that technology to make our children healthier? The need couldn’t be more dire. One in three children in America is overweight or obese, and obesity remains one of the biggest threats to the health of our children, both now and as they grow into adults. That’s why the Robert Wood Johnson Foundation announced that it will pledge $500 million over the next 10 years to expand efforts to ensure that all children in the U.S. — no matter who they are or where they live — can grow up at a healthy weight.

Building on a $500 million commitment made in 2007, this brings our funding of this issue to $1 billion. To get the biggest impact for those dollars, we need to come up with fresh ideas, creative approaches, and new tools that will help us build a culture of health for our children, and their children. What better tool than the digital devices our children have already mastered?

And adults can lead by example, because many of us have already embraced digital health tools. There are currently 17,000 mobile apps designed to improve our health; according to industry estimates, half of the world’s 500 million smartphone owners will have a health app on their device this year. Plus, some 70 million wearable fitness trackers were sold in 2014, and people are expected to buy another 160 million by 2016.

Of course, having health apps and using them is not always the same thing. And getting kids to use digital technology and social media for health is yet another challenge. But it’s not that big of a leap from Snapchatting with friends, or searching YouTube and Vine, to sharing stats and photos about how many days you walked to school, vegetables you ate or miles you rode on your bike. Almost 95% of 12- to 17-year-olds in the U.S. have Internet access at home or school. Why not meet them in their online world?

We already know it can work. Zamzee, a children’s online activity meter and motivational website designed by HopeLab, with feedback from actual kids (and funding from RWJF) is meant to get kids moving more. Research shows that Zamzee increased physical activity in kids by 59% on average over a six-month study period.

There is a growing number of such digital health tools designed with kids in mind. The Weigh2Rock.com website, founded by a pediatrician, allows overweight teens, pre-teens and their parents to form support groups, share tips and track their personal fitness goals online. It also allows healthcare providers to follow the progress and interact with their patients online. Leapfrog’s Leapband, introduced in August, is a personal fitness tracker for children. Worn like a watch, it uses games to get kids moving and allows them to rack up points as they progress though the challenges. FoodnMe.com, a site that promotes healthy eating, has a fun SmashYourFood mobile app that lets kids smash or explode a variety of foods (virtually, of course) while learning about their fat, sugar, and salt content. Actually, this one is fun for adults, too

I’d like to see a lot more of these digital health tools for children. My hope is that developers, parents, health professionals and coaches will start thinking more like kids. Or, better yet, ask some kids what technologies and apps would most entice them to embrace healthier choices. I’ll bet they’d come up with some pretty creative ideas. Let’s start now. If you have some ideas about how to harness personal data, digital technologies and social media in ways that can help kids, and their families, get and stay healthy, please share in the comments. Because even $1 billion won’t solve this problem without lots of help.

Are Annual Physicals Really Worthless?

Dr. Ezekiel Emanuel wrote a contrarian opinion piece in the Jan. 8, 2015, issue of the New York Times titled, “Skip Your Annual Physical.” Dr. Emanuel is an oncologist at the University of Pennsylvania and was an adviser to the Obama administration regarding the design of health reform. He is also the brother of Rahm Emanuel, a former presidential chief of staff.

As you can guess from the title of the opinion article, Dr. Emanuel believes that annual physicals are not worth having because they do not reduce mortality. He cites a Cochrane Review study to back up his statement. Click here to read a summary of the study by the American Association of Family Practice.

Dr. Emanuel’s comments bring the following question to mind: How is one to have the evidence-based screenings recommended by the U.S. Preventive Services Task Force (USPSTF) without an annual physical?

Here is a list of some of the USPSTF screenings and interventions that studies have shown to be of value by reducing morbidity or mortality that could be accomplished at an annual physical:

  1. Screening for Type II diabetes
  2. Screening for hypertension
  3. Screening for lipid disorders (e.g. high cholesterol)
  4. Screening and counseling for alcohol abuse
  5. Screening for cervical cancer every 3-5 years
  6. Screening for obesity
  7. Potential use of aspirin for the prevention of heart attack
  8. Counseling on folate vitamin supplements for all women capable of pregnancy to prevent neural tube defects
  9. Counseling overweight and obese patients to improve their diet and exercise habits

Source: American Association of Family Practice

Many of these conditions are not rare.  For example:

  • 9.3% of the U.S. population has diabetes-of whom, 9 million are undiagnosed (Click here for ADA source). Assuming a U.S. population of 300 million, 9 million is 3% of the population, so three in 100 screenings would find undiagnosed diabetes. In a company with 1,000 employees, screening for diabetes would result in identifying 30 new cases of diabetes.
  • 29% of the adult U.S. population has hypertension-17% are undiagnosed (Click here for CDC source). 17% of 29% is about (again) 3% of the adult U.S. population, so three in 100 screenings would find undiagnosed hypertension. In a company with 1,000 employees, screening for hypertension would result in identifying 30 new cases of hypertension.

An annual physical is a great way to address these nine proven screening tests and interventions that will lengthen life and reduce suffering. This is only a representative sample from the USPSTF.  There are actually more than nine. You would not “technically” need an annual physical, but you would have to have some other mechanism for having these screenings and interventions performed.  A similar point is made by the American Academy of Family Physicians in its review of the Cochrane study. However, the use of the doctor’s office as the setting for the screening means that if an abnormality is found (i.e. diabetes, hypertension, etc.), then the doctor can prescribe an intervention.

To skip an annual physical and to not have the screening performed some other way-and followed up on-is hazardous to your health