Obesity – Rethinking Assumptions on Weight Management and Benefit Programs 

By F. Randy Vogenberg

In 2002, two RAND researchers, health economist Roland Sturm and psychiatrist Kenneth Wells, examined the comparative effects of obesity, smoking, and heavy drinking on health expenditures in chronic conditions. Their research review found that obesity is linked to a big increase in chronic health conditions and significantly higher health expenditures affecting more people than smoking or heavy drinking. Although obesity had been a recognized health risk for a long time, Obesity was also recognized as a disease since 2013 by the American Medical Association (AMA). The idea that obesity is caused by insufficient willpower, lack of discipline, and bad choices began to transform how employers addressed health policy along with subsequent benefits.

While many focus on the body mass index (BMI) when thinking about obesity, clinical aspects of obesity has many manifestations by individual and varies based on the cause of weight gain. There is not just one type or cause for obesity so there is no single solution.  Obesity is related to genetic, psychological, physical, metabolic, neurological, and hormonal impairments. It is also directly linked to heart disease, sleep disorder, and certain cancers. Important to employers is that Obesity is among the few diseases that can negatively influence social and interpersonal relationships in the workplace.

WHY EMPLOYERS NEED TO ADDRESS OBESITY AS A DISEASE

Health benefits have become disconnected from effective management of obesity. For some, obesity as a disease dismisses the importance of caloric intake (beverages and food), and exercise and enables individuals with obesity to escape responsibility for their condition. For others, obesity as a disease is a bridge to coordination of effective treatment and increased resources for weight loss.

Since 2012 and ACA (Affordable Care Act) health reform coverage changes, many states now promote open coverage around efforts to diagnose obesity as well as management coverage for this medical condition. Uniform coverage remains prone to gaps or inconsistencies from plan to plan thereby allowing individuals with obesity to fall through benefit plan supports over time. This happens despite mandates for coverage in ACA although the same can’t be said for ERISA plans.

This issue is not a simple issue for HR managers and senior executives. Clinically, the Obesity Medicine Association has defined obesity as a “chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.” Why obesity is a disease is becoming more evident as we increase our knowledge about obesity and its effects on individuals and in benefit offerings. Key to successfully confronting the obesity epidemic requires attacking the disease and its manifestations, not just its symptoms.  Covid-19 has only heightened awareness around the importance of obesity and related health problems. Research is showing that individuals with obesity are at a higher risk for contracting as well as complicated medical management for symptoms associated with Covid-19, and in extreme cases death for young or old.

The value proposition for chronic weight management  includes addressing the fact that obese individuals have higher healthcare costs, so employers have an opportunity to comprehensively address this issue through improved benefit design. Engagement in these solutions can not only improve health risk and clinical outcomes, but address lowering the increasing costs of care year over year as a sustainable strategy.

WHAT EMPLOYERS CAN DO

Environmental support in the workplace is being addressed by many employers through efforts in providing healthy food options, allowing reimbursement for or providing opportunities to participate in various physical activity, and promoting regular water drinking habits while minimizing sugar intake.

Establishing a positive “Culture Of Health” has been addressed by employers but needs more to participate in the use of health promotion policies and programs offered to employees. Such policies support good lifestyle choices, access to services or support across simple lifestyle to medical supervised programs or surgery to address obesity in the workplace. This has been area of improvement in recent years, certainly since 2014.

Health benefit design and incentives remains an important and underutilized area where employers can do better easily. Fundamental program elements should include lifestyle management (improved diets, physical activity and weight management) along with the previously mentioned environmental support and culture of health. A comprehensive benefit strategy should include medical weight management (care plus supplements and/or anti-obesity medications), coverage of visits with clinical support professionals, and aligned incentives for participation in obesity management options – all in addition to coverage of bariatric surgery. Such a comprehensive approach should give plan members access to needed resources coupled with appropriate incentives to drive levels of engagement.

Community and family connections, similar to employees, need support, encouragement, and engagement by all family members with community resources and local events. Employers should develop partnerships with local businesses that offer access to fitness facilities and programs, access to healthy foods and beverage, and recreational opportunities.

Employers can do more to support their employees and plan members along their weight management journey, which is beneficial to all concerned. The value of investment into a comprehensive program will drive gains in employee performance, lower health care costs, and improve satisfaction with employer sponsored benefits. Such gains can be obtained in the short term and over the long run as these are sustainable and easily obtained solutions to implement by an employer. Use the checklist on the oppositive page to assess your current plan offering and determine opportunities for meaningful improvement that can be measured.