The Problem Continues To Grow, Employers Respond

In our article "Obesity In The Workplace" written last year we presented a large amount of information about obesity and how it affects individuals and employers alike.

The problem of obesity and obesity in the workplace is punctuated by growth rates of the number of people overweight in this country.

Blue Cross and Blue Shield of North Carolina estimate that 55 percent their 3 million members are overweight and getting heavier, while at the same time nearly one-third of the overweight members described their weight as "just right." 5 percent of obese enrollees also thought that their weight was just fine.

This indicates that the problem will continue to grow worse in part because many people don't even perceive it to be a problem.

However, employers understand the problem and are responding.

New programs like Blue Cross and Blue Shield of North Carolina's obesity initiative continue to be launched. In 2003, 58 percent of employers provided at least one such program, compared with 41 percent in 2002, according to a survey on employer-sponsored health plans conducted by Mercer Human Resource Consulting.

There have been a couple of new trends emerging. One is the emergence of benefits packages addressing specific obesity issues, and the other is the increase in the use of drugs and surgery for weight loss. We will take a look at these issues in this update.

Developments In Benefits Packages

Until recently most obesity intervention efforts have been more likely to fall under the umbrella of health improvement initiatives, such as sponsoring fitness programs, on-site fitness centers and programs, or healthier food choices in the cafeteria, etc.

Now we are seeing a shift in which more progressive self-insured employers are interested in covering weight-loss drugs and bariatric surgery, as well as benefits packages that show an emphasis on prevention and early intervention.

One example of this shift is that Blue Cross and Blue Shield of North Carolina is now offering a benefits package that can qualify members for a variety of services from nutrition counseling to weight-loss drugs and even bariatric surgery.

The "Healthy Lifestyle Choices" program is available to all 1.1 million eligible members. To enroll in the program, members must not only provide details about their height and weight, but also answer questions designed to assess their willingness to revamp their lifestyle, says Dr. Don Bradley, the health plan's senior medical director.

In addition to the obesity surgery and weight-loss drugs, the plan will pay for four doctor visits annually to discuss obesity issues, along with dietitian counseling.

The dilemma of this type of program is that with the rising health care costs most employers are going to be hesitant in adding benefits unless they are confident that there is a solid trade-off in terms of lower claims costs later.

The expectations are that long-term savings will far outweigh the upfront costs. "We are going to see savings on the medical side, but it's not going to be next month or next year necessarily," says Dr. Robert Harris, senior vice president and chief medical officer of Blue Cross and Blue Shield of North Carolina. "But it will come to pass."

Weight Loss Drugs and Surgery

Use of weight loss drugs and bariatric surgery has increased steadily.

Bariatric surgical procedures are major gastrointestinal operations that (a) seal off most of the stomach to reduce the amount of food one can eat, and (b) rearrange the small intestine to reduce the calories the bodies can absorb. This operation is for morbidly obese people only (at least 100 pounds overweight).

According to Blue Cross and Blue Shield of North Carolina, 495 surgeries were performed in 2003, compared with 75 in 2001. 340 patients underwent the procedure during the first six months of 2004 and it was expected that by the end of the year nearly 700 patients would have had the operation. Bariatric surgery can cost $35,000 to $40,000.

The Journal of the American Medical Association recently published a meta-analysis of 136 studies in which patients involved often dropped more than 120 pounds and saw improvement in diabetes, blood pressure and sleep apnea.

It seems that employers are not necessarily jumping on the bandwagon though, and the number of those qualifying for the surgery are relatively small in number. In 2003, 52 percent of employers didn't cover bariatric surgery at all, according to Mercer Human Resource Consulting's annual survey of employer-sponsored plans. An additional 18 percent required criteria to be met.

More employees are using weight-loss drugs as well. These drugs can cost as much as $100 a month but are no guarantee of significant weight-loss success.

A July 2004 report by the Agency for Healthcare Research and Quality only modest success with orlistat (Xenical ) and sibutramine (Meridia), the two drugs covered by Blue Cross and Blue Shield of North Carolina. The weight loss attributable to the medications after 12 months was under 13 pounds. However, the report's authors note that even this seemingly low figure could be clinically significant.

Skepticism Concerning Cost Effectiveness

Employers appear to be concerned and willing to investigate participation, but seem skeptical of the cost effectiveness of some of these solutions.

Health policy analysts and business groups, even those intrigued by BCBSNC's obesity initiative, describe research as mixed on the question of whether this sort of disease management effort will actually save money over the long run.

As another example, a Congressional Budget Office analysis looking at disease management's potential in the Medicare program found that "evidence on cost savings is limited,'' with few studies available. (October 2004)

Part of the concern over long-term return on investment has to do with turnover. An employer might pay for getting an employee healthy in hopes of a long-term work relationship only to find their competitors reaping the financial benefits.

Advocates of the programs point out that if this happens in a small number of cases the odds are still in the favor of the employer that the savings for existing employees will more than compensate for the difference.

They also point out that if you've got an employee who is lighter and healthier even over a period of months then there is an immediate impact on morale and productivity.

It seems for the employer that it is a matter of weighing options and determining the best way to minimize the effects of obesity in the workplace in a way that is both cost effective and provides for the welfare of their productive employees.