The Obesity Epidemic Is Growing —Affecting Employees and Employers Alike
Obesity is a growing epidemic and a driving factor in expanding health care costs in this country. Obesity is defined as having a body mass index (BMI) of at least 30. In 2013 the American Medical Association started classifying obesity as a disease. The number of people becoming obese grows every year. More than 40% of adults are now considered obese. Today the percentage of adults considered overweight or obese exceeds 70%. If current trends continue the Centers for Disease Control (CDC) projects that obesity rates will double by 2030, affecting 50% of our population.1
Chronic diseases that are linked to obesity such as arthritis, diabetes and heart disease are expensive. These conditions account for approximately 75% of our country’s health care expenditures. 2 Obesity is a key driver of many other costly chronic conditions, including:
• Depression
• Non-alcoholic fatty liver disease
• Obstructive sleep apnea
• High blood pressure
• High cholesterol
• Gastro-esophageal Reflux Disease (GERD)
Myths and facts about obesity
Many people believe obesity is simply a result of too little exercise, poor diet choices or a failure of personal responsibility. Previous assumptions about obesity were based on “energy in, versus energy out.” This limited view didn’t take into account the body’s complex bio-psychological responses (to defend and maintain one’s body weight) or that overconsumption of food and lack of physical activity are not the only causes of obesity.
Newer scientific evidence suggests that a much broader range of influential factors need to be considered to properly address the problem of obesity. Research indicates the causes of obesity are much more complex and cannot be fully explained by “calories in and out.” Health care providers, in partnership with their patients, need to develop personalized approaches that identify and address a range of root causes of weight gain.
Calorie absorption, or the energy derived by consumed food, varies from person-to-person. Calorie absorption is determined not only by portion size, but by factors such as a person’s own metabolism, gut microbes, hormones, digestive enzymes and nerve signals. There is growing body of evidence that shows that genetics, medications, stress, thyroid problems and other factors such as sleep deprivation, can also contribute to unhealthy weight gain.
How does sleep deprivation affect weight gain? If a person isn’t getting enough sleep or good quality sleep, his or her metabolism won’t function properly. Sleep deprivation can affect the levels of ghrelin and leptin in the body. Ghrelin is a hormone which sends signals to the brain when you’re hungry, and leptin is a hormone that tells the body you’re full. Lack of sleep leads to increased levels of ghrelin (causing increased appetite) and decreased levels of leptin (diminished feeling of fullness). In other words: more ghrelin, plus less leptin, can contribute to weight gain.
One-size treatment does not fit all
In recent years treatment options for obesity have increased with effective medications and improved treatment guidelines. Newer medications are in the development pipeline, too. Prescription medications (not those advertised on late night TV!) can complement an evidence-based obesity management plan to help people with severe obesity lose weight and improve their health. Another treatment option, suitable under certain conditions, is weight-loss surgery. All of these treatments are designed to augment, but not replace the need for changes in lifestyle, diet and physical activity.
The financial impact of obesity on employers and employees
Obesity impacts employers in both direct and indirect costs. For employees, obesity screening and counseling is covered, with no out-of-pocket costs in most health plans, under the Affordable Care Act. Coverage for weight-loss medications with private insurance varies. Realizing the true cost of untreated obesity, insurance companies are slowly revising their policies to provide coverage for obesity management.
The bulk of employee health care spending (mostly covered by traditional health insurance) is from treating expensive obesity-related diseases such as diabetes, cardiovascular disease and others. Indirect obesity costs are also incurred by employers because of an increase in sick leave and absenteeism and reduced productivity. It’s incumbent upon employers to take steps to reverse this costly trend affecting their bottom line.
Employers are encouraged to adopt a preventative approach to support a healthier work environment for their employees that can help address obesity in the workplace. Advocate Aurora Health has developed an Employer Checklist offering tips on Healthy Weight Management for employees. (https://go-employersolutions.aah.org/weight-management-resources)
To access the Employer Checklist and additional free downloadable healthy weight resources for your organization and employees visit go-employersolutions.aah.org/weight-management-resources. Resources include recorded webinars and how-to-get-started educational toolkits on nutrition, physical activity, behavioral therapy, weight loss medication and bariatric surgery. Additionally, you can request to schedule an appointment with one of our expert team members to discuss how we can implement and customize healthy weight services for your organization. Together, we can help your employees live well and work well.
Melanie Smith, D.O., is a family medicine physician at Aurora Family Medicine in Waterford, Wisconsin. She is board certified in obesity management.
1Derived from NHANES data (http://www.cdc.gov/nchs/hestat/obesity_adult_adult_09_1-.html#table1)
2https://cdc.gov/nchs/fastats/obesity-overweight.htm
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