The Health Insurance Costs of Obesity

While Mississippi claims the dubious distinction of being the “fattest state,” with a self-reported obesity rate of 34.9 percent among adults, the truth is that the obesity problem affects employers in the form of higher health insurance premiums and other economic costs in every state. Even in Colorado, the “slimmest state,” more than one-fifth of adults are obese.

Why Worry About Obesity?

For one thing, obesity has the effect of raising health insurance costs. Consider how obesity increases the risk of a number of common health conditions, including:

• Coronary heart disease
• Type 2 diabetes Cancers (endometrial, breast, and colon)
• Hypertension (high blood pressure)
• Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
• Stroke
• Liver and gallbladder disease Sleep apnea and respiratory problems
• Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
• Gynecological problems (abnormal menses, infertility)

In 2008, researchers estimated the medical costs associated with obesity at $147 billion. The medical costs for people who are obese were $1,429 higher than those of normal weight.

Obese employees will cost you more in workers’ compensation benefits as well. A 2007 study by Duke University Medical Center found that morbidly obese workers (with weights 100 percent or more above normal for their height) filed 45 percent more claims than workers of normal weight. Their claims also cost more — with 5.4 times the medical costs and nearly 8 times the indemnity claim costs as claims from workers of normal weight. A study by the American Medical Association concurred that obese workers have higher claim costs, finding that obese workers with workers’ comp claims have five times more lost days and medical costs more than twice as high as people of recommended weight.

Health experts recommend that people who are obese or overweight lose weight. Even a small weight loss (between 5 and 10 percent of current weight) will help lower the risk of developing diseases associated with obesity. People who are overweight, do not have a high waist measurement, and have fewer than two risk factors may need to prevent further weight gain rather than lose weight. Some of the actions employers can take to promote weight loss include:

Offer health risk assessments (HRAs). These confidential questionnaires help gauge an individual’s risk for certain conditions, based on health history and other factors. The information gained in an HRA can provide a starting point for counseling and program development for individuals with identified health risks.

Offer wellness and disease prevention programs and benefits. Offer employees programs and health benefits that help them stay healthy, including nutrition, physical activity, and obesity counseling; subsidize health club memberships, and provide insurance discounts for preventive services. Investing in employee health not only improves productivity but also cuts down on absenteeism.

Provide opportunities for employees to be active during the day. Maintain clean, well-lit stairwells to encourage employees to take the stairs, and focus on providing healthy food options in vending machines and in cafeterias.

Replace smoke breaks with fitness breaks. Encourage employees to engage in physical activity on their lunch hours and breaks. Employers have long allowed smokers to step outside for a cigarette break. Consider offering “walking breaks” instead, whereby employees can leave their desks for 10 minutes or so to walk around the office. Walking breaks can improve mental focus in addition to physical health.

Advocate for preventive services. Generally, physicians do not receive enough support, resources or reimbursement from insurance companies to prescribe preventive care for patients with chronic diseases. Employers can ask their insurers to offer plans that cover nutrition counseling, weight loss and weight management programs to decrease obesity and prevent the development of chronic diseases.

What Exactly is Obesity?

Obesity simply means having too much body fat. Several methods can determine body fat as a percentage of total weight, including underwater weighing, near-infrared interactance and DXA. However, due to cost, the body mass index (BMI) is most commonly used. Not an actual measurement, it is a ratio of weight to height and can provide a fairly reliable estimate of body fat. Although BMI can be used for most men and women, it does have some limits:

• It may overestimate body fat in athletes and others who have a muscular build.
• It may underestimate body fat in older persons and others who have lost muscle.

Using pounds and inches, you can calculate BMI using this formula: [weight (lb)/height (in)]2 x 702 You can also find an online calculator at http://nhlbisupport.com/bmi/bmicalc.htm. BMI ranges for adults are shown in the following table:

Measuring waist circumference also helps screen for possible health risks that come with overweight and obesity. Individuals who have most of their fat around the waist rather than the hips have a higher risk for heart disease and Type 2 diabetes. This risk goes up with a waist size greater than 35 inches for women or 40 inches for men.