March 25, 2004
Unless you have sworn off all media forms—which you haven't if you're reading this—you know that obesity has reached epidemic proportions in the U.S. It ranks No. 2, second only to smoking, as the leading cause of U.S. deaths. The Centers for Disease Control and Prevention (CDC) reported that tobacco use was the leading cause of death in 2000, killing 435,000 people, 18.1 percent of all deaths recorded. Obesity and its contributing factors, poor diet and physical inactivity, caused 400,000 deaths, 16.6 percent of all deaths recorded.
Obese persons are victims of employment and other discrimination, and they are penalized for their condition, despite many federal and state laws and policies.
Obesity exacts a terrible toll on human health, quality of life, and on businesses' productivity and bottom lines. The costs of obesity are staggering.
According to the U.S. Centers for Medicare and Medicaid Services, total U.S. health-care spending in 2002 was $1.5 trillion, around 15 percent of the gross national product for that year. In 1994 researchers conservatively estimated the direct medical cost of obesity in the U.S. at $51.6 billion. In 1998 the National Heart, Lung, and Blood Institute (NHLBI) reported the total costs attributable to obesity-related disease near $100 billion annually—almost double the 1994 amount.
The Washington Business Group on Health (WBGH), an employer organization that lobbies for health policies, recently estimated that companies' health-care costs attributed to obesity are $12 billion each year. According to Helen Darling, WBGH president, all health-care expenses—from prescriptions to hospital visits and stays—are more for obese patients. For example, employers spend 77 percent more on prescription drugs for the seriously overweight than for healthy-weight patients.
A two-year study of almost 200,000 General Motors employees, reported in the Jan./Feb. 2003 issue of the American Journal of Health Promotion, showed that overweight and obese individuals average up to $1,500 more in annual medical costs than healthy-weight individuals. The study, conducted by Dee W. Edington, Ph.D., of the University of Michigan, and colleagues, examined the relationship between health-care costs and six weight groups defined by the NHLBI's weight guidelines—underweight, healthy-weight, overweight, and three separate obesity designations based on average body mass index (BMI).
The researchers found that 40 percent of the GM employees in the study were overweight, and 21.3 percent were obese. Healthy-weight employees made up 37 percent, and 1.5 percent were in the underweight category. Generally, annual median medical costs were lowest for the healthy-weight group, compared with the costs for underweight, overweight, and obese employees. Almost 63 percent of the GM employees studied potentially cost the company more in health-care costs because of their weights and related conditions.
The study's authors said, "Controlling weight and obesity-related health conditions is especially important to corporations, where the percentage of revenue spent on medical benefits continues to increase."
According to the American Obesity Association (AOA), obesity is a disease that affects nearly one-third of the adult U.S. population, approximately 60 million. It's a chronic disease with a strong familial component. Obesity increases a person's risk of developing conditions such as high blood pressure; diabetes (type 2); heart disease; stroke; gallbladder disease; and breast, prostate, and colon cancer.
Our environment fosters the tendency toward obesity: lack of physical activity combined with high-calorie, low-cost foods.
Results of a National Health and Nutrition Examination Survey (NHANES), reported by the CDC, stated than an estimated 64 percent of U.S. adults are either overweight or obese, defined as having a BMI of 25 or higher. People with BMIs of 25 to 29.9 are considered overweight, and those with BMIs above 30 are considered obese—usually 30 lbs. overweight for a woman and 35 to 40 lbs. overweight for a man of average height.
The NHANES survey reported that as BMI levels rise, average blood pressure and total cholesterol levels increase, and average HDL, or good cholesterol, levels decrease. Men in the highest obesity category have more than twice the risk of hypertension, high blood cholesterol, or both compared to men of normal weight. Women in the highest obesity category have four times the risk of these conditions.
BMI is calculated by dividing a person's body weight in kilograms by his or her height in meters squared (weight [kg]/height [m]2) or by using a conversion with pounds (lbs.) times inches (in.) squared times 704.5. You can calculate your BMI in both English and metric methods at this link: http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm.
BMI isn't always an exact indicator of obesity. The number can be misleading for very muscular people or for pregnant or lactating women. Obesity is an excessively high amount of body fat or adipose tissue, in relation to lean body mass. Assessing the amount of body fat concerns both the distribution of fat throughout the body and the size of the adipose tissue deposits. Body fat distribution can be estimated by skinfold measures; waist-to-hip circumference ratios; or techniques such as ultrasound, computed tomography, and magnetic resonance imaging. All of these methods and healthy-weight measurements are described at http://www.cdc.gov/nccdphp/dnpa/obesity/defining.htm.
Losing weight is tough. For many, it's a lifelong struggle. Overweight and obese individuals must recognize the potential health hazards associated with carrying excess weight; adopt healthy eating habits and lifestyle changes that encourage weight reduction; and work to maintain weight loss. Whether a person succeeds at controlling weight and optimizing health ultimately depends on the individual. However, businesses seeking to optimize productivity and control costs would be wise to help employees in their quest to win the battle of the bulge.
Weight loss information is everywhere. E-mail spam includes pitches for miracle potions that magically make pounds disappear without dieting. Infomercials for body wraps, creams, and fitness equipment promise miraculous results. Advertisements for diet programs abound, and diet books regularly show up on best-seller lists. Clinics specializing in gastric bypass are growing in popularity, and grocery store shelves now feature many diet and low-carb foods. Yet the obesity epidemic continues unabated.
Losing weight and keeping it off require motivation, determination, and lifestyle changes. Businesses can help by encouraging healthy eating and activity in the workplace and by providing motivation and rewards.
Safety committees should make healthy living a priority, and safety programs should incorporate a healthy lifestyle component. If you don't have a safety committee, set up a healthy living committee with the mission of promoting a healthy lifestyle at work.
Explore ways to encourage workers to be more physically active during the workday. Perhaps you have space in your facility for fitness equipment that employees could use over the lunch hour, before, or after work. Encourage workers to take the stairs instead of the elevator. The CDC's StairWell to Better Healthproject offers suggestions for making stairwells more inviting. One suggestion is to place health- and fitness- related information—or framed art or candid staff member photos— in the stairwells. Change content regularly to keep stair users from becoming bored. Another suggestion is to pipe music in the stairwells.
Set up a friendly competition for lunch-time walkers. Establish a route or routes near the office that can be walked in half an hour. Note the distance for each route. Keep track of the number of days an employee walks, the distance covered, and pounds lost since the program began. Award prizes for the winners in each category—preferably a prize that not only recognizes the accomplishment, but also encourages continued healthy living, such as a massage, a spa day, tickets to a sporting event, a gift certificate to a sporting goods store, or a dinner for two at restaurant that serves healthy food. Also recognize important milestones along the way—incremental weight loss and mileage marks. Let high achievers mentor newcomers to the program. With participants' permission, you might want to take before and after pictures to post in the stairwell!
Consider bringing in physicians, nutritionists, fitness experts, and motivational speakers to address the employees and help them with their weight-loss struggles. Form a weight-loss group of employees who meet periodically to discuss their efforts.
Fill your break room vending machines with healthy snacks, including low-fat microwave popcorn. For food days, offer fruit and vegetable trays and encourage contributors to bring low-fat, nutritious, homemade items. Junk food addicts may balk, but limiting access to junk may be the impetus some need to begin eating healthier food.
Plan surprise fitness activities. For example, on a nice spring or early summer day, announce that all employees are to report outside over the lunch hour for a nature walk or friendly game of horseshoes followed by a healthy picnic lunch.
Most of all, make pursuing a healthy lifestyle fun. Laughter truly is the best medicine—one that can turn something as distasteful to a couch potato as healthy eating and exercise into an enjoyable part of daily living. Your employees will be healthier, and so will your bottom line.