January is the month when many people set fitness goals and resolve to lose weight, with varying degrees of success. Since overweight and obesity remain widespread, many employers are using disease management programs and incentives to encourage their workers to lose weight.

"Obesity management is being incorporated into existing disease management programs for diabetes and heart conditions. In the future, disease management programs will be offered with obesity as the primary condition. Disease management programs for obesity are few and relatively new," observes Sue Frechette, a principal consultant at Northfield Associates, a Warren, Vermont-based consulting firm.

Obesity "is probably the most daunting health problem facing America today. There is heightened awareness of treating obesity on its own," says Judy White, senior vice president of health operations for U.S. Care Management, a Jacksonville, Fla.-based disease management firm.

"We're hearing more and more that they'd like to incorporate weight management into their disease management or prevention overall. We're hearing a great increase in interest in trying to address it."

Some companies are offering a separate disease management program for employees who undergo bariatric surgery, says Mary Kaye Sawyer-Morse, a clinical manager at Avidyn Health, an Addison, Texas-based disease management firm.

Having a disease management program focused on obesity may help employees address their weight in a time and manner that's convenient and comfortable for them.

"Employees are utilizing it more and more, and it's something you can do at your own convenience. That way folks can get the support when they need it," comments Amy Milazzo, manager of disease management and wellness for Capital District Physicians' Health Plans in Albany, N.Y.

Considered a disease?

Some people question whether obesity should be considered a disease or treated like a disease by employers and disease management firms.

U.S. Care Management uses the term "weight management program" because "nobody wants to be labeled or participating in an obesity program," White remarks. Employers are reluctant to call obesity a disease because "it's not acceptable among their employee group," she says.

Sawyer-Morse agrees: "It's still framed as a comorbidity. They'll frame it under getting healthier, getting active, eating right."

Milazzo says: "You've got to be careful about that word [obesity]. Weight management is a less culturally offensive word."

Yet, Frechette feels this is changing.

"Employers and payers were initially hesitant [to call obesity a disease]. However, this has changed for two primary reasons," she observes. "Court decisions around obesity issues, whether workers' compensation, Americans with Disabilities Act and others, generally favor the employee."

Rising medical costs related to overweight and obesity also have changed some employers' views, she adds.

High cost of extra pounds

Cost is often the driver of the new approach in disease management. Employees with a high body-mass index have average medical costs more than 50% higher than normal-weight employees, according to Sawyer-Morse. In addition, obese employees are nearly 75% more likely to experience a high rate of absenteeism (seven or more absences during a six-month period) than normal-weight employees.

"Employers are recognizing that, with 65% of Americans being overweight and 30% obese, obesity is increasing the cost of doing business," Frechette notes.

"They are paying for obesity directly, for additional medical services, and indirectly, for additional absenteeism, disability and work-related injuries. They can pay now for obesity services or pay later for medical treatment of the implications of obesity - diabetes, heart conditions, etc."

Likewise, Dean Witherspoon, CEO of Health Enhancement Systems, comments: "We're losing ground in the fight against fat, and it's costing American businesses.

Annual health care costs are 11% higher among obese vs. nonobese people, and the trend is only getting worse. Comorbid conditions include heart disease, diabetes, musculoskeletal problems, depression, high blood pressure and high cholesterol to name a few."

"It's a rare case where obesity stands alone," without any comorbid conditions, White notes.

Milazzo adds: "Weight can affect so many aspects of your life and chronic illness. Dropping five or 10 pounds can sometimes be the difference between getting Type 2 diabetes and having your blood sugar be normal."

The estimated the cost of obesity is $29 per member per month for a health plan with one million members.

Overweight workers spend 37% more on prescription drugs, and obese workers spend twice as much on prescription drugs, compared to those workers who maintain a healthy weight.

Employees with a body-mass index over 40 have twice as many workers' compensation claims as employees at a healthy weight, according to Frechette.

"So much of that [cost] could be prevented with good attention to what the causes are," White suggests.

Weight problems are widespread

Kronos Optimal Health Co. recently screened more than 5,200 Americans, testing body-mass index, cholesterol levels and blood pressure. It discovered women are healthier than men, but both groups have high-risk factors that can lead to heart attacks, strokes and diabetes.

More than 75% of men ages 40 and older and 72% of men under age 40 are overweight or obese. Likewise, more than 64% of women over age 40 and 50% of women under age 40 are overweight or obese, Kronos found.

According to the Centers for Disease Control and Prevention, 66.3% of American adults age 20 and over are overweight or obese, and 32% of those age 20 and over are obese.

Businesses "should aggressively attack obesity from all fronts. The financial implications [of obesity] are ugly," Frechette asserts. She recommends that employers:

• Ask disease management vendors to incorporate obesity management into diabetes and heart disease programs.
• Find or request development of obesity-specific disease management programs.
• Incorporate obesity services into benefit plan design.
• Sponsor onsite programs like Weight Watchers.
• Create incentives for employees to reach or remain in specific body-mass index ranges.
• Be creative in incenting and helping employees reach and maintain a healthy weight.

It's best to introduce a program gradually so that employees "don't get mad about heavy-handedness and fearful about their jobs," Sawyer-Morse advises. Companies shouldn't expect an immediate return on investment because "weight and body-mass index are slow to move," she adds.

Al Lewis, executive director of Disease Management Purchasing Consortium International, warns against expecting too much from weight management programs.

"It's one of those classic situations that is measured wrong, and the benefits consultants don't seem to notice," he explains.

"You start with all these obese folks and say they lost 2,000 pounds collectively. Well, guess what, the people below the cutoff point for the program probably gained 2,000 pounds. The bottom line is weight regresses to the mean, just like everything else. I recommend that health plans offer it for employers because employers like it, but not do it on their own insured populations except as a rider."

Milazzo stresses the importance of following up after a weight management program to encourage participants to continue the healthy habits they started during the program. "It's not a one-shot deal if you really want people to be able to change. You've got to incorporate [ongoing supports]," like online tools and e-mail reminders, she says.

IBM launches incentive to combat childhood obesity

Knowing that the health expenses of dependents can add up significantly, IBM is tackling the problem of childhood obesity with a new wellness incentive.

Last October, IBM announced a $150 incentive for employees who use an interactive online tool to manage their family's eating and exercise. Families take an inventory of their eating and activity habits, considering factors such as how many servings of fruits and vegetables they eat each day and how often they exercise. The tool suggests activities, such as preparing dinners together, family walks and active games.

Participants keep a daily diary for 12 weeks and set goals to build on healthy habits. Children can mark their success with gold stickers on a printed version. At the end of 12 weeks, families complete an online inventory to evaluate their progress. The program does not have weight-loss targets or exercise requirements.

Maria Ferris, IBM's wellbeing director, says one of the program's goals is to have parents model healthy eating and physical activity for their children. "Children's eating habits are highly influenced by their home environment," she says. "If children have health issues, that's a preoccupation for their parents," possibly leading to higher stress and less productivity on the job.

The wellness incentive "is good for the business and good for the participant," she adds. "It's accessible. It's not hard. [The programs] do have an impact. We really are trying to adopt the long-term view."

Randy MacDonald, senior vice president of human resources for IBM, comments: "Healthy families mean healthy and productive employees, and IBM has always tackled employee wellness concerns head-on.

Employers today have to join the medical community, government and the food industry to respond to the issue of children's health. It is essential for the health of their workforce and the nation as a whole."