Kevin Eberly's Blog | Confronting America's Obesity Epidemic

Employers working to better the health of their company faced a recent setback. On April 30 the IRS ruled that most wellness programs cannot be included in minimum healthcare coverage, meaning requiring employees to participate in company-sponsored health programs won’t be as simple as previously thought.

Under the Affordable Care Act, employers are required to offer a minimum benefits coverage for full-time employees, which includes a healthcare package, or pay a steep fine if they choose to forgo providing coverage. The only wellness program that will qualify for the minimum benefits package is smoking cessation programs.

The IRS cited the potential for many wellness programs to be discriminatory, putting sick workers at a disadvantage for lower premiums, as the reason for excluding wellness programs from the minimum benefits package.

It’s an unfortunate ruling considering more than two-thirds of adults in the U.S. are overweight or obese, which, like smoking, is a condition that needs to managed over time and is costing employers thousands of dollars per year.

Managing obesity requires a strong support system, and organized wellness programs provide that. It takes time, dedication, and motivation, which, especially when in the form of cash, can be very effective.

Although I am disappointed with the ruling, it does not mean wellness has no place in the office.

It’s worth the investment to provide wellness programs to your employees—financially and for the success of your company—even if it means just taking a few minutes out of the day to walk around the office and assess the overall health of your workers.

Interact with your employees. Listen to their concerns. Maybe an at-risk individual is scared to make a change in his or her habits. It’s understandable; change isn’t easy. However, listening to your employees can help you determine a wellness program that will attract the most participation. For example, if the majority of your employees say they don’t have the time for wellness, you can consider making a wellness program convenient, potentially making it a part of the workday to encourage higher participation.

Make it a fun part of your company’s culture. Studies show financial incentives encourage healthy behaviors. Consider a little friendly corporate wellness competition. Have employees agree to sign up for a wellness program and offer small rewards at the end of each week for a certain period of time. It can even be as small as $10 gift cards, but the camaraderie and support from the workplace will motivate a larger number of people to participate. The employee that loses the highest percentage of body fat, for example, will receive a larger financial reward.

Educate your employees. An AP-NORC Center survey of 1,011 adults nationwide found about half of people think their weight is healthy despite statistics that show two-thirds of adults in the U.S. are overweight or obese. Consider hosting health seminars as part of on-the-job training and have a wellness program accessible to begin immediately following a lecture. If employees don’t realize they need to make a change, they won’t. You have to bring the issue to the forefront of your employees’ minds.

America is on the right track. According to a recent Buck Consultants survey, “Working Well: A Global Survey of Health Promotion and Workplace Wellness Strategies,” in 2012, 76 percent of companies in North America offered health promotion programs to their employees. 

However, tracking wellness programs has proven a little tricky. According to the survey, just 35 percent of firms in the U.S. measured these programs for specific wellness program outcomes, down from 37 percent in 2010. 

There could be several reasons for this decrease. The most commonly cited factor: lack of resources—time, money, staff. 

But tracking wellness program outcomes doesn’t necessarily require an abundance of resources. In fact, research consistently shows programs that are in place for five years or more see the most significant cost savings. Five years may seem like a long time, and I understand this requires patience, but the long-term rewards are often worth the effort. 

While I like statistics and fact-based results as much as the next guy, the success of a wellness program doesn’t have to be measured by numbers alone. You can often see signs of progress through observation, by taking a few minutes a day to leave your desk and walk around the workplace. 

What do you see? Do your employees seem more productive? Are they happier? Do you notice a boost in office morale? Are your employees continuously engaged in the program? It’s the intangible factors provided by a well-designed wellness program that can boost your business. 

Beginning in January 2014, we will enter a world where the Affordable Care Act focuses on rewarding providers and payers who take preventable measures. Positive outcomes from conditions like medical weight loss will ensure full insurance reimbursement and lower overall healthcare costs. While it may take time to get full traction in the workplace, it’s an effort to take the cost burden off employers and motivate employees to take wellness seriously. 

In the long run, with this system everyone wins. Employers are satisfied because healthier workers are less costly, more productive, happier workers. Employees are given a little extra push (and maybe it’s the final push they need) to make necessary changes in their health. The obesity numbers in this country are disturbing, and it’s time we take responsibility for our behaviors. 

Please check Agree or Disagree: Do you agree to the following terms?
“I pledge to keep my weight under control by maintaining a BMI less than 30. If my BMI is currently above 30, I agree to participate in a weight loss program.”

What if a candidate could be removed from consideration for a job by refusing to check “agree” to this question on an application? Or, what if breaking this agreement was grounds for increased health care premiums or higher deductibles?

Is this a crazy proposal? Is it smart? Forward-thinking?

Some companies already have health pledges, similar to the one above, requiring employees to agree to abstain from smoking. Before a potential employee submits an application, he or she is required to check a little white box, signifying his or her agreement to not use tobacco products.

So, requiring prospective employees to agree to keep their weight under control isn’t such a far-fetched idea. Cancer is the No. 2 killer in America, behind heart disease, which sits at No. 1. You prevent certain types of cancer by not smoking; you prevent heart disease, in many cases, by maintaining a healthy weight.

When you put the facts in perspective, suddenly the proposal doesn’t seem quite so crazy.

The most recent company to take a stand toward health is CVS. The company announced all employees who receive health insurance must report their weight, body fat, and glucose levels to the insurer. If employees refuse, they have to pay a $600 penalty. It’s not necessarily a health pledge, but it’s a step in that direction.

Clearly you can’t and shouldn’t discriminate against a potential employee because he or she is overweight, but you can promote a healthy workplace by having an overweight or obese employee pledge to complete a weight loss program. By requiring overweight employees to complete a program with proven results like The Center for Medical Weight Loss, you will see a significant difference in employee productivity and satisfaction and a decrease in overall healthcare costs over time.

If employees are willing to sign a health pledge and stick to it, they should be rewarded with lower premiums. If there is no incentive, you risk losing motivation. This can go a long way in ensuring both healthy habits and preventative care.

Encouraging employees to improve their health can be a positive initiative. If the payer of healthcare costs has knowledge of who is engaging in behavior that could drive costs up for everyone, he or she can begin to figure out how the costs could be reflective of individual healthy living profiles. The key will be to know where to stop, so genetic or pre-existing conditions do not cause penalties or higher premiums to be enacted.

Each company is different. In order to determine whether requiring a health pledge is beneficial for your company, you need to evaluate employee population and company culture.

What do you think? Is a health pledge a good or bad idea?

Your primary care physician is the first person you turn to if you have a health-related concern. You put trust in your physician to guide you in the direction to better health and trust he or she has confidence to do so.

One chronic condition many primary care physicians are not confident in treating: obesity.

A recent survey, published in BMJ Open, found only 44 percent of primary care physicians reported success in helping obese patients lose weight. This low percentage may come as a shock to you, but it doesn’t surprise CMWL’s chief medical officer Dr. Michael Kaplan. He tells me it’s training you just don’t get in medical school, and you learn more about malaria than obesity. Ironically, he’s never had to treat malaria, but he has seen countless obesity cases.

Why is this a problem? Think of primary care physicians as defensive linemen—the first line of defense. They’re the first people to see the play unfold and determine the actions necessary to stop the offense from advancing and reduce the number of yards gained. Primary care physicians are usually the first people exposed to a patient at risk for obesity, and the sooner it is acknowledged, the sooner steps are taken to treat it, resulting in fewer long-term health issues.

When it comes to treating obesity, many doctors feel underequipped, unprepared, uncomfortable, or a combination of three. However, I was surprised to find, as the survey indicated, that the majority of physicians believe obesity screening should be a routine part of a visit, and BMI should be included as a fifth vital sign.

This attitude, which 93 percent of primary care physicians surveyed supported, is promising. Doctors are starting to hear the noise that says they should be on the forefront of treating obesity. It’s a chronic condition that needs to be treated over time, and physicians are most qualified to do so.

Physicians recognize obesity as a problem and support regular screenings, but how do we boost their confidence? They need a toolbox.

CMWL equips physicians to be on the front line of preventative obesity medicine. I wouldn’t be here if I didn’t believe it works. It’s not just my speculation, but science backs it up. A study published in the American Journal of Medicine found people enrolled in a 12-week, physician-led weight loss program lost an average of 28 pounds. It proves the positive effect physicians can have on a patient battling with weight issues.

Imagine how much smaller our healthcare costs would be if 100 percent of doctors felt confident in treating obesity; if 100 percent of doctors had the proper treatment platform and tools to help patients lose weight and manage weight loss over time. The dollars obesity is costing America warrants its own post. But what do you think? Should primary care physicians be more active in treating obesity?

A recent report projected 44 percent of Americans will be obese by 2030.

F for Fat: Obesity Threatens America's Future 2012

Think it couldn't possibly be that bad? Look at data from 1991; in almost every state less than 10 percent were obese. Now look at the data from 2011; in all 50 states more than 20 percent are obese. 

Here's how the predicted rates of obesity threaten our future:

• there will be 7.9 million new cases of diabetes, compared to 1.9 million new cases in recent years. 
• There could be 6.8 million new cases of chronic heart disease and stroke every year, compared with 1.3 million new cases per year now. 
• Today, obesity-related medical costs are $147 billion to $210 billion (out of total healthcare spending of $2.7 trillion). In the future, add $66 billion more in annual obesity costs.  

The projected rates support a study published earlier this year in the American Journal of Preventive Medicine that found that by 2030, 42 percent of U.S. adults could be obese, adding $550 billion to healthcare costs over that period.

This is a real problem, what can we do today to start fighting it? 

I’m the kind of manager who likes to solve problems. And not just any problems, but those that have significant impact on people’s lives and wellbeing.  It may be why I’ve spent half of my professional life addressing one of the biggest problems facing the country for the last quarter century: obesity.

Why obesity? Obesity has proven to be a problem that is the root cause of so many other problems that are putting the health of the United States (literally) in jeopardy. Here are some facts that we’ve probably all read at one point or another, but they bear repeating because we have reached a point where none of us can afford (literally) to ignore them:

PROBLEM: Healthcare costs make up close to 20 percent of the national GDP, and 75 percent of healthcare costs are related to the diagnosis and treatment of preventable diseases such as diabetes, heart disease, and hypertension. The underlying cause of these diseases: obesity.

PROBLEM: Companies in the U.S. have faced staggering increases in healthcare costs, experiencing on average 12 percent in insurance premium rate hikes per year. The cost increases create severe challenges for companies to stay competitive in the global economy. What is cited as the reason for an estimated annual $73 billion in medical and lost productivity costs? Obesity.

PROBLEM: More than one-third of Americans can’t go a day without taking a medication to control a chronic condition, can’t walk without pain, can’t sleep without risking apnea, and can’t perform some of the most basic activities that enrich life’s experiences. What’s the cause? Obesity. And that number amounts to more than two-thirds of the population if we include people who are categorized as overweight.

In light of these statistics, which seem to keep going in the wrong direction, there must be a clear-cut solution, right? If only! But, being a problem solver at heart, I rely on hard data and facts to point me in the right direction. The statistics tell me that physicians hold the key to reversing these alarming trends. It’s the reason I am confident the physician-directed, non-surgical weight loss approach based on evidence will be the proven method for effectively managing long-term health and preventing obesity in those who currently are not affected.

The Center for Medical Weight Loss has been ahead of its time, with its participating physicians having successfully treated thousands of patients for the better part of the last decade. But it’s only recently that third parties have started to subscribe to its approach. These include:

• In January 2012 The Centers for Medicare and Medicaid Services (CMS) announced coverage for physician-directed behavioral counselling for obese patients (those with a BMI of 30 or higher). Private insurers quickly followed suit.
• In May 2012 the US Preventive Service Task Force endorsed physician behavioral counselling for obesity.
• In June 2012, The American Journal of Medicine published a major study of Center for Medical Weight Loss physician-directed results, reporting clinical outcomes of an average 26 pounds lost, or 11.1 percent of total body weight lost, in 12 weeks among obese and overweight patients. 

And this is just the beginning. While we don’t purport to have all of the answers, we are confident we are onto something. But there are still much work to do and many complex issues to explore. That is why I invite you to join in the conversation and lend your voice to what you believe are sustainable solutions to effectively addressing the clinical condition of obesity. Starting today, I’ll be posting new research and commentary. I look forward to hearing from you!