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

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?

A recent Danish study found routine annual physicals have little benefit for healthy people. Researchers went as far to conclude routine physicals are meaningless and a waste of money and resources.

The study breakdown: Study participants were randomly assigned either to receive a physical or not receive a physical. Participants were given a routine exam, which included screening tests, advice about lifestyle changes, and a physical exam. The results showed both groups were just as likely to die over a nine-year period.

However, I think the study fails to look at the bigger picture. We have recurring expenses for being in poor health, and if we don’t go to the doctor, how will we know where we stand?

The first step is a checkup. It allows a doctor to diagnose emerging issues early, so you don’t become one of those people who need to be subsidized by other people for avoiding care. Ideally, obesity screenings would be done with an annual physical.

Now, the study did point out that going to the doctor for a specific screening or a vaccine is beneficial for everyone, but researchers do not believe it is necessary to have screenings done every year, stating it costs a lot of money and overuses resources.

Here is where I stand: Prevention does cost money—there’s no denying it. But if you look at the costs of the conditions these annual physicals prevent—obesity, heart disease, diabetes—the cost of prevention comes out significantly lower; millions of dollars lower. The cost of diabetes in the United States, for example, has risen to $245 billion in 2012 from $174 billion in 2007, according to the American Diabetes Association. The number is a 41 percent increase over a five-year period for diabetes alone.

These conditions, which are often caused by obesity, are largely preventable. Annual physicals give doctors a platform to easily monitor and predict conditions over time. When patients come in regularly, meaning they keep up with their annual physicals, doctors can recognize health trends and see when a patient’s health took a bad turn, making it easier to pinpoint why and determine the best course of action.

The U.S. Preventative Services Task Force recommends all adults be screened for obesity annually. As Americans become larger, studies show we eat less healthy than we think. An annual checkup, under the care of a physician, is the most accurate way to monitor your health, and it’s essential these screenings are covered under insurance.

What do you think? Are annual physicals worth the cost?

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?