Gain through loss—weight loss

In the past few years, confronting the obesity epidemic has become a major policy focus around the world. From a medical and public health perspective, rising rates of obesity are resulting in commensurate increases in the incidence of many chronic diseases, including type 2 diabetes, cardiovascular disease and several types of cancers. [1] This has resulted in increased concern about the rising costs of heathcare for this population, given that approximately 30% of the population is obese and the current obesity epidemic is expected to worsen in the next few years. [2] Rising medical expenditures are not be the only costs resulting from rising obesity rates. Obesity and its related complications have significant economic consequences for employers. [3] A nationally-representative 1,000-person company incurs roughly $277,000 more in annual costs because of the presence of overweight and obese people [4], as the indirect costs of obesity—that include absenteeism, disability, premature mortality, presenteeism and workers’ compensation—are significant. This is because the end result of these obesity-related consequences ultimately imposes costs on employers through lost productivity. [5, 6]

Perhaps the only illness to rival obesity in terms of its economic impact on employers, are those that impact psychological wellbeing—especially depression and bipolar disorder. These illnesses are associated with high societal costs and again place a significant economic burden on employers because of absentesism and presenteism. According to current estimates, mental illness accounts for 15% of the burden of disease in established market economies such as those in North America. [7]

Ironically, high rates of medical co-morbidity also contribute to the costs associated with mental illness as well since individuals with these diagnosis have higher rates of obesity, diabetes, hypertension, dyslipidemia and cardiovascular disease than the general population does. [8] This is important for two reasons: persons with co-morbid conditions often have a poorer treatment response and a worse course of illness over time and, as described above, co-morbid medical conditions carry with them their own costs with respect to workplace productivity.

Implementing interventions
Issues such as mental illness and obesity should be the focus of governments and healthcare providers. Their impact on the financial bottom line can not be ignored for industries both large and small. The results of a recent study by the Centers for Disease Control and Prevention, and the National Center for Chronic Disease Prevention and Health Promotion indicate that even small initiatives can lead to significant improvements to employee health. This study indicated that low-cost policies or interventions in worksites may be more likely to be cost-saving than high-cost, with the improvement in employee wellness resulting in financial savings to the employer.

One such intervention that has positive impacts both on mood and obesity, either in combination or individually, is that of cognitive behavioral therapy. This type of behavioral program can be tailored to fit both a workplace-type setting, or can be provided individually to employees. It has even been shown to be effective when done via the internet, providing strategies and support both to employees and employers that are unable to access tertiary healthcare centres.

Across all overweight and obese employees, a 5% weight loss would significantly reduce total annual employer costs (medical plus absenteeism), and when done in a gradual, safe and supported manner, it is quite achievable. Workplace modifications that adhere to the “living while losing”G premise [11], make it possible for employees to be more productive at work while engaging in a program designed to help them improve their health, proving that small interventions can result in financial gain, often literally though loss.

References
1. Field A, Coakley EH, Must A, Spadano JL, Laird N, Dietz WH, Rimm E, Colditz GA. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 2001; 161: 1581–1586.
2. Flegal KM, Carroll MD, Ogden CL, Johnson CL (2002) Prevalence and trends in obesity among U.S. adults, 1999–2000. JAMA 288:1723–1727
3. Finkelstein E, Fiebelkorn I, Wang G. National medical spending attributable to overweight and obesity: how much, and who’s paying? Health Aff (Millwood). 2003;(suppl web exclusives):W3–219–226.
4. Finkelstein EA, Fiebelkorn I, Wang G. The costs of obesity among full-time employees. Am J Health Promot. 2005;20:45–51.
5. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA 2003; 289: 187–193.
6. Trogdon JG, Finkelstein EA, Hylands T, Dellea PS, Kamal-Bahl SJ. Indirect costs of obesity: a review of the current literature. Obes Rev. 2008;9:489–500.
7. Murray CJ, Lopez AD: Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997, 349:1436–1442.
8. Taylor VH, MacDonald K, McKinnion M, MacQueen GM. Adults with Mood Disorders Have an Increased Risk Profile for Cardiovascular Disease Within the First Two Years of Follow Up. Epub 2009 Canadian Journal of Psychiatry
9. Journal of Occupational and Environmental Medicine Issue: Volume 51(7), July 2009, pp 751-758 A Return-on-Investment Simulation Model of Workplace Obesity Interventions Trogdon, Justin PhD; Finkelstein, Eric A. PhD, MHA; Reyes, Michele PhD; Dietz, William H. PhD, MD.
10. Shaw K, O’Rourke P, Del Mar C, Kenardy J. Psychological interventions for overweight or obesity. Cochrane Database Syst Rev. 2005 Apr 18;(2)
11.Forhan M Disability & Rehabilitation, Volume 31, Issue 16 August 2009 , pages 1382 – 1388