For any employer only now starting to consider the idea of investing in employee health management (EHM), perhaps the best place to start is with a weight management program. Overweight/obesity is by far the most prevalent health problem in the U.S. and a growing problem in the rest of the world as well. Obesity ranges from 20-30%+ in almost all states (Colorado the sole exception), and has more then doubled in the past twenty years. Overweight affects roughly two-thirds of the population, and has grown at roughly the same rate.

The challenge is not merely to lose weight. Hundreds of different methods, diets, products and drugs enable people to lose weight. But most of them regain much or all of that weight in one year, and almost all within five years. The only long-term effective way to lose and sustain weight loss is to make permanent lifestyle changes, which are necessary even after bariatric surgery, for example. Making simple, comfortable, and sustainable changes a permanent part of daily routine is the key, mainly reductions in calorie intake and increases in calorie burning through daily exercise that fit well into daily lifestyles, and provide enough enjoyment to be welcomed rather than burdens.

Employers are perhaps the most logical choices for supporting weight management, since they have by far the most economic risk and benefit potential. Overweight/obesity have been found to raise healthcare costs as much as 52%, for example, while increasing absence costs by 126%. [“Employer-Sponsored Weight Management Programs: The Business Case” HealthEnhancementSystems.com 2007] And since presenteeism effects are normally about three or four times as great as absenteeism costs, this burden combined can easily be $8000 per employee per year in lost productivity alone, depending on average employee compensation. [“Why Marathon Health? The Real Problem = Total Costs” MarathonHealth.com 2007]

If overweight/obesity could be reduced to the levels we had even fifteen years ago, when only about 12% of the population was obese, for example, vs. double that, or even to 19%, while the prevalence of overweight declines to 32% as they were in 1998, the results would be dramatic, particularly in contrast to the continuation of present trends. Current trends will make the existing epidemic of diabetes and heart disease that much greater over time, and could lead to a far greater crisis in healthcare costs and in uninsured Americans.

A recent study of seven chronic disease and risk categories estimated that cutting obesity alone to 1998 levels would prevent 15 million of the forecast 69 million added cases of these conditions, and avoid $60 billion in sickness care costs, along with $254 billion in lost productivity. Only reducing smoking from a projected 19% prevalence to 15% would produce anywhere near comparable savings. With $31 billion in avoided sickness care and $79 billion in lost productivity. [R. DeVol & A. Bedroussian “An Unhealthy America” Santa Monica, CA the Milken Institute Oct 2007 (www.milkeninstitute.org)]

Obese workers, for example, account for almost $9000 higher disability costs per case than normal-weight employees, and have significantly more cases. “Worksite Weight Management Programs Pay Off for Business” PRNewswire.com Aug 19, 2007] Overweight/obesity is a major link to a wide range of chronic diseases and other productivity-impairing conditions, including arthritis, sleep problems, depression, poor fitness and diet, hypertension, and musculoskeletal pain of all kinds.

The worksite is arguably one of the best places to promote weight loss, particularly when it includes fitness centers, healthy foods in cafeteria and vending machines, walking trails, and similar support mechanisms. The ready availability of “buddies” to support each other in weight loss efforts, the potential for team competitions used successfully by many employers, and the use of employer-paid incentives for those who succeed in losing and keeping off excess weight make worksites far more likely to succeed.

Moreover, unlike many other forms of employee adherence to health preservation or improvement “prescriptions”, weight can be measured objectively and frequently, daily to weekly, which also helps keep participants in programs focused on their goal. Continuous incentives, such as reductions in premium share, deductibles or co-pays can serve both as a “carrot” relative to losing weight, and a “stick” relative to keeping it off, since regaining it would cause the loss of such incentives. Many weight loss programs come with onsite “kiosks” where participants can weigh themselves while inputting their weight into online records that help them track progress, and help employers verify achievement and maintenance.

For smaller employers who lack onsite opportunities such as fitness centers, cafeterias, walking trails, etc, offering incentives plus paying part of the costs of fitness club memberships or exercise equipment can be affordable and effective. With fitness club memberships, a minimum number of visits per month may be required to maintain the discount or subsidy. The trouble with home exercise equipment is that it is more often ignored than used, and tracking its use is far more difficult, though weight loss achieved in any way participants can succeed at it will still deliver savings to the employer.

Including family members in incentives and eligibility for subsidies can also make sense. Often, as dependents, they add to the employer’s sickness care costs, and a significant amount of absenteeism and presenteeism is related to the worker having to play a caregiver role for a sick family member. 2003 data showed that for every dollar of loss in absence and presenteeism caused by the worker’s own illness, there were also losses equal to almost ten percent more due to the illness of a family member. [[R. DeVol & A. Bedroussian An Unhealthy America Santa Monica, CA the Milken Institute Oct 2007 (www.milkeninstitute.org) p. 6]

The combination of reducing prevalence of obesity and smoking can have what is likely to be the greatest overall impact on the sickness care, labor costs, and performance of employees of all the EHM investments available. Both involve some of the most serious and difficult “addictions” to overcome, but also the greatest and often earliest potential gains, for both employers and employees. Smokers who quit need no longer leave their workstations for a “tobacco break” many times during the day, and automatically save themselves the exorbitant costs of buying tobacco. Workers who lose weight gain almost immediate improvements in energy and self-esteem levels, to say nothing of approval from their peers.

Either or both of these health risk and performance impairment factors can serve as a logical starting point for any employer just embarking on an EHM investment, while both are likely to require continuing attention to keep already non-smoking and normal-weight employees from lapsing into these risks, and “reformed” ones from relapsing. But they both figure to be worth it, combining the total health, labor costs and performance effects, to say nothing of improving recruitment and retention success.