Employers have a great deal on their plates, and much of it relates to the ongoing COVID-19 pandemic. Attracting and retaining workers has always been a challenge, but the pandemic-ravaged economy has nudged this to a whole new level of urgency. The COVID virus dangerously challenges the workplace in another way, and it requires long-term thinking by employers. 

This challenge relates to obesity.

Obesity

As we have learned during the past 20 months of the pandemic, obesity is a worrisome risk factor for hospitalization and death for those with COVID-19. A March 2021 Morbidity and Mortality Weekly Report, prepared by the Centers for Disease Control and Prevention (CDC), revealed evidence of a relationship found between body mass index (BMI) and COVID-19 severity. Obesity rates have nearly tripled in the U.S. over the last 50 years (Source: USA Facts).

The CDC uses the BMI scale that relates weight with height to determine obesity level. For adults, a BMI over 30 qualifies as obese. It should be noted that BMI is not a perfect measure of one’s current health. More about this in the next blog.

COVID-19 highlights the many risk factors for people who are both overweight and obese. For employers, these risk factors should be of great concern when promoting a healthy and productive workforce. In fact, employers must double-down on their efforts to confront this long-term threat to the wellbeing of employees. Pandemic or not, the associated risks with having high-BMI numbers will not go away any time soon.

Iowa Obesity Rates

Based on new CDC 2020 Adult Obesity Prevalence Maps of 50 states, Iowa adults are in the top 16 states having the highest rate of obesity (35 percent or more). A 2018 survey by The Behavioral Risk Factor Surveillance System (BRFSS), which is part of the CDC, found that almost 70 percent of adult Iowans are considered to be either overweight or obese. Put another way, 34.1 percent are overweight while another 35.3 percent are obese. However, 2020 data reveals that Iowa’s obesity rate has risen to 36.5 percent. This new map shows how Iowa compares to all other states, including the District of Columbia and two U.S. territories. 

Data from the 2020 U.S. Census Bureau shows that Iowa’s population was 3,190,369, of which 77 percent are adults aged 18 and over (2,456,584 total). Using 2018 BRFSS data, this means approximately 867,174 Iowa adults live with obesity, while another 837,695 have BMI numbers between 25.0 to 29.9 – which is considered overweight.

According to ConsumerProtect, which used CDC-based data, adult Iowans tend to move a bit more than their counterparts from other states, with ‘only’ 25 percent of adults engaging in zero physical leisure activities – ranking Iowa as the 31st state having the highest percentage of adults engaging in no activity. Kentucky was the state with the highest percentage of adults reporting no activity (34.4 percent).

Impact on Individuals and Employers

The risk factors of having a higher-than-healthy BMI number comes at a substantial cost. The aforementioned risk factors for obesity and excess weight on the individual include, but are not limited to, the following:

• All-causes of death (mortality)
• High blood pressure (Hypertension)
• High LDL, low HDL cholesterol, or high levels of triglycerides
• Type 2 diabetes
• Coronary heart disease
• Stroke
• Many types of cancer
• Mental illness such as clinical depression, anxiety, and other mental disorders
• Body pain and difficulty with physical functioning

According to a 2016 report by Wellmark, “The Health of Iowans,” obesity is a common factor that contributes to the most costly conditions among Wellmark’s members in Iowa. For employers, obesity is both a sensitive and challenging issue and varies by industry. The associated costs for obesity are primarily twofold: 1) treatment-related expenses, and 2) reduced worker productivity.  Treatment expenses are typically covered by employer-sponsored health insurance and workers compensation while reduced worker productivity adversely impacts employers through absenteeism, presenteeism and wage replacement due to disability. Together, both represent a drag on productive output and profitability – which adversely impacts local and state economies.

A 2014 report in the American Journal of Health Promotion found that an obese employee with a BMI of 35 has nearly double the risk of filing a short-term disability claim or a workers’ compensation claim than an employee with a BMI of 25. This report also revealed that morbidly obese employees cost an average of $8,067 per year in covered medical claims, sick days, short-term disability and workers compensation, which is more than double the cost for normal-weight employees ($3,830). 

According to a 2018 Milken Institute report, the chronic diseases that result from obesity and excess-weight were estimated to cost more than $480 billion in direct healthcare costs and $1.24 trillion in indirect work loss costs in the U.S. Together, both costs are equivalent to 9.3 percent of the U.S. gross domestic product (GDP).

Summary

The pervasive nature of an overweight and obese population is a profound challenge to all Americans and to employers. Changing behaviors on dietary and physical activity is the desired goal, but is often met with disappointing results. 

Depending on how incentives and disincentives are aligned with desired outcomes, implementation of wellness programs have had limited success for employers. Organizations must develop new, targeted approaches that are sensitive to their employees, yet impactful enough to provide positive outcomes.

My next installment will focus on the criticisms of BMI and its use as a measure of health.

This post is the first in a five-part series.

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