Obesity has reached record levels in every corner of the nation and, as a result, affected the bottom line of virtually every organization.

According to the Centers for Disease Control and Prevention, not one of the 50 U.S. states can claim a prevalence of obesity less than 20% as of 2010. In addition, the CDC reports that more than one-third of adult Americans (36%) are considered obese.

In growing numbers, employers are finding they can't hide from these statistics and are feeling the effects of obese and otherwise unhealthy workers in a variety of ways.

"Obesity continues to be an epidemic," says Beena Thomas, vice president of health and wellness at OptumHealth. "Companies are struggling with this topic. But forward-thinking companies are discovering the critical need to escalate wellness as a core business strategy."

Escalate may be the key word for those companies thinking they're already doing enough in the wellness space. With seven of 10 employers now offering some form of wellness initiative - and 60% of the total having done so since 2008, according to a survey by the International Foundation of Employee Benefit Plans - their popularity is undoubtedly growing.

But now the question becomes how can these programs go above and beyond to target and prevent the illnesses often associated with obesity, thus saving companies dollars in health care expenses and possibly even saving the lives of high-risk individuals.

 

Identify and strategize

Onsite health screenings remain a useful first step toward identification of at-risk employees and are becoming the springboard to robust health and weight management.

"Generally, obesity is determined by biometric screening data," notes Amy McAllister, director of health coaching and program development at Provant Health Solutions. "The screenings are absolutely critical, and many participants feel it's a benefit to offer a health screening. There is a lot of positive feedback."

Should a screening determine an employee has a chronic illness or obesity itself (as determined by factors such as body mass index), some companies are unleashing a campaign of engagement and consultation.

Provant has found that its health coaching services are particularly effective in achieving success with at-risk employees. These coaches partner with workers to help manage diseases and conditions uncovered during the screenings through phone, in-person or online avenues to achieve results and hold employees accountable through wellness program participation.

"We perform healthy coaching and interventions, and that moment where someone can see an opportunity in a nonstressed, informational way is a great start," says Barbara Haydon, vice president of clinical services for Provant. "It shows the employer cares enough and supports the identification and ongoing programs. Employers are getting much more ROI in obesity and how they are trying to manage weight."

 

Environmental change

Aside from health coaches, employers must look inside their own walls and whether or not they are fostering a healthy work environment to the greatest extent possible.

"Your social environment is one of the biggest predictors of weight," says Elisa Mendel, national vice president of HealthWorks and product innovation at Kaiser Permanente. "Employers are, more and more, understanding the impact poor health has on their bottom line and on their ability to do business."

Companies with greater resources may have built onsite gyms to encourage physical activity, feature clinics on their campus and even house nutritional and dietary specialists to help employees make better lifestyle decisions.

But for those organizations that cannot afford such perks, innovation is the path to a healthy workforce. Walking groups and challenges are prevalent in a vast number of companies. To keep employees motivated, Mendel says some companies have painted stairwells or rotated out pictures (perhaps of the workers themselves) at the top of each floor for a more welcoming and ever-changing space when climbing stairs.

In addition, companies may want to look at the contents of their vending machine and catering partnerships. Thomas says research indicates that if companies put healthier choices in the middle-right of their vending machines, workers are more likely to opt for that healthy choice, given where the eye is drawn.

Numerous employers are still encouraging camaraderie through weight loss management programs like Weight Watchers. One such company, insurance firm RCM&D, based in Baltimore, Md., has achieved results that have galvanized its base of 250-plus employees.

After 12 weeks on the Weight Watchers program, 35 of its workers lost a combined 800 pounds. Add to that a walking challenge where RCM&D workers challenged themselves to walk 5,000 steps a day. In six weeks, more than 4,700 miles were walked in total.

For executives at RCM&D, who partnered with Provant on its wellness initiatives and strategies after putting together an internal steering committee of its own to tackle health issues, the investments they are making are paying off.

Benefits manager Mary-Michael Rosling and benefit division practice leader Terrence Jeffery Crocker are witnessing a culture change, happier employees and a decrease in the prevalence of illnesses such as diabetes and high blood pressure.

Crocker reports that the number of employees who were considered to be ideal weight rose from 14% in 2010 to 23% in 2011.

Provant notes that one of the trends it sees time and again with clients is that companies have not effectively communicated all the resources employees already have in place to combat obesity and health-related concerns.

"Our goal is to drive an increase in whatever programs are available," McAllister says. "It's amazing how many employees are unaware of what's out there."

 

Legal considerations

Though the rise in obesity is resulting in some positive trends as far as outreach through wellness, employers should also be mindful of a small (but potentially growing) number of cases brought forth charging obesity bias related to discrimination claims.

The U.S. Equal Employment Opportunity Commission has brought a handful of cases against employers, alleging discrimination based on prospective and current employees who had weight concerns.

"All employers are on guard and should be much more aware and mindful these issues are out there and base their actions accordingly," says Leslie Silverman, partner with the Proskauer law firm and former vice chair of the EEOC.

"Courts seem to be struggling with whether obesity must be the result of a physiological disorder to be an impairment or if it is, in itself, one."

Two of the more recent EEOC cases have settled out of court for $55,000 and $125,000, respectively. Of particular note, the Montana Supreme Court ruled this summer in a separate case that obesity can be considered an impairment under the Montana Human Rights Act, which could open the door for similar discrimination claims.

Given the widening scope of what can be considered a disability under the Americans with Disabilities Act Amendments Act, companies would be wise to keep a watchful eye on the courts and any precedent settings.

Still, the burden of proof to successfully argue a company has practiced discrimination based on weight alone would require some hard evidence. "Evidence of why the employer took the action they did is very important; this is still a challenge and not a slam dunk," Silverman notes.

Making hiring, promotion and retention decisions based on qualifications and performance alone will continue to be the practice of most companies. For her part, Silverman does not see any slowdown in the number of employers offering healthier lifestyle programs when weighing the current climate of obesity-related suits against the greater good that wellness strategies afford.

"I definitely think we'll see more of this issue, but overwhelmingly we'll see employers continue to focus on wellness programs," she says.

 

Messaging with meaning

Whatever the program of choice, buy-in from senior leadership and leading by example are critical components to the successful implementation of a wellness strategy. Organizations are investing large sums of money in the health of their employees. And keeping employees engaged after the kickoff is just as, if not more, important to achieving the greatest return.

"An ongoing communication platform truly drives and motivates employees," Thomas says. "You must keep the message fresh. For companies to be able to look at obesity, they have to shift the paradigm - this is life-threatening as this continues."

While companies may not see an immediate correlation to health care costs, rapid gains can be achieved in three areas as a result of wellness programs - Mendel notes these as being presenteeism (how present an employee is at work), absenteeism (including a move in the duration of how long employees are out sick) and productivity.

Thomas adds that wellness can help companies become employers of choice to attract and retain good talent.

And while incentives - financial and otherwise - are widespread to get employees involved in wellness initiatives, Thomas notes that they only change behaviors for some workers. Mendel concurs that there has to be something more that truly drives participation.

"Everything simply boils down to 'move more, eat healthier and don't smoke,'" she says. "Incentives are helpful to get people to try things they wouldn't have already. [But] for the long-term, it must be an intrinsic motivator."

Kevin Sweeney, a former EBN Associate Editor, is a freelance writer based in Maryland.

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