People are living and working longer. But their livesand workplace performanceare negatively impacted by all manner of disability. The Global Burden of Disease Study released in December 2012 is a landmark effort to describe and predict healthcare trends around the world. Produced over five years by 486 researchers at 302 institutions in 50 countries, the study is the most detailed look at health on the population level ever attempted.
The study's authors reached a dramatic conclusion, as expressed by Christopher J.L. Murray, who headed the study: "We are in transition to a world where disability is the dominant concern as opposed to premature death."
Increasingly, that disability is a result of obesity.
Over the last 20 years the number of obese Americans has doubled. According to a new study by Cigna, based on an analysis of 1.56 million short-term disabilityclaims from 1993 to 2012, claims related to obesity increased by 3,300 percent. Making up 0.04 percent of claims in 1993, obesity ranked No. 173 on a list of 267 diagnostic drivers of absence that year. It landed at No. 40 on the list in 2012, making up 0.7 percent of claims.
To effectively address this reality, employers must think beyond wellness programs. They must apply a wide-angle lens to employee health, wellness, and even risk. This includes a coordinated strategy to meet employees health needs through a whole-person approach that includes behavioral health solutions.
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We know that the most prevalent physical conditions, including obesity, have a comorbid psychiatric condition, often depression. Ignoring this realityor, even worse, delegitimizing itis costly and results in both poor workplace and healthcare outcomes. Good mental health is central to good physical health, including a healthy weight that does not increase the risk of debilitating disease and disability.
So what are some of the concrete solutions to address the psychosocial drivers of obesity and other risk factors?
The first solution, with which HR professionals are very familiar, is an employee assistance program. Based on a 2012 DMEC Behavioral Risk survey, 97 percent of employers surveyed had an existing EAP program. But as prevalent as EAPs are, they are woefully underutilized.
Employers must do a better job of communicating that the services they provide are confidential and have no impact on an employee's work statusjust like other healthcare services. As stories from the U.S. armed forces attest, there is still a stigma against even acknowledging mental health issues. Business leaders must truly lead to overcome the stigma associated with behavioral health. This means proactive education and communication that starts at the top.
The second solution to identifying and properly managing behavioral health issues and their workplace effects is one that has been effectively applied to cancers and other diseasesincreased screening. Effective screening can help prevent minor employee issues from developing into more debilitating health conditions, including obesity.
In addition to identifying issues early, screening tools are also effective in monitoring and managing chronic conditions and depression, stress levels, adherence to condition management, and even pain management. Increased screening results include better adherence to treatment programs, decreased use and abuse of narcotics and alcohol, lower inpatient and outpatient days, lower emergency room usage, and decreased absenteeism and presenteeism.
The third solution is a greater reliance on psychotherapy as part of workers' compensation claims management. Typically this has been an area where payers did not want to address the psychological component of the claim. Recently, however, several workers' compensation payers are employing one of the leading forms of psychotherapycognitive behavioral therapy, for claimants who suffer from chronic pain and psychosocial issues that hinder their recovery and return-to-work.
Cognitive therapy is proving very effective, both in terms of better employee health and lower employer costs. A recent study conducted in the Netherlands and published in the Journal of Occupational Health Psychology found that employees absent due to common mental health disorders returned to the job on average 65 days earlier and saved employers an average of $5,275 when provided work-focused cognitive behavioral therapy.
While there have been encouraging gains in obesity in young people, where the rate appears to have stabilized, obesity will remain a significant issue for employers for many years to come. Effectively managing obesity-related disability entails identifying and addressing all relevant variables, including mental and behavioral health. As with every other cause of disability, that means learning and practicing a whole-person approach to health and wellness.
Terri L. Rhodes is executive director of the Disability Management Employer Coalition
