How providers, payers, employers should be fighting obesity

According to the latest statistics from the Centers of Disease Control and Prevention, more than 70% of Americans are overweight or obese, with 38% falling into the obese category. More than one-third of Americans have metabolic syndrome, a constellation of factors including high blood pressure, high blood sugar, elevated cholesterol and triglycerides and abdominal fat that puts them at high risk for heart disease, stroke and type 2 diabetes, according to the American Heart Association.

These expenses associated with obesity are a major driver of healthcare costs. The price tag for overweight and obesity in America is estimated to range from $147 billion to nearly $210 billion per year in direct and non-direct medical costs, including surgical produces, medication, counseling, and cost for treating obesity-related complications like diabetes, according to a Journal of Health Economics

. Furthermore, obesity is strongly correlated with employee absenteeism, at a loss of approximately $4.3 billion a year. It is also associated with lower productivity in the workforce, measured at an annual liability of $506 for each obese employee, according to a study published in the Journal of Environmental and OccupationalMedicine.  

On the positive side, the weight loss that results from successful treatment of obesity can significantly resolve many related health ills including type 2 diabetes mellitus, hypertension, and diastolic heart failure. Addressing obesity in a patient-centered, structured protocol can positively affect the health of patients and can potentially save billions of dollars in reduced claims to payers. 

The condition of obesity is now classified as a disease by the American Medical Association with physicians encouraged to treat it as they would any other chronic health problem like diabetes or HIV. However, treating and eliminating obesity is not that easy. A dual effort by physicians and healthcare providers, and payers including employers, is critical.

What physicians should do                                                                                                                                                           

For many physicians, the consequence of obesity and its associated diseases is a topic that is difficult to approach with their patients. But when doctors do have the weight-loss conversation, they have a strong impact. Research indicates that patients have greater success in weight loss when they receive guidance, education and encouragement from their physician, according to a study conducted by BMC Health Services.

However, there is a large gap in communication between patients who are overweight and physicians who are actively addressing weight with these patients. According to a Nielsen Strategic Health Perspectives survey sponsored by the Council of Accountable Physician Practices, 52% of physicians report that they recommend that patients enroll in a weight loss program, but only 5% of those patients say they heard this advice. Additionally, 90% of physicians report recommending better eating habits, yet only 19% of patients say they heard this message. With 70% of adults in the U.S. overweight or obese, this means that only one in 14 of these overweight individuals actually hear weight loss advice from their doctors.

This is an issue physicians must overcome. By doctors not counseling patients about weight and offering long term, patient-centered solutions, they are losing the opportunity to fight obesity and ameliorate its high human and fiscal cost.

The U.S. Preventive Services Task Force recommends screening all adults for obesity using the Body Mass Index (BMI), and pay-for-value incentives have made this screening and counseling for weight management a standard for reimbursement. These payment incentives will also encourage physicians to proactively work with patients to achieve a healthy weight and as a result, reduce and better control chronic illnesses associated with excess weight.

However, there is still a gap in physicians’ capability to work with patients to achieve weight loss goals. One of the main reasons that physicians don’t feel comfortable having conversations about weight loss with their patients is because they don’t think it is effective. They know that telling people to go on a diet or to exercise more is not enough. Yet they do not have the time or means to engage with patients on the counseling and coaching that is required to achieve and maintain weight loss.

Next: Stemming the tide of obesity

Stemming the tide of obesity: Good for patients and good for payers

To support office visit consults, physicians need resources such as organized, structured programs that incorporate coaching, education and one-on-one support for their patients who need to lose weight. Obesity is a chronic condition that requires ongoing monitoring and care.

By addressing obesity with consistent counseling, eating plans and ongoing monitoring, physicians can go beyond treating symptoms and help patients achieve a healthy weight, potentially avoid chronic illnesses and live longer lives. With physician oversight, the patient’s medical condition is evaluated and monitored as the weight is lost; any medications that may need to be adjusted as weight loss occurs will be managed by the doctor.

Partnerships work

When patients, physicians and employers organize weight management around these principles, they achieve positive results that benefit everyone. To illustrate, Wausau, Wisconsin-based Aspirus Heart and Vascular implemented a pilot weight loss protocol with 50 employees and family members, and the resulting weight loss and improvement in metabolic markers was so significant that the self-insured health system decided to offer it to their entire employee base of 6,500 people. 

In a study presented at Obesity Week 2016, Aspirus followed 306 employees who had successfully completed the same medically developed weight loss protocol and analyzed claims costs for these employees from 2013 to 2015. Results from the study, Effect of the Ideal Protein Weight Loss Protocol on Employee Healthcare Costs, indicated an average of $916.97 (18% reduction) decrease in overall average costs. Females had the greatest decrease from 2013 to 2015 averaging -$974.71 (17%) from 2013. Comparing 2013 to 2015, males reduced their claims by -$472.88 (19% reduction).

These finding indicate that employers can potentially save between $500 and $1000 annually per employee on medical claims. With 70% of the U.S. population of 325 million overweight or obese, multiply those numbers accordingly-these efforts could conceivably be saving the insurance industry more than $2 billion a year in claims related to the health complications of excess weight.

What stakeholders can do to promote weight loss

·      Employers should team with physicians and health systems to offer patient-centered, structured weight loss and weight maintenance protocols to their employees. Additionally, payers and employers should develop more focused, local resources to address obesity including hiring trained specialist and dieticians trained in safe, scientifically based weight-management techniques, including low carbohydrate, ketogenic diets. 

·      To support the permanent behavioral change needed to maintain weight loss, a focus on long-term lifestyle change, education, and support must be taken throughout the journey. Initial experience shows that the ROI on savings from obesity-related costs more than pays for the cost to implement the wellness initiative.

·      Employers and payers should incentivize healthy weight by paying for obesity care and treatment, including in some cases, anti-obesity medications and bariatric surgery. These costs can be shared-and should be-by the employee so they have “skin in the game,” but subsidies from employers and insurers will be an added incentive to undertake the challenge of long term weight management.

·      Employers should foster a healthy work environment, including healthy choices in the employee cafeteria and onsite vending machines. Educating employees about avoiding sugar and excess carbohydrates is also helpful.

With collaboration and initiative, physicians and payers can support patients as we together, reverse the tide of obesity and realize the benefits of better health and lower healthcare costs.  

Timothy N. Logemann, MD, FACC, ABOM, is a board-certified internist and cardiologist at Wausau, Wisconsin-based Aspirus Heart and Vascular. He is certified by the American Board of Obesity Medicine and is a member of the Ideal Protein Cardiology Advisory Board.