Obesity's Impact on Workers Compensation

Kevin Glennon


November 1, 2014

rm1114_obesityObesity is on the rise in the United States. An estimated 37% of Americans are now obese and this number is expected climb to 50% by 2030, according to the National Heart Forum.

Although obesity is generally classified by a person's body mass index (BMI), obese individuals are roughly 30 pounds or more above a healthy weight, and this can have dire health consequences. The Centers for Disease Control and Prevention reports that obesity increases an individual's risk for diabetes, osteoarthritis, heart disease, stroke and various types of cancer.

As a result, obesity has been a leading driver of healthcare costs. Related medical expenses were estimated at $147 billion in 2008 and could reach $344 billion by 2018, accounting for 21% of U.S. healthcare spending. The cost to businesses exceeds $13 billion a year, as obesity leads to a less productive workforce, with those who suffer from obesity-related health conditions missing more work (absenteeism) and potentially losing focus while on the job (presenteeism).

Obesity Weighs on Workers Comp Claims
Obese workers generally experience more injuries and more expensive claims due to a host of health conditions. Studies show that obesity is already having a profound impact on workers compensation, including:

1. Increased frequency of injury. In 2007, Duke University performed a landmark study, "Obesity Increases Workers Compensation Costs." Researchers found that, on average, obese workers filed twice as many workers compensation claims as their non-obese counterparts.

2. Higher incidence of comorbidities. As previously noted, obesity increases the risk of comorbid conditions, such as high blood pressure and diabetes, which can create medical complications. For example, if an obese injured worker has diabetes, the healing process may be hindered, slowing recovery and return-to-work.

3. Increased severity. Obese workers often experience injuries that are more severe because extra weight generates increased force during an accident. If an obese worker experiences a slip and fall, for example, there may be significantly more impact and, thus, damage to the back or vulnerable joints like wrists, ankles and knees. Further, obese individuals may already suffer from orthopedic problems and osteoarthritis.

4. Increased medical costs. The Duke study found that claims filed by obese employees cost seven times more than similar claims from non-obese workers.

5. Higher indemnity costs. In addition, weight-challenged claimants miss 13 times more days of work than claimants with a normal BMI. In a 2010 study, the National Council on Compensation Insurance (NCCI) found that the duration of indemnity benefits paid is at least five times greater.

6. Greater risk of disability. The 2010 NCCI study also found that obese workers were more likely to become permanently disabled.

7. Additional complications. There are myriad additional risks and complications. For example, obese individuals have an increased incidence of depression and other mental health issues, which can make them more susceptible to opioid abuse. Or, if they undergo surgery, there is a high danger of complications, such as blood clots. Medical and workers compensation professionals must be watchful for these risks and work to mitigate them.

New Obesity Issues
Recently, additional issues have come to light to further complicate this complex medical challenge. Workers comp professionals must be aware of these factors and begin to formulate proactive strategies to deal with them.

In June 2013, the American Medical Association (AMA) House of Delegates approved a resolution reclassifying obesity as a "disease state." This essentially means that one in every three Americans (78 million adults and 12 million children) suffer from a medical condition that requires treatment and interventions. Workers compensation costs could rise significantly as a result.

The AMA reclassification may mean that more physicians will begin to look at and treat obesity as part of a workers compensation injury, arguing that it is required for a more successful chance of recovery. Physicians may cite obesity as a disease on workers comp medical bills and counsel obese claimants on weight reduction prior to a major procedure like surgery.

For example, the Indiana Workers Compensation Board decided that an injured worker was entitled to bariatric surgery-which limits the size of the stomach with a gastric band, removal of a portion of the stomach or gastric bypass surgery-as well as disability benefits as he prepared for, underwent and recovered from the procedure.

The perception of BMI has also changed. While BMI has traditionally been used to determine levels of obesity, it can be an unreliable indicator. More precise methods of measuring body fat composition are being developed. These measurements, however, indicate that today's obesity rate may be even higher-closer to 60%-which means a larger population is susceptible to the risks outlined here.

Claims Management Strategies
Employers and workers compensation claims professionals should utilize some key guidelines to identify workplace injury claims affected by obesity and proactively manage them for optimal costs and outcomes.

For example, rather than calculating an individual's BMI to determine obesity, adjusters and nurses can simply observe the claimant's weight. Often, 250 pounds or more is a red flag, indicating that a claimant will likely have special needs with regard to treatment, bariatric equipment and, in some cases, home modification.

Overweight and obese patients may require bariatric equipment, so these needs should also be assessed. According to Reuters, the cost of a bariatric wheelchair or bariatric toilet could exceed $1,000 each.

They should also immediately determine if the claimant has existing comorbid conditions, such as osteoarthritis or circulatory issues, and whether these conditions could impact the claimant's needs. Obese claimants with comorbidities generally require longer recovery and may experience higher medical costs. Claims professionals should take these factors into account when setting reserves.

While the dosage on most medications will be unaffected by weight, there are a few prescriptions, such as the antibiotic Cubicin, which may require a higher amount. For example, a 130-pound claimant would require 295 units of Cubicin, which costs $590 per dose. A 350-pound claimant would require about 800 units, at a cost of $1,600.

Since obese claimants may require more recovery time, claims professionals should work with the treating physician to develop a proactive return-to-work plan that ensures quality care and communicate with the claimant regarding the company's return to work expectations.

Risk Management Strategies
To combat obesity's impact, many employers are considering the potential benefits of implementing wellness and weight-management programs at their worksites. In addition to potentially reducing healthcare and workers compensation costs, these programs can improve workplace productivity by decreasing absenteeism, increasing workforce efficiency and improving both employee morale and job satisfaction.

In the future, the workplace could serve a critical role in helping to control weight across the U.S. population. Every day, a vast majority of Americans go to worksites, where they spend a significant amount of time engaging in social groups that could offer support and encouragement toward weight loss goals. A 2004 National Worksite Health Promotion Survey showed that 26% of worksites now offer some type of health promotion program, including weight management.

Although there are many ways to implement these types of programs, employers should take certain considerations into account. First, employers need to create a supportive environment that avoids weight bias. Encouraging employees to reduce and control weight can be perceived as weight discrimination. In a survey of more than 2,400 overweight adults, 43% reported they experienced weight stigmatization from employers, and 54% reported weight bias from coworkers. Employers need to provide a supportive environment focused on educating all employees on the benefits of healthy behaviors.

Effective workplace programs often incorporate a two-pronged approach, fostering both a healthy diet and increased physical activity. To that end, employers can provide education and advice on nutrition and food portions, as well as behavioral counseling to help employees manage cravings and overeating triggers. Stress, for example, can lead to emotional eating and social eating. Beyond just education, employers need to provide healthy options in their cafeterias and vending machines.

Many physical activity initiatives are also being promoted, including bike-to-work and pedometer tracking programs. Employees may find further motivation through social events organized around exercise, such as lunch-time walks.

It is also important to understand that the true impact of obesity may be hidden from view. Companies should schedule a time to review workers compensation claims data to understand the depth and breadth of obesity-related cost drivers. This can help organizations design a game plan to address problem areas. For example, they may find that obese workers are prone to injure ankles and wrists during slips and falls, or to hurt their backs while lifting heavy objects. To reduce these injuries, employers could develop a safety training that provides all employees with helpful injury-prevention guidelines.

Employers should also consider incentives that promote participation and encourage healthy results. Monetary incentives have been successful at motivating weight loss, but it is easy for people to slide back into old eating habits and a lack of exercise. Consequently, they may regain the weight. Research by John Cawley at Cornell University found that three-quarters of people give up on diets, even if they stand to gain a lot of money from losing weight.

Whatever the incentives used, programs need to be designed with sensitivity toward employee perceptions and companies must remember that many health measures, including weight, may be largely determined by genetics.

A Lifelong Challenge
As waistlines expand and medical costs soar, these strategies can help to address and minimize the impact of obesity on workers compensation claims. While many employers are experiencing early success in implementing wellness programs, it is important to realize that long-term weight management may be a lifelong challenge for many people. Companies implementing a wellness program should be cognizant not to single out or penalize overweight individuals. Instead, they need to encourage wellness for all.

Studies have shown that even a modest improvement in weight can have significant health benefits. Employees should be encouraged to make small and gradual changes over time, such as reducing soda consumption, eating more fruits and vegetables and exercising regularly. By doing this, employers may impact more than just costs-they can have a profound effect on the wellness of their workforce.
Kevin Glennon is vice president of clinical education and quality assurance programs at One Call Care Management. He has more than 30 years experience in health care, encompassing clinical and claims management for workers compensation.