The NHNES reported that on average, between 1976 and 1980, 32 percent of adults between ages 20 through 74 were overweight (BMI 25-29.9). In the same time period, 15 percent of adults were obese (BMI 30 or higher). By comparison, between 1988 and 1994 those figures had increased so that 33 percent of adults were overweight and 23 percent obese. By 1999 and 2000, the NHNES reported that 33 percent of adults were overweight and 31 percent obese, which means that 64 percent of the adult population is now at least somewhat overweight. The figures for children and adolescents are just as disturbing, especially since they represent the next generation of workers. The NHNES survey found that over the past two decades, the percentage of overweight children has doubled while the percentage of adolescents has tripled. The 1999-2000 survey found that 15 percent of children are experiencing some weight problems.

Hartwig said part of the problem assessing the impact of workers' weight on injuries is the lack of information. Unlike disability problems, he noted, workers' comp doesn't track information such as workers' height, weight, and body mass. However, he said he is convinced that weight-related problems do have an impact on the ability of injured workers to return to work. For example, a person who is several hundred pounds overweight and suffers an ankle injury due to a slip and fall is going to have a harder time healing than someone who may just be mildly overweight. Other medical conditions could also influence a person's ability to heal from a workplace illness such as hepatitis. “If you look at it from a disability standpoint, a diabetic is going to take longer to heal,” Hartwig said.

In order to produce some initial judgments about the influence of weight on occupational injuries and illnesses, Hartwig said he has been studying disability insurance data that does take into account a worker's general health condition. Using the data, Hartwig sought to examine so-called “co-morbidity costs,” which are costs associated with medical conditions beyond the scope of the disability.

A 2004 study by the UnumProvident Corporation entitled “Disability Management — Obesity” found that the average indemnity costs per disability claim equaled $8,720. Further, the average medical costs per claim due solely to obesity reached $30,567. The co-morbid costs, or costs to treat other health conditions concurrent with a medical obesity claim, added on average another $11,736 per claim. The co-morbid costs are linked to common workers' comp injuries. For example, the study found obese employees with musculoskeletal injuries used 7.52 percent more medical services than non-obese employees. Other associated co-morbidity injuries included 15.99 percent for injury/poisoning, 16.3 percent for mental disorders, and 13.37 percent for respiratory system conditions. Given the study's results, Hartwig said that in his opinion state workers' comp systems are also absorbing co-morbidity costs just as disability insurers. “Why should workers' comp be any different?” he said. “This could be costing workers' comp billions”

Hartwig said that there is a need for new research into the effects of obesity on workers' comp claims. However, he said, there are some difficulties in conducting the research. For one, health care privacy rules will make it difficult to gather information about workers' general health conditions. There is also a concern that if such information is gathered and improperly distributed, it could result in employers discriminating against workers based on their physical condition. For that reason and others, the best approach to reducing costs associated with obesity may be a proactive approach by employers and carriers to promote health in the workplace.

Addressing Obesity in the Workplace

With the general consensus that obesity is a threat to the public at large and considering the amount of time adults spend at their jobs, the workplace is emerging as the logical place to provide opportunities for educating workers as well as providing opportunities for instituting healthy practices. While 65 percent of adult Americans are overweight, with nearly a third medically obese, obesity in other industrial nations is noticeably lower, averaging about 10 to 12 percent in Continental Europe. Experts suggest that part of the way of addressing this disparity is to address lifestyle changes, including changes in the workplace environment.

The newly formed Institute on the Costs and Health Effects of Obesity, a group of 175 large private and public-sector employers, recently released fitness initiatives for addressing obesity and examples of successful programs based on a survey of 84 large U.S. employers (June 2004).

The report noted that the most frequent opportunities offered by employers include:

o 77 percent of the companies had an on-site fitness center.

o 69 percent of companies had an on-site fitness program.

o 67 percent of companies sponsored fitness programs generally.

o 38 percent of companies had web-based instruments for tracking work and providing information.

In addition, 61 percent of employers surveyed asked employees to share some of their fitness programs; 27 percent pay the entire cost; and 12 percent pay nothing at all. These companies primarily promote these programs electronically as well as through posters, fliers, and e-mails.

In addition, the Institute gave examples of the strategies some companies have employed in order to promote strategies for reducing obesity among their workers:

o To encourage fitness, Sprint set up its 200-acre headquarters and banned cars, thus forcing employees to walk from parking structures far from offices. They also put in slow elevators and wide staircases with windows to encourage walking between floors.

o Highmark, Inc., a 12,000 employee health-insurance company in Pittsburgh offers weight management programs for groups or individuals, as well on online nutritional counseling, low-fat meals and snacks in both cafeterias and vending machines, discounts on nutritional products and services, and an employee fitness center.

o The Center of Disease Control encourages walking on stairways by making them more appealing with such enhancements as new carpeting, artwork, motivational signs, and piped-in music.

o Sparkle-People, an online coaching company in Cincinnati with only 25 employees, is able to provide access to a personal trainer and fitness center, a caf? featuring healthy foods, as well as a garden in the back of the company's office with vegetables produced for the employees.

Though the benefit of weight-loss programs in the workplace should be self-evident, many companies have avoided them. Too often, management fears identifying overweight employees because they fear being perceived of as discriminatory. The solution to such a concern is to be sure the programs are voluntary and that there are no disincentives for those who are overweight and do not participate.

Incentives help employers promote a healthier lifestyle for their employees. Offer on-site programs such as Weight Watchers or Overeaters Anonymous. Sponsor or subsidize health club memberships or add a health facility at work. Encourage group health vendors to offer more programs targeting the overweight population. Implement a healthy eating environment, particularly by including options in cafeterias and vending machines.