The Obesity Epidemic: Its Impact in the Workplace and What Employers Can Do

Transcription

1 1 The Obesity Epidemic: Its Impact in the Workplace and What Employers Can Do Dr. Monali Misra, MD, FRCS(C), FACS Assistant Professor Department of Surgery, St. Joseph s Healthcare, McMaster University Assistant Director Centre for Minimally Invasive Surgery (CMAS), St. Joseph s Healthcare 2 Overview Obesity Epidemic Impact in the Workplace Medical and Non-Medical Treatment Options Tips for Employers

2 3 What is Obesity? Obesity is a chronic disease of multiple causes Body Mass Index (BMI) is a measure of an individual s weight (kilograms) in relation to height, in meters squared 1 BMI is used as an indicator of healthy vs. unhealthy body weight Normal Weight (BMI 18.5 to 24.9) Overweight (BMI 25 to 29.9) (BMI 30 to 34.9) Severely (BMI 35 to 39.9 ) Morbidly (BMI 40 or more) 1 National Institute of Health Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults Obesity is on the rise Underweight Morbidly Severely Normal weight 23% of Canadian adults are obese Overweight 59% are overweight or obese Distribution of Canadian Adults in Each BMI Category, Statistics Canada (2004) Statistics Canada. Canadian Community Health Survey on Obesity. Health Reports, Vol 17, No. 3, August 2006.

3 5 Obesity in Canada (: BMI 30, or ~ 30 lbs overweight for 5 4 woman) No Data <10% 10-14% 15-19% 20% Katzmarzyk PT, Can Med Assoc J 2002;166: Statistics Canada. Canadian Community Health Survey on Obesity. Health Reports, Vol 17, No. 3, August Health Implications of Obesity

4 7 Obesity and Chronic Illness individuals are at increased risk of numerous diseases including: Type 2 diabetes (5 times) 1 Hypertension (3.3 times) 1 Heart Disease (2.2 times) 1 Osteoarthritis (2 times) 2 Colon cancer (1.5 times) 2 Post-menopausal breast cancer (1.5 times) 2 Asthma (1.5 times) 3 1 Statistics Canada. Canadian Community Health Survey on Obesity. Health Reports, Vol 17, No. 3, August Katzmarzyk PT, Janssen I. The economic costs associated with physical inactivity and obesity in Canada: An update. Can J Appl Physiol. 2004; 29(1): Beuther D. et al Overweight, obesity and incident asthma: a meta-analysis of prospective epidemiologic studies. Amer J of Resp and Critical Care Medicine Relationship Between BMI and Risk of Type 2 Diabetes Mellitus Men Women <22 < BMI 1. Chan et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994 Sep;17(9): Colditz et al. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995 Apr 1;122(7):481-6.

5 9 Impact of Obesity in the Workplace $$$$$ $$$ Overweight More chronic illness, medical & disability claims, lost time from work $ Normal Weight 10 More Medical Claims, Days Lost from Work and Injury Claims Per 100 FTEs Non-obese $51,091 7x x 2x $5, Medical Claim Costs Days from Work Work-related Injury Claims N=34,858 FTEs 1 Ostbye T, et al. Obesity and Workers Compensation. Results from the Duke Health and Safety Surveillance System. Arch Intern Med 2007; 167:

6 11 More Costly Short-Term & Long-Term Disability Claims Normal Weight LTD claims $38,500 $46,100 $7,600 more costly for STD claims $5,800 $13,000 $7,200 more costly for $0 $10,000 $20,000 $30,000 $40,000 $50,000 1 Kogon D. et al. Cost of Obesity Study. Accessed on Oct 24/07 from Benefit s Canada website. (Canadian data) 12 Obesity and Early Death individuals have 2-3 times greater risk of death Body-Mass Index and Relative Risk of Death From All Causes: Women < =40 Body Mass Index Note: the vertical bars represent the 95% CI Hu FB et al. Adiposity as compared with physical activity in predicting mortality among women. New Eng J of Med. 2004; 351: Relative Risk

7 13 Treatment Options Non-Medical Diet & Exercise Medications Medical Endoscopic Procedures Laparoscopic Procedures 14 Diet & Exercise Canadian Guidelines recommend 1 : Reducing calorie intake by 500 to 1000 kcal/day Moderate physical activity > Initially 30 minutes 3-5 times/wk > Then 60 minutes on most days Weight Watchers is the most effective of the weight loss programs 2 Diet and exercise are typically ineffective over time (5% to 10% excess weight loss, on average) 2 (i.e., 300 lb person whose ideal body weight is 150 lbs, may lose 7.5 to 15 lbs) High drop out rate Canadian Clinical Practice Guidelines on the Management and Prevention of Obesity in Adults and Children. CMAJ 2007;176(8): Wadden TA, Sternberg JA, Letizia KA, Stunkard AJ, Foster GD. Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a five-year perspective. Int J Obes. 1989;13(Suppl)2:39-46.

8 15 Diet & Exercise Weight is Usually Regained 5 Diet alone Behavior therapy Combined therapy Change in Weight (kg) * -20 Baseline End of Treatment 1-Year After 5-Years After Wadden TA, Sternberg JA, Letizia KA, Stunkard AJ, Foster GD. Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a five-year perspective. Int J Obes. 1989;13(Suppl)2: Medications Two medications approved in Canada One reduces fat absorption Other enhances satiety Studies show 5 to 10% excess weight loss 1,2,3 (i.e., 300 lb person whose ideal body weight is 150 lbs may lose 7.5 to 15 lbs) Not approved for long-term use despite chronic nature of obesity 4 Amount of weight loss is generally insufficient for effective treatment of comorbidities 5 1 Dixon JB, O'Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care. 2002;25(2): O'Brien PE, McPhail T, Chaston TB, Dixon JB. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16(8): Fisher, BL, Schauer, P. Medical and surgical options in the treatment of severe obesity. American Journal of Surgery. 2002; Volume 184 (6B) 4 Ontario Medical Advisory Secretariat. Bariatric Surgery: Health Technology Literature Review O Brien PE, Dixon JB, Brown W. Obesity is a surgical disease: Overview of obesity and bariatric surgery. ANZ Journal of Surgery 2004;74(4):200-4.

9 17 Endoscopic Procedures Intra-Gastric Balloon: Inflatable device placed in the stomach using an endoscope Filled with saline Restricts amount a person can eat In place for 6mths Typical weight loss: 38 to 44 lbs 18 Weight Loss Procedures Laparoscopic Adjustable Gastric Banding 1 hour clinic procedure Patient goes home after 2 hours Return to work: 7 days Low rate of serious complications Laparoscopic Gastric Bypass >2 hours hospital procedure Patient stays in hospital 2-3 days Return to work: 18 to 28 days Higher rate of serious complications Life-long vitamin supplementation needed

10 19 Weight Loss Procedures Canadian Clinical Practice Guidelines on Obesity 1 recommend weight loss procedures for patients with: BMI 35 with serious comorbidities (diabetes, high blood pressure, sleep apnea, reflux, etc ) BMI 40 Severely (BMI 35 to 39.9 ) Morbidly (BMI 40 or more) Bariatric surgery is highly effective in achieving sustained weight loss and resolving comorbidities Canadian Clinical Practice Guidelines on the Management and Prevention of Obesity in Adults and Children. CMAJ 2007;176(8): O'Brien PE, McPhail T, Chaston TB, Dixon JB. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16: Laparoscopic Adjustable Gastric Banding Results in Significant Long-term Weight Loss Patients lose 55% to 60% of their excess weight over 2 to 3 years 1 Study N 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years Dargent Fielding Allen O Brien Vertruyen Rubenstein Ren Belachew Ponce , Fielding GA, Ren C Laparoscopic adjustable gastric band Surg Clin N Am Ponce J. Laparoscopic adjustable gastric banding: 1,014 consecutive cases. J Am Coll Surg 2005; 201(4):

11 21 Complete Resolution or Improvement in Comorbidities: for example, with Laparoscopic Adjustable Gastric Banding Resolved Improved No Change Declined 100% 90% 80% 70% 93% 59% 79% 35% 90% 26% 93% 90% 14% 76% 60% 64% 50% 40% 44% 30% 34% 20% 10% 0% Asthma 1 1 Year Post-op (n = 32) Hypertension 2 1 Year Post-op (n = 50) Type 2 Diabetes 2 1 Year Post-op (n = 50) Sleep Apnea 3 1 Year Post-op (n = 123) Gastroesophageal Reflux 4 2 Years Post-op (n = 48) 1. Dixon et al. Obes Surg. 1999; 2. Dixon et al. Diabetes Care ; 3. Dixon et al. Arch Intern Med ; 4. Dixon et al. Obes Surg Cost Savings Expected Annual Cost of Medications to Treat Comorbidities Diabetes: $1,675 1 Hypertension: $830 to $1,170 High cholesterol: $450 Asthma: $4,000 Sleep apnea machine: $1,000 to $2,500 Osteoarthritis: $160 to $475 Reflux: $500 Depression: $1,500 Likely paying $2,000 to $3,000/yr on medications alone Does not include cost of: Absenteeism STD LTD 1 Harris SB et al Out-of-pocket costs of managing hyperglycemia and hypoglycemia in patients with type 1 diabetes and insul-treated type 2 diabetes. Cdn J of Diabetes 2007;31(1): Costs estimated based on prescribing guidelines.

12 23 Small Number of Employees Requiring Gastric Procedures 2% Procedure Rate Morbidly Severely with comorbidities Overweight person Normal Weight & Underweight 410 1,000 employees* Current procedure rate in Canada 0.001% * Not including dependents 24 Tips for the Workplace Provide educational materials on the health risks of being overweight and how to eat healthier Offer wellness classes on nutrition, exercise and weight management such as Weight Watchers Post the calories expended for common activities such as walking, swimming, bicycling Sponsor or subsidize health club memberships and/or personal trainers Offer healthy choices in cafeterias and/or vending machines Allow employees enough time for lunch so that they can walk or use the gym Provide worksite walking paths and bike racks Talk with health plan providers about the availability of employee educations materials and disease management programs Talk with your benefit consultant regarding coverage for laparoscopic gastric banding

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