The great expansion
Tom Clark hung up the phone, baffled by what he'd just been asked.
The year was 2003. The executive vice president of the Metro Denver Economic Development Corp. had fielded a call from a national site selection firm, hired by a large company to find a suitable area in which to expand.
The site selector asked Clark if he could provide a county-by-county obesity index for metro Denver.
"I'd never ever heard that question," Clark recalled recently. "But immediately I sensed a sea change. We didn't know where in the world to look for such a thing, but I said, ‘We're sure someone does that. We'll get right back to you.'"
The closest Clark could come at the time was an annual survey done by the state health department on the prevalence of diabetes, a disease closely linked to obesity. Obesity is shown to be a major risk factor for other chronic ailments, including high blood pressure, high cholesterol, stroke, heart disease and asthma. For employers, studies show that poor employee health leads to lower productivity, lower morale, higher absenteeism and higher insurance claims.
Why an obesity epidemic in the workplace? Jobs that have become mostly sedentary. The transition to a "knowledge economy," in which workers sit in front of a computer all day. People too busy to cook healthy meals. Video games, huge flat-screen, high-def TV screens.
"Productivity matters," Clark said. "It's never a deal-breaker for us, but it's definitely a factor when you're a high-priced market surrounded by low-cost competitive states with more money for economic incentives."
Clark and his team began to research the issue. "We began looking at the cost of obesity in the workplace and how it manifests itself," he said.
What they found was almost too good to be true. And it may not be true for long.
The national Centers for Disease Control consistently ranks Colorado as the least obese state in the country in its annual obesity index. In 2008, only one state - Colorado - had a prevalence of obesity less than 20 percent. Thirty-two states had a prevalence equal to or greater than 25 percent. Six (Alabama, Mississippi, Oklahoma, South Carolina, Tennessee and West Virginia) had obesity rates equal to or greater than 30 percent.
Also, the nonprofit Trust for America's Health says Colorado has some of the lowest rates in the country of overweight residents, physical inactivity, hypertension and childhood obesity. Overall, Colorado ranks as the leanest state in its study.
"We found we had a lot to brag about, so we did," Clark said.
The MDEDC began touting Colorado's newfound "skinniest state" reputation as a marketing tool for economic development. It embarked on a five-year, $4 million, national ad campaign - Energetic Bodies, Energetic Minds - branding the region as a prime place to locate a business.
"Metro Denver is one of the nation's fittest cities with the nation's second-highest percent of physical activity and the highest percentage of residents with health club memberships," the ads read.
Lisa Bailey loved the campaign. Since 1983, her Broomfield company, Health Promotion Management Inc., has implemented employee wellness programs for clients.
"We've got a healthy community. Let's publicize it," Bailey said. "It's a benefit, a marketing opportunity."
But a nagging negative trend has developed, one that may strip us of our bragging rights:
• According to a report released in February by the state health department, Colorado's obesity rate rose 89 percent from 1995 through 2008, while the national rate rose 67 percent.
• Over the past 15 years, the percentage of obese Coloradans has grown faster than any other state, except Virginia.
• The percentage of Coloradans classified as obese went from 10.1 percent to 19.1 percent during that time - still lower than the national rate of 26.6 percent, but discouraging.
"We've basically engineered physical activity out of our lives," said James Hill, a University of Colorado pediatrician who heads the Center for Human Nutrition, funded by the National Institutes of Health.
"Colorado, more than any state, has a culture of health," Hill added. "We value health, fitness, healthy eating and an outdoors lifestyle. But we're lapsing into a ‘culture of un-health' like most of the rest of the country. Even here, it's become too easy to make wrong choices about physical activity and eating.
"We're on a bad trajectory," he said. "Unless we do something soon, we'll fall in with the rest of the pack."
For shock value, Hill is fond of saying that Bill Gates has contributed as much to the obesity epidemic as Ronald McDonald.
"You don't have to be physically active to be productive any more," he said. "You can sit at a computer all day; sit in front of screens all night. It's not intentional, but you don't have to be active to be successful any more."
In Colorado, some even blame the problem on migration from other states. From 1990-2002 alone, nearly 2 million people moved to Colorado from other states. Nearly 20 percent - 349,402 people - came from the 10 states listed with the highest obesity rates in 2002. The problem is especially worrisome in the workplace:
• Obese employees cost U.S. private employers an estimated $45 billion yearly in medical expenditures and work loss, concluded a 2008 report by the Conference Board business research group.
• Medical expenses for obese employees in 2006 were 42 percent higher ($1,429 per employee) than for a person with a healthy weight, according to the Centers for Disease Control.
• Obese adults are 21.7 percent more likely to report having one or more poor physical health days per month, according to a 2009 report by the Colorado Business Group on Health.
"Coloradans should be as concerned about the obesity epidemic as everyone else in the country," said Eric Aakko, director of the health department's Colorado Physical Activity and Nutrition program. "Reversing the state obesity trend will take a comprehensive, community-based approach."
In the workplace, people like Lisa Bailey have been fighting obesity for years. Finally, she and her eight employees are finding it easier to get their feet in the door, as once-skeptical business owners run out of options for controlling their health-care costs.
"Employers are at a tipping point," Bailey said. "With double-digit health-care cost increases every single year, they can't ignore it any more. They're fed up with the options they've been given, and wellness is the last frontier.
"When I look at our clients today, they wouldn't be there without a senior-level exec who believed it was right thing to do," Bailey said. "But that's not enough. Fluff money has decreased. We have to convince them that we can impact their bottom line, in either health-care costs or productivity."
Figuring that an employer spends between $5,000 and $7,000 annually per worker, Bailey argues they should be willing to spend 1 percent to 3 percent of those costs on prevention.
"I tell companies we can affect 25 to 40 percent of their employees' annual health care claims through health promotion," Bailey said. "If there are cynics at the top, they won't put our programs in place. Is health promotion worth it? We on the prevention side are held under the microscope much more than medical testing people. Are MRIs worth it?"
What should be clear to employers is that the desk-bound lifestyle comes with a price.
"If employers want to calculate what physical inactivity is costing their company, I would suggest that they take a look at their total health-care expenditures for a year and take 15 percent of that," said Dr. Steve Aldana, a professor of Lifestyle Medicine at Brigham Young University. "In reality, that's going to be pretty close to the actual expenditures."
Bailey's Health Promotion Management typically begins a contract by assessing employee health with lifestyle questionnaires and physical measurements. A person's "body mass index" is computed after height and weight are measured. Someone is considered obese if their BMI is greater than 30.
The overweight range is 25 to 29.9, and a normal BMI is considered to be 18.5 to 24.9. For instance, according to a BMI index, if a man is 5 feet, 8 inches tall and weighs more than 178 pounds, he would be considered obese. A BMI is a serviceable indicator of body fatness and weight categories that may lead to health problems.
Once Bailey's team has done a health screening of a company's work force, they'll sit down with management to come up with a customized plan of attack.
"We tell them, ‘Based on risks of your employee population, we'd expect this much productivity loss, this much excess cost due to medical claims, this much excess absenteeism,'" Bailey said.
The recipe could include wellness classes, one-on-one coaching, group challenges on weight loss or pedometer use and possibly incentive programs. Some companies offer gift cards or other forms of cash reward, such as paying an employee's health-care deductible cost if a weight goal is met.
"We used to focus solely on the individual worker," Bailey said. "But there's been a gradual realization that the individual has a wife, kids, an office environment. Are they supportive of good health, or a barrier?"
Then she, and others, began to look at the larger community.
"Change is brought about most effectively at the policy level, whether it's corporate or governmental," Bailey said.
Dr. Eric K. France, chief of preventive medicine for Kaiser Permanente Colorado, agrees.
"For some of the issues we face, we need to go upstream and look at policies and plans," France said. "Doctors can solve health problems in the clinic, but urban environments can encourage healthy behavior. People have to find that the easy thing for them to do is the healthy thing for them to do. People have to naturally include physical activity in their daily activity."
"We have designed our cities to serve the automobile," he added. "That's why we are 30 years into an obesity epidemic."
Also engaged in the obesity battle is LiveWell Colorado, a nonprofit funded by the Colorado Health Foundation, Kaiser Permanente and the Kresge Foundation, parent company of King Soopers. LiveWell (www.livewellcolorado.org) advocates policy, environmental and lifestyle changes that would provide every Coloradan access to healthy foods and physical activity.
In April, LiveWell released a "Worksite Wellness Blueprint" to assess the current state of worksite wellness in Colorado and to guide future efforts.
"We must acknowledge the importance of workplaces that encourage, build and sustain healthy living initiatives," said Maren C. Stewart, president and CEO of LiveWell Colorado. "This Blueprint allows us to see what is currently working and what opportunities exist so we can effectively improve wellness among employees in our state."
The group plans to convene a Colorado Worksite Wellness Leadership Group this year to identify statewide workplace priorities and an initial list of strategies. The new health-care reform bill signed into law last month earmarks $200 million over five years for business owners with fewer than 100 employees to start wellness programs and offer incentives for workers to participate. Small businesses typically do not have the economies of scale to offer such programs for employees.
"The challenge to small business is affordability," said Burton Goldfield, chief executive officer of TriNet, a San Leandro, Calif., firm that provides human resourcing to small businesses. "Employees are absolutely interested, but small businesses unfortunately cannot afford the cost.
"Of course we would support small businesses in applying for wellness program grants," he added. "But we found the prospect of good health isn't enough to incentivize employee involvement. Participation is crucial in making wellness programs a success. Small businesses can concentrate funds from grants and subsidies toward offering incentives. According to the Employee Benefits Institute of America, there is a 70 percent jump in wellness program participation when incentives are offered."
CU's Dr. Hill said, "In some ways in recession we're willing to do more extreme things. How far should employers be allowed to go? We need to find that out. The Cleveland Clinic doesn't hire smokers. They are talking about the same thing for obesity. It'll help us to debate how far is too far. We need to answer that question."
One thing is abundantly clear: Colorado no longer escapes the national obesity epidemic.
"In Colorado, we're going backwards," Bailey said. "We are no longer winning the war on obesity."