The great expansion
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"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."
Rob Reuteman is a freelance journalist, former business editor of the Rocky Mountain News and immediate past president of the Society of American Business Editors and Writers.
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