Battle of the bulge: health plans are matching innovative ways with tried-and-true approaches to fight rising obesity and associated medical costs.

Expanding waistlines are shrinking companies' wallets. In fact, obesity-related costs to those businesses exceed $13 billion annually, according to the U.S. Department of Health and Human Services.

There's no end in sight for these costs. A recent Duke University/ RTI International/Centers for Disease Control and Prevention study anticipates 42% of U.S. adults will become obese by 2030.

And, the American Heart Association/American Stroke Association adds, if current trends continue total health care costs attributable to obesity could reach up to $957 billion by that year.

That has health plans and companies trying to balance the scale, with everything from weight reduction programs and discounted gym memberships to community farmers markets, health coaches and more. One of Omaha, Neb.'s largest employers, Creighton University, has seen improved weight management among staff and a significant return on investment from such initiatives. Its intensive risk-reduction wellness program, aimed at diabetes, high blood pressure and high cholesterol, offers employees tools such as nutrition training and pedometers.

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"Participants are significantly improving their quality of life," said Program Clinical Director Tom Lenz. "We wanted to create a program that was about personal care rather than population-level care and show we can make it cost-effective to spend the appropriate amount of time with someone it would take to modify their behavior."

Medical expenses for obese individuals are $1,420 more than those at normal weight, according to the CDC. Part of those costs stem from obesity's direct link to certain health conditions such as high blood pressure, heart disease, arthritis and diabetes.

Nearly 70% of BlueCross BlueShield of South Carolina's medical costs result from such chronic diseases, said Dr. Laura Long, vice president of clinical quality and population health. That's why employers need to recognize that reducing the percentage of overweight employees in their population will have an immediate impact on their bottom lines, she said.

"And it's more than just direct medical costs," Long added. "Absenteeism and workers' comp issues also arise, creating an additional 30% in expenditures from indirect costs due to obesity."

Something to Chew On

Obesity has become the first- or second-leading weight risk factor in large employers' populations, noted LuAnn Heinen, vice president of the National Business Group on Health.

"It's a shared concern among employers and health plans," she said. "About 80% of our employers have a fairly comprehensive wellness program offering for employees and their families, and virtually all are doing something around weight management."

Employers are striving to build a culture of health in their companies, added Susan Black, director of South Carolina Blues' clinical quality and population health.

"Our role is to help them put together wellness committees and other initiatives to grow a healthy workplace," she said. "Companies now are improving food offerings in their cafeterias and vending machines, subsidizing healthy choices by increasing costs of less-nutritional options, offering walking trails and holding contests to engage employees."

Balancing the Scale

Health reform may help trim the fat off obesity-related costs.

"That's because there's a greater focus on prevention and being able to reach individuals earlier," said Paul Coppola, who heads up Aetna's wellness programs, strategy and development. "Reform helps with that positioning because it's about bringing services and greater access to individuals."

Added Heinen, "Reform has been very supportive of wellness initiatives and those to manage health risks like obesity. The increase in allowable incentives from 20% of premium to 30% beginning in 2014 signals an understanding that incentives are quite valuable."

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The bottom line is that "we want to provide the right tools and services to our members because it's hard to change behaviors and lifelong patterns," Long noted.

"We can only change health with medicine about 15% of the time; a certain percentage is impacted by things like genetics that we can't control," Long added.

"But 40'% of a person's health is behavioral, and employers and health plans are looking at things like incentives, gaming and social connections to impact those behaviors."

Key Points

* The Problem: Health care costs for obese employees are as much as 21% higher than costs for employees at a healthy weight, according to a Gallup poll.

* Finding a Solution: Health plans are turning to education, interactive tools and incentives to help drive down obesity-related costs.

* What's to Come: Health reform is putting a greater focus on prevention, including weight management.

Reaping Rewards

Financial incentives are encouraging individuals to shed pounds. WellPoint members and employees can earn health credits by engaging in activities or making health and lifestyle changes. Health credits can be used as reduced premiums, health savings account contributions or gift cards.

The incentives are paying off. During the first year of the program, WellPoint's own workforce saw a slight decline in its overall obesity rate and a 14% increase in participants' self-reported exercise rate.

The 2010 U.S. health care reform law specifically addressed the use of incentives, allowing employers to charge obese workers 30% to 50% more for health insurance if they decline to participate in a qualified wellness program. The law also allows for "carrots and sticks" to persuade Medicare and Medicaid enrollees to see a primary care physician about losing weight, and funds community demonstration programs for weight loss.

This year, according to a Society of Human Resource Management study of 550 randomly selected member companies, the percentage of employers offering wellness bonuses climbed more than 50% since 2008. Health risks like obesity and smoking are the prime targets of those efforts.

The biggest challenge to weight loss initiatives, however, is a person's willingness to make changes, said Paul Coppola, who heads up Aetna's wellness programs, strategy and development. "They have to feel ready. It's important to find the right path with things like motivational interviewing, creating personal relationships and rewards."

But incentives alone aren't usually enough for long-term results, he said. "You also have to find out what a person's intrinsic motivators are by discovering what they're passionate about, like family, society or their community. Those can be the greatest motivators for reaching individuals."

Learn More

Aetna Health and Life Insurance Co.

A.M. Best Company # 08189

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BlueCross BlueShield of South Carolina

A.M. Best Company # 01727

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