Obese Employees Weigh Heavily on Bottom Line

DURHAM, N.C., April 24 -- Strains, sprains, and pains are more common in obese employees than in normal-weight workers, costing U.S. companies billions of dollars, according to researchers here.

The heaviest employees filed twice as many workers' compensation claims and missed 13 times as many workdays as those of normal weight, Truls stbye, M.D., Ph.D., of Duke and colleagues, reported in the April 23 issue of the Archives of Internal Medicine.

The obese employees' medical claims costs were seven times higher and indemnity claims costs were 11 times higher, the researchers found.

"Because many Americans receive health insurance through their workplaces, the health care costs of obesity are a significant concern for employers of working age adults," the authors said. In 1994, the estimated cost of obesity to U.S. businesses was .7 billion, including .7 billion in health-care costs alone, the study authors said.

Previous studies have shown that obese workers have up to 21% higher health care costs, but less is known about the costs of work-related illness and injury, the authors said.

Their retrospective study analyzed health and workers' compensation claims data for more than 11,000 employees of the Duke University Health System, the second largest employer in North Carolina. All study participants had undergone a health risk appraisal sometime from 1997 through 2005.

Workers with a BMI of less than 18.5 were categorized as underweight; between 18.5 and 24.9, recommended weight; 25 to 29.9, overweight; 30 to 34.9, obesity class I; 35 to 39.9, obesity class II; and 40 or higher, obesity class III.

At an average of three years follow up, the study found a linear relationship between BMI and workers' compensation claims rates. For recommended-weight employees, the rate of claims during the study period was 5.8 per 100 full-time workers. For obesity class I employees, that figure climbed to 8.81, and it doubled to 11.65 for obesity class III workers.

The study found a similar trend for lost workdays and insurance costs. For recommended-weight employees, the rate of lost workdays was about 14 per 100 employees. For obesity class I employees, the figure rose five-fold to about 75. For obesity class III workers, the figure was 13 times higher: more than 183 lost work days.

Medical claims costs were ,503 per 100 for recommended-weight workers. That figure more than doubled to ,661 for class I obese workers, and it increased by seven-fold for class III obese workers to ,091.

Indemnity claims costs were ,396 per 100 for those of recommended weight. That cost quadrupled to ,633 for the class I obese and rose by 11-fold to ,178 for the class III obese, the study found.

Workers with physically demanding jobs involving heavy lifting or other ergonomic stress had higher rates of claims. Top examples include laundry staff (27.7 claims per 100 employees), housekeepers (about 25 claims per 100), and laboratory animal technicians (about 63 claims per 100).

The most common sites of injury in obese employees were the back, lower extremities, wrist, and hand. The most common types of injuries were strains or sprains, slips or falls, contusions or bruises, and pain or inflammation, the study found.

Employees 55 and older were more likely to have more lost workdays (relative risk=1.81; 95% confidence interval=1.49 to 2.20) and higher medical claims costs (RR=1.28; 95% CI=1.11 to 1.47) than younger employees, regardless of weight. However, only 7.5% of study participants were 55 or older.

Black workers (27% of the total) were also at increased risk for filing claims (RR=1.28; 95% CI=1.16 to 1.41), "possibly reflecting greater concentration in higher-risk jobs," the study authors said.

"Maintaining healthy weight should be of strong interest not only to workers but also to their employers and to the workers' compensation system," the authors said.

"Complementing general interventions to make all workplaces safer, work-based programs targeting healthy eating and physical activity should be developed and evaluated," they suggested.

One limitation of the study was that it involved predominantly younger and middle-aged employees, said Luigi Ferrucci, M.D., Ph.D., of the National Institute on Aging in Baltimore, in an accompanying editorial.

Nevertheless, the data appear to confirm previous work suggesting associations between obesity, disability, and health care costs, Dr. Ferrucci said.

However, he noted, "several important questions about the relationship between obesity and disability remain unanswered." For example, "How does obesity lead to disability? Although obesity is a strong risk factor for many chronic conditions, such as osteoarthritis, diabetes mellitus, heart disease, and stroke, accounting for the presence of these diseases does not explain the relationship between obesity and disability," Dr. Ferrucci said.

Further research is necessary to explain the obesity-disability link, he said.

The authors also noted several limitations which prevent conclusions about the obesity-disability link:

• "Within each occupational group, it is possible that obese employees are at higher risk of adverse outcomes than those of normal weight. For example, if obese nurses (because of discrimination or for some other reason) are less likely to get promoted, they may be doing more of the heavy lifting."
• "It is also possible that obese workers, given the same illness or injury, may be more or less likely to submit a workers' compensation claim than a colleague of recommended weight."
• "Furthermore, there are potential underlying unobservable factors, that might make obese individuals more likely to get injured independent of their weight."