Obesity is the target as business health insurers draw a straight line between overweight workers and insurance claims for diabetes, hypertension, heart disease, high cholesterol and other conditions."Information about obesity programs is our biggest request these days," said Ann Clark, whose San Diego-based Ann Clark Associates administers employee assistance plans nationwide. "Employers want to know what they can do about it. And, they have a sense of urgency about it."
Clark said a combination of rising health-care premiums - up an average 9.2 percent last year and more than 57 percent over the past five years - and a steep run-up in obesity among the nation's work force has galvanized employers into believing they need to do something to create a healthier work force.
"The question is what to do," she said.
Nearly one in three adult Americans is considered obese, which is more than twice as many as in 1980.
Obesity-related costs total an estimated $13 billion a year for U.S. companies and account for 9.1 percent of annual medical expenditures, 39 million lost workdays and an uncalculated amount of lost productivity by those who report to work but are limited by their weight issues.
But dealing with personal health issues must be done delicately so as not to backfire against the company.
"It's a problem that everyone wrestles with," said Cheryl Pegus, medical director for Aetna in Blue Bell, Pa., which provides health-care benefits for more than 28 million U.S. workers.
"Even though you can show that these people have higher medical costs, you don't want something that punishes them for a lifestyle choice. At the same time, you want them to be healthier."
That's why most companies look to offer incentives or rewards to motivate employees to adopt healthier lifestyles.
Intuit, which develops and markets software for personal finance and tax preparation, offers $350 annual subsidies to workers who want to join fitness clubs. At the same time, it provides an in-house gym and other vehicles that it hopes will engage workers to make better lifestyle choices.
"There is no doubt that it is a huge issue," said Sarah Wilkins, a benefits analyst for Intuit, which has 1,200 employees at two sites in University City, Calif. "But it's quite new ground; businesses aren't sure exactly what to do."
Intuit, ranked on the Fortune magazine's Best Companies to Work For list for the past three years, also offers nutritional tips and healthy cafeteria options, educational seminars and special classes for such things as yoga or ballroom dancing.
"We realize that while the company may be concerned about health-care costs and the health of our employees, we can't do it alone," Wilkins said. "We are trying to educate our workers so they will be motivated to make lifestyle changes that improve their health. We feel like we are in a partnership with them."
Clark said that some companies have given up on experts finding wellness solutions and instead are experimenting on their own with programs that range from nutritional counseling and tips to exercise classes or walking programs.
"There are a lot of little homegrown efforts that are really impacting workplaces simply because they are getting people involved," she said.
In her office, workers spend their morning break in a vacant conference room, where they shed their shoes and do a quick yoga routine in work clothes.
"I'm certainly mindful of obesity, but I also know that yoga is something everyone can do because it doesn't require a high fitness level," Clark said. "I think just stretching or working your neck and shoulders will help with stress reduction or help prevent things like carpel tunnel or headaches."
The organic approach also took hold at San Diego Metropolitan Credit Union three years ago when Becky Ramos-Arzola noticed the large number of 30-ish co-workers eating junk food during the day.
"I just looked at them and knew this wasn't good," said Ramos-Arzola, the credit union's vice president of human resources.
With the assistance of a San Diego benefits consultant, SFG Benefits Financial's Bret Dudl, the credit union formed a voluntary employee committee to assess what workers might want in a wellness program.
A survey of employees put stress reduction, healthy eating tips and low-impact exercises at the head of the list.
The credit union has held a healthy-eating potluck lunch at which employees shared recipes and has featured presentations by nutritional and fitness speakers. It also has sponsored a Pilates class, set up a discussion on healthy snacks, and encouraged the formation of lunchtime walking clubs at its five offices.
"We want to make it convenient for people, and we want to give them what they want," Ramos-Arzola said. "We have some people who live out of Burger King and McDonald's and we may not get them to change, but at least we are showing them that they can lead healthier lives."
As a result of its wellness campaign, the 100-employee credit union estimates that it has shaved tens of thousands of dollars a year in premium costs.
Linda Rossi, a 10-year employee, participated in a walking program last year and said she's inspired by the company's interest in employee health.
"It sort of emphasizes that the whole person is important to the company and not just the work you are asked to do," she said.
Companies in San Diego may lag in the national wellness trend because about 80 percent use health maintenance organizations for medical coverage, said SFG's Dudl. He said that because those employers pay for HMO coverage on a per-head basis, rather than a claims basis, they might think they can't impact their rates.
"They can, but most companies don't think they can," he said. "There would be a lot more interest if they thought they could impact rates."
Pegus said the health care industry has been slow to push employers and workers into wellness programs.
"In the health care business, we don't do as good a job as marketing this as soft-drink makers have done in reaching the public," she said. "We need to figure out how to communicate the value of these things, how to incorporate it into companies and make sure that people see the benefits of it."
Recently, a Michigan-based HMO said it would begin offering discounted co-payments and deductibles for members who commit to healthy lifestyles. Blue Care Network of Michigan said employees and their spouses who participate in a health risk appraisal during the first 90 days of coverage and make improvement in some health conditions over time are eligible for the reduced co-payments and deductibles.
Employers, meanwhile, may be able to shrink their insurance premiums by as much as 10 percent if enough employees participate.
Intuit seems convinced that it can make a difference on its own. Wilkins said the company is planning a 6,000-square-foot gym for a building it's constructing. The gym will include room for exercise equipment as well as for yoga and exercise classes and will be staffed by trainers and a lifestyle coach.
Wilkins said the company is convinced that healthier employees will come to work in better physical - and mental - shape.
"The whole well-being of a person comes to work, and we want to make sure they are engaged when they are here at work," she said. "We realize that we have to educate them, but also provide them things that make it convenient for them to adopt a healthier lifestyle."
Carol Harnett of Hartford Financial Services Group, a major insurance and financial services company in Hartford, Conn., said many companies don't recognize the connection between obesity-related health problems and employee disability claims.
Health issues from preventable diseases account for up to 70 percent of all disability claims, she said.
"When you hear that, you realize you can make a difference by changing lifestyle habits, not that it's an easy task," Harnett said, pointing out that only 16 percent of those with New Year's resolutions to improve health are still sticking to them by July 1. "The best you can probably hope for is to help people be episodically good."
Even the simplest company effort to improve wellness can make a difference in the obesity battle, she said.
"It's easy for employers and their employees to overreach," Harnett said. "But there are some subtle changes people can make in their everyday lives that seem to make minimal gains but really can help fight weight issues."
She said individuals who drop 100 calories a day (equivalent to one pat of butter) and exercise enough to burn another 100 calories (a one-mile walk) will make progress over their weight.
"It's really about people doing just one or two things that reduce the risk factors for certain illnesses," she said. "If employers would get their employees to do that they would see a positive change in their health care costs."
The obesity rate of American adults has been soaring over the past three decades.
Overweight (including obese) ... Obese
1974 ... 47.7 (percent) ... 14.6 (percent)
1980 ... 47.4 ... 15.1
1994 ... 56.0 ... 23.3
2002 ... 65.2 ... 31.3
While the average per capita cost of health care increased 50.7 percent over a 14-year period, the costs linked to obesity climbed 357 percent.
Average cost ... Cost from obesity
1987 ... $2,188 ... $272
2001 ... $3,298 ... $1,244
Sources: Centers for Disease Control; Health Affairs Policy Journal