Employers know that obesity costs them enormous amounts of money each year, but they're still grappling with ways to create successful weight-loss programs for employees. Experts discussed effective strategies for employers, as well as lessons from their own experience, at the Obesity Congress in Washington, D.C.

Many speakers called for health plans to cover treatments specifically for obesity, noting that patients often are denied coverage for things like weight-loss counseling and bariatric surgery.

"Obesity should be recognized as an illness, like all illnesses," said Dr. Sunil Bhoryul, a bariatric surgeon with La Jolla Medical Group in California.

"There's not a single body system that's not affected by obesity." In fact, obesity creates a greater risk for heart disease, gallstones, diabetes, cancer, infertility and sleep apnea.

For long-term success, what really works is a weight-loss program that combines behavioral, pharmaceutical and/or surgical interventions, according to Joe Yaskin, project manager for the Department of Health Policy at Thomas Jefferson University.

Programs that offer just one of those three elements are not as effective, he stated. "Frequent reinforcement makes a big difference, and it really helps when these things are not limited to a short period of time," he added.

Chris Boyce, CEO of Virgin HealthMiles, a provider of wellness and incentive programs, recommends creating a wellness program that's fun and open to everyone - even your fittest employees. That way, there's a teamwork atmosphere, and no one will feel singled out for being overweight.

Prevention should be emphasized. "The data show that once people become obese, it's really difficult to get them back," Boyce remarked.

"You've got to look at stopping it before it occurs and making sure they have the incentive. Preventing obesity is as important as reversing it after it comes, and it's certainly easier to prevent it," he said.

Christine Ferguson, director of the STOP Obesity Alliance, said a normal body-mass index should not always be the goal.

Instead, she argued, modest weight-loss should be the goal because amounts as small as five or 10 pounds have been shown to bring real health benefits.

"You don't have to have huge weight-loss to have a successful intervention," she noted.

Ken Thorpe, a public health professor at Emory University and executive director of the Partnership to Fight Chronic Disease, is convinced that benefits and programs to combat obesity will help employers' bottom lines.

"If we do the right thing [for patients], I think it will save money," he said.

Obesity is an economic phenomenon, Eric Finkelstein, a health economist and director of the public health economics program at RTI International, argued at an earlier conference.

"Food prices, as well as prices for other sorts of labor-saving technologies and other things, have gone down [compared to many years ago], so we're seeing more food consumption and less physical activity," he said.

Unfortunately, healthier foods tend to be more expensive than unhealthy, processed foods.

Thus, Finkelstein presented an economic solution, saying, "You need to change the environment and make it cheaper and easier to engage in those behaviors that are health-promoting and more expensive to engage in those behaviors that are obesity-promoting."

That means focusing more on financial incentives than information campaigns.

"I don't think information campaigns are likely to have much of an impact because I think people either do know or could know that these things are bad for them," Finkelstein said.

"Information is maybe part of the story, but in and of itself, it is not going to be enough to significantly change behavior in an environment that's pushing us in the wrong direction."

However, "even small incentives matter and can be potentially effective, certainly more effective, potentially, if combined with some environmental and other changed factors that make it easier to engage in healthy behaviors," he added.

Boyce said as an incentive to participate in a workplace wellness program, cash tends to work better than prizes, gadgets and trinkets.

Bariatric surgery

Bariatric surgery can help patients who are severely obese, but only if they commit to lifelong healthy eating and sufficient exercise, several speakers at the Obesity Congress noted.

"We found well-established evidence that surgical intervention works," said Joseph Yaskin, project manager for the Department of Health Policy at Thomas Jefferson University in Philadelphia, Pa.

"People lose enormous amounts of weight and keep it off and have better health outcomes."

One of those people is Jim Fivecoat, manager of retirement plans for Michelin North America.

He weighed 303 pounds before he had bariatric surgery.

After the surgery, he reached his goal weight in less than one year, and he was able to stop taking medications for high cholesterol and gastric reflux. His blood pressure dropped to a normal level, and he avoided becoming diabetic.

His surgery cost Michelin $11,000, but without it, eventually his prescriptions would have cost the company much more money.

Spending on bariatric surgery can be cost-effective because it can eliminate the need to pay for treatments for heart disease, diabetes and cancer later on.

Usually, surgery costs are recouped in 12 to 18 months, according to Dr. Bhoryul. About 73% of patients who get a gastric band find that their diabetes goes away within two years, he added.

Bariatric surgery "improves quality of life. It improves on-the-job performance," Fivecoat asserted.

He recalled one tire-builder, who was obese, didn't perform well and was absent from the job a lot. After bariatric surgery, she was happier, had great job performance and didn't miss workdays.

Employers should cover bariatric surgery, but require employees go to a center of excellence, Fivecoat said.

The number of private insurers that cover bariatric surgery is slowly growing.

However, Medicare recently announced a new proposal to stop covering bariatric surgery for diabetics who are not morbidly obese.

"Limiting coverage of bariatric surgery in Type 2 diabetic patients whose body-mass index is less than 35 is part of Medicare's ongoing commitment to ensure access to the most effective treatment alternatives with good evidence of benefit, while limiting coverage where the current evidence suggests the risks outweigh the benefits," Dr. Barry Straube, chief medical officer for the Centers for Medicare & Medicaid Services, remarked.

Often, coverage and treatment decisions by Medicare influence what private insurers are willing to cover.

Binge eating

Employers and health care providers should pay more attention to the disorder called binge eating, according to Richard Bedrosian, a clinical psychologist and director of behavioral health science at HealthMedia.

About 20% of total obesity costs can be attributed to binge eating, he estimated.

"If we fail to address binge eating, there's going to be a significant gap in all the other services we offer for obesity," he said.

He recommended providing screenings and early interventions for binge eating as part of workplace wellness and disease management programs.

Online assessments may help people who are disabled, geographically isolated or reluctant to tell a live person that they are binge eating.

"Binge eaters fall through the cracks" because of stigma and a reluctance to seek treatment, combined with the fact that primary care physicians often don't screen for this disorder, Bedorsian noted.

Don't think your workforce is immune to binge eating; it's often hidden.

About 49% of people seeking bariatric surgery are binge eaters, and 10% of diabetics are binge eaters, Bedrosian estimated.

In addition, "binge eating is comorbid with depression. People use binge eating to manage negative emotions," Bedrosian explained.

Stats on obesity

» 26% of Americans are obese.

» Since 1993, the prevalence of Americans who are obese increased by more than 61%.

» 73% of employers view offering obesity-related services as effective.

» 67% of employers are concerned about the effects of obesity on medical claims expenses.

» The estimated cost of obesity in a hypothetical 1-million-member health plan is $29 per member per month.

» Over a nine-year period, obese people spend twice as much on drugs, compared to healthy-weight people.

» Employees with a BMI over 40 had twice as many workers' compensation claims as employees at their recommended weight.

» In the United States, the number of bariatric procedures climbed from 20,000 in 1996 to more than 100,000 in 2003.

Sources: The STOP Obesity Alliance, the Milken Institute and the Disease Management Association of America