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Working Together to Address Working Together to Address ObesityObesity

Maternal and Child Health BureauMaternal and Child Health BureauFederal/State Partnership MeetingFederal/State Partnership Meeting

October 17, 2007October 17, 2007

LuAnn HeinenLuAnn HeinenDirector, Institute on the Costs and Health Effects of Director, Institute on the Costs and Health Effects of ObesityObesityNational Business Group on HealthNational Business Group on Health

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Institute on the Costs & Institute on the Costs & Health Effects of ObesityHealth Effects of Obesity

• Build the business case• Promote environmental changes

at work• Reach families– especially

children• Redesign benefits• Communicate the value of

change to employers and employees

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Obesity is Weighing Us Obesity is Weighing Us DownDown

• More than a quarter of US health costs are related to physical inactivity, overweight and obesity

• 27% of the increase in health spending between 1987 and 2001 was attributable to obesity

• Between 1979 and 1999, obesity-associated hospital costs for children (6-17 years) more than tripled

Source: F as in Fat, Trust for America’s Health, 2007Source: F as in Fat, Trust for America’s Health, 2007

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Medical and Absenteeism Expenditures Attributable to

Excess Overweight and Obesity

Source: Finkelstein EA, Fiebelkorn IC, Wang G. The costs of obesity among full-time Source: Finkelstein EA, Fiebelkorn IC, Wang G. The costs of obesity among full-time employees. employees. Am J Health Promotion Am J Health Promotion 2005;20(1):45-512005;20(1):45-51

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Total Cost of Employee Total Cost of Employee IllnessIllness

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The obesity epidemic has been likened to a

“massive tsunami headed to the shoreline…”

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DisparitiesDisparities• Rate of death from heart disease 31%

higher among blacks than whites and 49% higher among men than women

• Rates of death from stroke 43% higher among blacks than whites

• Each year, about 40,000 more women than men have a stroke

• Geographic variation

• Rural access issues

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Unhealthier, EarlierUnhealthier, Earlier

• Approximately 177,000 children and teens under age 20 have diabetes

• 2 million adolescents (1 in every 6 overweight adolescents) have pre-diabetes

• Obese children as young as 6 may be on their way to heart disease (stiffer arteries and other risk factors as evidence)

• Emotional health concerns– poor body image, low self-esteem, symptoms of depression

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Health habits of Americans: Are Health habits of Americans: Are we doing all we can to maintain we doing all we can to maintain

health?health?

1. Control weight (normal range): 40% healthy BMI

2. Eat right: 23% eat at least 5 fruits and vegetables each day

3. Be physically active: 22% active at least 30 minutes per day, at least 5 days per week

4. Do not smoke: 75% nonsmokers

But…only 3% follow all 4 health habits

Source: April 25, 2005 Archives of Internal Medicine analysis of BRFSS survey dataSource: April 25, 2005 Archives of Internal Medicine analysis of BRFSS survey data

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Common GoalsCommon Goals

Public health and private sector seek to:• increase the health and productivity of

Americans • avoid unnecessary costs, reduce trend

Unhealthy lifestyles are harming America’s competitiveness, readiness, wealth/economic security, productivity and opportunity

Productivity impact = disability, absenteeism, presenteeism (lower productivity even when on the job)

Lifestyle-related health costs account for an estimated 50% of health care expenditures

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Explaining the Decrease in U.S. Deaths from Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980-2000Coronary Disease, 1980-2000

New England Journal of Medicine, June 7, 2007New England Journal of Medicine, June 7, 2007

Conclusion: “Approximately half the decline in U.S. deaths from coronary heart disease from 1980 through 2000 may be attributable to reductions in major risk factors and approximately half to evidence-based medical therapies.”

However, “increases in the body-mass index accounted for about 26,000 additional deaths in 2000, and increases in the prevalence of diabetes for about 33,500 additional deaths.”

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Employees are at work for Employees are at work for 35% of working hours35% of working hours

• Stable group environments can support long-term changes

• Employers have financial incentive to improve employee health

• Employers and employees benefit Source: Michael O’Donnell, Editor in Chief, AJHP

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What Are Employers What Are Employers Doing?Doing?

Large employers have a key role

1. Clinical Preventive Services

2. Worksite Health Promotion

3. Environmental Changes

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A Purchaser's Guide to Clinical A Purchaser's Guide to Clinical Preventive Services: Moving Preventive Services: Moving

Science into CoverageScience into Coverage

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Worksite Health Promotion Worksite Health Promotion ProgramsPrograms

• Visible leadership role & employee involvement

• Health assessments/population and individual reporting

• Behavior change & counseling interventions

• Evaluation and continuous improvement

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““Do” CampaignDo” Campaign

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““Do” CampaignDo” Campaign

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Fast Food does not have to Equal Fast Food does not have to Equal Fat FoodFat Food

Life on the run can include a Life on the run can include a healthy diethealthy diet

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Previous Previous Best Employers Best Employers for Healthy Lifestyles for Healthy Lifestyles

WinnersWinners • AetnaAetna• Bath Iron Works, A General Dynamics CompanyBath Iron Works, A General Dynamics Company• Cisco SystemsCisco Systems• Dell, Inc.Dell, Inc.• Florida Power & LightFlorida Power & Light• Hannaford Brothers CompanyHannaford Brothers Company• IBMIBM• Johnson & JohnsonJohnson & Johnson• Kellogg CompanyKellogg Company• Medtronic, Inc.Medtronic, Inc.• Motorola, Inc.Motorola, Inc.• Pitney BowesPitney Bowes• Texas Instruments, Inc.Texas Instruments, Inc.• Union Pacific RailroadUnion Pacific Railroad

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Leading ExamplesLeading Examples

• IBM rebate programs to support healthy lifestyles

• J&J nutritionally dense whole foods initiative

• FPL Group healthy food subsidies

• General Mills physical activity promotion

• HEB, Hannaford diverse workforce approaches

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Fostering PartnershipsPartnerships

•Childhood obesity•Nutrition education•Healthy weight initiatives•Physical activity•Breastfeeding•Prenatal information