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 Exploring Gaps, Needs and Opportunities
                   Topic B: Call to Action –
   Health Disparities, Health and Wellness
A Business Perspective on the Obesity Epidemic:
             How employers see a financial imperative
                            and responsibility to act


                                         Linda Barrington
                                         Research Director
                                     The Conference Board
         The Obesity Epidemic




Page:2
   Wanted: Graduates with good judgment about their
   health and wellness (and their money)


                  Emerging content areas most critical for future
              graduates entering your workforce in the next 5 years

             Make appropriate choices concerning health and wellness 76.1%


             Exercise personal financial responsibility                         71.5

             Use entrepreneurial skills to enhance workplace                    70.5
             productivity and career options

             Understand economic issues and the role of
             business in the U.S. and global economy                60.6

             Participate effectively in community
             and government as an informed citizen 51.0
         0         10      20       30        40          50   60          70          80   percent
         Respondents allowed to select multiple answers
Page:3
The Conference Board 2006 CEO Challenge study —
Health care benefits rate with greatest concerns of 1 in 5 U.S. CEOs.
Cost implications of Obesity ties with Smoking and Drug Abuse

   U.S. CEO Ratings of Challenge from Cost Implications of Employee:

         100%                 3.6%     3.1%      2.3%        2.3%         My greatest
                                                 10.9         9.7         concern(s)
                 20.1%                 10.7
                              17.8                                        Among my chief
         80%                                                              concerns
                                       26.0      24.9        28.8
                                                                          Important, but not
         60%                  29.9                                        a priority
                 43.9
                                                                          Somewhat
                                                                          important
         40%
                                                                          Applicable, not
                 24.9                                                     important
         20%
                                                                          N/A

          0%
                Health care   Stress   Obesity   Smoking   Drug/Alcohol
                 benefits                                     abuse


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     Official definition for U.S. Adults

          Body Mass Index (BMI) = weight in kilograms divided by
           the square of height in meters = (weight kg)/(height m)2
          Obesity: Body Mass Index (BMI) of 30

          Translated roughly into weight in pounds:

             Height        Normal       Overweight        Obese
              5’3”        104 to 140     141 to 168    169 or more
              5’6”        115 to 154     155 to 185    186 or more
              5’9”        126 to 168     169 to 202    203 or more
               6’         137 to 183     184 to 220    221 or more


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  Obesity* Trends Among U.S. Adults

                    (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




  BRFSS, 1985




         No Data   <10%       10%–14%

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  Obesity* Trends Among U.S. Adults

                    (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




  BRFSS, 1988




         No Data   <10%       10%–14%

Page:7
  Obesity* Trends Among U.S. Adults

                    (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




  BRFSS, 1991




         No Data   <10%       10%–14%        15%–19%

Page:8
  Obesity* Trends Among U.S. Adults

                    (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




  BRFSS, 1995




         No Data   <10%       10%–14%        15%–19%

Page:9
  Obesity* Trends Among U.S. Adults

                     (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




  BRFSS, 1996




          No Data   <10%       10%–14%        15%–19%

Page:10
  Obesity* Trends Among U.S. Adults

                     (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




  BRFSS, 1997




          No Data   <10%       10%–14%        15%–19%        20%–24%

Page:11
  Obesity* Trends Among U.S. Adults

                     (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




  BRFSS, 1998




          No Data   <10%       10%–14%        15%–19%        20%–24%

Page:12
  Obesity* Trends Among U.S. Adults

                     (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




  BRFSS, 1999




          No Data   <10%       10%–14%        15%–19%        20%–24%

Page:13
  Obesity* Trends Among U.S. Adults

                     (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




  BRFSS, 2000




          No Data   <10%       10%–14%        15%–19%        20%–24%

Page:14
  Obesity* Trends Among U.S. Adults

                     (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




  BRFSS, 2001




          No Data   <10%       10%–14%        15%–19%        20%–24%       ≥25%

Page:15
  Obesity* Trends Among U.S. Adults

                    (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




  BRFSS, 2002




          No Data   <10%      10%–14%         15%–19%        20%–24%      ≥25%

Page:16
  Obesity* Trends Among U.S. Adults

                     (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




  BRFSS, 2003




          No Data   <10%       10%–14%        15%–19%        20%–24%       ≥25%

Page:17
  Obesity* Trends Among U.S. Adults

                     (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)




  BRFSS, 2004




          No Data   <10%       10%–14%        15%–19%        20%–24%       ≥25%

Page:18
     Obesity* Trends Among U.S. Adults
                     (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




  BRFSS, 2005




          No Data   <10%       10%–14%        15%–19%         20%–24%       ≥25%


Page:19
     Obesity* Trends Among U.S. Adults
                     (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)




  BRFSS, 2006




                                                                 Almost 33 percent of
                                                                   adults in the United
                                                                 States are now obese,
                                                                 more than double the
                                                                           rate in 1980

          No Data   <10%       10%–14%        15%–19%         20%–24%         ≥25%


Page:20
      50 Years Into President’s Youth Program:
      Pounds Up, Not Fitness

                 Percent of children and adolescents ages 2-19 years
            20                    who are overweight*                19
                                                                                      17        17
                                                                        15 15    16
                          2-5 year olds
            15                                                                             14
                          6-11 year olds
                          12-19 year olds                   1111                11
                                                                   10
  percent




            10
                                                7       7
                                       6
                          5    5            5       5
             5        4            4

                  0
             0
                  1963-70     1971-74       1976-80     1988-94    1999-00      2001-02    2003-04

             *Overweight children defined as at or above 95% for CDC growth charts
Page:21
             Source: CDC/NCHS
     Obesity drives rise in spending on health
     services

                     Increase in Health Care Expenditures on Services
            40%        36%

            30%
                                      20%            21%            21%
  percent




            20%                                                                              14%
                                                                                     11%
            10%


             0%
                       Obese       Aging 30-50      Current      Past smoker    Overweight   Heavy /
                                                    smoker                                   Problem
                                                                                             drinking

     Compared to normal-weight individuals with no history of smoking or
       heavy drinking; same age, sex, with similar social demographics


Page:22
            Source: Strum R. (RAND research), Health Affairs, 2002; 21 (2):245-253
     And spending on medication

                   Increase in Health Care Expenditures on Medication
            120%
                               105%
            100%
                     77%
            80%
  percent




            60%

            40%                               28%            30%
            20%
                                                                              3%
             0%
                     Obese   Aging 30-50     Current      Past smoker      Overweight           -12%
            -20%                             smoker                                     Heavy/problem
                                                                                        drinker

     Compared to normal-weight individuals with no history of smoking or
       heavy drinking; same age, sex, with similar social demographics
  Source: Strum R. (RAND research), Health Affairs, 2002; 21 (2):245-253
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            Annual Medical Expenditures (2003$)
                  Attributable to Obesity
                        Surgery Non-Eligible               Surgery Eligible
                               (95% CI)                        (95% CI)

      Overall              $550 ($390-$720)          $2,230 ($1,770-$2,700)



      Men                   $310 ($65-$560)          $2,020 ($1,230-$2,800)



      Women               $890 ($640-$1,130)         $2,360 ($1,790-$2,920)




          Note - does not include costs for bariatric surgery
          Data from MEPS (Medical Expenditure Panel Survey)

  Source: Eric Finkelstein, RTI
Page:24
     Annual Absenteeism Attributable to Obesity
     (days missed)
                             Surgery Non-Eligible            Surgery Eligible
                                    (95% CI)                     (95% CI)
          Overall                   0.8 (0.4-1.3)             5.1 (3.3-6.9)



          Men                      0.4 (-0.2-0.9)             4.1 (1.2-7.1)



          Women                     1.8 (1.0-2.7)             5.5 (3.4-7.5)


      Obesity-attributable days missed due to illness or injury
      Based on data from National Health Interview Survey (NHIS)




           Source: Eric Finkelstein, RTI
Page:25
           Combined Value of Medical and Absenteeism

                                    Surgery        Surgery
                                  Non-Eligible     Eligible

          Overall                         $710     $3,150



          Men                             $410     $3,020



          Women                           $1,170   $3,230




          Source: Eric Finkelstein, RTI

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                       Annual Age-Specific Medical Costs for Normal and
                       Overweight Adults




                                                                 Overweight
    Costs (in thousands)




                                                             Normal weight



                           Source: Eric Finkelstein, RTI   Age
Page:27
      Incentive-Based Wellness Programs

           Employer                 Incentive Criteria                 Incentive
           Quaker Oats              Complete health risk appraisal     Health premium
                                    (HRA) and take lifestyle pledge.   and other benefit
                                                                       credits and cash
           Sara Lee Knits           Attend exercise classes and        Prizes
           Products                 seminars and recruit coworkers
           Cigna Corp.              Complete exercise program.         Prizes and gift
                                                                       certificates
           Star Tribune             Complete HRA and 3 health-ed       Health premium
                                    courses, exercise, and forswear    credits
                                    risky behaviors.
           Coors Brewing            Complete 12-week weight            Cash and prizes
           Company                  management program.
           Providence               Complete wellness challenge(s) and Prizes and cash
           Everett Med Ctr          limit med. claims and sick leave.
           VSM Abrasives            Lose weight and keep it off.       Cash and paid
                                                                       vacation

          Source: Eric Finkelstein, RTI

Page:28
     Current Research on Incentives


           4-week pilot to assess whether small financial incentives
              can increase total and aerobic steps among adults ages
              50+
                 12% average step increase for roughly $10-$15 /week as
                  measured via pedometers
           Payments for weight loss
              We found that at 3 months, those offered $14 for each
               percent of weight lost reduced their weight by roughly 5
               pounds




          Source: Eric Finkelstein, RTI

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