February 26, 2024

An Employer's Practical Playbook for Treating Obesity

For employers seeking to align their weight management strategy with the latest evidence, this resource offers recommendations on creating a comprehensive benefits package to treat obesity, including behavior-based interventions and pharmacological and surgical treatment.

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According to the most recent data available, 41.9% of U.S. adults have obesity, and by 2030, it’s estimated this number will jump to one in two adults; among those, a quarter will have severe obesity.^1,2 These increasing rates extend to children. In 2020, 22.4% of kids ages 2 to 19 had obesity, up from 19.3% in 2019.³ While the reach of obesity is vast, it affects some populations more than others; in the U.S., Black, Indigenous and People of Color (BIPOC) experience higher rates of obesity relative to other groups.²

The negative health effects of obesity are numerous

Obesity is associated with myriad conditions that can reduce quality and length of life. It increases the likelihood of high blood pressure and LDL cholesterol, type 2 diabetes, stroke, osteoarthritis and sleep apnea, to name a few, and in 2018, more than 500,000 people in the U.S. died from causes attributable to overweight and obesity, including cancer, diabetes and cardiovascular disease.^4,5 Obesity also increases the risk of poor outcomes from other conditions, including pregnancy and COVID-19.⁶ For example, research has found that obesity is associated with numerous pregnancy-related complications, as well as a higher risk of maternal mortality compared to pregnant women of a healthy weight.^7,8 And as another example, 30.2% of COVID-19 hospitalizations in the U.S. were attributed to obesity from the start of the pandemic through November 2020.⁹

Beyond the physical health effects of obesity, there is also a relationship between obesity and psychological well-being. A retrospective analysis found that body mass index (BMI) is independently related to health-related quality of life (which includes physical and mental health), with a higher BMI leading to lower quality of life.¹⁰

Scientists are also exploring the complicated relationship between obesity and depression, as “research over the past decade has described an intertwined and overlapping biochemical back-and-forth between the two conditions, with each conspiring to aggravate the other.”¹¹ Furthermore, experiencing weight bias or stigma, and then internalizing these negative stereotypes, has been associated with a host of negative mental health outcomes, including depression, anxiety, poor self-esteem and body image.¹²

Because of its effect on health and well-being, obesity is associated with significant health care spending

As of 2023, obesity ranks among the top ten most expensive chronic diseases for U.S. health care payers.^13,14 Higher BMI is associated with increased medical expenditures; one study found $1,800 in excess annual medical costs for individuals with obesity and another showed $2,505 higher annual medical costs for adults with obesity compared to those with a normal weight.^15,16 These same studies show annual medical spending associated with obesity ranging from $172 - $260 billion.^15,16 Productivity losses are also high; one retrospective study found that compared to normal weight, obesity increases absenteeism 3 days per year due to injury or illness, and the productivity loss from obesity ranged from $13.4 billion to $26.8 billion.¹⁷

Rates of obesity are rising worldwide due to multiple and often interrelated factors

Diet, physical activity and sleep, obesogenic environments and social determinants of health, genetics and epigenetics, metabolic adaptation, medications, slowing metabolism, and life events such as menopause and pregnancy all play a role in weight gain (Figure 1.1). Likewise, these factors also make weight loss and weight loss maintenance difficult but not impossible. Beyond these, scientists are studying other contributors to the obesity epidemic, such as the role of ultra-processed foods and the relationship between weight and the gut microbiome, illustrating an evolving and deepening understanding of this chronic condition.¹⁸ Both existing and emerging research are important to understanding obesity as a complex disease driven by our biology, environment and behavior, and can help reduce societal weight bias and change obesity treatment paradigms for the better. 

Data and research are informing evidence-based ways to treat obesity

Evidence-based treatments include intensive behavioral interventions, anti-obesity medications and bariatric surgery. These treatments represent three pillars of a comprehensive obesity benefit due to research supporting their efficacy; all three should be implemented within the context of a supportive workplace culture.  

 

Figure 1.1: Causes of Obesity

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