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Take a ‘Whole Person’ Approach to Obesity
The interplay between physical and psychosocial drivers is often ignored; it shouldn’t be

By Terri L. Rhodes  © Disability Management Employer Coalition (DMEC)  6/12/2014

People are living and working longer than ever before. But their lives—and workplace performance—are negatively impacted by obesity and the chronic illnesses connected to it. The result: increased workplace absence and disability.

The reports keep coming in about the breadth and depth of the obesity problem. Recently, a World Health Organization global burden of disease study reported nearly a third of adults and a quarter of children in the world today are overweight. Moreover, no country has turned the tide of obesity since 1980, meaning there have been no successes in reducing this problem in the past 33 years.

A June 2014 Obesity Update from the Organization for Economic Co-operation and Development (OECD) noted roughly 70 percent of U.S. adults are overweight—the second highest rate in the OECD (just after Mexico, 71.3 percent).

Overweight and obesity rates have increased steadily since the 1980s among both men and women. According to a study by Cigna of short-term disability claims from 1993 to 2012, claims related to obesity increased by 3,300 percent over this period. In 1993, obesity ranked No. 173 on a list of 267 diagnostic drivers of absence that year. It landed at No. 40 on the list in 2012.

Thinking Beyond ‘Wellness’

Wellness programs, now well entrenched in many workplaces in the U.S., have a place in addressing this issue. But HR professionals must think beyond traditional wellness efforts and apply a wide-angle lens to employee health, wellness and risk. This includes developing a coordinated strategy to meet employees’ health needs through a whole-person approach that includes behavioral health solutions.

Most prevalent physical conditions, including obesity, are associated with a co-morbid psychiatric condition, which is often depression. But the interplay between physical and psychological drivers is often ignored. It shouldn’t be. These factors must be acknowledged and identified so the issue can be addressed.

Approaches that include the psychosocial drivers of obesity and other risk factors include:

Employee assistance programs (EAPs). The first solution, with which HR professionals are already familiar, is an EAP. Based on the 2012 Behavioral Risk Survey by the Disability Management Employer Coalition (DMEC), 97 percent of employers surveyed had an existing EAP program. Unfortunately those programs are woefully underutilized, in part because an EAP program, much like mental health, has a stigma attached to it.

HR professionals have an opportunity today to lead the charge to overcome the stigma associated with behavioral health. This can in part be accomplished through rebranding.

Employers often look for new ways to brand other health care programs and might consider the same with EAPs. Employers need to change the current way these benefits are communicated and might even consider changing the name, along with providing proactive and consistent education and communication.

Of course, employers must still emphasize these programs are confidential and have no impact on an employee's work status—just like other health care programs offered.

Health screening. The second solution to identifying and properly managing behavioral health issues and their workplace effects is increased screening.

In addition to identifying issues early, screening tools are also effective in monitoring and managing chronic conditions and depression, stress levels, adherence to condition management, and even pain.

Effective screening can help prevent minor employee issues from developing into more debilitating health conditions, including obesity. This translates into reduced health care usage and expenditures, absenteeism and disability.

Behavioral therapy. The last solution is a greater reliance on psychotherapy as part of the overall treatment program for chronic illness, similar to what sometimes occurs with workers' compensation claims management. This has posed a major hurdle; recently, however, some workers' compensation payers have begun employing cognitive behavioral therapy for claimants who suffer from chronic pain and psychosocial issues that hinder their recovery and return to work.

This is proving effective, both in terms of better employee health and lower employer costs. A recent Dutch study published in the Journal of Occupational Health Psychology found that employees absent due to common mental health disorders returned to the job on average 65 days earlier and saved employers an average of $5,275 when provided work-focused cognitive behavioral therapy.

Obesity will remain a significant issue for employers for many years to come. To effectively manage obesity-related absence and disability, HR professionals need to identify and address all relevant variables. As with every other cause of disability, that means abandoning the centuries-old division between “body” and “mind” and learning and practicing a whole-person approach to health and wellness.

Terri L. Rhodes is executive director of the Disability Management Employer Coalition (DMEC).

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