The obesity crisis is on the rise in the United States, growing tenfold in the last 15 years and still climbing. Americans are larger than ever and health insurance rates have skyrocketed to new levels. Large companies, government agencies and school boards bear the grunt and continue to pay high prices for healthcare for their employees. According to the American Journal of Health Promotion, each obese employee costs their company 56% more for health insurance than each normal weight employee. This striking figure translates to millions of dollars a year and companies don't know what to do about it. One thing they think may help has to do with employee health and wellness programs.

Businesses are spending their dollars on company wellness programs like health screenings, exercise programs and heart healthy menus. Corporate health programs came into vogue recently whereby small companies are contracted by big business and health insurance companies to put on yearly health fairs or have a Nutritionist come in to do a lunch and learn. But does any of this work?

There are solutions for big business but a yearly health fair is not one of them. First of all, big businesses and government agencies need to take a hard look at their healthcare dollars and their employees. If they look close enough, they may see a solution staring them in the face.
Before we determine the solutions, let's look at the problem. The Food and Drug Administration says there is no simple answer to obesity. They say science dictates that calories need to balance and that diet and physical activity should be addressed together. The FDA recommendations, based on their obesity working group report, deal mostly with developing effective consumer messages that lead people to live healthier lives. Their other recommendations include better food label understanding, encouraging restaurants to serve healthier foods and designing more research. Seems to me that the FDA, like big business needs to look a little closer. What more research do we need? Just look at how many calories people eat a day and then look at the calories they burn with exercise, or lack of. You don't need Doctors and epidemiologists performing more scientific studies if we simply agree that we eat too much and exercise too little.

Despite trying, U.S. corporations face an uphill battle in their efforts to slim down employees. "You can lead a horse to water but you can't make him drink," said an economist at health researcher Innovus in Forbes magazine. The economist also said that we've proven that we can't fight obesity in this country. He has it all wrong. I know why an economist can't see the solution. His narrow vision is focused on a specific outcome, he forgot, or never learned about prevention. If an economist missed the solution, how can management executives be expected to spot it.
"Current approaches to controlling health-care costs are not working because they ignore the true drivers of cost, if insurers and their employers are serious about reining in health-care spending, then obesity prevention should be at the top of the agenda," said Thorpe in the American Journal of health promotion.

But little or no research has been done on the topic of large companies helping the obesity crisis. Searching the business journals brought up a big zero. I found plenty of articles on employer wellness programs, weight watchers at work and health fairs. Tons of research has been done to prove that employer dollars should be spent on wellness programs. All the studies showed positive outcomes of employee health screenings. Well, these are better than nothing but they don't have long term effects.

The American Association of Occupational Nurses cites data that shows that workplaces that establish health and safety programs reduce their injury and illness costs by about 30 percent. This is all well and good and does help to increase health and decrease spending but it doesn't address the whole problem from the beginning and it doesn't address obesity and physical activity.

My discovery came the other day in a strange way, when I was working at an employer health fair. This health fair was put on for the department of Sanitation, garbage men, by their health insurance company. Not at a small price. The insurance company hired an outside company to do cholesterol screening and body fat analysis and I was there as a Dietitian on the sidelines. The employees took blood tests and had their results explained to them by an obese person. She said things like, "Your cholesterol is high, eat oatmeal, or your blood pressure is high, lose weight." These sound bites without any counseling or continuous programs do nothing, especially when they are told to you by an obese person. My revelation of the solution came soon after. I had a small table with some hand outs about healthy eating and a piece of paper where people wrote in their height and weight and I would tell and interpret their BMI, body mass index. The BMI tells you if you are normal weight, overweight, obese or morbidly obese. I found 98% of the workers I spoke with were obese. Of the 5 women sanitation workers I saw, 3 were obese and 2 were morbidly obese. I only saw 4 people all day that were at a normal weight, a striking figure 4% of all employees seen.

One employee started telling me that he gained weight because he doesn't get his exercise anymore. Three years ago, the department purchased new trucks. The new trucks are great. They are automatic and everything can be controlled with the touch of a button. No need for the 2 workers on the back anymore, no need to haul the trash and hop on and off the truck. No need to move your legs more than a few inches all day. More time to sit in the truck and eat without burning off the calories.

The new trucks did a lot for expenditure. They also did a lot for injury prevention. Without people hopping on and off trucks, fewer accidents occur. Without people carrying heavy loads, fewer backs go out and less doctor visits are needed. But, the savings on labor and accidents cost a lot for health. The management decision to go with the new trucks was a good one for long term cost saving but a bad one for employees. Many of the employees have worked in their capacity for many years and were of course happy to have a less stressful job but they now see the health effect.

This is a big lesson for decision makers. Whenever someone makes a decision that affects a large number of employees, they need to stop and think about health. Health and safety are 2 separate issues, they may have saved money on workers compensation from back injuries but they made a big mess of the already out of hand obesity crisis. When these workers went from a long day of physical labor to one of sitting, they paid the price in their waist. Management should take this as a lesson; look at obesity and activity as a separate component in a health and safety program. Open your eyes to all aspects of health because a health fair once a year can't do what regular exercise can. This is thinking "outside the box," looking at the true crisis of obesity and the bottom line. Cutting cost while cutting physical activity is not a wise decision. Maybe you can have a healthcare professional to come in as part of a decision making team. In addition, a CEO or manager is a role model and has to look the part of healthy person. You may not have realized it, but the workforce is depending on you for more than just money.

Shari Portnoy, MPH, RD, LD/N is a Registered and Licensed Dietitian. She holds degrees in both Nutrition and Public Health and has completed the U.S. Food Laws course at the Michigan State University Institute of Food Laws. She has been a featured speaker at the American Culinary Federation National Convention and a board member of the American Dietetic Association.