Jason Lurk, an executive with Novo Nordisk, said obesity affects 650 million adults around the world with a 100% increase since 1980. He said it’s a chronic health condition that’s linked to 2.8 million deaths annually.
Health professionals spoke about the risks of obesity on wellbeing, workplace productivity and its association with a higher risk of complications from COVID-19, during the Greater Bentonville Chamber of Commerce WalStreet speaker event held virtually on Wednesday (Nov. 11)
Lurk said the reason this health condition has escalated into disease of epic proportion is because it is chronic, progressive and also affected by genes, hormones and lifestyles. Lurk said there is also limited coverage and successful treatment for the condition and most doctors leaving medical school are not adequately prepared to manage it and they also lack sufficient reimbursement for providing care.
Lurk said obesity is not simply a problem of lifestyle, but it also has its own pathophysiology. He said despite the World Health Organization, Federal Drug Administration and American Medical Association’s agreement that obesity is chronic disease, many employers and health insurers do not see it that way.
“Obesity is not a cosmetic disease, It has biology,” Lurk said during the webinar.
He said the historical view that obesity is mostly linked to food, lifestyle and physical activity, but a more modern view looks at brain chemistry and biology to determine eating behaviors. He said not all calories are alike and there are physiological factors that also drive weight regain after weight loss through dieting.
Lurk said obesity is directly correlated with mental, mechanical and metabolic functions. He said depression and anxiety are higher among the obese as are sleep apnea and asthma. Cardiovascular diseases, gallstone, coronary heart failure, chronic back, hip and knee pain and infertility are each more prevalent among the obese.
Recent research also indicates an increased risk of severe illness from COVID-19. As of August, half of people hospitalized with COVID-19 and 63% of those aged 18-49 years had a Body Mass Index greater than 30 which is the standard baseline for obesity.
Lurk said another growing phenomenon is the rise in adults with morbid obesity or a BMI over 40 which has doubled in the past 10 years. Part of the reason for this increase is the lack of success with treatment. He said lifestyle modification (dieting and exercise) typically allows someone to lose up to 3% of their body weight long term. When adding pharmacotherapy (drugs like appetite suppressants) that rises to 8%. Gastric Band surgery typically provides for 16% of body weight loss, Gastric Sleeve procedures can help patients accomplish a 22% weight loss. The more invasive Gastric Bypass surgery is the most effective with a 32% overall weight loss among most patients, long-term.
He said obesity does have a negative impact on employers as it’s associated with a 46% increase in inpatient costs and a 27% increase in non-inpatient costs. Prescription costs are 80% higher among the obese versus those with normal weight. Lost productivity costs are also concerning for employers, he said. as obesity accounts for additional sick leave ($1,002) and short-term disability costs ($205) among workers in the U.S. Lastly, he said the future workforce is also at risk as 20.6% of 12-to-19-year-olds in the U.S. have obesity.
Nancy Jester, senior manager of U.S. benefits at Walmart said continues to expand coverage for obesity as part of its overall wellness mission. During the webinar, she said this wellness mission includes providing tele-health opportunities at no-cost during the COVID-19 pandemic and expanding its centers of excellence to allow employees get world-class treatment for serious conditions without the risk of travel amid COVID-19.
She said the retailer does cover bariatric surgery through its center of excellence program, and first began covering bariatric surgery in 2016, expanding it again in 2019. Jester said the coverage for weight loss surgery, evaluation and after care is covered at regular medical benefits (75% after deductible.) She said Walmart negotiates one turnkey price paid upfront that includes aftercare and any complications that should arise.
Jester said Walmart saw significant medical costs drop after bariatric patients had surgery. She said the average monthly spend per patient before surgery and nine months later. Medical costs fell 54% and pharmacy costs declined 73%.
Dr. Mark Jansen, chief medical officer for Arkansas Blue Cross Blue Shield, said COVID-19 is not the only pandemic the world is experiencing in 2020. He said obesity is every bit a pandemic. He said more than one-third of U.S. adults and between up to 20% of children and adolescents are obese.
He said just like the presidential election in 2020, there was one in 1960, but then the average man weighed 169 pounds compared to the 202 pounds today – a difference of 33 pounds over the 60-year period. The majority of that weight (28 pounds) can be explained by the consumption of 142 more calories per day combined with more inactivity.
He said as technology has evolved, jobs and lifestyles have become more sedentary and there is more sugar in foods today as well as socio-economic issues like being afraid to walk in certain neighborhoods and less access to nutritious and lower calorie foods. He said as people age their metabolic rates also slows about 2% per decade after age 20 and that combined with less activity is likely to add weight.
Another issue for people trying to slim down is that the body is smart. He said those who have a history of dieting are at the greatest risk to regain the weight because the body’s metabolism will slow to conserve energy and fight against weight loss. He said genetics are about 30% of the cause of obesity.
“You can’t blame your genetics for all things but they can raise your risk for things like coronary artery disease. Recognizing the risk factors early and looking for the underlying causes is where we need to be. This could mean we don’t have to call a surgeon,” he said.