The Impact of Obesity on Employee Health, Absenteeism, & the Associated Costs of Chronic Disease

1. The Impact of Obesity on Employee Health, Absenteeism, & the Associated Costs of Chronic Disease William H. Dietz, MD, PhD Director of the Division of Nutrition, Physical Activity, and Obesity Centers for Disease Control and Prevention

2. Obesity Trends Among U.S. AdultsBRFSS,1990, 1998, 2008 1998 1990 2008 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

3. Changes in Prevalence of Obesity in Women 1999-2008 Prevalence Year Flegal KM et al. JAMA 2010;303:235

4. Changes in Prevalence of Obesity in Men 1999-2008 Prevalence Year Flegal KM et al. JAMA 2010;303:235

5. Prevalence of Obesity Among Children and Adolescents Ages 6-19 Years Source: JAMA, April 5, 2006, Vol. 295, No. 13:1549; JAMA 2010, and Pediatrics 1998; 101:497

6. Changes in Obesity Prevalence by Race/ethnicity, Boys 2-19 Years Ogden CL et al. JAMA 2008;299:2401

7. Changes in Obesity Prevalence by Race/ethnicity, Girls 2-19 Years Ogden CL et al. JAMA 2008;299:2401

8. Annual Adult per Capita Cigarette Consumption and Major Smoking and Health Events – US 1900-1998 Thousands per year 1st World Conference on smoking and health Broadcast advertising ban 1st Surgeon General’s report 1st Great American smokeout Nicotine medications Available over the counter End of WW II Fairness Doctrine messages on TV and radio Master settlement agreement 1st smoking cancer concern Surgeon General’s report on environmental Tobacco smoke Nonsmoker’s rights movement begins Federal cigarette tax doubles Great Depression 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 1998 Year

9. Impact of Childhood Overweight (BMI > 95th percentile) on Adult Obesity (BMI > 30) 25% obese adults were overweight children 4.9 BMI unit difference in severity Onset < 8y more severely obese as adults (BMI = 41.7 vs 34.0) 50% of adults with BMI > 40 were obese as children Freedman et al, Pediatrics 2001; 108: 712

10. Costs of Obesity – 1998 vs 2008 19982008 Total costs $78.5 B/y $147 B/y Medical costs 6.5% 9.1% Increased prevalence, not increased per capita costs, was the main driver of the increase in costs Finkelstein et al. Health Affairs 2009; 28:w822

11. Impact of BMI on Workplace Productivity (Workplace Limitations Questionnaire) Body Mass Index < 2525-29.930-34.9> 35 Time 12.0 12.1 9.3 18.5* Physical 14.8 11.5 11.3 21.7* Mental 11.7 11.3 8.4 13.2 Output 10.6 11.1 7.8 12.9 Gates DM et al. J Occup Environ Med 2008;50:39

12. Annual Costs of Absenteeismand Presenteeism Presenteeism: $506/year above costs for all other workers Absenteeism: $433/year above costs for all other workers Medical costs: $1429/year above costs for healthy weight Gates DM et al. J Occup Environ Med 2008;50:39 Finkelstein et al. Health Affairs 2009; 28:w822

13. Average Daily Energy Gap (kcal/day) Between 1988-94 and 1999-2002 • Behavioral implications of 150 kcal: • Replacing 1 can of soda (12 oz) with water (140 kcal) • Reducing TV watching by an hour (167 kcal/day)1 • Walking 1.9 hours instead of sitting (for a 30-kg boy) • Increasing PE from 1 to 3 times/week (240 kcal) Wang YC et al. Pediatrics 2006;118:e1721 Wiechaet al. 2006; Arch Pediatr Adolesc Med 160:436

14. Principal Targets Pregnancy: pre-pregnant weight, weight gain, diabetes, smoking Reduce energy intake Decrease high and increase low ED foods Increase fruit and vegetable intake Reduce sugar-sweetened beverages Decrease television time Breastfeeding Increase energy expenditure Increase daily physical activity

15. Priority Strategies to Address Target Behaviors Energy density Apply nutrition standards in child care and schools Promote menu labeling in states and communities Increase retail food stores in underserved areas Fruits and vegetables Increase access through retail stores Farm to where you are policies Food policy councils Sugar-sweetened beverages Ensure access to safe and good tasting water Limit access Differential pricing strategies

16. Priority Strategies to Address Target Behaviors Television viewing Regulations to limit TV time in child care settings Limit food advertising directed at children Breastfeeding Policies and environmental supports in maternity care Policy and environmental supports in worksites State and national coalitions to support breastfeeding Physical activity Community-wide campaigns Increase access with informational outreach Increase opportunities for PA in school settings

17. Settings for the Prevention and Treatment of Obesity • Industry • Child care • Medical Settings • School • Work Site • Community

18. Prevalence of Weight Loss Advice From a Health Care Provider Among Obese Persons No Advice 42% Received Advice 58% Galuska DA et al. JAMA 1999

19. Chronic Care Model Environment Medical System Family/Patient Self-Management Family School Worksite Community Information Systems Decision Support Delivery System Design Self Management Support Dietz WH et al. Health Affairs 2007;26:430

20. Settings for the Prevention and Treatment of Obesity • Industry • Child care • Medical Settings • School • Work Site • Community

21. CDC’s LEANWorks!(Leading Employees to Activity and Nutrition) Works!www.CDC.GOV/leanworks