Obesity is a national problem. This is not new news. Every day we are inundated with information about the obesity epidemic. Simply search the word on the Internet and you find over twenty-three million possible sites with information regarding obesity. Television is a non-stop advertisement for weight loss products and programs; and, there are hundreds of chat rooms, websites and community programs devoted to weight loss. Despite all of the resources and products aimed at fighting obesity, a real fix to the problem has not yet been realized.
Obesity significantly impacts the direct delivery of heatlhcare services and the productivity of our nation. According to the journal, Health Affairs, one percent of the GDP or $147 billion dollars a year is spent treating obesity related ailments. The estimated number of workdays lost to obesity related illness or injury is 40 million days per year. The statistics are appalling, and worse yet, the obesity epidemic is expected to continue to spiral out of control.
The frequency of workers’ compensation claims filed by overweight workers will skyrocket in conjunction with the rising level of obesity in our country. It is estimated that approximately sixty-five percent of the workforce is overweight, obese or morbidly obese. We can expect obesity to significantly affect the cost and resolution of workers’ compensation claims.
Workers with weight control issues are challenged every day to meet the physical requirements of their jobs. Weight challenged workers may struggle with many required physical activities such as:
Difficulty with these activities is caused by the exhausting burden of carrying more weight than the body is designed to handle. The spine and joints take the brunt of damage from excess weight. The degenerative process is hastened and the individual is at higher risk of workplace injury.
According to a study from Duke University Medical Center, weight challenged workers are twice as likely to file workers’ compensation claims. Once the claim is filed, the cost of medical care is seven times higher than the claims for non-obese workers. The cost of medical care is significantly higher because pre-existing heart disease, hypertension and diabetes, the three most prevalent obesity related non-industrial chronic conditions, significantly impact the treatment and outcome of workers’ compensation claims. An injured worker suffering from chronic disease experiences a slow and complicated recovery from the treatment of industrial injuries. Symptoms arising from the illness make it difficult to accurately diagnose the work related injury. Injured workers with diabetes are more likely to develop adhesive capsulitis or wound healing complications. Diabetic neuropathy makes it difficult to diagnose injuries with nerve related symptoms. Kidney failure, stroke or a heart attack are potentially fatal complications from any of these chronic diseases. The cost of the workers’ compensation claim is immediately higher when an individual has any of these chronic diseases. In order to treat the industrial injury appropriately, these conditions must be stabilized. It may require treatment of the chronic disease along with the work related injury to bring resolution to the claim.
In addition to addressing the issues of chronic disease, complications are encountered simply diagnosing industrial injuries. Weight challenged injured workers require specialized equipment for diagnostic procedures such as CT, MRI or ultrasound. These injured workers simply do not fit into the scanners. The radiology industry is responding to this trend and oversized units are in development but the number of units available is limited. The injured worker is fortunate to locate a facility with appropriate sized equipment but other issues emerge. Oversized equipment does not generally deliver the same quality product. Diagnostic images are frequently poor because scanning capabilities are not geared to image through layers of fat. The radiologist has difficulty reading the images due to the high level of fat obscuring the organ or skeletal structure in question. This leads to questionable diagnosis. The physician then encounters difficulty recommending a treatment plan due to the poor quality of the diagnostic procedure.
It may be at this point the physician chooses not to accept the injured worker as a patient. Many physicians will no longer agree to treat patients with weight challenges. The risks of surgery are disproportionately high and outcomes are poor or a total failure. Some physicians agree to treat the injured worker with the caveat that weight loss must occur. The physician recommends a weight loss program for the injured worker. The carrier refuses to fund the weight loss program because the injured worker had non-industrial weight issues that preceded the injury. Despite this determination, the physician refuses to perform surgery because of the risks involved without weight loss. A line is drawn in the sand and the parties addressing the industrial injury come to a stalemate. It is a no-win situation for everyone but most especially the injured worker.
The injured worker simply does not understand the challenges related to medical care. Their goal is simply to stop hurting and return to a productive life. Frustration mounts and a second opinion is sought. The injured worker intentionally seeks a physician willing to perform surgery despite the high risks and potential for poor outcome without weight loss.
Once surgery is authorized for a weight challenged injured worker, a multitude of challenges are encountered by medical professionals providing treatment. All of the challenges translate into higher costs for employers and insurance carriers.
Pharmacy: Pharmacy costs are significantly higher. Most drug dosages are determined based on weight. It takes much higher dosages to provide relief to individuals whose weight is outside of average weight brackets.
Anesthesia: Intubation is difficult. Patient positioning and identifying the appropriate sized equipment and medical personnel with the expertise to properly administer anesthesia to an overweight patient is a challenge. Surgical procedures require larger amounts of anesthesia and the increased levels prolong recovery time and place the patient at risk for complications.
Injections: Injections are difficult due to the size of the needle necessary to puncture or penetrate the skin. It is difficult to inject through the fatty layers and even more difficult to locate deep veins for injection.
Surgical Equipment and Hardware: Special operating tables or multiple tables may be required for the patient. Additional or oversized instruments and sheer manpower is required to perform surgery on an overweight patient. Surgical hardware utilized for spinal fusion or joint replacement is easily dislodged or fails altogether because of the pressure of the weight exerted by overweight patients. The cost of the claim rises exponentially when repeat surgeries are necessary to repair these failures. Unfortunately, even with repeat procedure, the outcome is likely poor at best without significant weight loss.
Post Surgical Complications: Obese patients frequently suffer from circulatory insufficiency due to decreased mobility. The possibility of pulmonary embolus or other unexplained pulmonary problems which are a risk for all surgical candidates, more easily occur with the obese surgical patient. Infection is a high probability and wound healing is problematic.
Durable Medical Equipment: Post surgical Durable Medical Equipment needs are costly. Most equipment is ordered based on the patient’s height and weight. It takes a longer period of time to locate or customize recommended equipment. There is a higher prevalence of breakage and repeated equipment replacement is required for overweight patients.
Rehabilitation: Rehabilitation is a long arduous process. The patient was deconditioned prior to the injury. Decreased mobility due to pain exacerbates the problem and exponentially increases the length of the rehabilitation program The cost of rehabilitation is much higher due to the increased length of time it takes for the patient to regain even nominal levels of strength and range of motion.
The frequency, duration and severity of claims related to overweight workers are a burden to the workers’ compensation system. The lack of a solution to the obesity epidemic will continue to take an economic toll on all business. It is time to consider any and all alternatives available to reduce the number of injuries in the workplace. Eliminating risk behaviors and addressing ergonomic issues that increase the likelihood of injury must be at the forefront of our approach. Recognizing that if we don’t take these steps to address the problem, we can anticipate increased business costs and a ripple effect that diminishes our productivity and competitiveness in the global marketplace. The downfall of our great nation as a result of out of control obesity is not the legacy we want to leave our children. We must work together to find a resolution or at least take the first steps necessary to address the problem. We can start in the workplace by reducing risk behaviors leading to injuries and simultaneously help our workers adopt healthier lifestyles.
This article was written by Maureen Kohl Bennington, M.S., CCM, CDMS, CPUR, CRC.
Maureen Kohl Bennington has over twenty years experience in the field of workers’ compensation. She has a Master of Science degree in Rehabilitation Administration and is credentialed in Case Management, Disability Management, Utilization Review and Vocational Counseling. Ms. Bennington has extensive knowledge related to all managed care products. She has been responsible for the development of case management, medical bill review and utilization review programs, file review and audit procedures, return-to-work programs and disability management product development and implementation procedures. Ms. Bennington has also worked with carriers in auto, general liability, group health, long term disability and short term disability. She is a published writer, experienced speaker and has been an educator in the field of workers’ compensation for over twenty years.