An Innovative Approach to Employer-Provided Benefits for Obesity Care: A Case Report on H-E-B's Healthier Lifestyle Choices Program.

Abstract

Obesity presents a formidable challenge to health care financing systems. According to the 2017-2018 National Health and Nutrition Survey (NHANES), rates of obesity among U.S. adults have now climbed to 42.8% (Hales et al., 2020). The problem of this high prevalence of obesity has been particularly highlighted during the COVID-19 pandemic, when individuals with obesity were shown to have increased risk for adverse outcomes of COVID-19, including hospitalization, admission to the intensive care unit, mechanical ventilation, or death (Kompaniyets et al., 2021). In addition, the increase in obesity rates has also led to an increase in the burden of other obesity-driven chronic diseases, such as heart disease, cancer, chronic lung disease, stroke, diabetes, Alzheimer’s disease, and chronic kidney disease. According to the Centers for Disease Control and Prevention (CDC), six in ten American adults have at least one chronic disease and four in ten have two or more (NCCDPHP, 2022). Given this connection between obesity and chronic disease, the impact of obesity on medical care costs is alarming. According to a recent study, aggregate medical costs in 2016 due to obesity among U.S. adults were $260.6 billion (Cawley et al., 2021). Adults with obesity (BMI >30 kg/m2) incurred $2,505 more in annual medical costs, double the medical expenditures of those with BMI between 18.5 and 25 kg/m2 (Cawley et al., 2021). Patients with obesity had higher costs in every category of care, including inpatient and outpatient expenses, as well as prescription drug expenses. Further, costs were shown to increase significantly with class of obesity, with class 1 (BMI 30<35 kg/m2), class 2 (BMI 35<40 kg/m2), and class 3 (BMI >40 kg/m2) categories demonstrating ascending costs. For those whose insurance was funded by public programs, annual medical expenditures were more ($2,868) as compared to those with privately funded health insurance ($2,058) (Cawley et al., 2021). Obesity also has economic implications beyond direct health care costs, including productivity costs (absenteeism, presenteeism, disability, premature mortality), transportation costs, and human capital costs (Hammond and Levine, 2010). This commentary explores a case study of one large employer, H-E-B, LP, that developed and implemented an employer-provided benefits program as an attempt to tackle the clinical and economic impacts of obesity among their workforce.