Bariatric Times

FEB 2018

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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24 Commentary Bariatric Times • February 2018 News and Trends February 2018 Response to ACOEM Guideline Statement on Obesity in Workplace MANAGING OBESITY IN THE WORKPLACE—NEW GUIDANCE FROM ACOEM Effective prevention and treatment steps—including coverage for bariatric surgery when indicated—can help employers to control the health and economic impact of obesity in the workplace, according to an ACOEM Guidance Statement, published in the January issue of Journal of Occupational and Environmental Medicine. The statement provides recommendations for employers and health plan designers to manage obesity among employees. The recommendations were developed by an ACOEM expert panel, based on 275 high-quality studies on obesity in the workplace. "Our findings support the use of both lifestyle modification and bariatric surgery to assist appropriate patients in losing weight," wrote ACOEM President and Panel Chair Charles M. Yarborough III, MD, MPH and colleagues. Nearly 38 percent of adults in the United States are obese (40% of women and 35% of men). Meanwhile, surveys suggest that most employees do not have coverage for obesity treatments. In addition to its effects on worker health and safety, obesity in the workplace has a major negative impact on healthcare costs, absenteeism, and productivity. Annual costs for obesity-related absenteeism alone are estimated at $8.65 billion. "The cost of obesity among workers is immense, and the responsibility for managing it is increasingly falling to employers," Dr. Yarborough and coauthors wrote. They cite evidence that work can also be a causal factor for obesity, with risk factors including social stressors, psychosocial work factors, working hours, sleep and night shift work, and sedentary behavior. Based on the evidence, the expert panel provides a set of treatment recommendations for addressing worker obesity. Treatment recommendations include implementing workplace wellness programs and behavioral counseling to aid employees in adopting healthier lifestyles. Based on studies showing health and economic benefits, the expert panel also recommends that employers offer insurance coverage and access to bariatric surgery for treatment of obesity. The recommendations include specific criteria for eligibility for bariatric surgery. The Guidance Statement also identifies key areas for further research, including studies to clarify and maximize the benefits of obesity medications and bariatric surgery. Dr. Yarborough and colleagues conclude, "As these interventions may prove cost effective in the long term, a case can be made that they be covered by insurance." Mitchell Roslin, MD, Director of Bariatric and Metabolic Surgery at Lenox Hill Hospital, New York, is a coauthor of the new report. "Whereas the impact of obesity on life expectancy, diabetes, sleep apnea, and health care costs are frequently discussed, the hidden damage and consequences of obesity on the American work force are less known and incredibly detrimental," Dr. Roslin comments. "Obesity leads to reduced performance, increased chance of disability, and greater likelihood for requiring performance waivers for certain aspects of employment. There is a direct impact on health care costs and a harder to quantify burden on productivity. "In this much-needed and sentinel document, specialists from multiple fields related to obesity and population health management have compiled critical information from evidence-based studies and made recommendations to begin to counteract this national epidemic. It is becoming widely known that companies with healthy employees succeed and have better employee and customer satisfaction. Obesity is a key determinant of health, yet increasing at alarming rates. The importance of adding greater awareness and better programs to combat obesity to the workplace cannot be overstated," Roslin said. For more information, visit: http:// BT Several years ago, our former CEO hired a senior vice president from a very successful manufacturing business that had nothing to do with healthcare to help run our health system. When challenged on his choice, he defended his decision quite well, stating "He kept his cost of care lower for his employees in his manufacturing business than we did for our employees, and we are in the healthcare business!" The responsibility (economics) of healthcare is no longer relegated to just those directly involved in taking care of patients. Traditionally, the three key players were hospitals, doctors, and insurance companies. Now, employers are taking the initiative in managing the health of their employees and, specifically, the cost of care regarding the disease of obesity. The impact that obesity has on the workforce with regard to absenteeism and disability is substantial, and employers are taking notice. The American College of Occupational and Environmental Medicine (ACOEM) took the lead in conjunction with a 15-member panel that included American Society for Metabolic and Bariatric Surgery (ASMBS) thought leaders to review the evidence of obesity in the workplace. They sought to develop a comprehensive guidance statement to aid employers in understanding the role that obesity prevention, treatment, and bariatric surgery play in the management of patients suffering from obesity. A unique aspect of the ACOEM statement was the recommendation to abolish the insurance-mandated six-month weight loss requirement for bariatric surgery that is often seen by employees as a barrier to access to care. In addition, employers are encouraged to cover bariatric surgery in prospective patients with a body mass index (BMI) of 30 to 35kg/m 2 and diabetes based on the growing body of level one evidence supporting the positive impact that early bariatric intervention can have on patients with type 2 diabetes. ASMBS thought leaders involved in the project included Stacy Brethauer, MD; John Morton, MD; David Sarwer, PhD; Mitchell Roslin, MD; and myself. It is clear that the business of healthcare is now every employer's business. The ACOEM Guidance Statement can guide employers, both large and small, in their ability to control costs of care with regard to obesity, provide lifestyle and behavioral interventions, and expand coverage and access for employees qualifying for bariatric surgery. The full guideline statement can be viewed at: joem/Fulltext/2018/01000/Obesity_ in_the_Workplace___Impact,_ Outcomes,_and.15.aspx BT by SHANU N. KOTHARI, MD, FACS, FASMBS Director of Minimally Invasive Bariatric Surgery, Gundersen Health System in La Crosse, Wisconsin Bariatric Times. 2018;15(2)24 Bariatric Times. 2018;15(2)24

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