The U.S. adult population is growing heavier at an unprecedented rate. The statistics stagger the mind, revealing a growing national crisis.

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Employers are not unaffected by these events. Americans don't leave their increasing waistlines at home in the morning; they bring them to work. And those extra pounds are having serious ramifications relating to health care costs, productivity, morale and potential employee discrimination.

As a result, HR professionals find themselves on the hot plate, facing the unenviable challenges of controlling costs, addressing the needs of a ballooning workforce, emphasizing healthy lifestyle options and sensitizing both the lean and the large to the advantages of overcoming harmful weight-based stereotypes.

A Health Crisis

Nearly two-thirds of all adults (64 percent) are either overweight or obese; nearly 14 percent (split evenly between men and women) are considered obese, up 61 percent since 1991, according to the National Center for Health Statistics, the Hyattsville, Md.-based statistical arm of the Centers for Disease Control.

The total costs to society from obesity's scourge are estimated to be as high as $300 billion. The costs to employers, while smaller, are still enormous: Obesity costs U.S. companies an estimated $12.7 billion annually, reports the National Business Group on Health (NBGH), a consortium of major employers working to control health care costs. The higher an individual's body mass index, or BMI, the higher the costs. (BMI is a ratio of height to weight. For more information, see "Measuring Obesity," above.)

"Health costs go up within each BMI category," says researcher Dee Edington, director of the Health Management Research Center at the University of Michigan. "Even a one BMI unit increase translates into dollars. Costs are pretty flat between 25 and 27.5 [within the overweight classification], but they really take off at 30 [the obese category]." (See "The Costs of Being Overweight," on page 45.)

On average, health care for obese workers costs 36 percent more than for normal weight workers, and medication costs 77 percent more, according to Roland Sturm, senior economist at RAND in Santa Monica, Calif., where he directs the Economic and Policy Research Program.

Direct costs of obesity include medical insurance, hospitalization, physician visits, outpatient testing/treatment, laboratory, radiology and pharmaceutical. Health insurance is responsible for $7.7 billion, followed by life insurance ($1.8 billion) and disability insurance ($800 million), according to the study "Estimated Economic Costs of Obesity to U.S. Business," published in the American Journal of Health Promotion in 1998.

Indirect costs include decreased productivity and increased absenteeism. Obese employees are twice as likely to be absent 14 or more times per year. Paid sick leave associated with obesity costs employers an estimated $2.4 billion per year.

Even when they are on the job, a quarter of obese workers under-perform because of infirmities related to their weight, estimates Dr. Eve Olson, director of St. Francis Medical and Surgical Weight Loss Center, and author of "Obesity in the Workplace: A Case for Treatment," (American Journal of Bariatric Medicine, 2003).

Overall, NBGH reports that obesity is associated with 39 million lost work days, 239 million restricted-activity days, 90 million bed days and 63 million physician visits.

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More important, obesity significantly affects the health and quality of life of employees. The condition is a risk factor for a large number of chronic diseases, such as diabetes, heart disease, hypertension, musculoskeletal conditions, depression, stroke, poor female reproductive health, as well as endometrial, breast, prostate and colon cancers. It can contribute to the onset of these disorders and worsen them.

Obesity also significantly affects life expectancy. Every year, between 280,000 and 325,000 people suffer premature deaths related to obesity.

With its relentless growth rate, soaring annual costs and deleterious effect on the length and quality of Americans' lives, there is consensus that obesity is a full-fledged public health crisis. But experts disagree on what constitutes a workable solution.

"No HR manager will be surprised that obesity is unhealthy or costly," observes Edington. "The issue is: What can you do about it that really works?"

A Flurry of Activity

To their credit, many companies are trying to find a solution to the obesity problem. "We find that between 40 percent and 50 percent of large employers are providing some kind of weight control assistance, either through Weight Watchers or a web site where people can track their calories," says Camille Haltom, health care consultant for Hewitt Associates in Lincolnshire, Ill. "Many are looking at providing nutritional counseling."

Data from the U.S. Department of Health and Human Services (HHS) show that even greater numbers of employers are involved in their employees' battle of the bulge. HHS estimates that more than 80 percent of worksites with 50 or more employees--and almost all employers with more than 750 workers--offer health improvement programs, most with an obesity component.

Companies also are building incentives into health improvement programs. An incentive may be to offer reductions in co-payments when employees participate in health improvement or disease management programs. In such programs, low-risk people automatically get the reduced rate. High-risk people get the same benefit if they agree to participate in the program.

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Savvy employers are finding cost-effective ways to offer these incentives, says Joe Marlow, senior vice president of Aon Consulting in Philadelphia. "They artificially increase the employee contribution so the net effect is break-even or even a savings," he says.

Diet and Exercise

Studies show that such efforts can effectively reduce employees' weight--and employers' costs. The HHS 2003 report, Prevention Makes Common "Cents," (see the online version of this article for a link to the report) cites unnamed health promotion and disease prevention programs that "return a median of $3.14 for every dollar spent." And the NBGH toolkit Best Practices and Strategies for Weight Management: A Toolkit for Large Employers lists companies and suppliers that seem to have winning formulas.

But experts who have tracked obesity solutions for extended periods attribute much of these short-term results to the "Hawthorne effect," the theory that any intervention shows initially positive results that don't last over time.

Edington has worked for two decades with a database that now totals 2 million employees; his findings show that weight loss efforts don't pay off. "Weight loss money is money down the toilet," he says. "Every diet program gets results, but none works beyond two years. There are individualized stories, but they can't be generalized."

Edington says employers have to realize that money spent trying to make obese people thinner is not a good investment--even when it works. Funds are more appropriately directed at helping thinner people stay within acceptable weight ranges, and keeping overweight and obese people from gaining even more.

Other experts agree that weight loss is not the most important focus for company-sponsored programs.

Encourage employees to improve their fitness--rather than concentrate on weight loss--says Glenn Gaesser, professor of exercise physiology at the University of Virginia and author of Big Fat Lies: The Truth about Your Weight and Your Health (Gurze, 2000). He argues that a person can be both fat and fit, and that it's easier for a fat person to become fit than to become slim. The health problem is not obesity per se, but lifestyle, he says.

"Take people who are fat [BMIs over 30], cut out junk foods and put them on an exercise program--30 minutes of walking, five days a week," says Gaesser. "I guarantee these people will improve their health and well-being in a matter of days, even if they don't lose weight."

When sedentary people are introduced to brisk walking, he says, "they will experience a risk reduction of 25 percent to 50 percent in major diseases, including diabetes and heart disease."

Once you get to a moderate level of fitness, weight becomes irrelevant, says Gaesser. "Your risk of diabetes is no different than a thin person's. It suggests that fitness is a more powerful predictor [than weight] of having a heart attack or diabetes."