This study analyzed self-reported healthcare utilization and productivity measures for over 10,000 workers in different professions, across multiple employers in various regions of the country. Our aim was to estimate the excess costs imposed on employers associated with overweight or obese workers, compared to normal weight workers.
As expected, we found that obese employees experienced significantly greater rates of doctor visits, ER visits, hospitalizations, absenteeism, and presenteeism than normal weight employees. Unlike other studies, we quantified the relative financial impact of excess weight on five different measures of healthcare utilization and productivity. Notably, the magnitude of obesity-related spending for absenteeism and presenteeism ($2,596 per employee per year in 2006 dollars) was roughly equivalent to spending for doctor visits, ER visits, and hospitalizations ($2,482) ().
Estimated Annual Costs of Healthcare Utilization, Absenteeism, and Presenteeism by BMI Category
However, when considering only those categories that were significantly higher, excess indirect costs for obese workers were almost five times greater than excess direct costs ($524 in excess costs related to productivity losses compared to almost $121 in excess costs associated with more doctor and ER visits for obese employees), thus demonstrating the importance of including productivity measures in estimates of the total financial burden of obesity to employers.
While excess per employee per year costs may seem modest (approximately $644 per obese employee), within this sample these costs totaled nearly $2.47 million ($644 multiplied by the 3,834 obese employees). Taken in aggregate, these additional costs represent a large financial burden borne by employers who may be motivated to institute effective obesity management programs that improve workers’ health and may save their organization some portion of these excess costs. To benefit financially from such programs, employers in our sample would have had to spend less than that amount on weight management programs.
It should be noted that some portion of excess costs attributable to obesity may ultimately be passed onto employees as well. While employers pay 83% of the premium costs for single coverage and 73% of the premium costs for a family, employees pay the balance and their contributions to premiums have increased by 128% between 1999 and 2009 (35
). Similarly, absenteeism and presenteeism costs are not only borne by employers. Economic theory suggests that workers in a competitive labor market are paid commensurate to the value of their marginal contribution to the firm, so if obese people are less productive, they may be paid less than their normal weight counterparts.
Our results parallel those of previous investigations examining the relationship between BMI and medical care and productivity costs. Findings from this study are similar to those reported by Durden et al., who found that overweight individuals’ overall healthcare utilization patterns were comparable to normal weight employees (16
). Durden et al. also observed that obese and overweight employees had more absences than the normal weight employees. They calculated similar excess direct costs for obese employees ($712) as did we ($620).
However, it should be noted that the two studies were different in their design, data sources, and calculations of excess costs. For example, Durden et al.’s estimates of healthcare spending included employer and employee payment amounts and pharmaceutical expenditures. Our study only included healthcare costs borne by the employer and not pharmaceutical costs. Further, their study relied on self-reported BMI measures while we used professionally collected biometric data related to height and weight.
Our findings corroborate previous studies that found the effects of excess weight on direct and indirect costs are most evident among obese employees (7
). In our study, overweight was not associated with higher direct medical utilization and spending but was associated with productivity losses. Studies remain mixed on the effects of being overweight on productivity outcomes. Other studies have found that while overweight may not have a financial impact on more overt health-related financial measures it does have a financial impact on the day-to-day performance of workers (15
). Presenteeism is often more difficult to quantify than absent days or costs associated with healthcare use due to illness. However, the costs associated with presenteeism among overweight employees in our study were still substantial, given that approximately one-third of the workforce in the sample was overweight. Some studies based on self-reported height and weight may underestimate the prevalence of overweight and obesity, as height may be overestimated and weight underestimated (37
). Because evidence remains unclear, further study of the effects of overweight on health and productivity are warranted.
A strength of this study is the use of biometric measures of weight and height, compared to previous studies that have relied on self-reported data, thus resulting in more accurate findings (37
). Known biases in self-report, particularly social desirability bias, for example, were therefore avoided (37
). This study has several limitations. First, while BMI is not a perfect measure of excess weight,(11
) a recent review found that BMI and measures of overfat and adiposity are highly correlated indicating that for large-scale population studies BMI is an adequate and practical measure of overweight and obesity (39
Second, the cross-sectional study design could also present a limitation, as differences in utilization, absenteeism, and presenteeism between employees in various BMI categories were assessed at a single point in time rather than longitudinally over longer time periods. Future studies need to prospectively determine the impact of change in weight over time, including weight gain and weight loss on health care utilization and productivity outcomes.
Third, while a large and geographically diverse sample was analyzed, results may not be generalizable to employee groups dissimilar to this sample.
Fourth, our analysis likely presents conservative estimates of the cost burden to employers of overweight and obesity among workers. Our study relied upon self-reported healthcare utilization, absenteeism, and presenteeism which are often subject to recall bias. Short et al. showed that self-reported healthcare utilization and absenteeism can serve as a proxy for administrative data. Respondents to surveys were able to accurately report the number of emergency room visits and inpatient hospital admissions over the past year but only 30% and 37% could accurately recall the number of doctor visits and absent days, respectively, in the previous 12 months (18
). For those with inaccurate recall, the majority under-reported their utilization, reporting fewer visits or days compared to administrative data. Given these findings, self-reported absent days and doctor visits in this study are likely underestimated, making our results more conservative.
Further, the accuracy of the self-reported data may be affected by respondents’ BMI values. In the Short et al. study, individuals classified as overweight or obese were less likely to accurately remember the number of annual doctor visits, annual inpatient hospital admissions, and annual absence days they experience (18
). This was probably because these individuals had more encounters with the health care system and were absent more frequently than normal weight respondents.
A fifth limitation is that this study also did not include pharmacy spending, which could impact the cost estimates, as excess weight is associated with a myriad of chronic health conditions that often require maintenance medication.
Finally, productivity costs were estimated using Bureau of Labor Statistics (BLS) average wage estimates; however, two-thirds of the sample was employed in managerial/professional positions. Thus, our productivity-related losses estimates may be underestimated.