By Rajitha Sivakumaran
In 2014, Statistics Canada released a report showing that 54 per cent of Canadians over the age of 18 were either overweight or obese. Although most Canadians don’t view it as an illness, obesity is a chronic, progressive and relapsing medical condition. New research about the genetic component of obesity has emerged with implications that change everything from how we view the condition to how we must respond to it, particularly in terms of the workplace and employee benefits coverage.
Dr. Sean Wharton, medical director of the Ontario-based Wharton Medical Clinic, says that people are born with the propensity to encounter higher rates of weight gain. Put into an environment that is enriched in triggers that send body weight up, such as easy access to calorie-dense foods or a lifestyle that promotes little exercise, these people tend to experience higher chances of weight gain often leading to an increase in cholesterol and blood sugar, and a heightened risk of heart attack and stroke. Extra weight and pressure on the joints can result in various mechanical problems like osteoarthritis. Constant negativity and the inability to meet societal standards for weight can result in mental issues like depression and anxiety.
“I think patients blame themselves because previously there was a lack of medical science to explain the causes of obesity, the genetic predisposition and the reason why the body wants to go back up in weight. So people need to know that obesity is not necessarily their fault, that there are multiple factors associated with increased weight that has very little to do with the person’s inability to practice restraint behaviours,” Dr. Wharton said.
In the workplace, the impacts of obesity are especially felt through reduced productivity and higher rates of absenteeism and disability, added Cathy Fuchs, a long-time employee benefits consultant at White Willow Benefit Consultants.
Within weight loss, there are two main types — short term and long term. The former is comparable to a bride losing just enough weight to fit into her wedding dress. Though easily done, it is difficult to maintain and weight regain becomes inevitable. “That is your cognitive willpower overriding your hypothalamus, which is an automatically functioning part of the brain that has a control on weight,” Dr. Wharton said.
Though we can override most of our body’s automatic functions, it can only be done for a short period of time. “That’s why almost everybody can manage short-term weight loss, but they can’t manage long-term weight loss because long-term involves making permanent and significant changes to the hypothalamus,” Dr. Wharton said.
Fad diets fail because they deal only with a person’s willpower rather than the underlying neurohormonal mechanisms. “It is unlikely that a person can maintain weight loss with any diet. So we can almost call even healthy diets fads when it comes to weight because it’s unlikely for any lifestyle modification to keep weight off long term in most people,” Dr. Wharton said. Only three per cent of patients following a healthy diet are an exception to Dr. Wharton’s statement.
Consequently, there is a demand for effective treatment. “There’s not one treatment that applies to all people living with obesity.
There are multiple treatments and as a result, a multidisciplinary team is necessary,” Dr. Wharton said. But how many of these options are readily available to employees through their insurance coverage?
Equipped with this new research on neurohormonal mechanisms, Fuchs advocates for the inclusion of obesity-related treatments in employee benefits packages.
The impact of obesity needs to be recognized in the workplace and education is the greatest defence against obesity. “The best way to treat it is to understand it,” Dr. Wharton said.
Fuchs, alongside Dana Hurst, director of wellness solutions at People Corporation, strongly encourages employers to launch campaigns that provide education and awareness about obesity as a medical condition. “There is so much more to this condition then we previously thought,” Fuchs said. Managers, in particular, need to understand this new research. “Until people understand the biology behind this, the conversations will not go very far,” Fuchs added.
Obesity-related treatments tend to fall under the lifestyle category of benefits packages. Consequently, there are many exclusions. Both Dr. Wharton and Fuchs specifically stressed the importance of employees having access to pharmacotherapy to combat obesity. “Lifestyle implies a level of control that we now know does not exist,” Fuchs said, adding that coverage for these medications may need to fall outside this category in order to successfully combat obesity.
A high percentage of drug costs are attributable to medications that treat obesity-related illnesses like high blood pressure and depression, but these costs can be reduced by allotting special attention to obesity. The economic value of incorporating obesity treatment into benefits coverage plans can result in a potential decrease in overall drug costs.
“Access [to medication] alone isn’t enough. The fact that the drug may be covered isn’t sufficient,” Fuchs said. “Effort must be made to create an environment where employees feel comfortable coming forward to address this issue.” In her experience, employees with questions about coverage don’t usually speak up. Additionally, employers need to encourage healthy eating and understand the impact of their day-to-day decisions, like the food served at meetings.
Since personal choices do influence obesity, Fuchs believes it is important to incorporate access to certified dietitians and life coaches in order to prevent relapse. Many of these services are already available through employee benefits programs, but they need to be leveraged to specifically address obesity. For example, many employers offer corporate fitness memberships, which is a great start, but to significantly lower health costs, Fuchs recommends yearly onsite health screening clinics to assess employee risk factors and measure improvement.
“I think it’s important for employers to support employees in their health journeys,” Dr. Wharton said. In his experience, Dr. Wharton has seen that weight loss regimes tend to be accompanied by healthy behaviours such as incorporating wholesome foods into one’s diet and exercising. “When you have a healthy behaviour, even if it does not result in a decrease in weight, it will result in a healthier person.”
Accordingly, it could be advantageous to incorporate behaviour modification programs, such as cognitive learning programs, nutrition, weight management, physical activity, stress management, diabetes management or smoking cessation, into coverage plans. Including family members in these programs could help to solidify behaviour changes outside of the workplace.
Sometimes, physical weight can deter an employee from performing to their fullest extent and in such cases, Dr. Wharton recommends employers support the use of medication or bariatric surgery. Medication can change the hypothalamus’ response to the energy that’s coming in and bariatric surgery can alter the hormonal levels within the brain — both allow for a different form of processing of calories to take place and are the best options to keep weight off permanently. The result of this support is employers equipped with a healthier workforce with improved psychological and metabolic profiles.