Authors’ Response

Abstract

To the Editor: We read with interest the letter from Dr. Nachman Brautbar regarding our article1 “The Association of Diabetes with Job Absenteeism Costs among Obese and Morbidly Obese Workers” published in this journal in May 2008. Dr. Brautbar asks how employers can facilitate employee weight management and who would bear the cost. We thank Dr. Brautbar for his interest and we are happy to provide the requested information. There are a variety of ways that employers can promote healthy weight among their employees. First, employers can engage in workplace health promotion programs. The Task Force on Community Preventive Services recommends use of worksite interventions that combine nutrition and physical activity to help employees lose weight.2 Some recent innovative programs involve employers offering financial incentives for employees to lose weight and maintain their weight loss.3 Second, employers can expand their health insurance coverage to include bariatric surgery, antiobesity drugs, and dietary counseling. Our research indicates that job absenteeism is highest among morbidly obese diabetics, implying that weight reductions in this group may benefit employers the most. This suggests that health insurance coverage of bariatric surgery is particularly relevant. A recent literature review singled out obesity surgery as the most effective treatment for achieving significant and sustainable weight loss,4 and it is considerably more successful than conventional medical and behavioral therapy in resolving diabetes among the obese population.5 The costs of weight loss treatments programs vary with the type of intervention chosen and with the targeting of the intervention. The cost-effectiveness of some antiobesity interventions has been documented but many more interventions remain to be assessed.6 With regard to who pays for expanded health insurance coverage, evidence from the labor and health economics literatures indicates that employees ultimately pay for it in the form of lower wages; in a recent survey 91% of health economists agreed that “workers pay for employer-sponsored health insurance in the form of lower wages or reduced benefits.”7 Thus, in the end employees bear any increase in health insurance premia that results from covering these treatments. Challenges remain to implementing such programs. For example, the costs of these programs must be paid up-front while some of the benefits occur in the distant future. Due to employee turnover, employers do not reap the full benefits of such programs, creating a disincentive for their implementation. Likewise, insurance companies do not reap all of the savings that result from preventive care because of turnover of their insurance pool. Finding ways to eliminate such disincentives is an important area for future research. John Cawley, PhD Department of Policy Analysis and Management Cornell University Ithaca, NY John A. Rizzo, PhD Department of Economics and Department of Preventive Medicine Stony Brook University Stony Brook, NY Kara Haas Ethicon Endo-Surgery, Inc. Cincinnati, OH