Posts Tagged ‘Safeway’

Safeway: Going for 0 and 2?

June 4th, 2013

The Administration’s employer wellness regulations were a big loss to the Safeway company and its former chairman, Steve Burd who retired recently. As a matter of common knowledge, the amendments in the Affordable Care Act expanding the size of the reward/penalty available to employers was known as the Safeway Amendment. The ‘success’ of the Safeway experience with incentives was never verified. Nevertheless, Senate Republicans adopted his idea during the debate on health care reform and the Obama Administration embraced it as a sign of bipartisanship.  (I had a brief comment on Steve Burd’s legacy in the San Jose Mercury News.)

Now, it seems, according to Bloomberg.com, that Safeway Inc. is one of the grocery chains pushing back on another provision of the Affordable Care Act, that would require display of the calorie content of the foods they sell. The FDA is still trying to get out a final rule this year, according to Bloomberg. Evidently, Safeway’s desire for healthier employees does not extend to customers.

 

 

Employer Wellness Incentives Questionable Origin

January 30th, 2013

The provision of the Affordable Care Act expanding the amount of the incentive/penalty in mandated health-contingent wellness plans was put forward by Senate Republicans at the urging of Safeway CEO Steve Burd during the 2009 debate over health care reform. Burd launched a whirlwind lobbying campaign claiming great improvements in employee health and lower costs for the company. President Obama embraced the proposal. The Safeway plan, called Healthy Measures, gives employees reduction in their insurance premiums if they are, and stay, within certain limits on four medical risk factors: smoking, obesity, blood pressure and cholesterol. Rebates for achieving the goals total nearly $800 for an employee or $1,600 for a family. People who test within the limits get lower health premiums at the outset of the year. An employee who fails the obesity test can get a retroactive payment if he or she loses 10% of his or her body weight by the end of the year. But if the person’s BMI is still over 30 at the beginning of the following year, the payment is withheld until the employee reaches the permanent goal of under a BMI of 30. (See, Bensinger Gail, Corporate Wellness, Safeway style,  accessed Jan. 29, 2013)

The lobbying campaign has been controversial. In a story titled,Misleading Claims About Safeway Wellness Incentives Shape health-care Bill,” David S. Hilzenrath of the Washington Post, wrote,

It’s a seductively simple solution to rising health care costs. Require workers to pay higher premiums if they flunk tests for measures such as weight, blood pressure and cholesterol. Then, bingo: You not only get a fitter workforce, you slash medical expenses.

Politicians of both parties have embraced that idea and expanded upon in the Senate reform bil, inspired largely by the claims of Steven A. Burd, Safeway’s chief executive. Burd says he as set an example for employers nationwide by rewarding employees for healthy behavior. “Safeway designed just such a plan in 2005 and has made continuous improvements each year,” Burd wrote in the Wall Street Journal. “The results have been remarkable,” he declared, adding that “our health care costs for four years have been constant.”

If only that were true.

In a legislative debate filled with misconceptions, few rival the myth about Safeway, which has become the poster company for a provision that big employers and insurers covet. The supermarket chain’s story show how the untested claims of interest groups can take on a life of their own and shape national policy.

As the House and Senate work to meld their bills, the Senate’s “Safeway Amendment,” which would more than double the potential rewards and penalties tied to wellness tests, has become a point of contention. Business groups have pushed for the increase, arguing that financial incentives encourage workers to take responsibility for their health. Opponents such as the American Heart Association and the American Cancer Society say the provision would undo a central element of reform – the promise that people’s premiums would no longer be influenced by their health status.

Rewarding or penalizing people based on wellness tests may save money over the long run, but Safeway hasn’t proved it. In the meantime, based on 2009 data, if the Safeway Amendment becomes law, American families with average health benefits could have $6,688 a year riding on blood tests and weigh-ins.

But a review of Safeway documents and interviews with company officials show that the company did not keep health-care cost flat for four years. The costs did drop in 2006 – by 12.5 percent. That was when the company overhauled its benefits, according to Safeway Senior Vice President Ken Shachmut. The decline did not have anything to do with tying employees to test results. That element of Safeway’s benefits plan was not implemented until 2009, Shachmut said.

After the 2006 drop, costs resumed their climb, he said…

Today costs are slightly higher than in 2005, Shachmut said.

So, when Safeway said it had flatlined costs since 2005, “we defined that, you might say, loosely,” he said. “Perhaps a more precise way to say it is that our costs today on a per capita basis are essentially the same as they were in 2005.”…

Burd’s assertions about the program’s success made him a rock star on Capitol Hill. He pressed his case in briefings for Senate Democrats and Republicans and in a May meeting with President Obama. Leading policymakers have cited Safeway as a model…

Obama has repeatedly invoked Safeway’s approach. “It’s a program that has helped Safeway cut health-care spending by 13% and workers save over 20% on their premiums,” he said in a June speech to the American Medical Association. “And we are open to doing more to help employers adopt and expand programs like this one.”

When Obama delivered those remarks, the program was less than six months old, and by Safeway’s own analysis the spending in question was on the upswing…

Safeway’s expanded incentives are rooted in a philosophy. “I have no problem with a smoker having a 10-pack-a-day habit an killing him or herself,” Shachmut said. “I mean, it’s a personal choice. It’s a free country. I just don’t want to have to pay the health-care costs of that personal choice.” (Editor’s note: This philosophy might be better grounded if the employer did not set the wages of the individual who is obese or smokes lower than peers in anticipation of extra health care costs. See these comments.)

In accessing the economic impact of incentives, it might be helpful to know who health-care expenses for employees in the voluntary Healthy Measures program with those for the rest of the Safeway workforce. Shachmut declined to provide such information. “We frankly haven’t been disclosing that,” he said. “And I would just prefer not to.” Pressed further, he said the data would not be available until April (2010) or later – long after Congress and the president aim to enact a health-care bill.” Hilzenrath D. Misleading Claims About Safeway Wellness Incentives Shape health-care Bill,” David S. Hilzenrath Washington Post, January  17,2010, accessed Jan. 30, 2013. (Hilzenrath is now editor in chief of the Project on Government Oversight, www.Pogo.org.)

 

War on the Obese – More Employers To Impose Penalties

November 17th, 2011

Reed Abelson of the New York Times reports that that higher penalties for employees who are obese are coming. He writes, “Policies that impose financial penalties on employees have doubled in the last two years to 19 percent of 248 major American employers recently surveyed. Next year, Towers Watson, the benefits consultant that conducted the survey, said the practice – among employers with at least 1,000 workers – was expected to double again. “ Smokers Penalized With Health Insurance Premiums – NYTimes.com The article looks closely at penalties imposed by  Wal-Mart on smokers.

The enhanced penalties are the result of the Affordable Care Act. Led by Steve Burd, CEO of Safeway Inc. a broad business coalition pushed a  provision (of course called a “wellness” provision in Washington-speak) to allow employers to charge overweight employees higher health insurance premiums than those meeting the employer’s weight standard. President Barack Obama applauded incorporating this “Republican idea” into his health care reform legislation Republican Ideas Included in the President’s Proposal | The White House.

Employer Incentives

September 27th, 2009

Employer Wellness Programs

In recent years, employers, mainly large ones, have developed wellness programs designed to promote healthier lifestyles among their employees while at the same time reducing their health care expenses. Recently, questions have arisen addressing how much of an incentive can an employer provide before it becomes a punitive measure. The National Business Group on Health has proposed as part of health care reform that the tax code be amended so that the expense of the employer-sponsored program is not taxed as income to the employee when provided off-site. Likewise, employees would be able to use their own health spending accounts for fitness and weight management.

Others have sought to change current laws to allow employers to provide significant financial rewards to persons with certain conditions under control or, from the other viewpoint, penalize workers who cannot bring such conditions, under control.

New research from the National Bureau for Economic Research indicates that financial rewards for weight loss simply do not work. Outcomes in a Program that Offers Financial Rewards for Weight Loss

Safeway, for example, has been promoting their plan called Health Measures. This plan gives employees reduction in their insurance premiums if they are, and stay, within certain limits on four medical risk factors: smoking, obesity, blood pressure and cholesterol. Rebates for achieving the goals total nearly $800 for an employee or $1,600 for a family. People who test within the limits get lower health premiums at the outset of the year. An employee who fails the obesity test can get a retroactive payment if he or she loses 10% of his or her body weight by the end of the year. But if the person’s BMI is still over 30 at the beginning of the following year, the payment is withheld until the employee reaches the permanent goal of under a BMI of 30. (See, Bensinger Gail, Corporate Wellness, Safeway style, http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/01/02/CM1714IPV8.DTL&type=health, accessed May 24, 2009)

Legally, the Safeway program may be pushing the envelope. Under the Health Insurance Portability and Accountability Act of 1996 (HIPPA), no person can be denied or charged more for coverage than other similarly situated person (e.g. full time, part time) because of health status, genetic history, evidence of insurability, disability or claims experience. HIPPA “makes it easy for health plans to reward members for participating in health-promotion programs but difficult to reward them for achieving a particular health standard, “ according to Mello and Rosenthal. In one allowable category for wellness programs, employee rewards are based solely on participation. The second category allows rewards based on attainment of a specific standard, such as losing a specific amount of weight, but the financial incentive is limited to less that 20% of the cost of the employee’s coverage. If the person cannot meet the standard if it is unreasonably difficult or medically inadvisable, that person must be offered a reasonable alternative standard. Other federal and state laws also apply to this situation. (Mello MM, Rosenthal MB, Wellness Programs and Lifestyle Discrimination – The Legal Limits, NEJM July 10, 2008; 359: 192-199) Wellness programs and lifestyle discrimination–th…[N Engl J Med. 2008] – PubMed Result

Safeway President Steven Burd has called for overturning the HIPPA 20% rule and the provisions of the Americans with Disabilities Act which prevent companies from being more aggressive about pushing employees reaching specific personal targets.

This is a highly sensitive issue for several reasons:

  1. Obesity is caused by a multitude of factors a few of which are under an individual’s control. By the time a person enters the workforce, the number of fat cells (adipose tissue) has been established and will not change no matter what the intervention, including bariatric surgery. Genetic predisposition and an environment overwhelming favoring the easy availability of food are two extremely strong factors for an individual to try to overcome. Eating and exercise habits are ingrained. It is therefore of some concern that the person who designed the Safeway program, Ken Shaclmut, Senior VP for Strategic Initiatives, indicated, “I want to be clear – we were adamant about designing this program to cover only those things for which our employees had control and which were clearly behavioral in nature. We do not differentiate for genetics and we did everything prospectively and transparently so that everyone had equal opportunity to improve their behaviors.” ( Emphasis added. http://www.thehealthcareblog.com/the_health_care_blog/2008/10/safeway-uses-in.html Accessed May 24, 2009).

A few things about this statement. First, obesity has a strong genetic basis. See, Understanding Obesity.

Second, Mr. Shaclmut may overstate the level of individual control over the three other factors – smoking, blood pressure and cholesterol. What makes these risks controllable has little to do with behavior and more to do with a variety of prescription and over-the-counter drugs for their control. Obesity is, unfortunately, lacking the number and variety of such products.

Three, employers already discriminate against persons with obesity in firing, promotion and hiring decisions. A recent paper addressed 32 experimental studies in weight discrimination in employment. The findings demonstrated that overweight and obese individuals are disadvantaged in workplace interactions, evaluations, and employment outcomes as a result of negative weight stereotypes. (Roehling MV, Pilcher S, Oswald F, Bruce T, The effects of weight bias on job-related outcomes: a meta-analysis of experimental studies. Academy of Management Annual Meeting, Anahiem, CA, 2008 )

Fourth, another recent study for the negative association between BMI and wages is larger in occupations requiring interpersonal skills with presumably more social interactions. This wage penalty increases as employees get older. This study demonstrates that being overweight and obese penalizes the probability of employment across all race and gender groups except for black men and women. (Han E, Norton ED, Stearns SC, Weight and Wages: Fat Versus Lean Paychecks, Health Econ 2009; 18:535-548 Weight and wages: fat versus lean paychecks. [Health Econ. 2009] – PubMed Result)

Fifth, obese employees in firms which provide employer paid health care are paid less than their peers for the same work. This indicates that employers are offsetting the higher health care costs of obese employees with lower wages. Bundorf MK, Bhattacharya J. The Incidence of the Health Care Costs of Obesity, Abstr AcademyHealth Meeting 2004;21: No. 1329. Available at www.nber.org/papers/w11303 – 17k – 2005-05-02)

Sixth, the difficulties of weight loss and maintenance of weight loss need to be understood. About 1/3 of American adults are engaged in weight loss efforts at any given time. Yet, obesity increases. Why is that? Some dieters do succeed in weight loss but few, 5-10%, manage to keep the weight off over the long term. (See, Freedman MR, King J, Kennedy E, Popular Diets: A Scientific Review. 2001, Obesity Res. 9 Suppl.1: 1S-40S. Popular diets: a scientific review. [Obes Res. 2001] – PubMed Result Maintaining weight loss is extremely difficult. As soon as weight starts to decrease, energy expenditure also drops in obese individuals. Not only is resting metabolic rate decreased; non-resting energy expenditure is also less because less mass is being moved. Take the situation with persons with type 2 diabetes, a common chronic disease highly correlated with obesity. Weight loss in this population is very difficult. Typically, patients lose weight over 4-6 months then plateau. Patients generally lose about 4-10% of their baseline weight. Hypothalamic signals in defense of body weight increase and intervene to prevent further weight loss. This initiates a regain of the lost weight. Neurotransmitters are activated to such an extent that the signal levels of increased hunger and decreased satiety become extremely difficult to ignore. Also, most diabetic patients are on anti-diabetes medications, many of which, like insulin, actually cause weight gain. (See, Pi-Sunyer, FX, Weight Loss in Type 2 Diabetic Patients, Diabetes Care, June 2005, 28;6:1526-7 Weight loss in type 2 diabetic patients. [Diabetes Care. 2005] – PubMed Result )

Seventh, employer wellness programs, as they apply to obesity, are not precisely defined. At present they encompass a variety of approaches and do not have a standardized format. It does appear that they provide advice on nutrition and physical activity and perhaps the ill effects of obesity. As such, they would be similar to the behavioral format used as standard therapy for control groups in randomized clinical trials, usually of pharmacological compounds. Such interventions have not been particularly effective. (See, Poston WS, Haddock CK, Lifestyle Treatments in Randomized Clinical Trials of Pharmacotherapies for Obesity. Obesity Research 2001 9;9:552-563. Lifestyle treatments in randomized clinical trials…[Obes Res. 2001] – PubMed Result) However structured, it is impossible to think that an employer wellness program would be as intense and well-funded as the Diabetes Prevention Program (DPP). In this study over 3,000 non-diabetic persons with elevated fasting and plasma glucose concentrations ( but not diabetes) were assigned to placebo, metformin (a drug to treat diabetes) or an intensive life-style modification program with the goal of at least a 7% weight loss and at least 150 minutes of physical activity per week. “The lifestyle modification intervention reduced the incidence of diabetes by 58% compared to 31% in the metformin group. The advantage of lifestyle intervention over metformin was greater in older persons and those with a lower body-mass index than in younger persons and those with higher body-mass index.” The weight loss difference between the lifestyle group and the metformin group was barely 4 pounds after 4 years. Only 10 million persons in the United States resemble the participants in the DPP. (Diabetes Prevention Program Research Group, Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin, New England Journal of Medicine, 2/7/2002 346:393-403. Reduction in the incidence of type 2 diabetes with…[N Engl J Med. 2002] – PubMed Result)

Eight, employer wellness programs do have adequate evidence of their effectiveness at long term weight loss and maintenance. A CDC Report evaluating such programs reported, “The Task Force determined that insufficient evidence existed to determine the effectiveness of single-component worksite interventions focused on nutrition, physical activity, or other behavioral interventions among adults.” (Katz DL, et al, Public Health Strategies for Preventing and Controlling Overweight and Obesity in School and Worksite Settings, A Report on Recommendations of the Task Force on Community Preventive Services, MMWR, Oct. 7, 2005 Public health strategies for preventing and contro…[MMWR Recomm Rep. 2005] – PubMed Result) More recently, Goetzel and Ozminkowski looked at the health and cost benefits of work site health-promotion programs. Commenting on a 2007 systematic literature review they observed, “Health and productivity outcomes from these interventions were reported from 50 studies qualifying for inclusion in the review. The outcomes included a range of health behaviors, physiologic measurements, and productivity indicators linked to changes in health status. Although many of the changes in these outcomes were small when measured at an individual level, such changes when measured at an individual level were considered substantial.” 38 38 (Goetzel RZ, Ozminkowski RJ, The Health and Cost Benefits of Work Site Health-Promotion Programs. Annu. Rev. Public Health 2008;29:303-23 The health and cost benefits of work site health-p…[Annu Rev Public Health. 2008] – PubMed Result)

Ninth, wellnessand prevention programs also may actually be working at cross purposes. It is not uncommon to see programs stress smoking cessation and weight loss. Rarely, however, do they seem to address the perception that smoking cessation will lead to weight gain. A 1991 study by the Centers for Disease Control published in the New England Journal of Medicine found mean weight gain after smoking cessation was 2.8 kg for men and 3.8 for women. Major weight gain of over 13kg occurred in 9.8% of the men and 13.4% of the women. (Williamson DF, Madans J, Anda RF, Smoking Cessation and severity of weight gain in a national cohort. NEJM, 1991 Mar.14;324 (11):739-45. Smoking cessation and severity of weight gain in a…[N Engl J Med. 1991] – PubMed Result) Smoking creates insulin resistance and is associated with central fat accumulation. As a result, smoking increases the risk of the metabolic syndrome and type 2 diabetes. ( Chiolero A, Consequences of smoking for body weight, body fat …[Am J Clin Nutr. 2008] – PubMed Result ) Weight control advice was not associated with reduction in weight gain after cessation. (See, Parsons AC, Shraim M, Inglis J, Interventions for prevention weight gain after smoking cessation. Cochrane Database Syst. Rev. 2009 Jan. 21;(1):CD006219 Interventions for preventing weight gain after smo…[Cochrane Database Syst Rev. 2009] – PubMed Result

Tenth, to the extent that wellness programs which shift costs to employees create stress, they may actually lead to weight gain. We know that chronic stress is a contributor to obesity and the metabolic syndrome. (See, Kyroou I, Tsigos C Chronic stress, visceral obesity and gonadal dysfunction, Hormones 2008 7(4):287-293. Chronic stress, visceral obesity and gonadal dysfu…[Hormones (Athens). 2008 Oct-Dec] – PubMed Result) Overweight women experience more stressful lives events than normal women. Obese and extremely obese men and women are more likely to report several specific stressful life events and more stressful life events overall compared to normal weight individuals. ( See, Gender differences in associations between stressf…[Prev Med. 2008] – PubMed Result

Twelfth, more punitive employer wellness programs are likely to operate like a tax on overweight employees. Compliance with any weight loss regimen involves both time and money. While employers may bear some of this in their programs, the economic burden is likely to fall mainly on overweight/ obese employees, who have already paid a penalty in their wages for their largely inherited status.

Successful maintainers who have lost at least 30 lbs. for an average of five years expended and average of 1.5 hours a day on exercise and consume less that 1,400-1, 500 calories. (See, Klem, ML, Wing RR, McGuire MT, Seagle HM, Hill JO, A descriptive study of individuals successful at long-term maintenance of substantial weight loss. 1997 Am J Clin Nutr 66;239-246 A descriptive study of individuals successful at l…[Am J Clin Nutr. 1997] – PubMed Result))

A recent collaborative position paper explains the issues of money, place and time stated:

The Role of Money

One hypothesis linking SES variables and childhood obesity is the low cost of widely available energy-dense but nutrient-poor foods. Fast foods, snacks, and soft drinks have all been linked to rising obesity prevalence among children and youth. Fast food consumption, in particular, has been associated with energy-dense diets and to higher energy intake overall. Calorie for calorie, refined grains, added sugars and fats provide inexpensive dietary energy, while more nutrient-dense foods cost more, and the price disparity between the low-nutrient, high-calorie foods and healthier food options continues to grow. Whereas fats and sweets cost only 30% more than 20 years ago, the cost of fresh produce has increased more than 100%. More recent studies in Seattle supermarkets showed that the lowest energy density foods (mostly fresh vegetables and fruit) increased in price by almost 20% over 2 years, whereas the price of energy-dense foods high in sugar and fat remained constant.

Lower cost foods make up a greater proportion of the diet of lower income persons. In U.S. Department of Agriculture (USDA) studies, female recipients of food assistance had more energy-dense diets, consumed fewer vegetables and fruit, and were more likely to be obese. Healthy Eating Index scores are inversely associated with body weight and positively associated with education and income .

The Importance of Place

Knowing the child’s place of residence can provide additional insight into the complex relationships between social and economic resources and obesity prevalence. Area-based SES measures, including poverty levels, property taxes and house values, provide a more objective way to assess the wealth or the relative deprivation of a neighborhood. All these factors affect access to healthy foods and opportunities for physical activity.

Living in high-poverty areas has been associated with higher prevalence of obesity and diabetes in adults, even after controlling for individual education, occupation, and income. In the Harvard Geocoding Study, census tract poverty was a more powerful predictor of health outcomes than was race/ethnicity. Childhood obesity prevalence also varies by geographic location. The California Fitnessgram data showed that higher prevalence of childhood obesity was observed in lower income legislative districts. In Los Angeles, obesity in youth was associated with economic hardship level and park area per capita. Thus, the built environment and disadvantaged areas may contribute in significant ways to childhood obesity.

The Poverty of Time

The loss of manufacturing jobs, the growth of a service economy and the increasing number of women in the labor force have been associated with a dramatic shift in family eating habits, from the decline of the family dinner to the emerging importance of snacks and fast foods. The allocation of time resources by individuals and households depends on socioeconomic status.

The concept of “time poverty” addresses the difficult choices faced by lower income households. When it comes to diet selection, the common tradeoff is between money and time. One illustration of the dilemma is provided by the Thrifty Food Plan (TFP), a recommended diet meeting federal nutrition recommendations at the estimated cost of $27 per person per week. While this price is attractive, it has been estimated that TFP menus would require the commitment of 16 hours of food preparation per week. By contrast, a typical working American woman spends only 6 hours per week, whereas a non-working woman spends 11 hours per week preparing meals . Thus, TFP may provide adequate calories at low cost, but requires an unrealistic investment in time. ( See, Caprio S, Daniels SR, Drewnowski A, Kaufman FR, Palinkas LA, Rosenbloom AL, Schwimmer JB Influence of race, ethinicity, and culture on childhood obesity: implications for prevention and treatment: a consensus statement of Shaping America’s Health and the Obesity Society. Diabetes Care 2008 Nov;31(11):2211-21. Influence of race, ethnicity, and culture on child…[Obesity (Silver Spring). 2008] – PubMed Result)

It is useful to consider that weight management is not the only thing people have to do. Time taken for physical activity and nutritional improvement is going to be time taken away from other activities, such as care for self and others, self-improvement, community activities and volunteering, time with children and family members, and recreation (including television viewing and using a computer/Internet)

Intrusive wellness programs have the potential to interfere with the employees’ right to privacy and complicate the doctor-patient relationship. Under the Safeway plan, for example, an employee can request an exception on recommendation of a physician. To whom the employee can request this is not clear. Nor is it clear under what circumstances the exception would be granted. Look at two common scenarios:

1. The employee has a disease like HIV/AIDs or cancer in which weigh loss is common and his or her physician does not want the employee to lose any weight if they can help it. Would the employee have to reveal this condition?

2. The employee has common diseases like type 2 diabetes or depression. The physician has recommended drugs which actually cause weight gain. Does the employee have to disclose this? What if the employer decides that another medication could be used? Does now the doctor, patient and often managed care plan have to discuss medical alternatives with Human Resources? In other words, will the employees health be endangered by the effort to live a healthy lifestyle?

Who is disadvantaged by employer wellness program? Programs such as Safeway’s may have unintended discriminatory effects. The biometrics used in such programs, to the extent they include obesity, elevated triglycerides and blood pressure, are part of what is known as the metabolic syndrome. Approximately 34% of adults meet the National Cholesterol Education Program’s criteria. Older males and females from 40-59 years of age are about 3 times as likely as those 20-39 to meet the criteria for the metabolic syndrome. Males and females over 60 were more than 4 and 6 times respectively to meet the criteria. Overweight and obese males were 6 and 32 times as likely as normal weight males to the meet the criteria and overweight and obese females were 5 and 17 times as likely to meet the criteria. (See, Ervin RB, Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003-2006. National Health Statistics Reports; No. 13.National Health Statistics metabolic syndrome – PubMed Results )

Therefore, we can expect that such programs deliver little in the way of improvements in individual’s body weight, while having a disproportionate impact on minorities, the elderly and those with serious health conditions. To the extent that these employees see a reduction in their health insurance (possibly to the point of zero if the 20% limitation is totally removed), they will only increase the ranks of the uninsured, thereby frustrating the whole purpose of health care reform.

For further information, see;

Insurance coverage and incentives for weight loss …[Obesity (Silver Spring). 2008] – PubMed Result

Effects of a reimbursement incentive on enrollment…[Obesity (Silver Spring). 2007] – PubMed Result

Worksite Opportunities for Wellness (WOW): Effects…[Prev Med. 2009] – PubMed Result

The Working Healthy Project: a worksite health-pro…[J Occup Environ Med. 1999] – PubMed Result

LEAN Works: About CDC’s LEAN Works | DNPAO | CDC

Public Health Strategies for Preventing and Controlling Overweight and Obesity in School and Worksite Settings </P><P>A Report on Recommendations of the Task Force on Community Preventive Services

Financial incentive-based approaches for weight lo…[JAMA. 2008] – PubMed Result

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August 18, 2009

Sleep apnea on increase Sleep Apnea Rises With Obesity, Boosts Deaths in Middle-Aged – Bloomberg.com; PLoS Medicine: Sleep-Disordered Breathing and Mortality: A Prospective Cohort Study

Push back on doctor’s campaign against obesity Anti-Obesity Dr. Jason Newsom Chomps Down on Dunkin’ Donuts « Vitals Spotlight – We Give the Doctor an Exam

August 11, 2009

President Obama calls for health insurance reform to cover obesity treatments, stating, “All I’m saying is let’s take the example of something like diabetes, one of — a disease that’s skyrocketing, partly because of obesity, partly because it’s not treated as effectively as it could be. Right now if we paid a family — if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they’re taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that’s $30,000, $40,000, $50,000 — immediately the surgeon is reimbursed. Well, why not make sure that we’re also reimbursing the care that prevents the amputation, right? That will save us money. Text – Obama’s Health Care Town Hall in Portsmouth – NYTimes.com

August 10, 2009

Nominee for Surgeon General attacked over body weight Does it matter what the doctor weighs? — latimes.com

Arena preparing to submit new obesity drug to FDA San Diego Business Journal Online – business news for San Diego, California

August 7, 2009

Recession could worsen obesity prevalence Recession could have negative impact on obesity levels | News | Nursing Times

July 17, 2009

Minorities, blacks hardest hit by obesity reports CDC Atlanta health, diet and fitness news | ajc.com

July 16, 2009

AHA: severe obesity increases risks in surgery Severe obesity increases risks of health problems during surgery

AHA: Clarity on the overweight mortality confusion Mortality, Health Outcomes, and Body Mass Index in the Overweight Range: A Science Advisory From the American Heart Association — Lewis et al. 119 (25): 3263 — Circulation

July 14, 2009

Excess weight speeds up osteoarthritis Excess Weight Speeds Up Osteoarthritis: MedlinePlus

July 14, 2009

RWJ releases report on taxes for sugar sweetened beverages Sugar-Sweetened Beverage Taxes and Public Health – RWJF

July 14, 2009 WHO addresses swine flu vaccine for persons with obesity. Swine Flu Vaccine Recommendations from World Health Organization – Health Blog – WSJ

July 10, 2009 CDC finds high prevalence of obesity in swine flu patients. Intensive-Care Patients With Severe Novel Influenza A (H1N1) Virus Infection — Michigan, June 2009

July 2009 Study finds insulin resistance in overeating lean humans for the first time. Short-term overeating induces insulin resistance i…[Mol Med. 2009 Jul-Aug] – PubMed Result

July 10,2009

The economy, stress and overeating Job Stress, Economy Weighing on Americans: MedlinePlus

June 24, 2009

Obesity: Africa’s Next Big Killer Africa’s newest silent killer: obesity | FP Passport

July 2, 2009

Connecticut Governor Vetoes Labeling Bill

Rell rejects nutritional labeling for chain restaurants – The Connecticut Post Online

July 1, 2009

Obama Address Obesity in Town HallObama Addresses Health-Care Reform at Virtual Town Hall Meeting – washingtonpost.com

July 1, 2009

Trust for America’s Health releases “F as in Fat 2009” http://www.rwjf.org/files/research/20090701tfahfasinfat.pdf

June 30, 2009

Institute of Medicine Issues Report on Comparative Effectiveness Research

Initial National Priorities for Comparative Effectiveness Research – Institute of Medicine

Read Morgan Downey’s Testimony

http://www.iom.edu/Object.File/Master/64/740/Speaker%20Testimonies%203-4PM%20b

lock.pdf

June 30, 2009

Oregon enacts restaurant labeling bill AP Wire – Oregon | kgw.com | News for Portland Oregon and SW Washington

June 29, 2009

More Data on surgery for diabetes Weight-Loss Surgery May Be Beneficial for Diabetes – NYTimes.com

June 29, 2009

Kentucky phasing out sugar sweetened beverages Congress May Look to Ky. Schools’ Healthy Example in Creating Nutritional Policy – washingtonpost.com

June 25, 2009

IOM release workshop on Food Desserts The Public Health Effects of Food Deserts. Workshop Summary – Institute of Medicine

May 28, 2009

IOM Releases report on Weight Gain in Pregnancy Report Brief. Weight Gain During Pregnancy: Reexamining the Guidelines – Institute of Medicine

May 9, 2009

Do obesity related diseases predispose to swine flu severity? Other Illness May Precede Worst Cases of Swine Flu – NYTimes.com