The statistics are everywhere: most of the adults in the United States are overweight or obese. These conditions are, of course, responsible for increased health care costs owing to chronic diseases such as diabetes, high blood pressure, high cholesterol, and heart disease. The patient may pick up some of these excess expenses, but society incurs the majority of the costs in the form of increased insurance premiums across the board, bigger taxes to pay for government-sponsored medical care or unemployment benefits, and decreased productivity including lost wages and reduced workplace efficiency.

Many studies have demonstrated a negative relationship between increased body mass index (BMI) and income. This relationship is most obvious in jobs that require interpersonal skills, often with a great deal of social interaction. The salary disparity between normal-BMI and high-BMI employees gets worse as the workers get older. Overall, being overweight or obese minimizes the chance of obtaining gainful employment. Health economists attribute this salary-weight association to consumers and employers disliking obese workers.

The wage-weight discussion expands not only to the actual salary workers bring home, but weight affects social success, too. Moving up or down the social hierarchy and accumulating social advantages is correlated to weight. A recent epidemiological study reported that downwardly mobile people were more likely to be overweight or obese than socially stable individuals of high socioeconomic status. The likelihood of being overweight or obese also increased with the accumulation of social disadvantages. This maintains the cycle of poor social status, increased weight, poor health, and decreased employment opportunities.

A recent health economics study calculates the overall economic burden attributable to overweight and obesity, if currently overweight adolescents become obese adults. The study examined the predicted population of working-age adults in the United States from 2020 to 2050. Based on current trends, that population will suffer from 161 million life-years complicated by obesity, diabetes, or heart disease. There will be 1.5 million life-years lost. These conditions will cost society $254 billion. Most of the expense is due to lost productivity either from early death or disease morbidity. Only $46 billion is related to direct medical expenses. Applying currently available treatments to obesity-related diseases would only decrease the life-years lost to 1.1 million, but would increase medical costs by $7 billion.

Most Americans spend most of their day at work. If society is losing money and resources because of overweight and obesity, it seems obvious that employers would want to address the issue and improve worker productivity. But, workplace interventions to promote proper nutrition and physical activity have little benefit in improving weight status. Most successful participants in workplace interventions already have a healthy or near-healthy BMI.

America is losing its reputation as a productive, prosperous country. If not to improve the physical health of the population, Americans should get fit and lose weight to improve the economic and fiscal health of this great nation.

References

Lemon SC, Zapka J, Li W, Estabrook B, Magner R, Rosal MC. Perceptions of worksite support and employee obesity, activity, and diet. American journal of health behavior 2009;33(3):299-308.

Anderson, L., Quinn, T., Glanz, K., Ramirez, G., Kahwati, L., Johnson, D., Buchanan, L., Archer, W., Chattopadhyay, S., & Kalra, G. (2009). The Effectiveness of Worksite Nutrition and Physical Activity Interventions for Controlling Employee Overweight and ObesityA Systematic Review American Journal of Preventive Medicine, 37 (4), 340-357 DOI: 10.1016/j.amepre.2009.07.003

Lightwood, J., Bibbins-Domingo, K., Coxson, P., Wang, Y., Williams, L., & Goldman, L. (2009). Forecasting the Future Economic Burden of Current Adolescent Overweight: An Estimate of the Coronary Heart Disease Policy Model American Journal of Public Health, 99 (12), 2230-2237 DOI: 10.2105/AJPH.2008.152595

Han, E., Norton, E., & Stearns, S. (2009). Weight and wages: fat versus lean paychecks Health Economics, 18 (5), 535-548 DOI: 10.1002/hec.1386

Clarke, P., O’Malley, P., Johnston, L., & Schulenberg, J. (2008). Social disparities in BMI trajectories across adulthood by gender, race/ethnicity and lifetime socio-economic position: 1986-2004 International Journal of Epidemiology, 38 (2), 499-509 DOI: 10.1093/ije/dyn214

Heraclides, A., & Brunner, E. (2009). Social mobility and social accumulation across the life-course in relation to adult overweight and obesity: The Whitehall II study Journal of Epidemiology & Community Health DOI: 10.1136/jech.2009.087692