Reducing Healthcare Costs by Reversing Chronic Care Conditions
Chronic health conditions don’t just impact the individual and their personal sphere, they have loud, wide-ranging implications for the workplace and economy at large. Obesity, and the litany of secondary conditions linked to it, such as heart disease and diabetes, cost the U.S. economy alone over $4 billion annually.The question is, how can employers be more proactive in fighting obesity among workers to help reduce healthcare costs and support employee well-being?“According to the CDC, 70% of the U.S. population is overweight, and 40% are technically obese. These are pretty staggering numbers,” said Dr. Connie Huang, the chief medical officer at Accolade. She also pointed out that obesity leads to nearly 200 other chronic diseases.Dr. Huang spoke with her colleague, Dr. Marika Holte, the associate medical director at Accolade, during a From Day One webinar. Their conversation covered the relationship between obesity and chronic conditions as well as effective measures to combat them.Dr. Marika Holte knows about weight management and cardiometabolic health – she guides the program at Accolade. She says patients don't always have a good partnership with their doctors in terms of losing weight and managing chronic diseases. “People have struggled with diet and exercise recommendations. And we really tried to recreate a space, both as physicians and as a program overall, that would make people feel really empowered to understand the factors that contributed to weight gain and chronic diseases.”She says it’s key that people succeed in taking care of their own health outcomes. “It’s often a progressive disease, and it causes inflammation and organ damage throughout the body. The link between obesity and life-altering chronic diseases can’t be overstated,” Holte said.According to the Centers for Disease Control and Prevention (CDC), 42.4% of all adults in the United States are obese, and obesity affects 650 million people worldwide.“11% of the U.S. population, or 38 million adults, have type two diabetes. 38% of the U.S. population, or 97 million adults, have prediabetes,” Holte said.Elevated blood sugars of any kind are toxic in terms of blood vessel health, and leads to higher risk factors for heart attacks and strokes, Holte says. “Heart disease costs the U.S. about $240 billion annually. And this included the cost of healthcare services, medicines, and loss of productivity in the workforce due to death. Obesity also increases the risk of chronic liver disease, cirrhosis, and liver cancers,” Holte said. “These facts really underscore the need to treat obesity and weight-related medical diseases in order to prevent chronic diseases as secondary outcomes.”Treating Obesity as a Chronic ConditionHolte put obesity into stages, where zero represents a normal, healthy weight and stage four being “irreversible complications of obesity.” Waiting until the end stage exacts a high financial cost, but there is a bright light at the end of the tunnel.Dr. Marika Holte of Accolade led the webinar (company photo)“The biggest breakthrough that we’re really seeing in the past few years is that we both know how to diagnose and treat weight-related conditions before they lead to secondary medical conditions.” Diet and exercise programs that many companies promote don’t always work, though. About 90% of patients regain the weight, and then withdraw from the programs.“We now understand that obesity is [a] multifactorial, chronic medical disease caused by a combination of easily accessible high calorie foods, lack of exercise, loss of muscle, poor sleep, chronic stress, unhealthy fat, and abnormal body signaling and lack of ability to feel full. Anyone who’s supposed to lose weight with diet and exercise is going to struggle if they're always feeling hungry,” Holte said.Newer treatments that affect Glucagon-like peptide-1 (GLP-1), a hormone that helps regulate blood sugar and appetite, like Ozempic, Saxenda, and Wegovy, are major breakthroughs Holte says. “The first thing that most people say when they start these medications is 'I'm not always thinking about food.’ So these medications have been profoundly effective [at] helping people lose weight.”Yet, knowing how to implement cost-effective programs in the workplace remains a major hurdle for employers. According to Holte, HR benefit managers can play a valuable role."You play a crucial role in identifying your employees health needs, you can also drive the shift and the perception of viewing obesity as a chronic disease, rather than a lifestyle choice, and prevent secondary complications of weight related diseases."The Way Forward to Combat ObesityDespite the overwhelming cost of obesity in the workplace, and the fact that these treatments are popular, Dr. Huang says many employers are still on the fence.“How should [employers] consider approaches to the initial medical evaluation [and] digital solutions to manage obesity and chronic disease among their employees? And what would this ultimately mean for employers and the workforce?” Huang asked.“The best way to really improve access to treatment for weight loss and these chronic conditions is to have a primary care-based program with physicians who understand how to treat obesity as a chronic disease, and can provide medical supervision and comprehensive support,” Holte said.Holte breaks up effective treatment into four categories. A visit to a primary care physician is the first category. The others are designing and outlining a comprehensive program (this could include long-term care), making sure the programs are proactive and data-driven, and having a personalized plan.Digital solutions can also play a big role in people’s personal weight loss journey, says Holte. “I’m in a telemedicine world, and I really [have] been blessed to be able to use digital solutions to help our patients with weight management and chronic disease management.”Holte points to the stigma of being overweight that keeps people from showing up in-person. Being able to have an appointment from the comfort of home brings more people to the doctor. And where there’s a lack of availability for appointments and time, telehealth can fill a gap. “Patients can often schedule an appointment with me within a week or a few days, or sometimes even the next day, if they want to.”“I think what matters most for our patients is really what makes them feel healthy. That’s the big question that we often try to get to. Listening to their stories and understanding what these goals are can really help us figure out how to achieve those goals and engage them in the process. And it helps them feel like they’re in control of this journey, and that they can really learn how to learn how to maximize their own health.”Editor's note: From Day One thanks our partner, Accolade, for sponsoring this webinar. Matthew Koehler is a freelance journalist and licensed real estate agent based in Washington, DC. His work has appeared in Greater Greater Washington, The Washington Post, The Southwester, and Walking Cinema, among others.