In a recently published study by the Lewin Group , pre-diagnosed Diabetes costs are costing the US $18B a year in addition to the $174B in annual expenses and lost productivity.

It is not uncommon for an individual with Diabetes to have co-morbidities such as Heart disease and Obesity that also result in high annual medical claims and lost productivity. What is interesting to me is that some health and wellness programs are focusing soley on Obesity as the underlying driver of Diabetes and Heart Disease and therefore, focusing their prevention efforts soley around weight management. Employers and health plans are making substantial investments in engaging the consumer in the battling the bulge. Weight management rewards programs have evolved from using incentives for participation to a more outcomes-based approach, rewarding participants for losing weight and rewarding them more for keeping it off.

Weight management programs have proven to be effective, delivering a return on investment of approximately 5-1. What strikes me as interesting is that while weight management rewards programs have proven to be effective, many health and wellness programs are still not emphasizing these programs for their population and I am not sure why.

In a collaboration of three of the largest stakeholders in the health system, former President Bill Clinton announced a national initiative aimed at covering 6 million children for routine visits with primary care physicians and dieticians. The collaboration includes organizations such as the American Heart Association, Pepsi Co. BCBS of MA and NC, Owens Corning, Wellpoint, American Academy of Pediatricians and American Diabetes Association. While 6 million only represents about 25% of obese children, this is a big deal. I think that the initiative addresses some critical factors that will determine success or failure:
- reimbursement for intensive counseling and education from physicians and dieticians
- parental and caregiver education
- collaboration and linkages of the healthcare value chain to provide an integrated patient intervention and continuum of care

Obesity related costs continue to burden the health system and related costs continue to grow. It will be interesting to see how this initiative progresses in trying to stem the epidemic of childhood obesity.

A new report from Trust for America’s Health and Robert Wood Johnson Foundation indicates that obesity rates rose for the second consecutive year in twenty-four (24) states and astoundingly NO states experienced a decrease in their obesity rates.

Here are a few insights to consider:
• More than 25% of adults are obese in 28 states.
• More than 20% of adults are obese in every state except for Colorado.
• In 1980 the national average of obese adults was 15%. Today it is estimated that 66% of American adults are overweight or obese.
• It is estimated that 23 million children are overweight or obese.

These statistics are frightening when you consider the fact that obesity is a trigger for many chronic health issues that plague our health system and continue to contribute to the escalating costs of chronic and multi-disease state care. Even more startling is the fact that the report found that many of the promising policies that have emerged to promote physical activity and good nutrition are not being adopted or implemented for a variety of reasons.

While organizations have typically used a disease management approach to try to manage and control weight of their employees and members, there is a company called Tangerine Wellness , has very compelling success stories about their ability to help people lose weight and keep it off. Recognizing that obesity is an issue that leads to many other health issues, Tangerine Wellness has used some basic principles of social networking, competition and long-term incentives to drive some amazing results for people who are overweight. Their success has been steeped in the understanding that losing weight is hard, but keeping it off over a long period of time can be even more difficult. Through the use of intermittent rewards and effective communication that recognizes participants when they hit key milestones, Tangerine has produced ROI numbers upward of 5% and has achieved participation and engagement rates averaging between 60% to 80%.

When considering programs where the health issue is as pervasive and serious as obesity, corporations may want to consider rewarding on outcomes over a 2 to 3 year period rather than soley on participation in a weight management program. Outcomes-based incentive programs do require more focus on HIPAA criteria however, I believe the ROI that companies like Tangerine have been able to deliver more than justify the investment in a robust outcomes-based incentive strategy.