Fighting fat critical to disability

Risk & Insurance, Nov, 2004 by Peter Rousmaniere

Does body weight influence prospects of employment, injury, and injury recovery? It seems that obesity can be dangerous, from getting a job to getting back to it after injury. Is our industry up to addressing this challenge? Some say a fat epidemic is a myth. But very heavy people pose real injury risks to hospital and other workers. And they are risks to themselves if they have health problems. Severe obesity may or may not increase risk of injury, but seasoned occupational medicine doctors and nurses are convinced it vastly complicates recovery after injury. Just visit a chronic pain clinic during patient hours.

I asked an ergonomics firm to track the history of weight among the job applicants it has tested over the years. It compared 1990 and 2004 test results for a few jobs. It told me that "applicants for physically-demanding jobs, like warehouse order picking, and beverage distribution and merchandising, are slightly older and 12 to 19 pounds heavier. They have up to five percent less aerobic capacity. When their physical capacity is compared to the requirements of the job for which they are applying, their relative fitness for their desired jobs was 12 percent to 34 percent lower." Greater weight seems to be linked to higher rejection rates.

The firm, Advanced Ergonomics, told me that the average "body mass index" (BMI) of applicants for grocery, jobs rose from (after rounding) 26 to 27 and for beverage delivery, jobs rose from 26 to 28. BMI is calculated by dividing a person's weight by her height. The applicants, men and women alike, have migrated from normal weight range to either marginally overweight or overweight.

A recent Dartmouth Medical School study of spine center patients found severe obesity related to a higher number of work loss days. This clinical team has been trying to piece apart a complicated relationship between risk factors. Obesity puts extra loads on the body, which may harm the body. Impairment may lessen physical activity, which allows weight gain, making recovery more difficult. Mental distress such as depression may prompt people to self-medicate by eating to excess. Impairment may prompt depression, which may prompt overeating, which ends in weight gain. The real challenge for workers comp claims payers is to think about behavioral interventions for very heavy injured workers. We are not talking about Weight Watchers, but rather professional counseling and guided exercise. Twenty years of scientific literature report the value of behavioral interventions to resolve chronic pain. I can think of only one or two insurers who are applying these findings.

Mike Shor, a Boston area workers comp professional, recently examined the files of hundreds of workers comp claimants. Shor found that those who complained of chronic pain had on average double the BMI of the average claimant at the time of injury. Shor is prescribing early intervention with an intensive regime of exercise and smoking cessation. The key goal is building up the workers' coping skills. Of course, the claimant is expected to comply.

Few adjusters have experience with these programs. But every month evidence is accumulating about the behavioral dynamics of obesity on disability and chronic pain. It may not be long before this evidence inflates permanent disability ratings and drives up settlements. Then we will really have a problem on our hands.

PETER ROUSMANIERE is a regular columnist for Risk & Insurance. He can be reached at riskletters@lrp.com.