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A Multi-Worksite Analysis of the Relationships Among Body Mass Index, Medical Utilization, and Worker Productivity

Goetzel, Ron Z. PhD; Gibson, Teresa B. PhD; Short, Meghan E. MPH; Chu, Bong-Chul PhD, MHA; Waddell, Jessica MPH; Bowen, Jennie MPH; Lemon, Stephenie C. PhD; Fernandez, Isabel Diana MD, MPH, PhD; Ozminkowski, Ronald J. PhD; Wilson, Mark G. HSD; DeJoy, David M. PhD

Journal of Occupational and Environmental Medicine: January 2010 - Volume 52 - Issue 1S - p S52-S58
doi: 10.1097/JOM.0b013e3181c95b84
Original Articles

Background: The relationships between worker health and productivity are becoming clearer. However, few large scale studies have measured the direct and indirect cost burden of overweight and obesity among employees using actual biometric values. The objective of this study was to quantify the direct medical and indirect (absence and productivity) cost burden of overweight and obesity in workers.

Measures: A cross-sectional study of 10,026 employees in multiple professions and worksites across the United States was conducted. The main outcomes were five self-reported measures of workers' annual health care use and productivity: doctor visits, emergency department visits, hospitalizations, absenteeism (days absent from work), and presenteeism (percent on-the-job productivity losses). Multivariate count and continuous data models (Poisson, negative binomial, and zero-inflated Poisson) were estimated.

Results: After adjusting for covariates, obese employees had 20% higher doctor visits than normal weight employees (confidence interval [CI] 16%, 24%, P < 0.01) and 26% higher emergency department visits (CI 11%, 42%, P < 0.01). Rates of doctor and emergency department visits for overweight employees were no different than those of normal weight employees. Compared to normal weight employees, presenteeism rates were 10% and 12% higher for overweight and obese employees, respectively (CI 5%, 15% and 5%, 19%, all P < 0.01). Taken together, compared to normal weight employees, obese and overweight workers were estimated to cost employers $644 and $201 more per employee per year, respectively.

Conclusions: This study provides evidence that employers face a financial burden imposed by obesity. Implementation of effective workplace programs for the prevention and management of excess weight will benefit employers and their workers.

From the Thomson Reuters (Healthcare) (Dr Goetzel, Dr Gibson, Ms Short, Dr Chu, Ms Waddell, Ms Bowen), Seattle, Washington, DC; Institute for Health and Productivity Studies (Dr Goetzel), Rollins School of Public Health, Emory University, Atlanta, Ga; Division of Preventive and Behavioral Medicine (Dr Lemon), University of Massachusetts Medical School, Worcester, Mass; Department of Community and Preventive Medicine and Department of Pediatrics (Dr Fernandez), University of Rochester School of Medicine, Rochester, NY; Consulting Economist (Dr Ozminkowski), Ann Arbor, Mich; and Department of Health Promotion & Behavior (Dr Wilson, Dr DeJoy), College of Public Health, University of Georgia, Athens, Ga.

Address correspondence to: Ron Z. Goetzel, PhD, Thomson Reuters (Healthcare), Emory University, Rollins School of Public Health, Institute for Health and Productivity Studies, 4301 Connecticut Ave., NW, Washington, DC 20008; E-mail:

©2010The American College of Occupational and Environmental Medicine