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Employers Slow to Address 'Metabolic Syndrome' Despite Sharp Impact on Health Costs

Awareness of the health condition, which is largely preventable through diet and exercise, remains low.

October 11, 2005
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A huge driver of health care costs in the workplace is a medical condition that most human resource professionals, CFOs or CEOs have probably never heard of.

    While it’s been discussed in the medical community for years and afflicts nearly 50 million Americans--almost one-quarter of U.S. adults--many employers aren’t aware of what’s known as "metabolic syndrome." It’s a diagnosis that has become increasingly common because of the obesity epidemic. Metabolic syndrome is a condition characterized by having a cluster of risk factors, such as hypertension, excessive abdominal fat, abnormal cholesterol, elevated levels of fats in the blood, called triglycerides, and insulin resistance or glucose intolerance.

    Alone, any one of these conditions usually can be treated, but together they dramatically increase the chance of heart disease, diabetes, liver and kidney disease, and possibly cancer. The underlying cause of metabolic syndrome is the body’s inability to use insulin efficiently. While some people are genetically disposed to the syndrome, others develop it from being overweight and not exercising enough.

    The prevalence of metabolic syndrome in Americans over age 40 has increased by more than 60 percent in the past decade, according to a report from the Mayo Clinic. The average yearly pharmacy cost of treating adult patients with metabolic syndrome exceeds $4,000. That’s more than four times the average annual amount spent on drugs for all other patients, according to recent data from Medco Health Solutions Inc.

    The health risks and costs associated with metabolic syndrome are yet another reason why employers need to be more proactive in encouraging their employees to lead a healthy lifestyle, says Dr. Robert Epstein, Medco’s chief medical officer. While more and more employers are offering programs to fight obesity, few are focusing on the combination of risk factors that make up metabolic syndrome.

    The syndrome is largely preventable through diet and exercise, and that’s what employers need to focus on when tackling the health care costs of this condition, he says. "(Metabolic syndrome) is really not on the radar screens as something that’s preventable or costly, and it ought to be," Epstein says. "It’s dramatically increasing … so it’s time for employers to get aggressive and do something about it."

Powering up prevention
   
One company that does have metabolic syndrome on its radar screen is GE Energy, which has been recognized for its cutting-edge program to address the health problem. A business unit of General Electric Co., Atlanta-based GE Energy, with almost 39,000 employees, is one of the world’s largest suppliers of technology to the power industry. The business uses a cardiovascular risk assessment to identify employees who are at risk for metabolic syndrome and then offers follow-up programs to help those employees reduce their chance of developing diabetes and heart disease.

    The programs are making a measurable difference. Results show everything from thinner waistlines to lower cholesterol counts to fewer employees being classified as having metabolic syndrome. There also is an initial projected savings of more than $750,000 in avoided health care costs. GE Energy’s risk assessment and follow-up Diabetes-At-Work program earned recognition earlier this year from the National Business Group on Health, which gave the company its President’s Award for outstanding performance and commitment to providing quality health care benefits to its employees.

    GE Energy’s programs, which take a disease management approach to help ward off future illnesses, are a model for how other employers should address metabolic syndrome, says Dr. Tom Barela, medical director for the Segal Co., a New York-based consulting firm.

    Employers need to have a very visible program that’s clearly supported by management, rather than just giving it lip service, which happens a lot, says Barela, a pediatric endocrinologist in Phoenix. "It has to be overt," he says. "There is no other medical condition that is potentially as pervasive for this country as metabolic syndrome."

    The impetus behind the programs at GE Energy was its medical director Dr. David Pratt, a public health expert, internist and lung specialist who was concerned about cardiovascular disease among employees.

    "We spend a lot of money on cardiac events," defined as a heart attack, the need for bypass surgery or a sudden cardiac death, says Dr. Donna Tomlinson, GE Energy’s health promotions manager, whom Pratt hired to help reduce the risk of cardiac disease among GE Energy’s workforce. Tomlinson is a physician with a specialty in preventive medicine and preventive cardiology. "We see it in claims and we see it in terms of people we work with--people who succumb to heart disease."

    Since it launched the cardiovascular risk assessment in 2002, GE Energy has screened more than 8,000 employees. Employees answer 11 health questions and are given a short exam to measure height, weight, girth and blood pressure. They also undergo a blood test to assess levels of lipids and glucose. A one-page report card predicts individuals’ risk of having a stroke or heart problem over the next 10 years and whether or not they have any of the metabolic syndrome risk factors.

    About 17 percent of those screened at GE Energy have metabolic syndrome, which means they have at least three or more of the five risk factors. In some locations, 40 percent of those assessed have metabolic syndrome.

    Being able to identify and help those employees who have metabolic syndrome is key in preventing other diseases. Metabolic syndrome doubles the risk of heart disease and increases the risk of developing diabetes by 30 percent. But simply screening employees has made a difference.

    GE Energy’s research found that for every 125 employees screened, one of those cardiac events is averted over the next 10 years. At a cost of $68 per assessment, it costs $8,500 to prevent one cardiac event, versus the estimated $40,000 health care cost of one event. In all, almost 25 events were avoided among the employees who were assessed, which translates to more than $750,000 in savings. "You can see how cost-effective that is," Tomlinson says. "We save lives and we save dollars."

Maintaining good health
    One of the follow-up programs to the risk assessment is the "0-5-10-25 Challenge." The numbers stand for using zero tobacco; eating five fruits and vegetables per day; walking 10,000 steps per day and keeping an optimal body mass index of 25. Using an online software application, employees sign up for the challenge, log in their diet and exercise data and receive bimonthly newsletters. Employees also can work one-on-one by phone or e-mail with health coaches who help them design their own diet and exercise regime.

    Almost 2,800 employees in 44 countries are enrolled in the challenge. Participants have shown a statistically significant increase in their intake of fruits and vegetables and in the amount of exercise they’re doing, and a statistically significant decrease in weight loss, according to a study of the data from 2002 to 2004. While some employees are working to lose weight and others to maintain their weight, in the past six months participants have shed a total of 4,600 pounds.

    There’s no big prize or incentive for employees, but they can enter raffles to win small fitness-related prizes, such as arm-band radios, water bottles and stability balls. E-mails nudge them to stay on track, but in the end, the motivation to stay fit comes from the employees, says Marcia Jandzio, GE Energy’s global health services manager.

    Employers are smart to put more of the responsibility on employees when it comes to making lifestyle changes, says Lale Iskarpatyoti, a consultant for Watson Wyatt in Philadelphia. "This is their life, about their health," she says. "Employers should be putting more of the onus on their employees." Employers, she says, are "paying the tab for something that’s a lifestyle choice."

    The third piece of GE Energy’s approach, the Diabetes-At-Work program, was launched last year to help employees with metabolic syndrome change their lifestyle and reduce their chance of developing diabetes and heart problems. In the six-month-long program, employees attend 11 lunchtime classes led by nurses. They learn ways to reduce their health risks by such things as controlling their blood pressure and avoiding saturated fats in their diet, and then do exercise at the end of class.

    The program was launched in Houston with 30 employees and has since been offered in other cities. The class in Houston saw measurable results. As a group, employees saw statistically significant drops in their total cholesterol, blood pressure, and glucose and triglyceride levels. Most dramatically, the number of metabolic syndrome risk factors dropped from an average of 3.2 to 2.4. For those who dropped to just two risk factors, that means they are no longer classified as having metabolic syndrome.

    "When people take our message to heart … it’s the kind of thing they have time to do something about," Tomlinson says. "They can make lifestyle changes to reduce the risk."

    What was key in launching the program was support from top executives, Tomlinson says. The 0-5-10-25 program was designed at the request of GE Energy CEO John Rice. When the programs were first launched at a meeting in Houston, Rice led a "Run With Rice" in which he went for a jog with the conference participants.

    General Electric CEO Jeffrey Immelt, too, touts the importance of staying fit. At a recent meeting with the African American Forum, he detailed to conference participants his daily workout regime, which includes time on the elliptical machine, treadmill and StairMaster, Tomlinson recalls. "Showing support for a healthy lifestyle--this is in our culture," she says. "This is supported at the top."

Workforce Management, October 10, 2005, pp. 68-70 -- Subscribe Now!

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