By Healthesystems
An injured worker’s recovery is influenced by many factors – type of injury, adherence to physical therapy or medication regimen, and so on – but perhaps the greatest indicator of longer recovery times is comorbidities. According to a 2024 Healthesystems survey of workers’ comp stakeholders, 65 percent of respondents say comorbidities are the number one barrier to injured worker recovery.
And one of the most prevalent comorbidities in the United States is obesity. More than 2 in 5 U.S. adults are obese, according to the Centers for Disease Control. The World Health Organization summarizes obesity as a chronic complex disease defined by excess fat deposits that can impair health, noting that anyone with a Body Mass Index (BMI) of 30 or more is considered obese.
Beyond negatively impacting a person’s health, obesity has other implications for injured workers. It can be a catalyst for the injuries themselves, and afterward, it can increase healthcare costs and lengthen time away from work. Let’s look at the impact of obesity on overall health, injury risk, and recovery.
Risk Factors for Obesity
In 2013, the American Medical Association voted to recognize obesity as a disease rather than a comorbidity factor. This means it is considered a medical condition that requires treatment.
According to the Centers for Disease Control, the risk factors for the disease of obesity include:
- Health behaviors such a lack of physical activity and unhealthy eating patterns
- Health conditions such as polycystic ovary syndrome (PCOS) or hypothyroidism
- Medications such as antidepressants, steroids, and blood pressure and diabetes drugs
- Systems and environment such as access to healthy food and safe places for physical activity
- Stress
- Genes
Obesity may also be caused by injury itself. A study in the Journal of Occupational and Environmental Medicine found that the risk of clinically significant weight gain doubled for workers who were out of work for more than 180 days after an occupational back injury.
While some of the risk factors for obesity are out of a person’s control – for instances, genes – some risk factors can be counteracted through behavior changes, diet, and exercise. Weight loss procedures such as gastric bypass and medications can also help.
Health and Recovery Complications
People who suffer from obesity are at increased risk for many health conditions. According to the Centers for Disease Control, these include:
- High blood pressure, high cholesterol, and heart disease
- Type 2 diabetes
- Stroke
- Cancer
- Body pain and difficulty functioning
- Mental illnesses
- Sleep apnea and breathing problems
As mentioned, obesity can also be an impediment to recovery for injured workers. According to the Immunity scientific journal, excess fat can cause inflammation that slows the healing process. In addition to that, obesity can limit circulation, reducing blood flow to a wound. The pain caused by obesity can also increase injury-related pain.
A 2010 NCCI study concludes that there is greater risk that injuries will create permanent disabilities if the injured worker is obese. This may be because if a person is obese, an injury can make it especially difficult to participate in physical therapy as well as strengthening and endurance activities.
Obesity can even restrict pharmacy options. Breathing problems secondary to obesity can contraindicate certain medications, and high blood pressure and heart conditions secondary to obesity can also limit medications.
Impacts of Obesity on Workers’ Compensation
As it relates to workers’ compensation, obesity has a tremendous impact on claim frequency, cost, and duration.
Obesity can be a contributing factor to injuries. This is evidenced by a Duke Medical Center analysis which found that obese workers filed twice the number of workers' compensation claims as non-obese workers. A second study published in the Journal of Safety Research found that overweight and obese workers were 25 percent to 68 percent more likely to experience injuries than normal-weight workers. The most common types of injuries were sprains/strains/twists, cuts, and fractures.
Obesity also increases healthcare costs. A 2010 NCCI study found that claims with an obesity comorbidity diagnosis incurred significantly higher medical costs than comparable claims without such a comorbidity diagnosis. And the PLOS One scientific journal notes that obesity was associated with $1,861 excess annual medical costs per person (in 2019 dollars) and severe obesity was associated with excess costs of $3,097.
For workers with major injuries, high BMI is associated with higher workers’ compensation costs. The Journal of Occupational and Environmental Medicine found that costs averaged about $470,000 for obese workers compared to $180,000 for normal-weight workers.
Aside from costs, obesity negatively impacts workers’ comp claims in other ways. For instance, the Duke Medical Center analysis found that, compared to non-obese workers, obese workers had thirteen times the number of days absent because of work injury. And a 2013 California Workers’ Compensation Institute study shows that claims with obesity as a co-morbidity have had significantly higher rates of lost-time from work, permanent disability, and attorney involvement.
Obesity Drugs to the Rescue?
In the last few years, there have been several new drugs approved for the treatment of obesity, along with an increase in the off-label prescribing of certain diabetes medications for the treatment of obesity. Some of these popular obesity medications include Ozempic® and Wegovy®.
Compared with 2023, these therapies are even beginning to trend in workers’ comp prescription drug transaction data. While the overall number of scripts is still very small, the high cost associated with a single prescription can quickly have an impact on spend, making obesity medications a drug category to watch.
To learn more about new obesity drugs, read our RxInformer magazine article, Weighing the Options: Keeping Track of New Obesity Drugs.
