Obesity is growing globally, with Americaleading the way. In the United States, the incidence of obesity isthe highest of all reporting countries and the trend continuesunabated. Research conducted by the Centers for Disease Control andPrevention over the past several decades shows:

• In 1990, among states participating in asurvey, 10 states had a prevalence of obesity less than 10 percent,and no states had prevalence equal to or greater than 15percent

• By 1999, no state had prevalence less than10 percent, 18 states had a prevalence of obesity between 20percent–24 percent, and no state had prevalence equal to or greaterthan 25 percent

• In 2009, only one state (Colorado) and theDistrict of Columbia had a prevalence of obesity less than 20percent. Thirty-three states had prevalence equal to or greaterthan 25 percent; nine of these states had a prevalence of obesityequal to or greater than 30 percent.

Intuitively, the implications of this trendfor workers' compensation are disturbing, and recent researchconfirms anecdotal data that work-related injuries are far morecostly if the injured worker is obese. Furthermore, thedramatically higher medical costs suggest that the types and natureof injuries sustained by obese workers, especially the morbidlyobese, are more likely to result in permanent disabilities.

A new study by the National Councilon Compensation Insurance (NCCI) advances this research byanalyzing the differences in outcomes between workplace injurieswith obese and non-obese claims. (Obesity is generally defined ashaving a body mass index of 30 or more. Morbid obesity is generallydefined as having a body mass index of 40 or more. However, ingeneral, workers' compensation claims data typically does notcapture weight, height, or body mass index information. Therefore,in this study, claims were categorized as obese when a medicalprovider includes on the billed medical transaction a diagnosiscode indicating obesity.)

The NCCI paper, “HowObesity Increases the Risk of Disabling Workplace Injuries,” reports on differences in injury types and treatment patternsbetween a sample of more than 7,000 claims with obesity as asecondary diagnosis and another 20,000 claims with virtuallyidentical characteristics — primary diagnosis, gender, industrygroup, year of injury, state, and approximate age — but no obesitydiagnosis.

Key Findings
The study concludes that there are systematic differences in theoutcomes for obese and non-obese claimants with comparabledemographic characteristics. The study also concludes that there isgreater risk that injuries will create permanent disabilities ifthe injured worker is obese.

Case studies indicate that, in general, evenwhen both the obese claim and non-obese claim are the same injurytype, the range of medical treatments, costs, and durationtypically is greater for obese claimants. (These examples, however,also indicate that there is considerable variation at theindividual claim level and that in some cases the non-obese claimmay be more costly.)

Case Studies
For the case studies examined, treatment categories that tended tobe the primary cost drivers included physical therapy, complexsurgery, and drugs and supplies.

In one case study, two claims were submittedfor “Lower Leg Injury Not Otherwise Specified.” Both claims weremedical only and the obese had significantly more treatments andcosts. The non-obese claim was treated only with an office visit,two X-rays, and a drug or supply the day after the injury, whiletreatments for the obese claim occurred over a period of more than200 days after the injury. In total, the obese claim had more than10 times the number of treatments than the non-obese claim had.

Another study, this one involving two claimsof “Sprain of Shoulder/Arm Not Otherwise Specified”, compared anon-obese medical-only claim and an obese permanent partial claim.The obese claim was significantly more costly due to an entirerange of treatments including physical therapy and complex surgerythat the non-obese claim did not incur. Essentially, the non-obeseclaim had only an office visit, X-ray, and drug treatment the dayof the injury and a follow-up office visit the next day. In total,the non-obese claim had four treatments, while the obese claim hadmore than 75. A major cost driver for the obese claim was complexsurgery.

Harry Shuford is a practice leader andchief economist with NCCI. Tanya Restrepo is an economist.