title: Obesity, fitness, willingness to communicate and health care costs.
abstract: BACKGROUND
  Obesity and low levels of physical fitness are independently associated with a variety of diseases and disorders. These conditions are modifiable and affect health care utilization. The degree to which these health risks are modifiable is directly related to the readiness of individuals to change the underlying behaviors. This study analyzes the relationship between health care costs, obesity, physical fitness, and willingness to communicate. In addition, we tested the hypothesis that willingness to communicate is directly associated with an individual's readiness to change behavior.
  
  
  METHODS
  Multiple regression was used to estimate the relationship between adverse behavioral health outcomes, willingness to communicate, and annualized health care costs incurred over a period of 33 months before the completion of a health risk assessment survey in an employed population enrolled in a Midwestern managed care organization (N = 8822).
  
  
  RESULTS
  High body mass index (BMI), low physical fitness (predicted VO2max), and greater willingness to communicate were directly and significantly (P < 0.05) associated with higher health care costs. Relative to low-risk, annualized health care costs for each of the high-risk factors were 8% higher for BMI (rate ratio, 1.08; 95% confidence interval, 1.01-1.15), 10% higher for low predicted VO2max (rate ratio 1.10, 95% confidence interval, 1.02-1.18), and 22% higher for willingness to communicate (rate ratio, 1.22, 95% confidence interval, 1.14-1.30). The association between these health risks and health care costs was independent of age, sex, age-sex interaction, role-mental and role-physical limitations, and nine chronic conditions. Furthermore, willingness to communicate was directly related to a greater readiness to change behavior.
  
  
  CONCLUSIONS
  The prevalence of obesity and low physical fitness is high, and these health risks are directly related to health care costs. Willingness of health plan members to communicate around health improvement opportunities appears greatest among those who incur higher costs, and these patients also have more favorable readiness to change profiles. Effective, proactive population-based health improvement efforts appear to have significant potential for positive economic impact.
authors.affiliation: HealthPartners, Center for Health Promotion, Minneapolis, MN 55440-1309, USA. nico.p.pronk@HealthPartners.com
authors.forename: N P
authors.initials: NP
authors.lastname: Pronk
authors.forename: A W
authors.initials: AW
authors.lastname: Tan
authors.forename: P
authors.initials: P
authors.lastname: O'Connor
mesh_terms: D000328:Adult; D000367:Age Factors; D001294:Attitude to Health; D015992:Body Mass Index; D002908:Chronic Disease; D003142:Communication; D016001:Confidence Intervals; D005260:Female; D015438:Health Behavior; D017048:Health Care Costs; D006293:Health Promotion; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009765:Obesity / Q000191:economics / Q000503:physiopathology / Q000523:psychology*; D016017:Odds Ratio; D010101:Oxygen Consumption / Q000502:physiology; D010809:Physical Fitness / Q000502:physiology*; D015995:Prevalence; D012044:Regression Analysis; D018570:Risk Assessment; D012309:Risk-Taking; D012737:Sex Factors