title: A multi-worksite analysis of the relationships among body mass index, medical utilization, and worker productivity.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Thomson Reuters (Healthcare), Emory University, Rollins School of Public Health, Institute for Healthand Productivity Studies, 4301 Connecticut Ave., NW, Washington, DC 20008, USA. ron.goetzel@thomsonreuters.com
authors.forename: Ron Z
authors.initials: RZ
authors.lastname: Goetzel
authors.forename: Teresa B
authors.initials: TB
authors.lastname: Gibson
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Short
authors.forename: Bong-Chul
authors.initials: BC
authors.lastname: Chu
authors.forename: Jessica
authors.initials: J
authors.lastname: Waddell
authors.forename: Jennie
authors.initials: J
authors.lastname: Bowen
authors.forename: Stephenie C
authors.initials: SC
authors.lastname: Lemon
authors.forename: Isabel Diana
authors.initials: ID
authors.lastname: Fernandez
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Ozminkowski
authors.forename: Mark G
authors.initials: MG
authors.lastname: Wilson
authors.forename: David M
authors.initials: DM
authors.lastname: DeJoy
mesh_terms: D000041:Absenteeism; D000553:Ambulatory Care; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004526:Efficiency; D006293:Health Promotion / Q000191:economics; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D009765:Obesity / Q000191:economics* / Q000503:physiopathology* / Q000517:prevention & control; D014481:United States; D017132:Workplace