Obesity can be a sensitive subject — and for good reason. People with obesity face weight stigma, or discrimination rooted in negative ideologies about body size, in almost every area of their lives. The workplace is no exception; according to the World Obesity Federation, people with obesity experience salary disparities, fewer promotions, harsher disciplinary actions, discrimination during interviews and higher contract termination rates.
For some, the bias is layered on top of other common biases related to race, ethnicity and other identity characteristics, a concept referred to as intersectionality.
In April, the Northeast Business Group on Health, an employer-led coalition of business leaders and healthcare stakeholders, released “Obesity, Diabetes and Racial Health Equity: What Employers Can Do.” The guide is intended to help employers improve benefits-related outcomes for employees with obesity and diabetes, a commonly associated condition, with a special focus on employees of color.
“The science of obesity is unequivocal that obesity is a disease, not an individual’s fault or merely a product of lifestyle choices or environmental conditions,” the guide stated. “People with obesity are often viewed as lacking willpower or self-control and having psychological problems that limit their ability to restrict food intake.”
The weight stigma that arises from misunderstandings about the condition isn’t just a psychological tax on workers with obesity, the guide noted. It also results in underuse of healthcare benefits that can treat the condition and potentially improve their quality of life.
The following are five tips for employers from NEBGH’s guide.
Analyze healthcare uptake along racial and ethnic lines
First, to understand the effectiveness and equity of health benefits, employers can implement a structural approach to collecting benefits data, including analyzing claims by race and ethnicity. This can be a privacy issue with small employers, Dr. Mark Cunningham-Hill, medical director at NEBGH and one of the report’s authors, told HR Dive. “But if you’re an employer with several thousand or tens of thousands of employees, then you can start getting some aggregate data and looking at … age, sex, ethnic origin,” he said. “Most of that data is collected by health plans. You just need to ask for the data.”
After identifying where gaps in usage exist, NEBGH recommends asking employees for their input. “Shifting the conversation from ‘why aren’t you engaging in what we offer?’ to ‘what about our benefits and programs isn’t working for you?’ assures people that their opinions are valued, more effectively invites them to get involved in a process, and encourages them to remain engaged,” the guide stated.
Employee resource groups can also be helpful. “Employees are not expected to be experts on health issues like obesity and diabetes, but they can share experiences, raise issues and describe challenges they and others may face,” the guide points out.
Review healthcare options to ensure comprehensive coverage is available
For employees with obesity looking to better understand and treat the condition, it can be difficult to know where to start. “Primary care isn’t necessarily equipped for this,” Andrew Schneider, medical accounts associate director of Novo Nordisk and an expert consulted for the report, told NEBGH. “We are so far behind when it comes to [the] obesity management landscape, and we have a population void of any systematic treatment approach.”
Even more challenging, only about 5,000 physicians nationwide are certified in obesity medicine. While it may “sound like quite a lot,” Cunningham-Hill said, it works out to roughly 1 doctor per 20,000 patients, if every person with obesity were paired with a trained doctor.
Still, employers can help. The guide points to a collated list of doctors from the Obesity Medicine Association, which employers can check against their insurance options to evaluate access and look toward improvement.
Reduce financial barriers to benefits uptake
In addition to reviewing healthcare plans for specialist accessibility, employers can look closely at the costs associated with using the plans. “Reducing financial barriers such as high deductibles and out-of-pocket cost sharing has been shown to improve medication adherence, reduce health care spending and mitigate health disparities among certain racial and ethnic groups, including Black and Hispanic people,” the guide said.
Employers may be able to make certain visits or procedures exempt from high deductibles or copayments, such as regular check-ups, BMI screenings and consultations with obesity specialists. They can make anti-obesity medications exempt from deductibles or cost-sharing, or they can find insurance with a low, fixed-dollar copayment for such medications. They can provide coverage for bariatric surgery when desired, along with follow-up care. (The guide also includes a list for reductions in diabetes-specific costs.)
Larger employers have more leeway to craft their options than the smaller ones, Cunningham-Hill said. “They can design and customize what’s in and what’s out. … The question is how much the companies have the will to go and sit down with the health [insurer] and say, ‘No, we want this, this and this,’” he said.
Make sure benefits communications are clear and representative
Sometimes, the problem isn’t that benefits aren’t available — it’s that employees don’t know what they have access to. Employers can provide more than just the standard meeting during open enrollment, when health plans are quickly glossed over, leaving many workers overwhelmed. NEBGH suggests having information available in different formats (videos, flyers, etc.) and different languages. It also suggests providing tools that make it easy for employees to identify which plan options cover their specific needs and provide care management for obesity and diabetes.
It’s also important to make sure employees feel represented among the health materials provided, NEBGH noted. “Benefits leaders need to be intentional about making sure employee populations can see themselves reflected in health and benefits communications,” the guide said.
Ask healthcare vendors about DEI values and practices
Finally, employers can do their part to work with healthcare partners that prioritize DEI and work toward specific diversity-related goals. NEBGH suggested employers ask questions like “How do you engage users in evaluating how well your offerings meet their needs? How do you ensure that feedback reflects diverse users?” and “What is your strategy for understanding those you’re not reaching?”
Employers can also evaluate plans’ cultural competence by looking at their Healthcare Effectiveness Data and Information Set and Consumer Assessment of Healthcare Providers and Systems scores, the guide said. These programs aim to improve healthcare performance outcomes and patient experience through data-gathering and evaluation.
Finding healthcare partners that provide up-to-date, unbiased and patient-centered care can be crucial in encouraging employees to engage with their benefits. A June 2021 study of 14,000 adults across six Western countries found that among those who reported a history of weight stigma, two-thirds reported experiencing it from doctors.
“Across all six countries, after accounting for demographics, BMI, and experienced stigma, participants with higher internalized weight bias reported greater healthcare avoidance, increased perceived judgment from doctors due to body weight, lower frequency of obtaining routine checkups, less frequent listening and respect from providers, and lower quality of healthcare,” the study noted.