City of Dallas Working to Cut Obesity Among Its Workers

City of Dallas Working to Cut Obesity Among Its Workers
Posted on 04/18/2014

Dallas News

Dallas hopes to shed its “Big D” moniker, at least as it applies to the health and fitness of city workers.

Of the nearly 21,000 people insured under the city’s health care plan, almost 80 percent are overweight or obese. That’s based on estimates derived from health assessment surveys taken by some plan members.

Dallas officials say that’s the highest rate of corpulence of any group insured through UnitedHealthcare, the company that administers the city’s health care plan. UnitedHealthcare serves more than 45 million Americans.

“It’s unacceptable,” said Mayor Mike Rawlings. “We’ve got some treadmills to get on around here.”

The mayor and others at City Hall are looking to foster culture change. They hope to boost participation in wellness and disease-management programs. The city has increased financial incentives for those who pursue healthier lifestyles, and it’s trying to raise awareness about the gravity of the problem.

The stakes go beyond the well-being of city employees and retirees, their spouses and other dependents.

Obesity is linked to serious — and costly — health problems, including diabetes, hypertension and cardiovascular disease. Given that the city contributes more than $65 million to its health plan each year, there’s a hefty pile of taxpayers’ dollars on the line.

The city of Dallas is far from alone in facing the obesity epidemic, which has ballooned across the United States in recent years.

More than 63 percent of Americans are overweight or obese, according to the most recent statistics from the U.S. Centers for Disease Control and Prevention. The Texas comptroller’s office has estimated that obesity will cost Texas businesses $32.5 billion a year by 2030.

Obesity rates are typically derived from the body mass index, a tool for estimating body fat through calculations based on height and weight.

It’s not the most precise tool, or the best indicator of overall health. At 6-6 and 261 pounds, for example, Jason Witten, the Dallas Cowboys’ muscular tight end, would be considered obese based on his body mass index.

Still, health officials say, the index provides a useful baseline. A guy who’s 5-8 and 200 pounds has about the same body mass index as Witten, and that guy’s far more likely to be downing tacos than scoring touchdowns.

For those battling the bulge at City Hall, the challenges go deep.

More than 37 percent of city employees are obese, meaning they have a body mass index of 30 or higher. More than 5 percent are morbidly obese, with a body mass index of 40 or higher.

The incidence of hypertension in Dallas workers is 40 percent higher than in peer cities and 51 percent higher than what should be expected, based on the demographics of those on the city’s health plan.

The rate of diabetes with complications is 11 percent higher than in peer cities, and 26 percent higher than expected.

“There’s no question we have a problem,” said Molly Carroll, the city’s human resources director.

But why is the problem worse here?

One factor is the age of the city’s workforce. The average municipal employee in Dallas is 3 years older than in comparable cities. As if you hadn’t noticed, we tend to put on pounds as we get older.

Also, Dallas city workers have fewer dependents covered under the city’s health plan than do workers elsewhere. Dependents usually means kids. While childhood obesity is itself a huge problem, it’s not as bad as for grownups.

And in truth, the obesity and overweight numbers might look bad in part because Dallas is finally getting a handle on the problem.

The city has long had a wellness program, but it didn’t ramp up its efforts in earnest until last year.

That’s when a shift was made to an approach that provides incentives to people who get serious about staying fit, said Dolores Lewis, the city’s benefits manager.

A points system was established to give users opportunities to save money by either being healthy or trying to get that way.

If an employee gets an annual physical, for instance, that’s 100 points. Taking a health risk assessment earns 50 points. Meeting targets for blood pressure, body mass index, cholesterol and glucose level count for 25 points each.

The goal is to reach 250 points. That qualifies an employee for a $20 monthly discount on health premiums, or, if the employee has a health reimbursement account, an additional $300 for the year.

Points can also be earned other ways: by attending educational seminars, signing on to behavior modification programs, or simply hitting the gym.

The efforts — hundreds of city workers now show up for health seminars, officials say — mean Dallas is starting to gather better data on the extent and cost of health problems.

An employee who is earning points or participating in disease management programs costs the city health plan nearly $4,100 a year, officials said. One who isn’t costs almost $5,300.

“There’s a tremendous opportunity here,” City Manager A.C. Gonzalez said. “Instead of spending our money chasing a problem, we could be spending less preventing a problem.”

It could be awhile before the city makes a real dent, although there was a slight decrease over the past year in the obese and overweight numbers.

But other employers have proved that sweeping change can happen.

Dallas-based Methodist Health System is just now seeing progress in an employee health program the hospital company launched five years ago.

Participation rates are way up. This year, the company saw the percentage of employees who are overweight or obese drop from 60 percent to 55 percent.

“It takes time,” said Carrie Camin, Methodist’s assistant vice president over wellness.

The city of Dallas, which partners with Methodist on some wellness programs, is trying to accelerate its timeline by thinking creatively.

Take a pilot program established last year in the streets department to allow employees to focus on fitness during work hours.

A healthy lifestyle is especially important in that department, since commercial driver’s licenses typically prohibit a dependence on insulin, used to treat diabetes.

Those who signed up for the pilot program saw measurable results, officials said. More important, many of them continued their healthy habits off the clock, even after the pilot ended. So the city is looking to start a similar effort this year in the aviation department.

“We’re not where we want to be,” Carroll said. “But the first thing is admitting you have a problem.”

Follow Tom Benning on Twitter at @tombenning.