Bonuses or salary increment should not be given to obese healthcare

personnel

Definition: Obese- BMI>30; Healthcare personnel (HCP)- persons who have special
education on health care and who are directly related to provision of health care
services, such as doctors, nurses, medical assistants and therapist.

Necessity of this issue:

1. Obesity is a disease
Evidence: The American Medical Association and Canadian Medical Association has
recognized that obesity is a disease in 2013 and 2015 respectively.

2. Obesity is increasing in trend in Malaysia

Evidence: The 2015 National Health and Morbidity survey supported this fact by
revealing that nearly half of the Malaysian population aged 18 and above (47.7
percent) were overweight or obese. Obesity is a catalyst for chronic diseases like high
blood pressure, high cholesterol and diabetes. Obesity rapidly increases the risk of
chronic disease. The survey also showed a rapid rise in chronic diseases among
Malaysians. 30.3 percent of Malaysians aged 18 and above suffer from high blood
pressure, 47.7 percent have high cholesterol levels and 17.5 percent have diabetes.

3. Healthcare burden bound to increase as a result of this

Evidence:
Two types of costs are associated with the treatment of obesity and obesity-related
conditions:
Direct costs are those that result from outpatient and inpatient health services
(including surgery), laboratory and radiological tests, and drug therapy.
Indirect costs, which have been defined as resources forgone as a result of a health
conditions fall into various categories:
Value of lost work. Days missed from work are a cost to both employees (in
lost wages) and employers (in work not completed). Obese employees miss
more days from work due to short-term absences, long-term disability, and
premature death than non-obese employees.

According to McKinsey Global Institute, obesity one of the top three global social
burdens generated by human beings. This places obesity on the same scale of impact as
smoking and armed violence, war and terrorism. Obesity alone has made an impact of
roughly US$2 trillion. For a sense of scale, smoking makes an impact of about US$2.1
trillion. The same report mentioned that 20% of all healthcare spending attributable
to obesity, through related diseases such as type 2 diabetes and heart disease. Lets not
forget the overall economic productivity and employers are both affected by impaired
productivity.

Malaysian Association for the Study of Obesity (MASO) had already published a paper
in 2015 that would show the economic costs of obesity are important issues, not just
for healthcare providers, but also for policy makers.
Malaysia holding the award for the highest rate of obesity in Asia with 45.3% of the
national population categorized as obese, and computing it with the above, it would
not be that much of a leap of logic to infer that the possibility of a loss of productivity
in any company in Malaysia is that much higher compared to other countries.

It boils down to simple mathematics. With a higher rate of obesity, there is a higher
chance that someone working is obese, which, when coupled with the higher chances
of illness among the obese, would lead to a higher possibility of a loss of productivity.

If this were to happen, we would in turn face a dip in numbers among productive
healthcare workers. Theoretically, it seems likely that the nation could very well grind
to a halt if the variable of the rate of obesity is maintained. It is a scary thought to
imagine that a country could be brought low by its own people that way.

4. HCP are educated in diseases, understand the ramifications of obesity, they

should set good examples to be more convincing in their message

Root cause of the problem:

1. Long working hours, hostile work environments among healthcare personnel
2. Lack of amenities and gym facilities in hospital for usage
Evidence: American Journal of Preventive Medicine recognizes that these issues are
contributed to higher obesity rates. Analyzing data from the 2010 National Health
Interview Survey and adjusting for confounding factors such as race, gender, and
smoking, researchers identified health care (32% of HCP are obesed).

Singapore Medical Journal article identify that 30.1% of HCP are obese under WHO
classification.

3. The HCP have knowledge, but to have real behavioral changes, avenue must
be provided (eg. tutor, yoga classes, gym)

It begs the question, this contradiction of obesity in the health care industry... Could
changing the work environment help reduce the high incidence of obesity among
health care workers? Do current work schedules contribute to overeating, stress, and
too few healthy food choices, especially for evening and overnight shift workers?
Should exercise facilities be made available on the premises, or at least a room for
yoga, Pilates and relaxation techniques?

Ironically, the health care profession is in the best position to implement a healthier
work environment among its employees, because it is the health professionals who are
telling the rest of us how to eat, exercise, decrease stress, and live more balanced lives.
If they take care of their own by making it easier for them to maintain a healthy
lifestyle, the health profession will be an example for the rest of us. But if they are not
interested or fail, then the take-away message for the patient is, Do what I say, not
what I do.
Policies:
1. By not giving bonuses to healthcare personnel, we are providing them with
real concrete reasons to start rectifying the issues.
2. We send messages across nation that we are fiercely committed in fighting
against obesity
3. Impracticality issues: Incentives, rewards are increased cost. The problem is
not just about money, but the root cause of problem- long working hours and
lack of accessibility to gym facilities.
You cannot spend something that you didnt earn, or the country could go
bankcrupt
Evidence:
The UK National Health Service partnered with a weight loss incentive firm, Weight
Wins, to trial the Pounds for Pounds program, where participants who achieve and
maintain weight-loss targets under medical supervision receive payments up to 425.
Six hundred obese participants, with an average starting weight of 218 pounds, lost an
average of 14 pounds in six months and 29 pounds over 12 months if they stayed active
in the program.

In Germany, health insurers permit individuals to accumulate points for healthy

behaviour, such as participating in nutrition classes, fitness programs or tests of
endurance, strength and coordination. Points are redeemable for rewards such as
bicycle helmets, sports watches or Wii Fit consoles. People can qualify for cash
payments if they meet body mass index, blood pressure and cholesterol targets. The
largest national health insurer in South Africa offers a health promotion program in
which members are eligible for discounted gym memberships and accumulate points
for engaging in fitness activities. A study published in American Journal of Health
Promotion analyzing five years of data from the program revealed that engagement
in fitness-related activity increases with continued membership [in] an incentives and
rewards-based health promotion program (Patel et al. 2011). Additionally, members
with higher levels of physical activity had fewer health insurance claims and lower
hospital admission rates for cardiovascular, endocrine and metabolic diseases and
cancers (Patel et al. 2010).

Companies are also offering incentives for employees to adopt healthier lifestyles. A
major US healthcare company, Indiana University Health (formerly Clarian Health)
offers a bonus of up to $30 each pay period for employees who meet specified health
targets. IBM created a childhood obesity prevention initiative that offers parents up to
$150 for completing a 12-week program aimed at improving nutrition and physical
activity in families with children.

Financial incentive not effective in long-term basis as evidence in Systematic review of

the use of financial incentives in treatments for obesity and overweight published in
Obesity Review Journal. Journal of General Internal Medicine: An RCT on financial
incentives showed that that people who receive short-term incentives typically fare no
better a year or more later in sustaining weight loss than those who did not receive
payments.

However, an article in BMJ shows that it may be advantageous to offer incentives for
weight loss or maintenance of healthy body weight to high-risk groups in contact with
the healthcare system. Healthcare Education Journal shows that A promising finding
of some studies is these group of who received additional assistance, such as
personalized fitness training and nutrition counseling they achieved weight loss by
modifying their diet (97%) and getting more exercise (86%).

4. The salary increment/bonuses will be converted into health coupons that

HCP can use to attend gym classes
5. The savings can be redistributed into investment in facilities and
infrastructure
6. Long working hours stem from insufficient HCP into employment. Savings
can also allow more HCP to be employed
7. We also take care of HCP by giving them chance to take care of their own
health, indirectly they become the advocate of health

Pros/Cons:
1. Continue to give them bonuses and salary increment; they will continue their
cavalier attitude. Hence, they become poor messenger to the general public.
Maintaining status quo is not an option.
2. Bonuses and salary increment save could be converted into healthcare
coupon, allow government to work with private industry to ramp up effort
on exercise and healthy living
3. Could also be used to invest in gym facilities in hospital
4. The impracticality of incentives: will only increase costs, our financial
structure may not be sound enough to resolve this issue
5. Taking good care of ones health is in itself a reward. Plus theres no
guarantee that incentives will work just as well as behavioral changes need
more than just incentives and financial motivation to sustain.
6. It needs to be translated into avenues allowing HCP to exercise and workout,
which in turn is added cost, but by decreasing the bonus, we help shoulder
the impact on our national budget

The problem: Even though youre saying that youre giving discounts, people see it as
being penalized, she said. So it is very controversial. Thats called outcomes-based
incentives, and I would never encourage a client to start with that, because its
definitely very controversial and may not be very well received.

Whats a better way? How the whole issue is framed is very important, according to
director of wellness at Tufts Health Plan, Ludovici said. The government can explain
that its putting its faith in its workers, counting on them to try to get healthier even
though. It can use its wellness program to help give employees the sense that theyre
cared about, she said, and working in a good place oriented toward high performance.
She, herself, has been known to use a car-insurance analogy: If youre a high-risk
driver youre going to have to pay more in premiums. And I think the industry is
driving excuse the pun in that direction. If you want to eat triple cheeseburgers
every day, go ahead, but youll pay more.

Mari Ryan of AdvancingWellness, chair of the board of directors of the new Worksite
Wellness Council of Massachusetts, says similarly that she would recommend starting
a wellness program by first explaining to employees how their health is important
both to them and to the whole company. Self-care can be a company value.

She would never advise going right to a standards-based program that offers
rewards for reaching health goals; rather, she said, she would focus on creating a
supportive environment: through, say, smoking policies and smoking cessation
programs, or putting healthier food in vending machines.

Anne Marie Ludovici says that she sees the key as engagement rather than
accountability. Our philosophy at Tufts is we try to keep people engaged in health
coaching if they need it, she said, and keep them engaged in the behavioral change
programs that will result in those improved outcomes. That feels right to me. I ran the
governors initiative in Rhode Island, and I saw that what was really getting people
excited was being part of a healthy culture where employees thrive and feel this is a
great place to work. And focusing on outcomes could really defeat that whole purpose.

Citations:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298019/
2. http://www.kinibiz.com/story/issues/131892/the-obesity-crisis-and-its-
part-in-malaysia.html
3. http://abcnews.go.com/Health/study-finds-55-percent-nurses-overweight-
obese/story?id=15472375
4. http://www.huffingtonpost.com/judith-j-wurtman-phd/why-are-
healthcare-worker_b_8330804.html
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879173/
6. http://commonhealth.legacy.wbur.org/2012/09/wellness-program-legal-
limits