Response to ACOEM Guideline Statement on Obesity in Workplace

| February 1, 2018 | 0 Comments

by Shanu N. Kothari, MD, FACS, FASMBS

Director of Minimally Invasive Bariatric Surgery, Gundersen Health System in La Crosse, Wisconsin

Bariatric Times. 2018;15(2)24

Several years ago, our former CEO hired a senior vice president from a very successful manufacturing business that had nothing to do with healthcare to help run our health system. When challenged on his choice, he defended his decision quite well, stating “He kept his cost of care lower for his employees in his manufacturing business than we did for our employees, and we are in the healthcare business!”

The responsibility (economics) of healthcare is no longer relegated to just those directly involved in taking care of patients. Traditionally, the three key players were hospitals, doctors, and insurance companies. Now, employers are taking the initiative in managing the health of their employees and, specifically, the cost of care regarding the disease of obesity. The impact that obesity has on the workforce with regard to absenteeism and disability is substantial, and employers are taking notice. The American College of Occupational and Environmental Medicine (ACOEM) took the lead in conjunction with a 15-member panel that included American Society for Metabolic and Bariatric Surgery (ASMBS) thought leaders to review the evidence of obesity in the workplace. They sought to develop a comprehensive guidance statement to aid employers in understanding the role that obesity prevention, treatment, and bariatric surgery play in the management of patients suffering from obesity.

A unique aspect of the ACOEM statement was the recommendation to abolish the insurance-mandated six-month weight loss requirement for bariatric surgery that is often seen by employees as a barrier to access to care. In addition, employers are encouraged to cover bariatric surgery in prospective patients with a body mass index (BMI) of 30 to 35kg/m2 and diabetes based on the growing body of level one evidence supporting the positive impact that early bariatric intervention can have on patients with type 2 diabetes.

ASMBS thought leaders involved in the project included Stacy Brethauer, MD; John Morton, MD; David Sarwer, PhD; Mitchell Roslin, MD; and myself.

It is clear that the business of healthcare is now every employer’s business. The ACOEM Guidance Statement can guide employers, both large and small, in their ability to control costs of care with regard to obesity, provide lifestyle and behavioral interventions, and expand coverage and access for employees qualifying for bariatric surgery.

The full guideline statement can be viewed at:,_Outcomes,_and.15.aspx  



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