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The following information was derived from the journal publication: Job Absenteeism Costs of Obesity in the United States – National and State-Level Estimates published by Cawley et al in the July, 2021 issue of the Journal of Occupational and Environmental Medicine.¹ This article is significant in that it provides the first estimates of the causal impact of obesity on job absenteeism and the associated substantial productivity loss per worker at national and state levels.

Introduction

The rising prevalence of obesity in the United States (U.S.)^2–4 imposes a substantial economic burden due to both direct medical care costs and indirect productivity-related costs. The latter includes increased job absenteeism, presenteeism, disability, and payments from workers’ compensation insurance.^5–10 Individual studies and systematic reviews of the literature have found consistent evidence of an association between obesity and loss of workdays or productivity at work.^11–16

Impact of BMI on Job Absenteeism

Based on pooled national data, an additional unit of BMI raises the number of days that an individual missed work because of injury or illness by .24 days per year. The estimate of productivity loss per worker per year associated with an additional unit of BMI ranged from $21.32 (assuming only half of each day was affected) to $42.64 (assuming all of each day was affected).¹

Impact of Obesity on Job Absenteeism

Compared to individuals with normal weight, obesity raises job absenteeism by 3.00 workdays, from 2.34 to 5.34 days (128.2% increase), at the national level. The impact of excess weight on absenteeism rises with class of obesity; national-level per-worker job absenteeism was higher by 2.07 days for those with class 1 obesity, 3.67 days for those with class 2 obesity, and 7.13 days for those with class 3 obesity, compared to workers with normal weight.¹

Impact of Obesity on Value of Lost Productivity Per Worker due to Job Absenteeism

The study by Cawley et al1 demonstrated among 5 states (California, Texas, Virginia, Wisconsin, and Michigan) that average annual productivity loss per worker due to obesity ranged from $270.79 (assuming a half day was lost) to $541.58 (assuming a full day was lost). Among these states, annual productivity loss per worker caused by obesity had the following lower and upper bounds: $221.83 to $443.67 in California, $228.38 to $456.75 in Texas, $293.27 to $586.53 in Virginia, and $255.18 to $510.36 in Wisconsin. Michigan differed from the other states in the analysis, with individual productivity loss ranging from $911.73 to $1823.45.

By class of obesity, the productivity loss in the national sample was $186.65 to $373.31 for those with class 1 obesity, $331.66 to $663.32 for those with class 2 obesity, and $643.27 to $1,286.54 for those with class 3 obesity. The five states exhibited a similar pattern by class of obesity, with the greatest range in Michigan.

Aggregate Work Productivity Loss due to Obesity

In 2016, across the U.S., obesity was responsible for productivity losses that ranged from $13.42 billion to $26.84 billion, for half and full day productively loss, respectively. Estimates indicate that the aggregate productivity losses rose from 2001 to 2016. Productivity losses in 2016 varied by state, with costs in Texas ranging from $2.09 billion to $4.17 billion and those in Virginia ranging from $0.28 billion to $0.56 billion. As seen with the previous analyses, the greatest costs were for Michigan, where obesity was responsible for between $2.23 billion and $4.47 billion in productivity losses.¹

Summary

This 2021 study by Cawley et al provides the first-ever estimates of the causal effect of obesity on job absenteeism in the U.S., at the national and state level, both in terms of lost workdays and the dollar value of the lost productivity. National estimates indicate that obesity (relative to normal weight) raises the number of workdays lost to illness or injury by three days per worker per year (from 2.34 to 5.34), or by 128.2%. The impact of obesity on job absenteeism and productivity loss is more pronounced in some states compared to the others. The impact of excess weight on absenteeism rises with class of obesity, to an estimated seven workdays lost for an employee with class 3 obesity (relative to a worker of healthy weight). These lost workdays translate to a per-worker annual productivity loss caused by obesity ranging from $270.79 (assuming that only half of the affected workdays were lost) to $541.58 (assuming that the full workdays were lost). When class of obesity is considered, the lower (upper) bound of the per-worker productivity loss per year is $186.65 ($373.31) for individuals with class 1 obesity, $331.66 ($663.32) for those with class 2 obesity, and $643.27 ($1286.54) for those with class 3 obesity.

Aggregated at the U.S. national level, the total annual productivity loss due to obesity in 2016 ranges from a lower bound of $13.42 billion (assuming half-workdays lost) to an upper bound of $26.84 billion (assuming full workdays lost), both in 2017 dollars. The increase in productivity loss between 2001 and 2016 could be explained by a combination of factors including a growing adult population in the U.S., the rising prevalence of obesity, increases in hourly wages (above and beyond that of general inflation), and changes in clinical complications of people with obesity (e.g., number and type of comorbidities).

Relevance to Employers

The finding that obesity among employees increases missed workdays is relevant for employers. One margin by which employers can potentially promote healthy weight among their employees is by their choice of health insurance plan, in particular the extent to which it covers effective treatments for obesity. Another margin is that employers can take advantage of the increased flexibility for workplace wellness programs provided by the Affordable Care Act (ACA), for example, by offering incentives for healthy weight. However, evidence on the effectiveness of workplace wellness programs is mixed.¹⁷ However, there are numerous methods of obesity prevention and treatment that have been found to be effective and cost-effective.¹⁸

References

1. Cawley J, Biener A, Meyerhoefer C, Ding Y; Zvenyach T, Smolarz B, Gabriel M, Ramasamy A. Job absenteeism costs of obesity in the United States – national and state-level estimates, 2021 issue of the JOEM 2021; 63:565-573.
2. Revels S, Kumar SAP, Ben-Assuli O. Predicting obesity rate and obesity-related healthcare costs using data analytics. Health Pol Technol 2017; 6:198–207.
3. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA 2016; 315:2284–2291.
4. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 2016; 387:1377–1396.
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17. Jones D, Molitor D, Reif J. What do workplace wellness programs do? Evidence from the Illinois Workplace Wellness Study. Q J Econ 2019; 134:1747–1791.
18. Cawley J. An economy of scales: a selective review of obesity’s economic causes, consequences, and solutions. J Health Econ 2015; 43:244–268.