Diabesity: A Perfect Storm of Comorbid Conditions
There’s an alarming health trend, related to growing rates of obesity and diabetes, called Diabesity. In this WorkersCompensation.Com feature, Nancy Glover uncovers how these two comorbidities are affecting the workers' compensation industry – from reduced productivity to increased absenteeism. Catch the entire article, featuring National Product Leader for Physical Therapy Michelle Despres, and learn ways to best manage claims affected by diabesity.
Sarasota, FL (WorkersCompensation.com) - More than 7 million people are walking around with diabetes and have no idea they have it. While many have no symptoms, they are more often than not also obese. The marriage of these two comorbidities is increasingly being seen among American workers, causing reduced productivity and higher absenteeism.
For the workers' compensation system the combination is even more problematic, leading to an increased rate of injuries, slower recoveries, and higher costs. Stakeholders seeking to mitigate the development and effects of these comorbidities need to understand the issue and implement best practices to manage affected claims.
The combination of obesity and diabetes, being referred to as ‘diabesity,' is associated with a variety of risk factors, explained Michelle Despres, VP and National Product Leader for Physical Therapy at One Call. During a webinar on the emerging comorbid condition, she cited:
More low back injuries
Additional comorbidities, including
- Joint issues
- Slower healing times
- Extended therapy durations
- Heightened risk for re-injury
Despres said the industry can start to address the issue by understanding “the alarming trends related to growing rates of diabesity,” which show no signs of slowing down anytime soon.
“Ninety percent of injured workers who go to outpatient physical therapy, have at least one comorbidity,” she said. “Sixty percent have at least two.” Beyond age 55 the number of comorbid conditions increases further. The main comorbidity is obesity.
Body mass index is the term used to identify overweight and obesity, where a BMI of 25 – 29.9 is considered overweight, over 30 is obese and a BMI over 40 is morbidly obese.
“BMI is not a perfect science,” Despres said. Some people may be considered ‘overweight' who are mostly muscle. “If you're so muscular and built that your BMI is high, congratulations. That's not most of us.”
An estimated 70 percent of the U.S. population is overweight, and 33 percent are obese. Obesity, declared a disease by the American Medical Association in 2013, is expected to impact 51 percent of the population by 2030, according to the National Institutes of Health.
Obesity can zap a person's strength, putting them at increased risk for injuries. Excessive weight also changes a person's center of gravity, which increases the risk of falls and injuries to the low back, hips, knees, wrists and shoulders.
Workers who are morbidly obese have:
- 45 percent higher claim volume
- 8x more missed work days
- 5x higher medical costs
- 8x greater indemnity costs
Obesity carries risk factors for many additional comorbidities, such as cardiovascular disease, breast and colon cancer, high blood pressure, and gall bladder surgery. Additionally, 80 percent of Type II diabetes is related to obesity, Despres said.
In addition to the nearly 30 million Americans with diabetes, another 86 million are pre-diabetic, or 1 in 3 people. The biggest issues around diabetes for employers are reduced productivity and absenteeism. Diabetes can also put physical limitations on a worker, such as stooping, bending, kneeling and standing. One in 3 diabetics say they cannot stand for more than two hours.
The disease also carries its own set of complications among injured workers. For example, less severe injuries may become more serious in a diabetic. It is also associated with 20 percent of musculoskeletal disease claims. Other problems include:
- Substantial increases in permanent total disability (PTD)
- Adhesive capsulitis, or frozen shoulder
- Wound healing complications
- Diabetic nerve pain delays recovery
- Diabesity Best Practices
“Really being on top of these cases is helpful,” Despres said. “We need to identify the comorbid factors and address them with changes, such as different exercises and goals. The treatment plans should reflect the comorbidities we see in the injured workers.”
She outlined several strategies to address the issue.
- Because of the change in the center of gravity, physical therapy might need to focus on balance considerations, and fall prevention. Educating the worker on proper posture may be also helpful.
- For low back injuries in a worker who does not tolerate weight bearing well, aquatic therapy may be effective. Anti-gravity treadmills are another option to ‘unweight' the person, although these may be expensive.
- Customized treatment plans may be necessary to address the person's tolerance for exercise and expected delays in healing.
- Understanding the worker's job requirements. “That is a big piece to be successful,” Despres said, “what is the end goal? You need to know what the job is.”
- Teaching body mechanics and different approaches to accomplish tasks that may be challenging for the person.
- Fit the work to the worker by modifying the work area as needed.
- Educating the worker on joint protection, body mechanics and work cycles, or rotating tasks in a different way.
- Injury prevention programs
- Fall protection
- Onsite wellness activities
- Prescreening and fit-for-duty programs to match the demands of the work to the body
“To get better outcomes, all stakeholders should have a say,” Despres said. “The adjuster and case manager needs to be aware of goals and have a job description.”
Medical providers should communicate with one another and the rest of the team. Employers can create detailed job descriptions, provide wellness programs and watch for patterns of injuries in specific areas or departments.
“We need injured worker buy-in,” Despres said. “They need to have confidence they are heard and their goals are going to be met.” For example, if the injured worker's goal is to be able to walk his dog and the employer's goal is to return the person to work, “we marry those two together.”