HBCH Diabetes and Obesity


Addressing a top health spend issue with evidence-based population health approaches.

While clinically septate chronic conditions, Obesity (ICD-10-CM Diagnosis Code E66.9), Type 2 Diabetes (CD-10-CM Diagnosis Code E11.9), and Prediabetes (ICD-10-CM Diagnosis Code R73.09) they are so interrelated that it is of value to understand and address them one chronic co-morbid condition.    HBCH recommends accessing the resources in this Quick Links section to learn how employers can take proactive actions through benefits design to reduce the burden of these disease states on healthcare costs and productivity.

OBESITY is a complex, multifactorial condition characterized by excess body fat according to several U.S. professional associations including the American Medical Association.  It must be viewed as a chronic disorder that essentially requires perpetual care, support, and follow-up.  Obesity causes many other diseases, and it warrants recognition by health-care providers and employers. 

The CDC estimates that more 18% of full-time employees are obese.   Class 1 Obesity is defined as a BMI of 30-34.   This equates to 203 lbs. for a person 5’9” or 169 lbs. pounds for a person 5’3”.   Class 2 is a BMI of 35-39 and Class 3 is a BMI >40. Obesity if left untreated increases the incidence rates 2-5 times of other chronic conditions, notably diabetes, hypertension, heart disease and osteoarthritis.    The CDC estimates that its prevalence by age groups is 2.8% (18-44), 17% (45-64), and 27.3% (65-74).  

Obese adults spend 42% more on direct health costs than adults who are a healthy weight. Employers have long provided resources to help employees lost weight, but most attempts have not been successful.   Recognizing the “tug-of-war’ of weight management is due more to body chemistry rather than lack of willpower is a valuable insight.  In people with obesity, the body will try to put the weight back on for at least 12-months after weight loss.    Lifestyle modifications must be part of any weight-loss intervention but are not always sufficient for maintaining weight loss. 

Today it is widely recognized that obesity management in the workforce warrants a stepwise approach.   All treatment options include diet, physical activity, and behavioral therapy.   Employers should consider pharmacotherapy for those with a BMI more than 30. Employers typically cover a full range of pharmacologic therapies to address hypertension and hyperlipidemia.  Employers should consider similar options for obesity.  Surgical options for with MBI’s greater than 35. 


T2 PRE-DIABETES and Diabetes Prevention Program for Houston EMPLOYERS

T2 PRE-DIABETES is defined as fasting blood sugar level from 100 to 125 mg/dL.  If you have prediabetes, the long-term damage of diabetes — especially to your heart, blood vessels and kidneys — may already be starting.   Approximately 88 million American adults—more than 1 in 3—have prediabetes. Of those with prediabetes, more than 84% do not know they have it.    Approximately 30% of the workforce has pre-diabetes and 15-30% of those convert to T2D within 5 years.  Those that convert to T2D average more than $10,000 in annual healthcare costs, more than twice that of healthy adults.   

National Diabetes Prevention Program (NDDP) for Houston Employers
The Centers for Disease Control and Prevention (CDC) developed and launched the NDPP in 2010.  More than 25 clinical trials have proven its effectiveness, reducing the risk of conversion to T2D by 60%.  The NDPP is typically implemented through the employer’s existing health plan structure as a medical claim, but some employers fund through other means such as the employer’s wellness fund.     The cost to provide the DPP is a maximum of $600 and is only paid if results are archived.   CDC clinical trials demonstrated healthcare savings of ~$2,500 per year for the three-year follow-up.

A key part of the National DPP is the lifestyle change program to make lasting lifestyle changes, like eating healthier, adding physical activity into their daily routine, and improving coping skills.  The 1-year program lifestyle change curriculum is proven to reduce body weight by 5-7% and increase physical activity to 150 minutes/week.    It is conducted weekly for 26 weeks and then bi-weekly for the rest of the year.     The success of the DPP is attributed to the peer support it provides and the quality of its delivery.

HBCH recommends accessing the resources in this Quick Links section for more information.

HBCH has partnered with the University of Texas Medical Branch (UTMB) and Health Science Centers (UT-HEALTH) to provide the DPP to local employers.   The attributes of the HBCH-UT delivery model include:

  • Local Delivery & Knowledge with Proven Results
  • Fully Recognized by the CDC
  • Live On-Line Delivery and Peer Support
  • Multiple Employer Cohorts
  • Flexible Delivery Times Including Weekends
  • 100% Virtual Retention of Participants
  • Available in English & Spanish
  • Covered by UHC, Cigna, AETNA, BCBSTX