Thinking about an obesity-related disease management program for your organization? Here’s what you need to know.

In order to be effective, the program must meet participants’ individual medical and psychological needs, not to mention your own organization’s need to control long-term health costs.

How wide-reaching should the program be? After all, it doesn’t make sense to pay for services your employees don’t want or can’t use.

Mary Beth Chalk of Resources for Living suggests that obesity programs can be broken down into four tiers of employee need, from which your organization’s return on investment (ROI) can also be measured.

Tier 1: Education

Tier I employees struggle with weight management problems but don’t need a health coach. Instead, they may benefit from a self-directed program that provides weight-management related materials online, targeted mailing, and/or access to nurse call line.

How to measure ROI: utilization. Do employees click on the Web site? Do they return to the site regularly? Do people use the nurse line? Your program vendor should provide you detailed use stats.

Tier 2: Clinical supervision

If the employee has been diagnosed as obese — a body mass index (BMI) score over 30 is obese, over 35 is clinically obese — he or she would do better working with a health coach in a clinically supervised program.

Three keys to getting maximum results:

1. Periodically have participants rate their relationship with their health coaches. Not everyone clicks, so a change may be in order.
2. Coordinate your disease management care with your employee assistance program (EAP)services. Reason: Inability to control weight is often closely tied with mental health issues — and one can negatively affect the other. The more closely your EAP and obesity program managers work together, the higher the chance for success.
3. Beware of the fade-out effect. Many employees in weight-loss programs get off to a great start and then fall back into old habits. People should re-commit to the program after three sessions, four months and nine months.

To measure ROI, look at utlization, goal achievement and reduced presenteeism. Of course, presenteeism is notoriously difficult to measure with reliable dollar figures. So how can you overcome that problem?

• Start with employees’ salaries. Let’s suppose one participant earns $40,000 per year.
• Ask workers to self-report how energetic and productive they feel on the job, on a percentage scale. Then have supervisors estimate the employee’s productivity and split the difference. For this example, let’s assume it averaged to 50%.
• Collect scores again six months and one year into the program and then multiply the difference by salary. The result is your estimated productivity ROI.

In the example above, if the employee earning $40,000 improves from 50% to 75% after one year, the productivity related ROI is $10,000.

Tier 3: Medical management

At this level, the obese employee needs a higher level of care than a health coach can offer. The employee has chronic health conditions related to obesity — such as diabetes, high blood pressure, and/or sleep apnea — and needs a physician case manager. Specifically, the employee needs to set up regular visits with the doctor and create a treatment plan.

To measure ROI, start with the lower-tier criteria, then track quarterly and year differences in FMLA or paid absences, and prescription drug costs. Then compare it to the per-participant cost of the obesity program.

Tier 4: Morbid obesity

At this level, the employee has been diagnosed as morbidly obese — BMI over 40 — and is considered a potential candidate for gastric bypass surgery.

ROI is measured through ongoing health claims as well as the previous criteria.