RENEE MONTAGNE, HOST:

American employers are becoming increasingly concerned about the impact of obesity both among their staff and on their business. Obesity leads to complications like diabetes and heart disease which raise health care costs. it also increases absenteeism and the risk of injury on the job. Still, as a NPR's Yuki Noguchi reports, it can be a difficult problem for employers to address.

YUKI NOGUCHI, BYLINE: For several years, Ryan Tax Services of Dallas has offered a wellness program to its 2,000 workers. It includes health fairs, free screenings, cooking demos and health club memberships. There's nearly 70 percent employee participation, and it has helped curb health care costs. Still, when I asked Executive Vice President Delta Emerson whether obesity is still a major concern, she said...

DELTA EMERSON: Fifty-six percent of the employees that tested are overweight, which is a little shocking to me because we have a very young population - average age is in the high 30s.

NOGUCHI: But Emerson says it's hard to do more.

EMERSON: We have to be very sensitive about the fact that there are some people that are not going to want anyone to have a conversation with them about that even indirectly. So that's the biggest difficulty I see.

NOGUCHI: Several states away in Cedar Rapids, Iowa, Geonetric is a software firm with 65 employees. It, too, has controlled insurance costs in recent years in part by promoting child's play during what employees call the Geonetric games.

ANNE OHRT: They dress up in funny costumes, and they're shooting basketball hoops together and having chair races and tug-of-war.

NOGUCHI: Anne Ohrt handles the company's operations. She says health considerations went into its new building as well.

OHRT: Our company will be on the third floor, so people have to go two flights of stairs to go down to the cafe and eat. It will encourage them to get away from their desks and eat. We have 10-inch plates and tall, narrow glasses.

NOGUCHI: Ten-inch plates and tall, narrow glasses help workers manage their portions. The strategy, in other words, consists of many different things.

OHRT: We try not to absolutely target one thing because we don't want anyone to feel like we're singling them out.

LAUREL PICKERING: It sounds easy to target individuals for these programs, but in reality it's really not that easy.

NOGUCHI: Laurel Pickering is executive director of the North East Business Group on Health, a nonprofit focused on reducing health care costs. She says it's difficult to address obesity because wellness programs must be voluntary. Employers can offer incentives, but they can't talk directly to an employee about a weight problem. Also there are medical privacy rules and laws prohibiting employer discrimination based on a person's genetic makeup. Also health is a sensitive and personal issue. And there are those like Matthew Woessner who think employer-sponsored wellness programs sometimes go too far.

MATTHEW WOESSNER: We commonly refer to it as the great wellness rebellion.

NOGUCHI: Woessner is a public policy professor at Penn State and leader of that rebellion last summer. The university asked employees to participate in a medical screening survey or pay $100 more a month for their health insurance. It asked...

WOESSNER: Whether they were depressed, whether they were having marital problems. It got into such intimate details of our lives that we thought it was inappropriate for the university to require such a survey and not give us a way to opt out.

NOGUCHI: It seemed invasive, he says, even though it was anonymous. Woessner says he's sympathetic to the university's need to control health care costs, but he says he thinks simply responding to a survey can't achieve that because that in itself won't make people healthier. So he circulated a petition. Eventually, his side prevailed. Now those who participate in the survey receive a cash benefit, but there's no penalty for those opting out. At the same time, Woessner acknowledges, perhaps the cost burden has simply shifted.

WOESSNER: I recognize that my health care rates are driven up by persons who don't live right and don't eat healthy. But I'm willing to pay a higher rate because I, in the end, believe that liberty is more important than lower health care bills.

NOGUCHI: That must be balanced by very real cost issues. The Northeast Business Group on Health estimated U.S. businesses lose $73 billion a year in productivity because of obesity. Edwin Foulke is former head of the Occupational Safety and Health Administration. He says over half of teenagers are overweight, and that means employer health care costs for everything from insurance, to injury and illness will balloon.

EDWIN FOULKE: If you don't address these issues, the cost is going to be so great that it's going to affect the viability of the company.

NOGUCHI: That, he says, is the biggest challenge few businesses are openly talking about. Yuki Noguchi, NPR News, Washington.

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