Megan Wilson was nearly 80 pounds overweight, but it didn’t worry her. 

Until her regular physical two years ago.

Then the doctor told her she had diabetes. She needed to lose weight to reduce the risk of complications such as blindness, kidney damage, amputation or diabetic coma.

“It was devastating,” Wilson said. “Suddenly, obesity wasn’t just a label. It was a medical condition.”

Wilson isn’t alone. According to data reported by Duke employees on health risk assessments in the last two years, obesity affects nearly one third of the Duke workforce. This figure mirrors the epidemic of obesity in the state and nation. North Carolina residents considered obese (roughly more than 30 pounds above normal weight) increased from 16.9 percent in 1995 to 29.5 percent in 2008, according to the Centers for Disease Control and Prevention (CDC).

Extra weight drags down the health of Duke’s faculty and staff and pushes up costs. Three of the four illnesses costing Duke employees the most last year were exacerbated by excess weight: diabetes, heart disease and high blood pressure. To fight obesity, Duke has invested in health programs that encourage employees to make lifestyle changes to lose – and keep off – extra weight, and employees are increasingly taking advantage of them.

“The data clearly shows that we, as a nation, have gotten bigger,” said Kyle Cavanaugh, vice president for Human Resources. “And although weight is often considered a private matter, the increasingly obvious link between excessive weight and healthcare costs makes finding ways to manage weight a shared concern for us all.”

Burden of Excess Weight

Although scientists have yet to understand how obesity affects the body at the cellular level, data clearly show that excess weight puts people at risk for a variety of diseases. Many of these diseases require long-term use of medication and close monitoring to prevent them from spiraling out of control.

For example, pharmacy spending on diabetes, the life style-related disease that costs Duke health plans the most to care for, was more than $1.2 million in 2008. Pharmacy costs for hypertension were about $610,000.

“Obesity is now the major cause for conditions such as hypertension, diabetes and abnormal cholesterol, all of which put patients at higher risk for heart disease, the leading killer of adults in the U.S.,” said Laura Svetkey, a Duke physician specializing in treating high blood pressure. “Losing weight significantly reduces the impact of all of these conditions.”

Long-term studies reveal that overweight patients can lower their risk of diabetes by losing as little as five pounds, and dropping their blood pressure by up to 10 points by losing 10 pounds.

A change to the waistline also helps the wallet. A paper in the July 2009 issue of “Health Affairs” estimated people who are obese spend, on average, about $1,429 more on health care each year than normal weight colleagues, largely because of chronic diseases.

With evidence weighing heavily against being overweight, why don’t more people choose to lose?

“Because it is hard,” Svetkey said. “Our bodies are hardwired to resist losing weight. Information alone is seldom sufficient to inspire people to lose weight. Support is vital.”

Support for Slimming

Duke supports employees through a variety of programs ranging from intensive one-on-one coaching through LIVE FOR LIFE and Duke Prospective Health  to programs like the Run/Walk clubs and discount gym memberships.

Andrea Clauden, a staff specialist in the Office of Information Technology, is one of the hundreds of employees using these offerings. Like many struggling with weight, Clauden once ate a few hundred more calories than she needed daily, resulting in slow but steady weight gain over the years.

“When the scale hit 330 pounds, I knew it was time to get help,” she said.

In April 2008, Clauden joined LIVE FOR LIFE’s Pathways to Change program, an intensive 12-month wellness program available to benefits-eligible employees coping with high blood pressure, diabetes, cardiovascular disease or obesity. The program’s quarterly ‘weigh-ins,’ coupled with frequent, one-on-one guidance from a registered dietitian, changed Clauden’s relationship with food, and pounds melted away.

“I had to keep a food journal, and that showed that portion control was a big issue for me,” Clauden said. “My dietitian, Kay Pratt, taught me to read the nutrition information on labels and got me to buy a calorie guide, so I knew how many calories I was eating.”

Clauden broiled, instead of frying, chicken. She snacked on fruit instead of fudge. She pushed aside most sweets and meats. And blood pressure and weight dropped. 

“I called Kay every time I reached my goal of losing another 10 pounds,” Clauden said. “She kept me motivated.”

A year and a half later, Clauden is 50 pounds lighter, three dress sizes smaller, and her blood pressure is 20 points lower.

Bruce Farley, a financial analyst for the Health System, has a similar success story.

He spends eight hours a day at his computer, but since January, Farley has turned technology into a weight loss tool with support from LIVE FOR LIFE, Duke’s employee wellness program.

Farley was considering losing some of his 300 pounds last fall when he looked at vacation photos and thought, “Wow, is that what I look like?” But the real incentive came when his 42-year-old sister was diagnosed with diabetes.

“Just like me, she’s been a little heavy for years,” he said. “I thought I’d better start taking care of myself, too.”

In January, Farley enrolled in the free, online challenge “Eat Wise and Exercise” through LIVE FOR LIFE to track his eating, exercise and weight. Initially, he was skeptical about using the Internet to track progress, “but I found it easy to use. And having the weekly accountability of reporting my weight was really great.”

At the end of the 10-week challenge, Farley lost 37 pounds and had more energy to keep up with his 4-year old son, Wade. “It makes a big difference to have this support at work,” he said.

A Weight Lifted

For Wilson, the marketing specialist diagnosed with diabetes, the convenience of using a Duke gym is key to managing weight.

A member at the Wilson Recreation Center on West Campus for six years, Wilson’s daily 60-minute exercise routine helped control her diabetes and led to losing 45 pounds. But after a year, her weight loss stalled. To get unstuck, she took advantage of a free fitness consult in March with Mary Ann Dobbins, a LIVE FOR LIFE exercise physiologist.

“She explained how I needed to change things around to keep losing weight and helped me set up a new routine,” Wilson said. “It ratcheted things up another notch and got me back to losing weight.”

According to Svetkey, the Duke physician, maintaining a healthy weight is critical to overall success.

“Have short term, realistic goals with concrete action plans for reaching them, and don’t quit if things don’t go perfectly,” Svetkey said. “Most important: plan on making changes that you can stick with for a lifetime.”

Having lost 61 pounds over two years, Wilson has that long view in mind.

“I have five more pounds to lose to drop from the obese to the overweight category,” she said. “Once I make that goal, I’ll keep losing until I get to my healthiest weight. I don’t care if it takes me 10 more years to get there. I just want to make sure I don’t gain again, because I’ve learned that managing my weight is the key to good health.”

Below, Andrea Clauden, right visits with LIVE FOR LIFE nutritionist Kay Pratt to discuss eating habits.