The High Cost of The American Diet

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The High Cost of The American Diet

• Employers Pick Up the Tab for Poor Nutrition

Rallie McAllister, MD, MPH, MSEH Medical
Director, Benefit Insurance Marketing
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American Corporations in Crisis

• Healthcare costs continue to skyrocket
• Health and productivity of employees continue to
  deteriorate

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Poor Nutrition Physical Inactivity

• The New American Way of Life

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Poor Nutrition Physical Inactivity

• Fuel chronic diseases that cause disability and
  claim the lives of 365,000 Americans annually
• Cost the U.S. economy approximately 117 billion
  per year
• Costs are increasingly borne by employers

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Whats wrong with this picture?

• 70 of chronic disease are preventable primarily
  through simple lifestyle changes
• Of the 2 trillion spent annually on healthcare
  in the U.S., only 5 is spent on prevention
• Despite spending more money on healthcare than
  any other nation in the world, Americans are the
  unhealthiest population in the developed world
• Centers for Disease Control and Prevention, 2005

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Whats wrong with this picture?

• Some fast food restaurants spend 650 million
  annually on advertising
• The Centers for Disease Control and Prevention
  spends less than 12 million on programs designed
  to promote good nutrition and increased physical
  activity
• Centers for Disease Control and Prevention, 2005

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Chronic Diseases Fueled by Poor Nutrition

• Sleep disorders
• Fatty liver disease
• Gastro-esophageal reflux disease
• Osteoarthritis
• Osteoporosis
• Diverticulosis

• Obesity
• Diabetes
• Cardiovascular disease
• High blood pressure
• High cholesterol levels
• Heart attack
• Stroke

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Obesity

• Still on the Rise

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Obesity

• Nearly 70 of Americans are overweight 33 of
  these individuals are obese
• Second leading cause of preventable death in the
  U.S. claims the lives of 300,000 Americans each
  year
• Compared to normal-weight individuals, more than
  twice as many obese employees have work-related
  limitations

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Economic Impact of Obesity

• Healthcare costs for obese workers are up to 5
  times greater than those for workers of normal
  weight
• Obesity-related healthcare costs 130 billion
  annually
• U.S. corporations bear the brunt of the financial
  burden

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Economic Impact of Obesity

• Cost for prescription drugs
• double
• Cost of inpatient services
• 40 higher
• Obese employees are 75
• more likely to experience high
• rates of absenteeism
• (14 days or more per year)
• Overweight adults have a 15 higher risk of
  injury
• Morbidly obese adults have a 48 higher risk of
  injury

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Humans arent the only ones affected.
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Fat Dogs

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Fat Cats
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Fat Rats

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Fat Horses
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Type 2 Diabetes

• The diabetes epidemic is like a runaway train
  that shows no signs of slowing down.
• Desmond Williams, M.D., PhD, medical
  epidemiologist, U.S. Centers for Disease Control
  and Prevention

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The best explanation is that our society has
become more toxic. We have become too
sedentary, we eat bad food, and we have poor
lifestyle habits.

• Linda Geiss
• Chief of Diabetes Surveillance, CDC Diabetes
  Program

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Diabetes A National Epidemic

• Affects 24 million Americansone million new
  cases diagnosed each year
• One third of those with diabetes are unaware that
  they have the disease
• Sixth leading cause of death
• Major risk factor for heart
• attack and stroke
• Leading cause of blindness,
• Kidney failure, and amputation
• American Diabetes Association, 2002

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Diabetes No End in Sight

• Nearly 25 of Americans over age 20 have
  pre-diabetes, and will likely develop type 2
  diabetes in the next decade
• Of the children born in 2003, 33 will develop
  type 2 diabetes in their lifetimes
• International Journal Of Pediatric Obesity, 2006

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Diabetes is a major cause of lost productivity
and absenteeism

• Employees with diabetes lose 8.3 workdays per
  year compared to 1.7 days for non-diabetic
  employees

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Diabetes Costs Out of Control

• Total cost rose 32 last year 174 billion in
  2007 ¹
• Diabetic employees healthcare costs are more
  than double those without the disease
• Medical expenditures for diabetics average
  11,744 per year 6,700 attributable to diabetes
  
• Conservative estimate doesnt include 6 million
  Americans with undiagnosed diabetes
• ¹ American Diabetes Association

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Diabesity A Sign of the Times

• Excess weight is the single most important
  contributor to type 2 diabetes
• Obese individuals 12 times more likely to be
  affected than normal weight individuals
• Poor nutrition is the single most important cause
  of excess weight

• Obesity
• Diabetes
• Diabesity

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Diabesity A Sign of the Times

• Weight gain of 11 to 18 pounds doubles the risk
  of type 2 diabetes in ten years
• Weight gain of 44 pounds quadruples the risk of
  developing type 2 diabetes in ten years
• Diabetes reduces life expectancy by 5 to 10 years
  
• American Diabetes Association, 2007

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The Good News

• Nutrition and exercise programs that allow
  individuals to achieve a weight loss of just 5-7
  can reduce the risk of type 2 diabetes and other
  complications by 58
• American Diabetes Association,
  2007

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The American Way

• Too Much
• Foodextra large portions
• Sugar
• Soft drinks
• Simple, refined carbohydrates
• Saturated fat and cholesterol
• Most animal products fast foods, fried foods
• Trans fats
• Doughnuts, pastries, fast foods, junk foods

• Too Little
• Fruits
• Vegetables
• Legumes
• Nuts
• Seeds
• Whole grains
• Water

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Portion Sizes

• At home and in restaurants, portion sizes have
  tripled in the past three decades
• The more we are served, the more we eat
• Rise in obesity and prevalence of chronic disease
  has mirrored increase in food consumption

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Super-size Me!
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Fast Food Nation

• In 1970, Americans spent 6 billion on fast food
• In 2000, Americans spent more than 110 billion
  on fast food
• more than is spent on higher education, books,
  personal computers, or new cars
• Americans spend approximately 40 of total food
  dollars on fast food 15 on fruits and
  vegetables
• Eric Schlosser, Fast Food Nation The Dark Side
  of the All-American Meal
• Journal of the American Dietetic Association, 2007

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Fast Food Nation

• Adults who eat frequently at fast food
  restaurants gain more weight and are at higher
  risk for type 2 diabetes, obesity, high blood
  pressure, high cholesterol
• After 15 years, those who ate in fast food
  restaurants more than twice each week had gained
  an extra ten pounds and had a two-fold increase
  in insulin resistance
• The Lancet, 2005
• Circulation Journal of the American Heart
  Association

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Dangerous Dietary FatsSaturated fats, trans
fats, cholesterol

• Elevate LDL (bad) cholesterol and total
  cholesterol
• Increase risk of obesity, diabetes, and heart
  disease
• Trans fats lower HDL (good) cholesterol and
  interfere with metabolism of essential fatty
  acids, hormones, and clotting factors

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Americas Sweet Tooth

• The average American consumes 150 pounds of sugar
  each year, much in the form of soft drinks

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Soft Drinks A National Addiction

• Soft drink consumption grew 135 from 1977 to
  2001
• Americans consume approximately 52 gallons per
  year per capita
• Americans spend more than 65 billion annually on
  soft drinks

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Soft Drinks

• One 12-ounce soda provides 12-15 teaspoons of
  sugar (more than total daily amount recommended
  by USDA)
• Excess soda consumption linked to type II
  diabetes, obesity, high triglyceride levels,
  osteopenia and osteoporosis
• Soda drinkers consume approximately 200 more
  calories per day than those who refrain
• Eliminating just one soda a day can result in a
  weight loss of one pound per month

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Effect of Simple Sugars on Blood Glucose and
Energy Levels
Blood Sugar Level
Hunger
Hunger
Normal
Eat Simple Carbohydrate Food
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Effect of Complex Carbohydrates and Protein on
Blood Glucose Levels
Blood Sugar Level
Hunger
Hunger
Normal
Eat Complex Carbohydrate or Protein Food
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What about diet sodas?

• In a study of more than 8,000 adults at
  University of Texas Health Sciences Center,
  researchers found that for every can or bottle of
  diet soda a person of normal weight drank per
  day
• 65 increase in the risk of becoming overweight
• 41 increase in the risk of becoming obese

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Diet sodas are not the answer

• Calorie free, but not consequence free
• Instill preference for sweet taste
• Lead to phenomenon known as cephalic phase
  response

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Fruits and Vegetables

• Americas No. 1 Nutrition Omission

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Mom was right.

• Eat your vegetables!

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Some of us just werent listening

• Fewer than 11 of Americans follow current USDA
  guidelines for fruit and vegetable consumption
  (even when French fries and ketchup are included)
• Approximately 62 of Americans consume no whole
  fruit on a daily basis
• Approximately 25 of
• Americans eat no vegetables
• on a daily basis
• National Health and Nutrition Examination
  Surveys, 2007

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Fruits and Vegetables

• USDA guidelines recommend 5 -13 servings per day
• 5-9 servings for a person consuming 2,000
  calories per day
• The average American consumes 3 or fewer servings
  per day
• NHANES, 2005

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Benefits of Fruits and Vegetables

• Reduce risk of heart disease and stroke
• Harvard study of 110,000 adults found 30
  reduction in cardiovascular disease¹
• Lower blood pressure
• Dietary Approaches to Stop Hypertension (DASH)
  study showed dramatic reductions in blood
  pressuresimilar to those achieved by
  prescription medications²
• Reduce risk for many cancers, high cholesterol,
  type 2 diabetes, gastrointestinal disorders,
  macular degeneration, and obesity
• ¹Journal of the National Cancer Institute,
  2004
• ² New England Journal of Medicine, 1997

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Do your employees have access to high-quality
fuel at work
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Or are they consuming poor-quality fillers?
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The Proof is in the Performance

• High Quality Fuel

• Poor Quality Filler

• Improves memory, learning, and concentration
• Stabilizes blood sugar levels
• Improves mood
• Reduces risk of accidents and injury
• Improves energy level
• Supports a healthy weight
• Improves overall health

• Reduces ability to learn, remember, and
  concentrate
• Increases sleepiness and risk of accidents and
  injury
• Promotes fatigue
• Promotes irritability
• Promotes weight gain
• Detracts from overall health
• Increases the risk for dozens of diseases

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On-the-Job Nutrition

• Fulltime employees need access to healthy eating
  options at work
• Without access to fruits and vegetables in the
  workplace, a working adult would have to eat 1 to
  2 cups of fruits or vegetables every waking hour
  after work to meet the recommended daily intake

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Providing Healthy Eating Options at Work

• Improve access to nutritious foods
• Work with cafeteria staff and outside vendors
• S. Tufts, Employee Health Manager, L.L. Bean

• L.L. Bean in Maine encouraged healthy eating by
  subsidizing nutritious foods, and funding the
  subsidy with a premium on high-fat foods,
  including French fries. After two months, they
  found a 50 increase in the sale of healthy
  foods, and a 50 decrease in the sale of high-fat
  foods.

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Revamp the Vending Machines

• Insist on nutritious foods from your vendors
• Work with a dietician if necessary
• Gradually reduce non-nutritious offerings that
  are high in calories, sugar, trans fats,
  cholesterol, and saturated fats
• Cookies, chips, candy bars
• Pies and pastries
• Soft drinks
• Gourmet coffee drinks

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Revamp Worksite Vending Machines

• In a study of worksite vending machines, when
  low-fat healthy snacks were provided at a 50
  discount, sales increased by 93.
• Increased sales offset the cost of the discounts
• Profits remained steady
• American Journal of Public Health, 2001

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Vending Machine Detox

• Low-fat popcorn
• Whole Wheat Crackers
• Granola Bars
• Dried Fruit
• Nuts and Seeds

• PopSecret 94 Fat Free
• Jolly Time Healthy Pop
• Wheat Thins Multi-Grain
• Triscuits
• Kashi Chewy Granola Bars, Natures Valley
• SunMaid Raisins, Currants, Fruit Bits, Apricots
  and Figs
• Sunsweet Apricots and Dried Plums
• Blue Diamond Almonds, Planters Mixed Nuts

• Healthy Choice

• Examples

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Refrigerated Vending Machine

• Fresh fruit
• Canned fruit (lite or packed in juice)
• Baby carrots and other pre-packaged veggies
• Salads with low-fat dressings
• Canned vegetable-based soups
• Yogurt and low fat pudding
• String cheese
• Water, unsweetened tea, fruit and vegetable juice
• Low-fat or non-fat milk
• Healthy vending options at www.fitcitychallenge.o
  rg

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Examine Cafeteria Offerings

• Gradually decrease and eliminate food choices
  that are high in unhealthy fats, sugar, and
  calories
• Pizza
• Burgers
• French fries
• Pies and pastries
• Cookies and cakes

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Clean Up Cafeteria Offerings

• Gradually add more nutritious foods
• Salads with fat-free or low-fat dressing
• Broth-based soups
• Steamed vegetables
• Fresh, raw fruits and vegetables
• Brown rice
• Cold cereal with low-fat or no-fat milk
• Whole grain breads and low-fat deli meat
  sandwiches

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No Cafeteria?

• Consider inviting a caterer to offer nutritious
  foods on-site
• Encourage employees to pack their lunches and
  avoid fast food restaurants
• Create an on-site farmers market in the break
  room or parking lot
• Consider hosting Fresh Foods Friday or Tasty
  Tuesday
• Offer complimentary fresh fruit and vegetables to
  employees one day a week

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Encourage Eating In Make the Break Room More
Inviting

• Comfortable seating
• Refrigerators for storing packed lunches
• Ice machine
• Filtered water with cups
• Napkins and plastic utensils
• Adequate lighting
• Clean, neat, and attractive
• Educational materials

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Offer Nutritious Foods at Meetings and Company
Events offer this
instead of this

• Doughnuts
• Pizza
• Cookie tray
• Fried Chicken
• Assorted chocolates
• Ice cream sundaes

• Bagels
• Low-fat deli tray
• Granola bar basket
• Grilled chicken wraps
• Fruit skewer tray
• Yogurt parfaits

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Offer Education Increase Awareness

• Invite community experts to host educational
  lunch n learns for employees
• Diabetes counselors, registered dieticians, and
  other healthcare professionals from hospitals,
  clinics, and health departments
• Host cooking classes to introduce employees to
  new recipes using fresh foods
• Keep educational materials on hand
• Create a healthy recipe bulletin board

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Increase Excitement

• Create a nutrition challenge for all employees
• Employees record fruit and vegetable or water
  consumption for 6-12 weeks
• Offer meaningful, health-promoting incentives
  based on participation, rather than performance
• Cash
• Stationary bicycle
• Lunchbox
• Thermos

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Encourage Involvement

• Management
• Employees from all shifts and departments
• Identify champions and leaders
• Conduct surveys
• Maintain suggestion boxes
• Welcome feedback and ideas
• Reward and recognize effort and interest

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Creating a corporate culture of healthy eating
and good nutrition is a journey.

• The rewards are well worth the efforts.