Worksite Health Promotion and Obesity

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Worksite Health Promotion and Obesity

• Donald D. Hensrud, M.D., M.P.H.
• Chair, Division of Preventive, Occupational,
  Aerospace Medicine
• Associate Professor of Preventive Medicine and
  Nutrition
• Chair, Health Promotion Committee
• Mayo Clinic College of Medicine
• Rochester, MN

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Disclosure

• Speaker Discloses he is a speaker for Blue Cross
  Blue Shield of North Carolina and receives an
  honorarium for his speaking services.

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Obesity,Risk Assessment and Classification
Disease Risk Relative to NormalWeight and Waist
Circumference
Men ?40 inWomen ?35 in
Men gt40 in Women gt35 in
BMI
Category
Underweight Normal Overweight Obesity Extreme
obesity
Increased HighVery high Extremely high
lt18.5 18.5-24.9 25.0-29.9 30.0-34.935.0-39.9 ?40
High Very highVery high Extremely high
An increased waist circumference can denote
increased disease risk even in persons of normal
weight.
Adapted from Clinical guidelines on Obesity.
National Heart, Lung, and Blood Institute Web
site. Available at http//www.nhlbi.nih.gov/guide
lines/obesity/ob_home.htm
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Obesity, Health Complications

• Type 2 diabetes mellitus
• Hypertension
• Dyslipidemia
• high triglycerides
• low HDL cholesterol
• small, dense LDL cholesterol
• Coronary artery disease
• Stroke
• Overall mortality

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Obesity, Health Complications

• Most cancers
• Respiratory diseases
• obstructive sleep apnea
• restrictive lung disease
• obesity hypoventilation syndrome
• asthma
• Osteoarthritis
• Cholelithiasis
• Gastroesophageal reflux disease (GERD)
• Nonalcoholic fatty liver disease (NAFLD)

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Obesity, Health Complications

• Gynecologic abnormalities
• abnormal menses
• infertility
• polycystic ovarian syndrome
• Venous stasis
• Skin problems
• intertrigo
• cellulitis
• Increased risk of complications during surgery or
  pregnancy

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Prevalence of Obesity Among U.S. Adults BRFSS,
1990
Approximately 30 pounds overweight
N/A
gt15
Mokdad AH JAMA 200028215
CP999299-17
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Prevalence of Obesity Among U.S. Adults BRFSS,
2000
Approximately 30 pounds overweight
N/A
lt10
15-19
gt20
Mokdad AH JAMA 20012861195
CP999299-26
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Prevalence of Obesity Among U.S. Adults BRFSS,
2005
Approximately 30 pounds overweight
N/A
lt10
15-19
20-24
25-29
gt30
CP999299-26
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Prevalence of Diabetes Among U.S. Adults BRFSS,
1990
N/A
lt4
4-6
gt6
Mokdad AH Diabetes Care 2000231278
CP999299-29
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Prevalence of Diabetes Among U.S. Adults BRFSS,
2000
N/A
lt4
4-6
gt6
Mokdad AH JAMA 20012861195
CP999299-33
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Prevalence of Overweight and
Obesity, NHANES 2003-4

• All Men Women
• gtOverweight 66.3 70.8 61.8
• Obese 32.2 31.1 33.2
• Extreme Obese 4.8 2.8 6.9

JAMA 20062951549
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Prevalence of Obesity, by Sex and Race

• Men Women
• White 31.1 30.2
• Black 34.0 53.9
• Hispanic 31.6 42.3
• Black females 14.7 extreme obesity

Data from NHANES 2003-4 JAMA 20062951549
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Obesity, Physical Activity

• Changes in activity
• cars, buses, trains
• elevators
• sedentary jobs
• step-saving activities
• technology
• computers
• remote controls

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Obesity, Dietary Factors

• Past couple decades
• slight increase in calories
• decrease in fat, increase in sugar intake
• Increased calorie intake
• ? eating out
• ? portion size
• ? variety of most foods
• ? refined carbohydrate
• ? intake of snacks, soft drinks, and pizza

Curr Opin Gastroenterol 200420119
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Obesity, the Sobering Facts

• The cost of obesity has been estimated at up to
  117 B (cost to business - 13 B), and is greater
  than smoking or problem drinking1,2,3,4,5,6
• Obese employees have 36 greater health care
  costs

1Obes Res 19986173 4Surgeons General Report
2001 2Health Affairs 2003SupplW3-219 5Am J
Health Promot 199813120 3Obes Res
20041218 6Am J Health Promot 200317183
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Barriers to Clinical Treatment of Obesity

• Public health problem
• Behavioral change difficult
• Physician education and training
• Time
• Reimbursement BCBS of NC
• Resources
• Available programs with ongoing followup

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Disincentives for Employers to Cover Obesity

• Lack of good efficacy data
• Long term return on investment of
  prevention/treatment
• Mobile work force
• Young employees havent developed complications
• Medicare assumes costs at age 65

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Prevalence of Risk Factors, U.S.

• 66 Overweight, 32 obese
• 60 Sedentary
• 8 Diabetes mellitus
• 35 Hyperlipidemia
• 24 Hypertension
• 21 Smoking
• 23 Prevalent cardiovascular disease
• Among all cancers, 1/3 are related to tobacco and
  1/3 related to diet

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More Risk Factors Higher Costs
5,520
3,460
3,039
2,199
Edington, AJHP 2001 15341
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Medical/Drug Costs by Weight Group
Wang, AJHP 200317183
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Key Findings in Worksite Health Management

• High risk high cost
• High risk decreased productivity
• Participation and low risk are the most
  important metrics to predict success of worksite
  health management
• Low-risk maintenance programs important

U of MI HMRC, Cost Benefit Analysis and Report
2006
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Healthcare Trends

• Increasing costs
• Quality
• Population health management
• Disease management
• Health promotion/risk reduction

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Evidence For Worksite Health Promotion

• For each 1 invested in prevention, return of
  approximately 2 4
• 44-56 of companies offering health promotion
  activities report
• Decreased healthcare costs
• Decreased absenteeism
• Increased productivity
• Should be comprehensive and include all employees
• Opportunities to add to this literature

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U of MI HMRC, Cost Benefit Analysis and Report
2006
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Worksite Health Promotion

• 66 of companies provide wellness programs
• Should be based on needs assessment
• Support at all management levels crucial
• Branding under a title and logo common
• To control overweight and obesity, worksite
  interventions should be multicomponent
  (nutrition, physical activity, etc.)

National Business Group on Health
www.benefitnews.com, 9/1/06 Task Force on
Community Preventive Services MMWR
200554(RR-10)1-12
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Employer Health Plan Components

• Health awareness tools (newsletters)
• Healthy lifestyle programs (HRA, behavior change
  programs)
• Disease management programs (diabetes)
• Demand management programs (self-care books)
• Decision support tools (selecting MD, plan)
• Onsite offerings (fitness center)
• Health advocacy programs (help to negotiate)
• Outcomes research

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Employer Health Promotion Initiatives

• Define strategies, goals, measures
• Communicate to employees (simple messages,
  win-win)
• Provide tools and incentives (HRA)
• Create supportive work environment
• Develop benefit plan to include health promotion
• Onsite fitness facility or health club
  reimbursement important

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Worksite Health Promotion Outcomes

• Track, if possible
• Wellness program enrollment and participation
• Fitness center participation
• HRA data
• Medical and pharmacy claims
• Disability and workers comp data
• Absenteeism
• Dining room purchases
• Financial impact

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Industry, Best Practices

• Aetna, Inc.
• Baptist Health South Florida
• FPL Group
• Johnson Johnson
• Medical Mutual of Ohio
• Pitney Bowes
• Texas Instruments Inc.
• Union Pacific Railroad

Platinum Winners, National Business Group on
Health www.businessgrouphealth.org
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Worksite Health Promotion Programs

• Johnson Johnson
• 225/person/year reduction in health care
  expenditures, with most benefit occurring in
  years 3 4
• BCBS Indiana HP program
• 24 lower health care costs
• Procter Gamble
• 29 decrease in health care expenditures in year
  3 of the program

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Mayo Health Promotion Committee

• Established by Board of Governors 2004
• Directly engaged with various areas involved with
  health promotions
• Catalogued and coordinating health and wellness
  programs at Mayo
• Developed 6 key health objectives to focus
  efforts with communications plan

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Mayo Health Promotion CommitteeKey Health
Objectives

1. Encourage employees to maintain a healthy weight
2. Promote opportunities to increase physical
   activity
3. Educate employees about the importance of
   nutrition and healthy food choices
4. Direct employees to resources to manage emotional
   and behavioral health issues
5. Promote resources to help employees become
   tobacco free
6. Increase overall employee awareness on the
   importance wellness and preventive services

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Mayo Health Promotion Committee

• Established by BOG 2004
• Directly engaged with various areas involved with
  health promotions
• Catalogued and coordinating health and wellness
  programs at Mayo
• Developed 6 key health objectives to focus
  efforts with communications plan
• Created LiveWell name and new graphic identity
  to connect future efforts

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Mayo Health Promotion Committee

• Nutrition Committee established wellness meal
  criteria, put nutrition information on cash
  register receipts, and improved employee
  cafeteria, committee meal, and vending machine
  options
• Applied for and received 2.5 FTE and modest
  budget
• Received approval for research position to
  document return on investment of health promotion
  activities
• Vision is to establish a premier medical center
  model for wellness

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Employer Health Promotion Initiatives

• Define strategies, goals, measures
• Communicate to employees (simple messages,
  win-win)
• Provide tools and incentives (HRA)
• Create supportive work environment
• Develop benefit plan to include health promotion
• Onsite fitness facility or health club
  reimbursement important

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Summary

• Increasing health risks, including obesity, are
  associated with increased health care costs
• Increasing evidence that comprehensive worksite
  health promotion programs can decrease health
  risks and health care costs

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References

• The Practical Guide to the Identification,
  Evaluation, and Treatment of Overweight and
  Obesity in Adults. http//www.nhlbi.nih.gov/guidel
  ines/obesity/ob_home.htm
• Hensrud DD, ed. Mayo Clinic Healthy Weight for
  Everybody. Mayo Clinic, Rochester, MN, 2005.
• Health Management Research Center. Cost Benefit
  Analysis and Report 2006. University of
  Michigan, Ann Arbor, MI, 2006.
• Chapman LS, et al. Population health management
  as a strategy for creation of optimal healing
  environments in worksite and corporate settings.
  J Alt Comp Med 200410(Suppl 1)S127-S140.
• Pelletier KR. A review and analysis of the
  clinical and cost-effectiveness studies of
  comprehensive health promotion and disease
  management programs at the worksite update VI
  2000-2004. J Occup Environ Med 2005471051-8.

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References

• Anderson DR, et al. Conceptual framework,
  critical questions, and practical challenges in
  conducting research on the financial impact of
  worksite health promotion. Am J Health Prom
  200115281-8.
• Hensrud DD, ed. The Mayo Clinic Plan 10
  Essential Steps to a Better Body Healthier
  Life. Time, New York, NY, 2006.
• Supplement on Bariatric Surgery in Extreme
  Obesity. Mayo Clin Proc Oct 1, 2006. Available
  online at http//www.mayoclinicproceedings.com/su
  pplements.asp
• Lang RS, Hensrud DD, eds. Clinical Preventive
  Medicine, 2nd ed. AMA, Chicago, IL, 2004.

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