Kevin Eberly's Blog | Confronting America's Obesity Epidemic

I’ve talked about how wellness programs aren’t one size fits all. Wellness programs need to be personalized for each company, just as weight loss programs should be personalized for each individual, which is emphasized at The Center for Medical Weight Loss. A combination of factors can help you determine what type of program will be most effective. Castlight Health recently published “Six Drivers of Engagement,” which outlines factors to help you maximize your benefits program. As I go through the list, ask yourself, “How does this reflect my company’s culture?”

Gender: Females register for benefits at a 7.2 percent higher rate than males do. This doesn’t mean you should assume women will sign up without any incentives, but the gender demographic of your company can help you determine how to spread the word. If your company is dominated by men, for example, it may be wise to offer additional incentives or make the healthcare benefits more prominent. You may want to consider holding healthcare-focused meetings to educate and reiterate its importance.

Email: The survey found email is the most effective way to reach employees. Those with direct email access registered at a rate of 17.7 percent higher than those without access. Many jobs give employees instant access to email—it’s hard to miss one. It’s a simple way to grab attention and encourage an employee to take action. If you have the time, sending a weekly newsletter can also be beneficial. Make sure you highlight how a wellness program can be a fun and effective way to manage health. It’s a low-cost way to raise awareness and encourages employees to interact.

Plan Design: When the money is coming out of the employees’ pockets, they’re more conscious about their healthcare decisions. High-deductible plans bring money to the forefront of employees’ minds. Your workers are more likely to take steps to lower the cost of healthcare if it means keeping money in their wallets. This is where wellness programs come in. Present them as a way to lower costs. Emphasize that the healthier you are, the less medical attention you will need.

Incentives: In terms of engagement, the survey found incentives are very effective, with a high incentive seeing a 30.4 percent increase in registration compared with no incentive. Simply, incentives provide motivation if it doesn’t come from within. They can come in the form of monetary rewards, additional time off, gift cards, or company recognition.

Print Promotion: For those who do not have a desk job, digital promotion may not be the best option, which is where print promotion comes in. Hang posters around the office, send mail to the employee’s home address, and give away stickers, pens, or refrigerator magnets. Besides drilling it in employees’ heads, it also brings the conversation outside the office and into the home. Healthcare becomes a discussion about the family, which is a priority in many people’s lives. If healthcare is not a priority for your employee, it may be for his or her spouse, who can provide the nudge to make a change.

Employers working to better the health of their company faced a recent setback. On April 30 the IRS ruled that most wellness programs cannot be included in minimum healthcare coverage, meaning requiring employees to participate in company-sponsored health programs won’t be as simple as previously thought.

Under the Affordable Care Act, employers are required to offer a minimum benefits coverage for full-time employees, which includes a healthcare package, or pay a steep fine if they choose to forgo providing coverage. The only wellness program that will qualify for the minimum benefits package is smoking cessation programs.

The IRS cited the potential for many wellness programs to be discriminatory, putting sick workers at a disadvantage for lower premiums, as the reason for excluding wellness programs from the minimum benefits package.

It’s an unfortunate ruling considering more than two-thirds of adults in the U.S. are overweight or obese, which, like smoking, is a condition that needs to managed over time and is costing employers thousands of dollars per year.

Managing obesity requires a strong support system, and organized wellness programs provide that. It takes time, dedication, and motivation, which, especially when in the form of cash, can be very effective.

Although I am disappointed with the ruling, it does not mean wellness has no place in the office.

It’s worth the investment to provide wellness programs to your employees—financially and for the success of your company—even if it means just taking a few minutes out of the day to walk around the office and assess the overall health of your workers.

Interact with your employees. Listen to their concerns. Maybe an at-risk individual is scared to make a change in his or her habits. It’s understandable; change isn’t easy. However, listening to your employees can help you determine a wellness program that will attract the most participation. For example, if the majority of your employees say they don’t have the time for wellness, you can consider making a wellness program convenient, potentially making it a part of the workday to encourage higher participation.

Make it a fun part of your company’s culture. Studies show financial incentives encourage healthy behaviors. Consider a little friendly corporate wellness competition. Have employees agree to sign up for a wellness program and offer small rewards at the end of each week for a certain period of time. It can even be as small as $10 gift cards, but the camaraderie and support from the workplace will motivate a larger number of people to participate. The employee that loses the highest percentage of body fat, for example, will receive a larger financial reward.

Educate your employees. An AP-NORC Center survey of 1,011 adults nationwide found about half of people think their weight is healthy despite statistics that show two-thirds of adults in the U.S. are overweight or obese. Consider hosting health seminars as part of on-the-job training and have a wellness program accessible to begin immediately following a lecture. If employees don’t realize they need to make a change, they won’t. You have to bring the issue to the forefront of your employees’ minds.

A patient’s experience starts the moment he or she steps foot in the office. It starts with the greeting from the assistant at the front desk, followed by the amount of paperwork to fill out, followed by the interaction with the nurse, and then, finally, the doctor.

It’s often a long process, not exactly a patient’s idea of fun, and a physician’s communication skills play an important role in whether a patient is willing to be receptive of the information provided. Today, the physician’s role goes beyond writing a prescription and sending a patient on the way.

America’s obesity crisis is affecting workers’ productivity and overall health of the nation, and physicians have a say in prevention, which starts a ripple effect. Prevention means fewer people are obese, fewer people driving up healthcare costs, fewer employees taking sick days. So, you can see why communication skills play a critical role.

You may not be able to teach empathy, but specific care models can set patients up for success. The Center for Medical Weight Loss, for example, focuses on a team atmosphere, one where the physician provides support and gets to know the patient on a deeper level, where the doctor really understands the underlying causes of unhealthy habits. It’s a personalized experience where each treatment plan is different. The model allows doctors to form a unique bond with each patient who steps through the door.

The more welcoming the office, the more likely a patient will be open to suggested treatment. Our healthcare system puts physicians in a powerful position. It puts physicians in the primary prevention role, and like all diseases, the sooner the problem is detected, the easier it is to treat.

By taking advantage of this role, we can significantly lower healthcare costs in this country. One overweight employee can add $1,500 in health costs per year, and with two-thirds of Americans overweight, the costs add up quickly.  Part of the solution to these startling costs is the evolution of the physician role to a more patient-centered approach, one where weight loss becomes a team effort. 

Everything is at our fingertips. With a touch to our smartphones we can have food delivered to our door in minutes, get the latest updates on our favorite sports teams, read a book, and surf the Internet without leaving the couch.

On one hand it sounds like the perfect setup for a sedentary lifestyle, but on another hand, technology can help us reach our fitness and weight loss goals. And according to a study conducted at the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University, the workplace environment combined with technology is a successful strategy.

The study found workplace programs that include behavioral counseling coupled with supportive emails are effective in managing weight long term. During the study, program participants received professional counseling during their lunch hour, which focused on strategies for menu planning, managing hunger, portion control, and ways to deal with emotional eating. They also received email support from their counselor.

After six months, results showed that employees who participated in the program significantly reduced their risk for cardiovascular disease and diabetes. Researchers believe the camaraderie of the work environment contributed to the positive outcomes. It became a part of the culture, sort of a ripple effect.  

While in-person behavioral counseling, like the one conducted in the study above and counseling provided by physicians at The Center for Medical Weight Loss, has proven to be the most effective weight loss strategy, telephone and email counseling have also proven popular in our fast-paced world. 

If companies cannot afford to bring in a physician to the office to provide behavioral counseling, a program set up over the telephone or through email comes in a close second, considering we have email at our fingertips. In a six-month study that included counseling over the phone and email, dieters lost, on average, 8 percent of their body weight. Those who received in-person counseling lost 9 percent, on average.

When technology is used correctly, it can combine convenience with results, and the best results include behavioral counseling. Ninety-five percent of self-help diet attempts usually fail, and unfortunately, 83 percent of diet attempts are self-help.

But we are in a situation where now, more than ever with the development of technology, the workplace can make a difference and focus on providing effective wellness programs that include behavioral counseling in some way, shape, or form. 

We spend the majority of our time at the office, and it is where we likely adopt healthy or unhealthy behaviors. The statistics speak for themselves, and these easy-to-implement wellness strategies can make a big difference in the overall health of America. 

America is on the right track. According to a recent Buck Consultants survey, “Working Well: A Global Survey of Health Promotion and Workplace Wellness Strategies,” in 2012, 76 percent of companies in North America offered health promotion programs to their employees. 

However, tracking wellness programs has proven a little tricky. According to the survey, just 35 percent of firms in the U.S. measured these programs for specific wellness program outcomes, down from 37 percent in 2010. 

There could be several reasons for this decrease. The most commonly cited factor: lack of resources—time, money, staff. 

But tracking wellness program outcomes doesn’t necessarily require an abundance of resources. In fact, research consistently shows programs that are in place for five years or more see the most significant cost savings. Five years may seem like a long time, and I understand this requires patience, but the long-term rewards are often worth the effort. 

While I like statistics and fact-based results as much as the next guy, the success of a wellness program doesn’t have to be measured by numbers alone. You can often see signs of progress through observation, by taking a few minutes a day to leave your desk and walk around the workplace. 

What do you see? Do your employees seem more productive? Are they happier? Do you notice a boost in office morale? Are your employees continuously engaged in the program? It’s the intangible factors provided by a well-designed wellness program that can boost your business. 

Beginning in January 2014, we will enter a world where the Affordable Care Act focuses on rewarding providers and payers who take preventable measures. Positive outcomes from conditions like medical weight loss will ensure full insurance reimbursement and lower overall healthcare costs. While it may take time to get full traction in the workplace, it’s an effort to take the cost burden off employers and motivate employees to take wellness seriously. 

In the long run, with this system everyone wins. Employers are satisfied because healthier workers are less costly, more productive, happier workers. Employees are given a little extra push (and maybe it’s the final push they need) to make necessary changes in their health. The obesity numbers in this country are disturbing, and it’s time we take responsibility for our behaviors. 

There are just too few hours in a day. Or, I should say employees don’t give wellness programs their time of day. 

According to a Global Corporate Challenge report, 86 percent of employees do not participate in wellness programs because they feel they do not have the time to do so. An initiative not being perceived as fun, interesting, or engaging was the second-most cited reason for omitting participation in wellness initiatives, as reported by 45 percent of employees.

If time is really the issue, it’s time we start looking at wellness programs in a new light. According to the report, wellness initiatives need to be easily accessible to employees, a part of the organization’s culture, and integrated into employees’ daily routines—in and out of the office. It’s about altering the thought process: It’s not a break from work, but a part of work. 

The good news is, for the majority of organizations, improving employee health is a main goal. Companies are recognizing the importance of wellness programs, and the next step is to make them an engaging priority. 

The key word: engaging. 

Almost all organizations, 99 percent, report the importance of fun as medium or high. However, only 10 percent of employees report wellness programs reaching high levels of fun. Many commercial wellness programs may be perceived as dull—you pick up meals, eat the same foods, and have few interactions with other individuals. 

This is where The Center for Medical Weight Loss stands out. CMWL’s focus on behavioral counseling sets the program apart from other weight loss centers. Patients build lifelong relationships with their physicians who monitor their weight loss, and the entire staff becomes a weight loss support system. 

According to the report, 84 percent of organizations believe long-term behavioral change is key to wellness strategy. This statistic is reassuring—quick fix weight loss is now the minority. Focus on behavioral counseling sits at the core of CMWL’s values. The program is engaging because it’s individualized, it recognizes weight loss isn’t one-size-fits-all, and it focuses on adopting a new lifestyle.  

So, what’s next? 

Organizations recognize the importance of wellness initiatives. It’s a step in the right direction. However, the report also shows the most at-risk individuals are not taking advantage of the programs offered. Take the time to set up a meeting with at-risk individuals and discuss how you, as an employer, can help them achieve better health. If you understand your employees’ priorities, you can work together to free up some time on their schedules for wellness initiatives; maybe even convince them that they can have fun while they lose weight. 

A recent study researching employee healthcare spending found 10 health risk factors, which could be altered by making lifestyle changes, contribute to more than one-fifth of employer and employee spending.

The study, which was published in Health Affairs, found that 22.4 percent of $366 million spent annually by seven companies was attributed to the following risk factors:

• High blood pressure
• High cholesterol
• High blood glucose
• Depression
• Obesity
• Stress
• Tobacco use
• Poor diet
• Physical inactivity
• Excessive alcohol use

Obesity, no surprise to me, clocked in as the highest cost per capita per year, followed by physical inactivity. Obesity costs alone clocked in at $347 per capita per year.

Yes, it’s jaw dropping. But here’s what gets me: The majority of these risk factors are largely prevented by controlling your weight. If this isn’t a strong enough case for the importance of employee wellness programs, then I’m not sure what is.

Upcoming changes to the Affordable Care Act encourage employers to invest in wellness programs, myself included.

Currently, employers can charge higher insurance premiums without discussing steps with their employees to better their health. Beginning in January 2014, employers will have to refer employees to various wellness programs in order to charge higher insurance premiums for not meeting a specific goal. If an employee refuses to participate, an employer will legally be allowed to increase premiums up to 30 percent higher than the standard premium, as long as employees are given ample time to change their habits through a wellness program.

Essentially, this change, which seems slight, can significantly alter the way we look at changing our lifestyles. This requires employees and employers to have the obesity conversation, regardless of whether they want to. It brings the issue to the forefront of employers’ and employees’ minds. It forces everyone to acknowledge it.

Hopefully, the focus on wellness programs will decrease the cost of these risk factors, leading to reduced overall healthcare costs. It’s a win-win situation.

As an employer, if I’m going be required to invest in and recommend wellness programs to my employees, I’m going to take the time to look at the facts and suggest a program with proven results.

A study published in the American Journal of Medicine found physician-directed medical weight loss produces significant, effective, and sustainable results. It makes sense. We trust our primary care physicians with the majority of our chronic health problems, so why would our weight be an exception?

I strongly believe the majority of these risk factors cited can be controlled with the guidance of trained physicians. Do you think these changes will lower long-term healthcare costs?

Please check Agree or Disagree: Do you agree to the following terms?
“I pledge to keep my weight under control by maintaining a BMI less than 30. If my BMI is currently above 30, I agree to participate in a weight loss program.”

What if a candidate could be removed from consideration for a job by refusing to check “agree” to this question on an application? Or, what if breaking this agreement was grounds for increased health care premiums or higher deductibles?

Is this a crazy proposal? Is it smart? Forward-thinking?

Some companies already have health pledges, similar to the one above, requiring employees to agree to abstain from smoking. Before a potential employee submits an application, he or she is required to check a little white box, signifying his or her agreement to not use tobacco products.

So, requiring prospective employees to agree to keep their weight under control isn’t such a far-fetched idea. Cancer is the No. 2 killer in America, behind heart disease, which sits at No. 1. You prevent certain types of cancer by not smoking; you prevent heart disease, in many cases, by maintaining a healthy weight.

When you put the facts in perspective, suddenly the proposal doesn’t seem quite so crazy.

The most recent company to take a stand toward health is CVS. The company announced all employees who receive health insurance must report their weight, body fat, and glucose levels to the insurer. If employees refuse, they have to pay a $600 penalty. It’s not necessarily a health pledge, but it’s a step in that direction.

Clearly you can’t and shouldn’t discriminate against a potential employee because he or she is overweight, but you can promote a healthy workplace by having an overweight or obese employee pledge to complete a weight loss program. By requiring overweight employees to complete a program with proven results like The Center for Medical Weight Loss, you will see a significant difference in employee productivity and satisfaction and a decrease in overall healthcare costs over time.

If employees are willing to sign a health pledge and stick to it, they should be rewarded with lower premiums. If there is no incentive, you risk losing motivation. This can go a long way in ensuring both healthy habits and preventative care.

Encouraging employees to improve their health can be a positive initiative. If the payer of healthcare costs has knowledge of who is engaging in behavior that could drive costs up for everyone, he or she can begin to figure out how the costs could be reflective of individual healthy living profiles. The key will be to know where to stop, so genetic or pre-existing conditions do not cause penalties or higher premiums to be enacted.

Each company is different. In order to determine whether requiring a health pledge is beneficial for your company, you need to evaluate employee population and company culture.

What do you think? Is a health pledge a good or bad idea?

A recent Danish study found routine annual physicals have little benefit for healthy people. Researchers went as far to conclude routine physicals are meaningless and a waste of money and resources.

The study breakdown: Study participants were randomly assigned either to receive a physical or not receive a physical. Participants were given a routine exam, which included screening tests, advice about lifestyle changes, and a physical exam. The results showed both groups were just as likely to die over a nine-year period.

However, I think the study fails to look at the bigger picture. We have recurring expenses for being in poor health, and if we don’t go to the doctor, how will we know where we stand?

The first step is a checkup. It allows a doctor to diagnose emerging issues early, so you don’t become one of those people who need to be subsidized by other people for avoiding care. Ideally, obesity screenings would be done with an annual physical.

Now, the study did point out that going to the doctor for a specific screening or a vaccine is beneficial for everyone, but researchers do not believe it is necessary to have screenings done every year, stating it costs a lot of money and overuses resources.

Here is where I stand: Prevention does cost money—there’s no denying it. But if you look at the costs of the conditions these annual physicals prevent—obesity, heart disease, diabetes—the cost of prevention comes out significantly lower; millions of dollars lower. The cost of diabetes in the United States, for example, has risen to $245 billion in 2012 from $174 billion in 2007, according to the American Diabetes Association. The number is a 41 percent increase over a five-year period for diabetes alone.

These conditions, which are often caused by obesity, are largely preventable. Annual physicals give doctors a platform to easily monitor and predict conditions over time. When patients come in regularly, meaning they keep up with their annual physicals, doctors can recognize health trends and see when a patient’s health took a bad turn, making it easier to pinpoint why and determine the best course of action.

The U.S. Preventative Services Task Force recommends all adults be screened for obesity annually. As Americans become larger, studies show we eat less healthy than we think. An annual checkup, under the care of a physician, is the most accurate way to monitor your health, and it’s essential these screenings are covered under insurance.

What do you think? Are annual physicals worth the cost?

Some employers have sticker shock when they see the cost of workplace wellness. Understandable, it’s costly, but let’s look at the bigger picture: Studies show for every dollar spent on wellness programs, medical costs fall an average of $3.27, and costs for days that employees are absent fall $2.73. 

It’s easier to understand when you crunch the numbers: Workplace wellness programs are not costing you, but they are actually saving you money. I’ve stressed the importance of obesity prevention, and employers are in a powerful position—they have a say in the health of their employees. I believe that incentives, especially when coupled with leadership from the top, allow employees to understand their employers’ priorities. 

In 2014, the Affordable Care Act will expand employers’ ability to reward or penalize workers who participate in and meet the goals of various wellness programs. When there is change, particularly in healthcare, there are questions. How will this impact employee plans? 

Many expert consultants advocate incentives early on as a way to encourage employees to make proper wellness choices that can have a positive impact on their longer term health and well-being and result in lower future healthcare-related costs. In the future, employees might be choosing health plans from a menu of options and have to pay for the difference of the cost of the plan and a subsidy provided by their employer. If this is the way things unfold, it would be in the best interest of employees to focus on wellness so they can choose cost-efficient health plans in the future. 

Of course, in line with most things in life, providing incentives and penalties have pros and cons. What works well for one employer may not work well for another. Here, I will acknowledge both sides, and let you decide which program will resonate best with your company.  

THE PROS

Incentives can make people happy. By covering the cost of a wellness program, or even just covering a portion of the cost, employers have the ability to take the cost burden of the most efficient programs off of employees’ shoulders. Investing in clinically-proven wellness programs fosters healthier, more productive, and happier employees.   

Financial rewards may generate weight loss results. Studies indicate programs that use financial rewards have positive results and may be effective in producing weight loss. Valued incentives lead to more participation. This could include gift cards, bonuses, or awards of different amounts based on various levels of success. 

Penalties, such as higher health insurance premiums if an employee does not meet the company’s goals, may motivate employees to stick with it. On the contrary, you can also penalize employees who do not meet the company’s wellness standards. In the perfect world, everyone would be healthy simply because they know it’s good for them. But that’s not always the case. Employees are aware that health insurance is costly, and for some, taking money out of their pocket is just the push they need to achieve weight loss. 

Contests and competitions can boost morale and encourage participation. Friendly competition can go a long way. If you work in a competitive environment, it may be beneficial to make wellness a competition. Plus, it puts everyone in the same boat, so it can make sticking to a weight loss plan fun, encouraging, and supportive. 

A wellness program that demands results equals a healthy and wealthy company. Making wellness a priority by providing incentives can attract the best employees to your company. It shows you care about the well-being of your employees, which will in turn make top prospects want to work for you. 

THE CONS

It can discourage employees from participating in the company’s health benefits. For some, the idea of required participation in a wellness program is intimidating. If an employee doesn’t reach the company’s goal and money is involved, it can potentially add stress. Participation then becomes unaffordable and an employee may seek health benefits elsewhere. 

Behavioral differences. We come in different shapes and sizes, and that’s OK. Health is made up of numerous factors, and some are out of a person’s control. For instance, some people are genetically predisposed to high blood pressure, high cholesterol, and even diabetes, and it is important to take these factors into consideration when developing an effective wellness program.