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Addressing Obesity at the Workplace Promising Approaches HERO Forum for Employee Health Management Solutions September 1

Addressing Obesity at the Workplace Promising Approaches HERO Forum for Employee Health Management Solutions September 18-20, 2006 Chicago, IL Nico Pronk, Ph.D., FACSM, FAWHP Vice President, Health & Disease Management Executive Director, HealthPartners Health Behavior Group

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Addressing Obesity at the Workplace Promising Approaches HERO Forum for Employee Health Management Solutions September 1

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  1. Addressing Obesity at the WorkplacePromising ApproachesHERO Forum for Employee Health Management SolutionsSeptember 18-20, 2006Chicago, IL Nico Pronk, Ph.D., FACSM, FAWHP Vice President, Health & Disease Management Executive Director, HealthPartners Health Behavior Group Senior Research Investigator, HealthPartners Research Foundation HealthPartners Minneapolis, Minnesota

  2. Objectives • Background and context related to excess weight • What do we know works? • Systematic review of weight loss strategies • Promising approaches to address excess weight for employed populations

  3. Excess Weight • Overweight prevalence in the U.S. exceeds 65% of the population • Excess weight is associated with a variety of diseases, disorders, disability, function, quality of life, musculoskeletal pain, diminished social functioning, and premature death

  4. Optimal, best possible performance, fully present Fully absent, no work or duties performed Worst possible performance, fully present 100 75 50 25 0 -25 -50 -75 -100 100 75 50 25 0 -25 -50 -75 -100 Performance Quality Units (%) Hours-on-Task (%) The Work Loss Continuum Work Performance Scale Source: Pronk, NP. ACSM’s Health & Fitness Journal 2003;7(3):31-33

  5. The Total Cost of Illness Defined Medical and Pharmaceutical 24% Direct Medical Costs Indirect Medical Costs Presenteeism 63% Long-term Disability 1% Workers’ Compensation <1% Absenteeism 6% Short-term Disability 6% Source: Hemp, P. Harvard Business Review, October, 2004

  6. Excess Weight • Excess weight impacts on both direct costs and indirect costs for employers Medical and Absenteeism Expenditures Attributable to Excess Weight Source: Finkelstein, et al. Am J Health Promot 2005;20(1):45-51.

  7. Health is more than the absence of disease… • Despite proclamations to the value of health, morbidity and mortality are what counts and gets counted (i.e., measured) • Evaluations are primarily based on reductions in mortality and morbidity, and their known behavioral risk factors, such as PA and diet • Do individuals characterized as being in “complete health” incur less health care costs and are they more productive than those characterized as being in “incomplete health” or “complete ill health”?

  8. Does Health as a Complete State add Benefit to the Bottom Line? * * * * * * * * All p-values < 0.001 Source: Keyes, Grzywacz. JOEM 2005;47:523-532.

  9. Productivity and Health RisksObesity and Work Limitations • Obesity impact on work limitations • NHANES III and NHANES 1999-2000 data • Obese workers, regardless of gender, are more likely than normal weight workers to report being limited in the amount or type of work they can do because of physical, mental or emotional problems (6.9% vs. 3.0%, respectively) Impact of obesity on work limitations is akin to 20 years of aging Source: Hertz, et al. JOEM 2004; 46:1196-1203.

  10. Weight-related Factors and Productivity Dep. Var. Effect on PROD PA moderate Quality Improvement Work rate Improvement PA vigorous Work rate Improvement Cardiorespiratory Fitness Quantity Improvement Cardiorespiratory fitness Extra effort Improvement BMI obese Getting along Decrement BMI morbid Work loss days Decrement Physical inactivity Absenteeism Decrement No HPDP program participation Absenteeism Decrement Physical inactivity Presenteeism Decrement Poor diet Presenteeism Decrement High Stress Presenteeism Decrement Lack of emotional fulfillment Presenteeism Decrement Sources: Pronk, et al., JOEM, 2004; 46(1): 19-25; NBGH Issue Brief Dec. 2005.

  11. What do we know works? • Basing decisions on evidence is a good idea • By and large, the best evidence for many decisions comes from a systematic review of all the evidence • Systematic reviews currently provide the best, least biased, and rational way to organize, cull, evaluate, and integrate the available research evidence

  12. HealthPartners Systematic Review on Obesity • Study question: • “What lifestyle strategies and/or treatment components contribute to successful weight management defined as 5% to 7% of starting (baseline) body weight, 5% loss maintained for 1 year or longer?” • Studies published after January 1997 • Randomized controlled trials 12 months in duration • Observational studies 5 years in duration • Meta-analysis of studies meeting study criteria • Results presented by intervention type • Advice-only; diet-only; diet plus PA; exercise-only; meal replacements; VLCD; anti-obesity medications

  13. Literature Review • Diet advice only • 16 studies with diet advice alone as 1 arm: 3,786; 3,418 completers • Exercise alone • 4 studies; 6 studies with exercise alone as 1 arm: 325; 260 completers • Diet the primary therapy • 8 studies; 39 studies with diet alone as 1 arm: 7,798; 4,979 completers • Diet plus exercise • 13 studies; n=2,183; 1,950 completers • Meal replacements • 8 studies; n=470; 376 completers • Anti-obesity medications • 21studies; n=6,634; 4.241 completers • Very-low calorie diets • 11studies; n=925; 551 completers Total: 80 studies; N=24,698; 16,823 completers (68%)

  14. Systematic Review of Weight Loss StudiesAverage Weight Loss of Subjects Completing a Minimum 1-Yr Weight Management Intervention80 Studies, 24, 698 Subjects, 16,823 Completers (68%)

  15. Task Force on Community Preventive Services • Obesity-related systematic review for worksite setting • Multi-component interventions aimed at diet, physical activity, and cognitive change • RECOMMENDED • Single component interventions aimed at diet, physical activity, or cognitive change alone • INSUFFICIENT EVIDENCE See www.thecommunityguide.org

  16. Optimizing Practice through Research The application of “evidence-based” recommendations

  17. Evidence-maps and summaries Logic Framework Depicting the Conceptual Approach to Development of an Adult Weight Management Protocol Height and Weight (Body Mass Index) • Structure • Intervention components • Individual • Correspondence • Multi-component • Group-based • Technology use • Providers • Clinical care guidelines • Platforms of operations • Program design Intervention Treatment Prevention Maintenance Prevention Comorbid Conditions Adult Population (age 18 and over) • Process • Delivery methods • Integration • Referral patterns • Provider role • Intervention processes • Process improvement Evidence-informed health promotion protocol Demographic Variations Prevalence and Incidence Financial Impact • Outcomes • Participation • Weight change • Behavior change • Quality of life • New disease diagnoses • Satisfaction • Clinical management Social Ecology • Worksite-based • Clinic-based • Health plan-based • Community-based • other settings Design and Process Improvement Source: HealthPartners Health Behavior Group, 2004

  18. Promising Approaches • Program strategy and design elements • Clear goals and objectives • Strong leadership • Socio-ecological approach recognizing both individual-level and organizational-level program characteristics • Program intensity and cost • Communications and incentives • Inter-relatedness of all elements

  19. Program Elements to Consider • Program intent • Intervention target level • Intervention design features • Program intensity and cost • Target population • Program approaches (tactics; options)

  20. Program Components Related to Successful Outcomes • Behavioral weight loss strategies: • Calorie reduction • Fat reduction • Increased fruit/vegetable intake • Increased exercise/physical activity • Elimination of sweets • Consumption of less food • Any use of strategies (singly or in combination) is associated with weight loss • Use of these strategies is related to better weight loss in a dose-response fashion Source: Linde, et al Int J Behav Nutr Phys Act 2006, 3(3) [access online].

  21. Program Components Related to Successful Outcomes • Successful weight loss maintenance • Dietary composition – moderately low fat diet consumption and total caloric intake monitoring • Breakfast – 7 days per week • Self-monitoring – daily or weekly monitoring of body weight • Physical activity – regular PA; 1 hour of moderate intensity PA daily (or ~28 miles of walking per week) Source: Wyatt, et al Obesity Management 2005;1(2):56-61.

  22. Approaches to Weight Management Services Population Size

  23. Addressing Obesity at the Worksite Assess Organizational and Environmental Risks Physical environment (physical surroundings) Social environment (policies, norms, etc.) Health education programming (learning resources) Management support (leadership support, resources) Organizational foundations (supporting structure incl. health benefits) Population Measurement and Evaluation Improved employee health Increased productivity Assess Individual Risks Stratify Population by BMI Risks Manage Health Improve Health Maintain Health High cost High intensity Moderate cost Moderate intensity Low cost Low intensity Severely obese obese Population Size Program Cost Overweight Healthy weight

  24. Open Dialogue

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