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Which methods really work to combat obesity?
Use carrots, not sticks, as incentives
There is no doubt that obesity is a growing and costly problem for employers nationwide. But the question remains: What should be done about it? To date, there isn't any data proving that a particular approach works best.
"Cutting edge approaches are really comprehensive approaches; they cover more bases," says LuAnn Heinen, director of the Washington, DC-based Institute on the Costs and Health Effects of Obesity. "There is not a silver bullet." Here are recommendations for approaches to combat obesity:
Programs that appear most effective are those that provide employee incentives for improvement and those that include multiple contacts with health promotion staff over an extended period of six to 12 months, says John Dement, PhD, principal investigator for development of the workplace safety surveillance program at Durham, NC-based Duke University Medical Center.
"Unfortunately, few studies are available to show long term maintenance of weight loss," Dement says. "Additional research is needed to better define programs which impact obesity in the long term."
To increase participation in wellness programs, a growing number of employers are offering financial incentives. At Duke, employees who participate in wellness programs earn incentive dollars that can be used to purchase items in the Duke health promotion store. And at Stamford, CT-based Pitney Bowes, Health Care University is an online tool used by employees quarterly to record progress. For every quarter that progress is made, the worker receives 75 dollars as a credit toward their health coverage for the following year.
J. Brent Pawlecki, MD, the company's corporate medical director, says that incentives are part of our overall health and wellness programs for employees. "We find it effective, on many levels, to use the carrot and not the stick," Pawlecki says.
Offer workers a wide range of innovative programs and opportunities, says Heinen. Heinen created the Best Employers for Healthy Lifestyles award, given annually by the National Business Group on Health.
This year's winning companies offer a wide variety of wellness and lifestyle improvement programs — onsite fitness and health clinics, weight-management, smoking cessation and tobacco cessation programs, health coaches, web-based health and fitness tools, financial incentives for participating in fitness programs, and health risk assessments.
At Pitney Bowes, a multifaceted approach to obesity is taken, including weight loss programs, onsite medical health clinics with preventive screenings. a certified nutritionist on staff who works with employees, and nutritional consults with cafeteria staff.
Duke offers the following programs to its employees:
— HealthCheck, a confidential health assessment including blood pressure, cholesterol, height, weight, and body mass index (BMI), and assistance in making lifestyle changes. A summary report is sent to the employee's physician if requested by the employee.
— Health education classes in classroom and self-paced settings to help employees adopt positive health habits.
— Personal health counseling through "Pathways to Change" and "Steps to Health" programs, developed in-house at Duke, which offer confidential assistance for high blood pressure, high cholesterol, obesity, and/or smoking.
— Personal consultations in nutrition and/or fitness.
Increasingly, employers are subsidizing healthier cafeteria options and raising the prices of less healthy choices, says Grace K. Paranzino, MS, RN, CHES, FAAOHN, national clinical manager of Troy, MI-based Kelly Healthcare Resources. Also, employers are creating opportunities for physical activity at work with walking programs, providing pedometers, putting mile markers around campus, opening stairwells, and using signage to encourage walking.
Quest Diagnostics' employee wellness program, called HealthyQuest, offers healthful food choices at cafeterias and vending machines, and it encourages physical activity through fun events, such as organized pedometer competitions and involvement in community walk and running events for nonprofits. "So far this year, we estimate that more than 2,000 pounds have been lost by employees who participated in local weight loss challenges," says Dori Bontempo-Ziegler, program manager of the wellness initiative for Lyndhurst, NJ-based Quest Diagnostics.
New technology is now available that could take that a step further. The "walk and work" desk would allow obese office workers to exercise while they work. A recent study indicated that if sitting time were replaced by treadmill walking for two or three hours a day, a weight loss of 44 to 66 pounds per year could occur for those who are obese.1
However, employers might be reluctant to invest in the machines. Although not commercially available currently, researchers estimate their cost will be about $1,600 per unit. "There would be tremendous costs associated with this, and it would have to be offered to all employees so as not to discriminate," says Paranzino. "There would also need to be more research to look at productivity outcomes."
While the machines may well help workers lose weight, it remains to be seen whether they are actually feasible in the workplace, says Fred R. Williams, director of health benefits management for Quest Diagnostics. "We would need considerably more information about cost, safety, and other factors, before we could speculate as to whether we think it would be an appropriate and worthwhile technology for employees," he says.
• Tie weight loss to benefits.
You need benefit design that supports the healthy weight and lifestyle goals you are encouraging. "Perhaps [registered dietitian] consults are covered and health risk assessments are free. Or Weight Watchers may be offered or subsidized on site," says Paranzino.
• Answer the question "What's in it for me?"
This is perhaps the most important question you need to answer, says Paranzino. "Knowing what makes your employees tick cannot be understated," she says.
1. Levine JA, Miller JM. The energy expenditure of using a "walk and work" desk for office workers with obesity. Br J Sports Med 2007. Accessed online: 15 May 2007. doi:10.1136/bjsm.2006.032755.
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Ask questions, assess your obesity program
To assess your obesity program, ask these questions, recommends Grace K. Paranzino, MS, RN, CHES, FAAOHN, national clinical manager of Troy, MI-based Kelly Healthcare Resources: