When we sit down with the leadership of our clients and their HR/Benefit departments, we usually get heads nodding when we share that 40-50% of Americans born after 2000 will have diabetes. There are plenty of peer-reviewed case studies to show that leading companies who invest in establishing a culture of health and accountability in the right way experience returns that go far beyond the expense side of the ledger.
Almost 60% of the U.S. diet is made up of sugar and carbohydrate. Since 1977, Americans have doubled their daily intake of sugar, lurking in processed foods like cereal and catsup. Our sugar intake has lead to a corresponding rise in obesity, metabolic syndrome and chronic conditions that are the result of a pancreas that eventually exhausts itself from producing the hormone insulin.
How could it be that from 1980 to 2000, fitness memberships doubled along with a corresponding doubling of the obesity rate? If our willpower is to blame why do we have obesity in 6 year olds? And of all the nutrients listed on a food label, how is it that sugar, a substance more addictive than cocaine, is the only nutrient that a food manufacturer does not have to disclose under the food label's percentage daily recommended allowance guidelines? Could it be that Americans were misled into believing that a "low-fat" diet was best for us based on junk science? Could federal guidelines have been influenced by powerful food lobbies and corporate profits placed ahead of our public health interests?
Realizing we now have an epidemic that we are not going to be able to exercise our way out of, the U.S. Preventive Task Force (USPTF) has recommended coverage for progams that have demonstrated clinical success in reversing symptoms of Metabolic Syndrome be covered under the Affordable Care Act (ACA) at 100% with no cost sharing. In a future post, I'll share more about how and when employers must cover behavioral weight management as a benefit and what our ACAP Health subsidiary is doing to help companies reverse these metabolic trends caused by sugar.
Our company will continue to endorse only programs that adhere to evidence based guidelines from trusted voices like Dr. David Katz, Dr. Mark Hyman, Dr. Robert Lustig, Tim Church, M.D., M.P.H., Ph.D and Dr. David Kessler. Please commit to watching "Fed Up", produced by Katie Couric and Laurie David.
Living well and living long are two different things. and one of the country's leading preventive health researchers, Dr. Tim Church, states it plain and simple—maintaining a high quality of life means finding time for physical activity.
One of the things I've really learned in medicine is that there are certain things that resonate with us that we believe in, with or without data – it just must be true. And the idea of, 'we are what we eat,' it is amazing to me how people hold onto that. People have a hard time getting their arms around, 'we are what we do.'
As a physician, through med school, through residency, I just got frustrated with treating things that were 100 percent preventable. And, you know, I love to say we like to heroically clean up after the car accident, but we don't like to put up stop signs. And, I just was always drawn towards prevention and then in my prevention quest so to speak, physical activity and exercise just made so much sense. It didn't matter what the analysis was. It didn't matter what we were looking at. There was always this one variable that was so powerful. It was exercise.
When it comes to weight loss one of my favorite sayings is: you diet to lose weight, and you exercise to keep it off. It doesn't matter what the macronutrient components of that diet are. You can focus on low carbs. You can focus on low protein. You can focus on low fat. It doesn't really matter. It tends to be an individual thing.
But, once you get the weight off, exercise becomes so critical in keeping it off. It's not hard to lose weight. It's very easy to lose weight, that's why all the fad diets work. That's why all this bogus stuff works. The challenge is keeping the weight off, keeping it off at six months, keeping it off at 12 months, keeping it off at two years.
Everything counts. If you're doing nothing now, this is not all or nothing, this is not about, 'hey if you don't get to 150 minutes a week, then it's a waste of time.' Just getting off the couch has benefits. In fact, the most sedentary individuals who have the worst health are the ones that benefit the most from a little bit of physical activity. The return on investment for a little bit of physical activity is huge for those guys. The person who's running a 10K all the time and ramps it up to a marathon. They don't get any more benefit when they go from 10K to marathon, they've already kind of maxed out. But that person who's totally sedentary and takes up a walking program? Huge benefits.
It's not about how long you're gonna live. How long you're gonna live is primarily determined by how long your grandparents lived, how long your parents lived. It's about how long you live well. Can you go duck hunting in your 80s? Can you chase your grandkids? You know, can you do the things that you love doing? And there's no pill for that. We can't go to the doctor and get a pill for quality of life. There's one thing we know that works for maintaining quality of life. And that is being physically active. That is leading an active lifestyle which may or may not include formal exercise. So, you want to lead the life you want to lead? You've got to be physically active.
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The following is a must watch for anyone who endeavors to change the health risk of a population. Our industry needs to move beyond treating our people like they are asses. We assume humans are like farm animals motivated by dangling a carrot or giving a smack on the rear. As Dr. BJ Fogg explains in the video below, an employee's level of motivation is hardly the culprit.
The research and understanding of "B=MAT" - behavior = motivation, ability and trigger ... is worth the small time investment it will take to watch this video. Dr. Fogg’s research is some of the most groundbreaking in terms of how human beings change behavior. Dr. B.J. Fogg is the Director of the Persuasive Technology Lab at Stanford University.
I came across this video at Rock Health when launching my own startup in the digital health technology space.
From Leonardo da Vinci to Dr. Atkins, society often ridicules those with different points of view. Here Dr. Peter Attia discusses some compelling reasons why we might want to question the conventional thinking around obesity and insulin resistance. Dr. Peter Attia's presentation has nearly garnered 1MM views and it's worth the watch.
As a young surgeon, Peter Attia felt contempt for a patient with diabetes. She was overweight, he thought, and thus responsible for the fact that she needed a foot amputation. But years later, Attia received an unpleasant medical surprise that led him to wonder: is our understanding of diabetes right? Could the precursors to diabetes cause obesity, and not the other way around? A look at how assumptions may be leading us to wage the wrong medical war.
Both a surgeon and a self-experimenter, Peter Attia hopes to ease the diabetes epidemic by challenging what we think we know and improving the scientific rigor in nutrition and obesity research.
Source: TEDMED - April 2013
As the summer winds down, I could not help but be thankful for the fun we had in our backyard pool. It suddenly dawned on me that our private swimming pool provided many analogies as it relates to the direction of our federal health care reform initiatives. Many Americans, like my younger sister, will be the first to benefit from affordable coverage without any restrictions for preexisting conditions on January 1, 2014. The Affordable Care Act ("ACA") allows older Americans to pay a higher rate than younger Americans, but the community rating band will be broken down by only three different age groups. AARP lobbied strongly for this and it is an absolute boon to the baby boomers and a real shaft to Generation X, Y, and Millennials who will bear the brunt of the top third oldest risk tier by age. As an example, state exchanges will have age rating bands of 3:1 that will prevent insurers from charging an adult age 64 or older more than three times the premium they charge a 21 year old for the same coverage. Many believe the bands will be modified to reflect more of a 5:1 ratio as the individual market typically uses today.
Roughly 60% of Americans receive private health coverage through their employer. Think of each one of these employers as having their own swimming pool. When I look out at my own pool, our crystal blue waters are meticulously maintained by a cleaning crew that our family gets to select. When the job doesn't get done, we simply hire another supplier to get better results. We also get to decide who goes in and out of our family oasis (aside from a random duck that finds his way every year or so to the deep end). We have control over the environmental factors of our pool like if I want a salt-water or a chlorine pool. Additionally, we use brushers, skimmers and a Polaris as preventive measures that keep the water clean and healthy. This is not any different from an employer that sponsors their own corporate health and wellness plan.
On January 1, 2014, there will be another option - a public pool. When I was little I used to go to our community rec pool and my mom would pay to gain entry or buy a summer pass. Twenty-seven states (27) have agreed to run a community pool but do not really want to manage it. This leaves the cleanup and maintenance to a much larger pool cleaning company called the Federal Government. While Kathleen Sebelius and others will try hard to sell annual passes to younger Americans with lower health risk, there are three groups that will likely end up donning their swimming caps and jumping into the water:
a. Early retirees - This pre-Medicare eligible group is one of the most costly to have on your health plan with claims costs that are actuarially equivalent to three times that of the normal working population. A report by the Employee Health Benefit Research Institute (EBRI), shows around 17% of employers offered such coverage. The number of non-working early retirees who enroll through their employer is around 2 million lives. In a recent Aon Hewitt Survey, nearly a third of employers who provide early retiree coverage plan to direct them to the individual exchange market. Minnesota based 3M company is exhibit A here after eliminating their group plan for early retirees in favor of redirection to the public exchange pools in each state in 2014. This is typically done through transition credits through a health reimbursement arrangement (HRA). Not to blame 3M, as this is a rational market response when comparing premiums under three-tiered banded rates.
b. State continuation enrollees - As the insurer of last resort, state continuation enrollees and participants in the federal Pre-existing Condition Insurance Plan will be another group that will contribute to the losses in the state exchanges. About a quarter of a million Americans fall into this category with more than a dozen states declaring intentions to close their plans in the first six months of 2014. ACA provides a three-year transition period during which the costs of these programs will be shared across the market. However, many feel the $5 billion appropriation will not be enough to help states offset the costs through ACA.
c. Low-income Americans - There are numerous studies that unfortunately show a direct correlation between low-income wage earners who are uninsured and the propensity to be obese, have chronic illness and pre-existing conditions. This group will continue to be attracted to the community pool and have higher health risks when compared to their private plan cohort. While those who qualify for subsidies (household incomes of between 100-400% of the federal poverty level) are the ones who need it most, their risk factors should predictably drive costs higher each year over private plans. Over two-thirds of enrollment (CBO estimates) in the exchanges are anticipated to come from those receiving premium credits. This is something for employers contemplating "pay or play" moves should consider as a one year cost comparison may prove to be short-sighted without thinking through the tax implications and future trends of wading through the public waters.
What is the x-factor that will help keep public exchange costs in check? - those young invincibles ("Young-ens") with no claims who are predicted to enroll. Lets not count on them rushing in for fear of an underfunded IRS staff that will struggle to collect a paltry penalty (the higher of $95 per year or 1% of family income) from the uninsured. Keep in mind that ACA is a law whose details are unfamilair to two-thirds of Americans. Unless the IRS blocks access to the Young-ens X-Boxes until they join an Exchange, this group is going to take awhile to put on their swimming suits. Those of us who studied actuarial science and risk management in college know that the dreaded "death-spiral" can occur when younger healthier risks avoid the pool as costs go up leaving behind poorer risks with costs escalating higher each year.
Advice for Tending to Your Own "Swimming" Pool
An August 2013 Towers Watson survey confirmed that 98% of employers surveyed will retain their active medical plans for 2014 and 2015. The rationale given was that they view maintaining their own health plan (or swimming pool) as an important part of the employee value proposition and a competitive advantage for their companies.
My advice to my colleagues in senior level HR and Benefits who serve as the "lifeguards" of their private pools:
Hire the right crew and invest each year in preventive measures that deliver crystal clear waters.
Lighten your load or pay more! This NPR report describes rationale for why it is permissible under the federal health reforms for employers to use incentive programs encouraged healthy behaviors.
This is the time of year when your employees are contemplating whether or not to eat that remaining peanut brittle or move on with 2012. For employers considering investing more in corporate wellness programs, we wanted to pass along a quick story and some rules for your folks who head to the gym. We recently visited with a prospective client who shared with us their meticulously overcooked wellness program where participants could receive points and olympic levels of achievement for enrolling online, taking tests, watching videos, and reaching out to coaches as "engaged" members. These "valuable" points could then be used to purchase a lot of left over things that retailers failed to sell over the holidays.
After listening intently how the employer was told the wellness plan would save the company a lost of money, we politely explained that this program was in reality money that could have been invested in a different way. Our Health Risk Solutions team will be doing more of these interventions throughout the year. For those who are not afraid of the truth ... our gift to you is Jason Gay's 27 Rules (as printed in today's WSJ) to share with your people:
1. A gym is not designed to make you feel instantly better about yourself. If a gym wanted to make you feel instantly better about yourself, it would be a bar.
2. Give yourself a goal. Maybe you want to lose 10 pounds. Maybe you want to quarterback the New York Jets into the playoffs. But be warned: Losing 10 pounds is hard.
3. Develop a gym routine. Try to go at least three times a week. Do a mix of strength training and cardiovascular conditioning. After the third week, stop carrying around that satchel of fresh-baked chocolate chip cookies.
4. No one in the history of gyms has ever lost a pound while reading "The New Yorker" and slowly pedaling a recumbent bicycle. No one.
5. Bring your iPod. Don't borrow the disgusting gym headphones, or use the sad plastic radio attachment on the treadmill, which always sounds like it's playing Kenny Loggins from a sewer.
6. Don't fall for gimmicks. The only tried-and-true method to lose 10 pounds in 48 hours is food poisoning.
7. Yes, every gym has an overenthusiastic spinning instructor who hasn't bought a record since "Walking on Sunshine."
8. There's also the Strange Guy Who is Always at the Gym. Just when you think he isn't here today...there he is, lurking by the barbells.
9. "Great job!" is trainer-speak for "It's not polite for me to laugh at you."
10. Beware a hip gym with a Wilco step class.
11. Gyms have two types of members: Members who wipe down the machines after using them, and the worst people in the universe.
12. Nope, that's not a "recovery energy bar with antioxidant dark chocolate." That's a chocolate bar.
13. Avoid Unsolicited Advice Guy, who, for the small fee of boring you to death, will explain the proper method for any exercise in 45 minutes or longer.
14. You can take 10 Minute Abs, 20 Minute Abs, and 30 Minute Abs. There is also Stop Eating Pizza and Eating Sheet Cake Abs–but that's super tough!
15. If you're motivated to buy an expensive home exercise machine, consider a "wooden coat rack." It costs $40, uses no electricity and does the exact same thing.
16. There's the yoga instructor everyone loves, and the yoga instructor everyone hates. Memorize who they are.
17. If you see an indoor rock climbing wall, you're either in a really cool gym or a romantic comedy starring Kate Hudson.
18. Be cautious about any class with the words "sunrise," "hell," or "Moby."
19. If a gym class is going to be effective, it's hard. If you're relaxed and enjoying yourself, you're at brunch.
20. If you need to bring your children, just let them loose in the silent meditation class. Nobody minds, and kids love candles.
21. Don't buy $150 sneakers, $100 yoga pants, and $4 water. Muscle shirts are for people with muscles, and rhythm guitarists.
22. Fancy gyms can be seductive, but once you get past the modern couches and fresh flowers and the water with lemon slices, you're basically paying for a boutique hotel with B.O.
23. Everyone sees you secretly racing the old people in the pool.
24. If you're at the point where you've bought biking shoes for the spinning class, you may as well go ahead and buy an actual bike. It's way more fun and it doesn't make you listen to C+C Music Factory.
25. Fact: Thinking about going to the gym burns between 0 and 0 calories.
26. A successful gym membership is like a marriage: If it's good, you show up committed and ready for hard work. If it's not good, you show up in sweatpants and watch a lot of bad TV.
27. There is no secret. Exercise and lay off the fries.
Listen in and apply these principles to our corporate-wellness initiatives. We could not agree more that intrinsic over extrinsic motivators provide longer-term results. We welcome your comments below and invite you to read Dan Pink's Drive to compare with Thaler and Sunstein's Nudge.
The HRSouthwest Conference is the largest regional human resources Conference in the United States. The Conference offers world-renowned keynote speakers, two and a half days of educational sessions networking opportunities and exposure to the latest HR products, techniques and services. This educational session features Lockton Dunning Benefits Vice President, Steve Harris, CEBS and Health Risk Management Director, Hayley Hines, MS, CHES, CWPD. They address how an employer can tackle the obesity epidemic, corporate health plan interventions, and successful wellness case studies in the workplace.
So many people spend their health gaining wealth, and then have to spend their wealth to regain their health. - A.J. Reb Materi, Our Family
This video reinforces that obesity costs healthplans an additional $1,500 per member per year or 40% additional compared to a normal weight person. Confronting the obesity epidemic in the workplace pays dividends in direct costs like medical and pharmacy expenses and indirect costs like retention, productivity and employee morale.