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Breakout Session VII—Influences of Family,
Schools, and Worksites on Obesity
Discussion Group E: Worksite Influences on
Obesity
Moderators: Rebecca
Reeve, Garry Lindsay
Recorders: Maria Bettencourt, Nancy Berger, Amy Jesaitis
Purpose: Adults spend
most of their day in the work setting. This discussion group examined
the influences on diet and activity in worksites and made recommendations
as to how this environment can be modified for obesity prevention.
Process: The group opened
with brief presentations from the moderators and selected five areas
as actionable priorities through a consensus-making process. A brief
discussion of the specific recommendations contained within each
priority is included in the discussion that follows each recommendation.
Introduction
The introduction by Garry Lindsay described how worksites are a
subset of the community at large. Changes in the physical work environment,
corporate policy, and corporate culture are needed to create a supportive
worksite environment. Environments that support healthy lifestyle
activities are created when employers understand that healthy employees
are a good investment in terms of the bottom line. The goal of having
a work environment that supports physical activity and good nutrition
then becomes mission-driven. Rebecca Reeve emphasized making a business
case for a healthy worksite environment. We must translate our public
health goals (e.g., healthy employees) to business goals (productivity
and competitiveness) to make business sense to employers. Back to Top
Actionable Priority: Identify
Incentives to Encourage Businesses to Provide a "Supportive Environment"
Policies and practices are needed to create an environment that
supports physical activity and good nutrition. Examples include
healthy food choice options in vending machines, formal policies
that encourage supervisors to allow employees to use "flex time"
to exercise, installation of showers for employees who want to exercise
during the work day, and ensuring clean and safe stairwells.
Ideas and Considerations
- An expert panel is needed to include the business,
payer, and provider perspectives. Identify the C. Everett Koop
National Health Award winners and what they think we need to do
next.
- Health professionals need to think more like business
professionals.
- Survey employees to identify the most worthwhile
incentives.
- Evaluate resources related to environmental changes.
- Fund and evaluate demonstration projects at the
worksite. Establish how to quantify benefits. Information on costs
and return on investment are needed to justify the costs of change.
- Offer financial/tax incentives to businesses to
adopt prevention-oriented human resources policies.
- Include facility adaptations for employees with
disabilities.
- Barriers include lack of middle-management support
(e.g., sometimes only union employees can make structural changes),
time needed to make physical changes, and lack of space (e.g.,
no room for a gym or a shower).
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Actionable Priority: Establish
Third-Party Reimbursement
Third-party reimbursement is needed for health-promotion activities,
including nutrition education and physical activity programs based
at the worksite.
Ideas and Considerations
- Build health promotion into the national agenda.
Identify which standard or certifying body would determine whether
this specific program is reimbursable.
- Measure effectiveness of programs. Evaluation could
include health outcomes and long- and short-term cost-effectiveness.
- Establish relationship and buy-in for payer.
- If worksite health promotion is reimbursable, employer
costs may drop, or they may increase to cover the premium needed
to create reimbursement funds.
- Establish guidelines and standards for approved
programs and services. Determine who establishes the standards
governing the providers of services. Establish criteria to determine
"reimbursable" providers. For example, is there a need for American
College of Sports Medicine or Certified Health Education
Specialist certification to be reimbursed?
The paperwork burden must be considered.
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Actionable Priority: Produce
an Annual Report Card
Produce an annual report card on the prevalence of obesity, exercise,
and nutrition risk and tie rates to associated costs.
Ideas and Considerations
- Define obesity-related costs using expertise from
health economics, biostatistics, and medicine.
- Build on existing work to establish attributable
costs. Determine the direct or indirect costs associated with
the reported prevalence of adult or childhood obesity, the costs
of healthcare, and reduced productivity. Build on the work of
Ann Wolf and others. For attributable costs, a software package
similar to SAMMEC (Smoking-Attributable Morbidity, Mortality,
and Economic Costs) is needed. This would allow making a better
"business case" for spending money to reduce obesity.
- Establish a report card based on the leading health
indicators of Healthy People 2010. Create a way to make
it easy for every community in the United States to know its prevalence
of childhood and adult obesity, and use the Healthy People
2010 goal as a benchmark for successful obesity reduction.
- Define what constitutes adequate cost data. Identify
the resources required to create "OAMMEC" (Obesity-Attributable
Morbidity, Mortality, and Economic Costs) software.
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Actionable Priority: Promote
Worksite Policies That Enhance Physical Activity and Healthful Nutrition
Develop and promote policies that enhance physical activity and
healthful nutrition at the worksite.
Ideas and Considerations
- Identify and publicize existing successful companies.
Convince employers that wellness activities in the worksite, including
nutrition and physical activity, make a difference.
- Create employee demand and provide incentives to
increase participation.
- Develop a network of sentinel companies to collect
data to evaluate the impact of nutrition and physical activity
programs on healthcare costs.
- Make the business case (document the value and
benefits).
- Work with corporate attorneys to consider legal
aspects of promoting worksite wellness activities.
- Incorporate the requirements of Americans with
disabilities.
- Barriers include confidentiality issues (if health
cost data are included in reports) and employee resistance.
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Actionable Priority: Determine
and Promote Best Practices in Worksite Wellness Programs
Determine best practices in worksite wellness programs (could use
CDC's Best Practices for Comprehensive Tobacco Control Programs
as a document model), segment by disparate population groups, and
include health outcomes to establish return on investment.
Ideas and Considerations
- Encourage experts in worksite behavior science
to develop guidelines and standards for best practices.
- Consider cultural competence during the planning
stage and throughout the process.
- Document the biomedical, behavioral, or social
science basis for programs that work. Such programs should have
a scientific base, documented effectiveness, a proven return on
investment, an ethical implementation plan, and a successful marketing
message to businesses.
- Engage corporate champions.
- Establish a formal Federal structure for worksite
health promotion. Currently, the responsibility for goals and
objectives related to worksite health promotion in Healthy
People 2010 resides in various Federal organizations. A goal
is to establish a single Federal focus, such as the CDC's Division
of Adolescent and School Health, which is where Federal health
promotion activities for school-based programs are found.
- Barriers include gaps in tested interventions and
evaluation methods that are less than ideal.
- Determine whether popular programs are desired
because they are driven by need or data or because they are simply
"feel good" programs. Linking worksite health promotion to productivity
and return on investment measures is key to integrating programs
into standard business practices.
- There is competition for media air and board time.
Determine how to keep this issue in the forefront. Media are tired
of some health issues; they are more likely to cover fad diets
than sustainable, proven programs.
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