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Teamwork, convenience drive long-term weight loss program success
Occ-health professionals also buying into low-carb approach
With more employers recognizing the real costs of overweight employees and getting behind weight management programs, why do the headlines continue to scream that Americans are the fattest people in the world? Does anybody know the secret to successful, long-term weight loss?
In a series of interviews, the experts shared their thoughts on what has worked — and what hasn’t — in their own workplace efforts.
"The key is to change lifestyle behavior," says Lady Ellen Clark, COHN-S, CCM, corporate director of health services for San Antonio-based manufacturing company C.H. Guenther & Son Inc. "I was blessed to have senior officers really promote it from the very top. With that, I was able [in 2001] to get my very first decent budget."
"We tell them they are going to be in a weight management program for life," adds Missy Dubyak, COHN-S, a nurse with Lockheed Martin in Manassas, VA, citing the importance of a realistic approach to long-term success. "The camaraderie of teammates also offers great encouragement."
She adds that all the recent publicity surrounding obesity actually can be turned into positive reinforcement of her wellness message. "It makes it easier for me as a practitioner to get people to do what I want them to do," she says.
Lewis Schiffman, president of Atlanta Health Systems, a wellness consulting firm, adds: "To begin with, [you must] raise peoples’ levels of awareness — that this is in fact a problem that is costing everybody. It’s particularly important for employees to realize that health benefits are a finite resource; and that if people continue to incur health care costs for preventable illness [due to obesity], no company will be able to afford to buy health benefits for their employees. Everyone must recognize their responsibility in protecting the future of their health care benefits."
Schiffman also counsels realism. In a program he currently offers at Atlanta Gas Light Resources (AGL), he presents it as a beginning — not an end in itself. "It’s being done in a more informal way, with friendly competition, fun, and a chance for everyone to win," he explains. "At the end, those who want more help can be referred to a more formalized intervention program."
The Atlanta-based American Association of Occupational Health Nurses (AAOHN) recently conducted a survey of 10,000 Americans, only 2% of whom claimed participation in an employee-sponsored weight management program. Nevertheless, 48.5% of those who said they had participated indicated they had reached and maintained their weight loss goals. Here are some of the keys to a successful program, according to AAOHN:
The survey respondents who had been successful attributed that success to the following:
Nearly all of these factors were touched on by the occ-health experts interviewed by Occupational Health Management.
An uphill battle?
Despite the fact that many occupational health professionals apparently know what works (or what should), they are sometimes fighting an uphill battle against a number of dynamics in our society, notes Schiffman.
"Obesity is definitely the No. 1 health risk and threat in the country today, and we are undoubtedly the fattest country in the world; but before we fix the problem, we have to understand why we have it," he observes.
Here, says Schiffman, is the challenge we face: "In the same way that the tobacco industry has set out to addict young people to cigarettes, the junk food industry has set out to addict children to sugar, salt, grease, and white foods with no nutritional value, and they’ve done this through advertising and through invading schools with their products [in vending machines] and making it more attractive for children to make poor choices. Kids who get addicted to these foods become overweight and become overweight adults, and teach these same poor eating habits to their children, who also become overweight."
This makes combating weight gain in the workplace a sensitive issue for a lot of people, he notes. "Many workers believe employers should not tell them what to eat," says Schiffman. "Many of them have eating disorders and/or food addictions they believe they have little control over."
Weight also is something that affects peoples’ self-esteem, and so companies, in implementing programs, must be sensitive to presenting them in a very positive light, he continues. "Most people who are overweight have tried to lose it at one time or another, and because of using ineffective methods, they have gained the weight back and more. In these cases, their unsuccessful attempts at dieting have made them feel guilty, and in turn made them want to eat more."
Success still possible
Despite these obstacles, many occ-health professionals can and are being successful. For example, Clark says she began an aggressive wellness program in May 2001 and has achieved impressive results.
"We started with an on-site WeightWatchers program almost three years ago," she recalls. "We’ve had a core of 25-35 people in that. Within a year’s time, they lost over 1,000 pounds, and in 2½ years a total of 1,682 pounds."
Some employees stayed on the program the whole time, while some went off and on, Clark notes. "We looked at and researched all [the weight loss programs], and what we found most successful with WeightWatchers was moderation, pushing water, and eating fruits and vegetables."
What she particularly liked about WeightWatchers was that with a point-counting system, employees could eat what they wanted, but it also taught employees to make better eating decisions.
The company partially underwrote the sessions, so employees paid $5 instead of $13. "We still have a good strong core group who are lifetime members [those who have reached and stayed at their goal weight]," says Clark. "They may gain five or 10 pounds, but then they start counting points again. I’m one of them; I lost 45 pounds, and I don’t sacrifice anything in terms of food. What I learned is to go back to basics, and change my lifestyle behavior."
She admits she arrived at these conclusions after "a lot of trial and error." She began with a comprehensive walking program, using American Express [Amex] gift certificates as incentives for reaching goals. "But nobody cared much about the incentive of Amex gift certificates," Clark says. "There needs to be a lifestyle change, and it has to be an internal change you want."
Much of the budget was transferred to giving health risk appraisals and blood draws each year. "Much of our nutritional success stories have been because of that," she says. "Our population is sedentary and overweight. They get their report, read the warning signs, and we try to be available to them and get them to good physician sources and early intervention on what risks are there."
This approach, Clark notes, "has been super successful." In the past two years, she reports, 79% of the participants have not only achieved their weight loss goals but have maintained them for a second year. "These are hard, effective data," Clark asserts.
At the Lockheed Martin facility in Manassas, each employee belongs to the nearby Freedom Center, which includes a very large swimming pool and a track. The cost is underwritten entirely by the company.
"It’s almost as good as having something in the building, but in some ways it’s even better — it’s outside, but close enough that you can go for lunch," says Dubyak.
One reason this benefit was added was to support weight management efforts, she notes. "We have WeightWatchers on site. We also offer pedometers for people to use when walking on site, if they are shy about going to Freedom Center."
Membership in the center, which is an $855 benefit from the company, engenders camaraderie, says Dubyak. "When you first join, you get a personal trainer for an hour," she notes. "You also fill out a personal wellness evaluation questionnaire."
Because a lot of people at the site have been together 15-20 years, the team spirit is a logical point of inspiration. Dubyak says that the membership benefit has been "well worth the investment." She adds, however, that a proactive staff are also important.
"With employees over 40, some have had teammates who have had surgery or have even died [due to obesity complications]," Dubyak says. "Some have opted for gastric bypass. But our diabetes rate has been awful. To prevent bad complications, we nag them. We give them a pedometer, and tell them to go out and see what they can do." For the very obese workers, she adds, water aerobics at the Freedom Center are recommended.
AGL Resources in Atlanta is currently sponsoring a weight loss challenge, where each of its offices is given a scale that measures body fat as well as weight. "People sign up to participate in the program, and are eligible to win a variety of prizes from a weekend at a bed & breakfast inn to pedometers and exercise equipment," says Schiffman. "They also participate in a nutrition and weight management seminar, and have the availability of a nutritionist to provide coaching for them." Thus far, he reports, more than 30% of the work force has signed up to participate.
Schiffman offers these additional strategies companies can try to reinforce their weight management efforts:
Don’t let them eat carbs
Nutrition is a critical component of any weight loss program, and all the media attention being paid recently to different low-carb diets may have the general public confused, but professionals are clear on what should be recommended to employees.
"For starters, diets don’t work; by their very nature, they are temporary," Schiffman explains. "When you go on one, it means at some point you will go off it. We want to help people develop better eating habits to maintain long-term health."
Schiffman says that nutritionists have known for many years that white foods such as white pasta, white rice, white bread, corn, potatoes, and sugar are nutritional losers. "They also are addictive; the more you eat, the more you want to eat, and they actually rob your body of vital nutrients," he says. "This contributes to diabetes and functional low blood sugar."
However, he adds, all carbs are not equal, and all are not bad. "We do want to eat some whole grains; certainly, we want to maximize and be appreciative of the carbs we receive from fruits, vegetables and legumes [beans], all of which help speed the transit time of our food and help protect our blood vessels," he says.
Animal products, on the other hand, are not healthy, he maintains. "They take a long time to digest, they increase the risk of colon cancer, and the antibiotics and hormones fed to commercially raised animals weaken your immune system and are considered by many a causal link to cancer," he says. Recognizing, however, that most people are not vegetarians, he recommends "eating range-fed animals raised without hormones and antibiotics — and eat them in moderation."
Schiffman is a big advocate what he calls the diversity diet. "Stay away from white foods and eat foods with more natural color," he says, noting his approval of a food pyramid designed by Walter Willett, MD, DrPH, of Harvard Medical School.
"I recommend everything in moderation — eating balanced meals," says Clark. "The key is pushing water; if there’s not enough, your body wants retain water and you bloat."
Like Schiffman, she also recommends a colorful diet. "You should learn to like all colors of fruits and vegetables; they are high in fiber, they are nutritional and they fill you up, leading to small portions of proteins."
Clark also brought in a nutritionist from Texas A&M to speak with employees. "She taught people how to cook healthily," she explains.
"I sit down and counsel employees within a direction they choose," says Dubyak. "Some employees are on Weight Watchers; the problem is they allow them the sugars, which re-addict them. My belief is it leads to more malignancies that we’re seeing."
In terms of nutrition, Dubyak advises employees to consider the Atkins diet, Suzanne Somers’ diet, Sugar Busters — any of the low-carb diets. "Because of the ketosis factor, I tell them not to be so rigid," she notes. "For example, Atkins may recommend 22-32 grams of carbs a day. I’ll sit down with an employee and say, I think 30 may be low for you; how about aiming for something a bit higher?’ I suggest they start exercising, too, and then come back and see me."
Employees also have to be educated about reading labels, she says. "But that’s easy; people are not stupid — they can definitely be educated."
Education, then, can be added to the long list of Do’s for successful weight loss programming. "The issue of excess weight is a health, performance, and bottom-line issue for all companies, and it also must be handled with sensitivity," Schiffman concludes.
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