Are we losing the war on obesity? Study raises serious questions

Corporate preference for 'quick fixes' curtails weight-loss programs

After all the medical studies, after all the warnings, Americans keep getting heavier. That's the conclusion of a stunning article in a recent issue of Science,1 by James O. Hill, MD, director of the Colorado Clinical Nutrition Research Unit at the University of Colorado in Denver. Hill found that 54% of all American adults are heavier than is healthy. Calling obesity "a normal response to the American environment," Hill goes on to warn that if the trend continues, at some point the obesity number could get closer to 100%. And still the warnings continue. In a "Call to Action" in the journal Circulation,2 the Dallas-based American Heart Association upgraded obesity to the category of "major risk factor" for coronary heart disease.

What's going on here? Are weight-loss programs at corporate worksites experiencing similar problems? Is participation down, or are programs simply failing to work? How can we help employees overcome the temptations they meet in everyday life? An informal Employee Health & Fitness survey of weight loss experts, worksite health promotion professionals, and employees shows a mixed bag of failure and success, with plenty of blame to go around.

Looking for a quick fix

One of the major challenges for worksite weight-loss programs is that their benefits take years to show up on the bottom line, which doesn't endear them to corporate executives seeking quick returns.

"There has been a pendulum swing in the worksite away from programs for long-term behavioral change like losing weight, in favor of self-care programs that show short-term results," says Elaine Frank, MEd, RD, vice president of The American Institute for Preventive Medicine, in Farmington Hills, MI. "Companies have turned away from programs that require long-term behavioral change to show success. Of course, we want both types [of programs]."

Frank also blames health care providers and insurance carriers. "Their attitude seems to be, 'This insured won't be with me 10 years from now, so it may be somebody else's problem when they get a heart attack,'" she observes. "The smarter point of view is to say somebody will insure this person. They will be somebody's employee when long-term health problems arise."

While employees may not weigh less these days, their desire for getting help has not diminished, insists Margaret A. Sisko, MS, COHN-S, CCM, wellness manager at Chase Manhattan Bank, in New York City. "I'm being asked [to start new programs] all the time," says Sisko, who oversees a "Weight Watchers at Work" program for her employees.

What is it that employees need most from a weight-loss program? "They need a sense of control - control over their lives," says Sisko. She says they get that from the Weight Watchers program. "It helps you to make choices and discusses how to make those choices when you are eating out, for example. And keeping your point total (every food portion is assigned a point value) in your journal gives you a sense of control. We've had one instructor tell us that when we're in the supermarket we should shop around the periphery, because sweets and more fattening foods are in the center of the store. This makes the employees realize there are a lot of things they can control."

Frank agrees. "The No. 1 thing we can do is help an employee recognize that they can be in control," she says. "It's a lot easier to not succeed when you say the task is impossible. Getting people to use something at all is hard because most of them have already tried to lose weight and failed. You've got to catch their attention and get them going.

Don't forget exercise

One of the weaknesses of Hill's thesis, says Frank, is that he doesn't recognize the importance of exercise. "From what I know, for most of the years we have seen a climb in the average American's body weight, there hasn't so much been an increase in caloric intake as there has been a drop in physical activity," Frank says. "One hundred years ago, our normal activity would typically burn about 1,000 more calories a day than our typical activity in the '90s."

Sisko agrees. "As the Surgeon General's report last year showed, the biggest focus needs to be on exercise. I've done oodles of weight control classes, and I always like to ask the students two questions. When I ask them if they have done anything to improve their eating habits, everyone raises their hands. But when I ask them how many have increased the number of calories they burn off, maybe only half will raise their hands. The mindset we need to develop is that we still need to burn calories." (For more on exercise and weight loss, see "Ten-minute exercise sessions fight obesity," in our Health & Well-Being insert this month.)

Of course, says dietitian Frank, we can't overlook the importance of a healthy diet. What type of food regimen should wellness professionals encourage their employees to follow?

"The [FDA's] Food Pyramid is an excellent choice," she says. "It helps take away the 'magical mystery' part of the diet; there's no special formula, just a sensible balance."

Employees should be encouraged to "look at it as an assignment" to eat certain amounts of fruit, vegetables, and grains, Frank says. "If employees work at eating those things first, they'll probably feel satisfied and not tempted to look at other things," she says. "If they want sweets, they have to have these things first."

A low-cost alternative

Companies particularly concerned about the bottom line can still help their employees lose weight with low-cost programs such as those made available at local YMCAs or discounted memberships offered by local hospitals or health clubs. Another low-cost alternative is Weight Watchers at Work.

All the employer is required to provide is meeting space, storage space for materials, and publicity to employees, explains Harriet Colen, sales manager for the At Work program for Woodbury, NY-based Weight Watchers International. "Some employers will frequently underwrite at least a part of the cost [typically $11 a meeting]," says Colen. "Or they will offer to reimburse a percentage of the cost if the employee attends, say, eight of 10 sessions. Some will also allow for a payroll deduction, which is very helpful in increasing enrollment."

Americans may be getting heavier, but Colen says employees are participating in her company's program in record numbers. "We are having a banner year," she says. "I've been with the company since 1990, and I haven't seen anything like this." She credits the company's new "1,2,3, Success" program, their new spokesperson, Dutchess Sarah Ferguson, and "the poor PR the weight-loss medications received this year. We got to see a lot more obese people."

Colen has more good news for budget-conscious employers. "Blue Cross/Blue Shield of Pennsylvania conducted a study for H.J. Heinz [the Pittsburgh-based firm that owns Weight Watchers], comparing health claims costs of Weight Watchers employees to non-Weight Watchers," she says. "For the period of 1992-1994, the Weight Watchers' claims costs were 51% lower."

References

1. Hill JO. Environmental contributions to the obesity epidemic. Science 1998; 280:1371-1374.

2. Eckel RH, Krauss Ronald M. American Heart Association call to action: Obesity as a major risk factor for coronary heart disease. Circulation 1998; 97:2099-2100.