Health and Wealth: The Importance for Lifestyle Medicine.

Many people spend years dreaming about their retirement. Unfortunately, today's workers will likely work longer, suffer greater economic uncertainty, and might have poorer health status compared with retirees in previous generations. Preserving good health during the working years is associated with a more consistent employment record, greater financial resources, and reduced risk of disease. Making smart financial decisions as a younger adult also translates to improved finances in retirement. While many people are aware of these relationships, many continue to make poor health choices. Employers and lifestyle medicine professionals can both work to improve financial well-being in retirement. Employers can offer effective worksite financial wellness programs and promote participation in retirement savings programs. Physicians and other health providers can foster healthy behaviors, encourage preventive services compliance, and help adults foster overall financial and health well-being. Adopting a healthy lifestyle as early as possible would increase the likelihood that today's workers will enjoy financial security in retirement.

Lifestyle Medicine and Worker Productivity.

The issue of employee productivity has become a major concern for companies. Inefficiency can occur at every stage of production either as poor design, worker limitation, or other factors. It is generally assumed that a healthy worker is more productive than an unhealthy worker. As early as 1776 Adam Smith observed and published in The Wealth of Nations that poor worker health was a detriment to industrial productivity. The objective of this article is to review the literature documenting the gain or loss of productivity related to the health of workers, as well as any lifestyle management strategies that can be used to improve employee health and productivity. The impact of employee obesity, smoking, physical activity, sleep, and behavioral health on productivity will be explored. By identifying and addressing health risks that impair worker performance, lifestyle medicine professionals can demonstrate a significant return on investment by creating a healthier and more productive work force.

Analysis of the association between metabolic syndrome and disease in a workplace population over time.

OBJECTIVES: While research has confirmed an association between metabolic syndrome (MetS) and diseases such as heart disease and diabetes, none of these studies have been conducted in a worksite population. Because corporations are often the primary payer of health-care costs in the United States, they have a vested interest in identifying the magnitude of MetS risk factors in employed populations, and also in knowing if those risk factors are associated with other health risks or medical conditions. METHODS: This study identified the prevalence of MetS risk factors and self-reported disease in employees (N=3285) of a manufacturing corporation who participated in a health risk appraisal and biometric screening in both 2004 and 2006. Health-care costs, pharmacy costs, and short-term disability costs were compared for those with and without MetS and disease. RESULTS: The prevalence of MetS increased from 2004 to 2006 in this employed population. Those with MetS were significantly more likely to self-report arthritis, chronic pain, diabetes, heartburn, heart disease, and stroke. Employees with MetS in 2004 were also significantly more likely to report new cases of arthritis, chronic pain, diabetes, and heart disease in 2006. The costs of those with MetS and disease were 3.66 times greater than those without MetS and without disease. CONCLUSIONS: MetS is associated with disease and increased costs in this working population. There is an opportunity for health promotion to prevent MetS risk factors from progressing to disease status which may improve vitality for employees, as well as limit the economic impact to the corporation.

Health and Economics of Lifestyle Medicine Strategies.

The cost of medical care in the United States is increasing at an unsustainable rate. The lifestyle medicine (LM) approach is essential to influence the root causes of the growing chronic disease burden. LM addresses health risk factors in primary, secondary, and tertiary prevention of developing disease rather than limiting resources and medical expenditures on acute care and reacting to illness, injury, and disease. Employers have much to gain financially from such an approach due to their status as the payer of health care costs for their employees, and as the recipient of productivity gains among their employees. This article discusses LM programs delivered at the worksite, including important findings from the University of Michigan Health Management Research Center. Examples of evidenced-based population LM interventions are summarized for physical activity, weight management, and nutrition programs that address chronic diseases such as cardiovascular disease, cancer, and diabetes mellitus. These approaches have the potential to reduce health care cost trends, increase employee performance/productivity, and improve patient health outcomes.

The cost and impact of health conditions on presenteeism to employers: a review of the literature.

Employers are becoming concerned with the costs of presenteeism in addition to the healthcare and absenteeism costs that have traditionally been explored. But what is the true impact of health conditions in terms of on-the-job productivity? This article examines the literature to assess the magnitude of presenteeism costs relative to total costs of a variety of health conditions. Searches of MEDLINE, CINAHL and PubMed were conducted in July 2008, with no starting date limitation, using 'presenteeism' or 'work limitations' as keywords. Publications on a variety of health conditions were located and included if they assessed the total healthcare and productivity cost of one or more health conditions. Literature on presenteeism has investigated its link with a large number of health conditions ranging from allergies to irritable bowel syndrome. The cost of presenteeism relative to the total cost varies by condition. In some cases (such as allergies or migraine headaches), the cost of presenteeism is much larger than the direct healthcare cost, while in other cases (such as hypertension or cancer), healthcare is the larger component. Many more studies have examined the impact of pharmaceutical treatment on certain medical conditions and the resulting improvement in on-the-job productivity. Based on the research reviewed here, health conditions are associated with on-the-job productivity losses and presenteeism is a major component of the total employer cost of those conditions, although the exact dollar amount cannot be determined at this time. Interventions, including the appropriate use of pharmaceutical agents, may be helpful in improving the productivity of employees with certain conditions.

Factors associated with incidental sickness absence among employees in one health care system.

PURPOSE: Assess the association of taking incidental sickness absence with health risks and health status. DESIGN: Observational. SETTING: One Midwest health care system. SUBJECTS: Individuals who were employed for 2 years (2006-2007) and had completed at least one health risk appraisal (HRA) in 2007 (N = 3790). MEASURES: Outcomes were any incidental sickness absence and absence duration in 2007 measured by an absence tracking system. Health risks and health status were estimated by HRAs. Program participation was captured using 7-year HRA data and 5-year wellness data. ANALYSIS: Multivariate, binary logistic regression for the probability of taking any absence day among the overall population as well as four demographic subgroups; proportional odds model for the probability of taking more absence days. RESULTS: Different patterns were observed in association with taking incidental sickness absence among age and gender subgroups. Among the overall population, three health risks (smoking overweight, and use of medication for relaxation) were positively associated with taking absence (at least p < .05 for all three health risks). Participation in a wellness program for more years was also associated with a less likelihood of taking absence (odds ratio, .72; p = .002). Results from the proportional odds model were consistent with results from the binary logistic regression. CONCLUSION: Sickness absence is an important productivity concern of employers. Employers may implement early interventions to focus on preventable causes. Special interventions may target absence-causing risks such as smoking behavior and excess body weight. Study limitation includes a lack of measures for psychosocial work environment.

Financial costs due to excess health risks among active employees of a utility company.

OBJECTIVE: The objective of this study was to examine the health risk-related excess costs of time away from work, medical claims, pharmacy claims, and total costs with and without considering the prevalence of health risks. METHODS: A total of 2082 of 4266 employees of a Midwest utility participated in a health risk appraisal (HRA). Individuals were classified by their HRA participation status and also by 15 health risks. Total and excess costs were analyzed for all employees. RESULTS: There were significant excess costs due to individual risks and overall excess health risks in all cost measures. Both excess cost per risk and prevalence of the risk were important factors in determining the excess costs in the population. As compared with low-risk participants, HRA nonparticipants and the medium- and high-risk participants were 1.99, 2.22, and 3.97 times more likely to be high cost status. CONCLUSIONS: Approximately one third of corporate costs in medical claims, pharmacy claims, and time away from work could be defined as excess costs associated with excess health risks.

Documenting participation in an employer-sponsored disease management program: selection, exclusion, attrition, and active engagement as possible metrics.

OBJECTIVE: The objective of this study was to document participation in a large employer-sponsored disease management program. METHODS: This retrospective study tracked participation and attrition rates for asthma, diabetes, coronary heart disease, and congestive heart failure programs over a 4-year period. RESULTS: Across all four illnesses, only 25% of those identified had any participation. Over 12 months, only 7% continued participating. Of the 93% who were lost, 35% were excluded, 15% could not be contacted, 25% declined to participate, and 17% dropped out over time. All groups improved their adherence to recommended treatment guidelines. Nonparticipants showed the greatest absolute improvement in receiving recommended medical services; however, they also had the lowest rate of service use at baseline and remained lowest at follow up. CONCLUSIONS: Documenting active engagement and attrition rates may provide useful information for decision-makers.

Association of healthcare costs with per unit body mass index increase.

OBJECTIVE: The objective of this study was to quantify the healthcare costs per unit increase in body mass index (BMI). METHODS: This cross-sectional study included 35,932 employees and spouses in a manufacturing company who participated in an indemnity/PPO plan and one health risk appraisal during 2001 and 2002. RESULTS: Within the BMI range of 25 to 45 kg/m, medical costs and pharmaceutical costs increased dollar 119.7 (4%) and dollar 82.6 (7%) per BMI unit, respectively, adjusted for age and gender. The adjusted medical costs related to diabetes and heart disease increased by dollar 6.2 and dollar 20.3 per BMI unit. The likelihood of having any medical claim increased 11.6% per BMI unit for diabetes and 5.2% for heart disease. CONCLUSIONS: Each unit increase in BMI is associated with higher healthcare costs and increased likelihood of having claims for most major diagnostic codes and for diabetes and heart diseases.

Effectiveness of an incentive-based online physical activity intervention on employee health status.

OBJECTIVE: The objective of this study was to test whether a financial incentive integrated with health benefits for an online physical activity program was associated with increased employee participation and improved health status among participants compared with nonparticipants. METHODS: Participation in the Virtual Fitness Center (VFC), an online physical activity program associated with a 150 dollars cash rebate, was assessed. Risk status for 2004 VFC participants and nonparticipants was compared using a health risk appraisal. RESULTS: A total of 53.8% of total eligible employees were VFC participants and reduced their risk for physical inactivity (8.4% points), life dissatisfaction (2.1), low perception of health (1.9), high risk status (1.3), smoking (0.4), and high body weight (0.2). CONCLUSIONS: Providing a cash incentive is one strategy for encouraging VFC participation and eliciting improved health status in an employer-sponsored, web-based physical activity program.

The association between health risk change and presenteeism change.

OBJECTIVE: This prospective study investigates whether changes in health risks are associated with changes in presenteeism (on-the-job productivity loss). METHOD: A total of 7026 employees of a national financial services company responded to a health risk appraisal (HRA), which included a modified version of the Work Limitation Questionnaire (WLQ) in both 2002 and 2004. The association between changes in health risks and changes in self-reported presenteeism was examined. RESULTS: Changes in perceptual/psychologic health risks had a strong association with changes in presenteeism. Individuals who reduced their risks generally saw an improvement in productivity, whereas those who gained risks or remained high-risk status saw deterioration in productivity. Each risk factor increased or reduced was associated with a commensurate change in 1.9% productivity loss over time and estimated to be 950 dollars per year per risk changed. CONCLUSIONS: Positive and negative changes in health risks are associated with same-direction changes in presenteeism.

The savings gained from participation in health promotion programs for Medicare beneficiaries.

OBJECTIVE: The objective of this study was to estimate savings to Medicare associated with participation in one or more health promotion programs offered to 59,324 retirees from a large employer and their aged dependents. METHODS: Propensity score and multiple regression techniques were used to estimate savings adjusted for demographic and health status differences between elderly retirees and dependents who used one or more health promotion services and nonparticipants. RESULTS: Participants who completed a health risk assessment saved from $101 to $648 per person per year. Savings were generally higher as more programs were used, but differences were not always statistically significant. CONCLUSION: Using the health risk assessment as a guide for health promotion programs can yield substantial savings for the elderly and the Medicare program. The federal government should test health promotion programs in randomized trials and pay for such programs if the results suggest cost savings and better health for Medicare beneficiaries.

The association of two productivity measures with health risks and medical conditions in an Australian employee population.

PURPOSE: To investigate the impact of health on job performance using two measures of productivity loss: (1) a self-reported measure of health-related presenteeism and (2) an objective measure of absenteeism. DESIGN: A cross-sectional survey using a Health Risk Appraisal (HRA) to evaluate self-reported presenteeism and the prevalence of 12 health risks and eight medical conditions. SETTING AND SUBJECTS: Employees (n=224) of a private insurance provider in Australia. MEASURES: A Health Risk Appraisal (HRA) questionnaire was used to evaluate self-reported presenteeism on different aspects of job demands and to assess the prevalence of 12 health risks and eight medical conditions. Illness absent hours were obtained from company administrative records. RESULTS: Increased presenteeism was significantly associated with high stress, life dissatisfaction, and back pain, while increased illness absenteeism was significantly associated with overweight, poor perception of health, and diabetes. Excess presenteeism associated with excess health risks (productivity loss among those with medium- or high-risk status compared to those with low-risk status) was independently calculated at 19.0% for presenteeism and 12.8% for illness absenteeism. CONCLUSIONS: This study demonstrates an association between health metrics and self-reported work impairment (presenteeism) and measured absenteeism. The study provides a first indication of the potential benefits of health promotion programming to Australian employees in improving health and to the corporation in minimizing health-related productivity loss.

The association of corporate work environment factors, health risks, and medical conditions with presenteeism among Australian employees.

PURPOSE: To investigate the impact of selected corporate environment factors, health risks, and medical conditions on job performance using a self-reported measure of presenteeism. DESIGN: A cross-sectional survey utilizing health risk appraisal (HRA) data merging presenteeism with corporate environment factors, health risks, and medical conditions. SETTING: Approximately 8000 employees across ten diverse Australian corporations. SUBJECTS: Employees (N = 1523; participation rate, 19%) who completed an HRA questionnaire. MEASURES: Self-reported HRA data were used to test associations of defined adverse corporate environment factors with presenteeism. Stepwise multivariate logistic regression modeling assessed the relative associations of corporate environment factors, health risks, and medical conditions with increased odds of any presenteeism. RESULTS: Increased presenteeism was significantly associated with poor working conditions, ineffective management/leadership, and work/life imbalance (adjusting for age, gender, health risks, and medical conditions). In multivariate logistic regression models, work/life imbalance, poor working conditions, life dissatisfaction, high stress, back pain, allergies, and younger age were significantly associated with presenteeism. CONCLUSIONS: Although the study has some limitations, including a possible response bias caused by the relatively low participation rate across the corporations, the study does demonstrate significant associations between corporate environment factors, health risks, and medical conditions and self-reported presenteeism. The study provides initial evidence that health management programming may benefit on-the-job productivity outcomes if expanded to include interventions targeting work environments.

Worker productivity loss associated with arthritis.

This study at a major financial services corporation sought to investigate the association of arthritis with on-the-job productivity, also termed "presenteeism." Using a modified version of the Work Limitations Questionnaire (WLQ) incorporated into a Health Risk Appraisal (HRA), 17,685 employees responded to the survey in 2002. Of the 16,651 respondents meeting inclusion criteria, 2,469 (14.8%) reported having arthritis, and 986 (39.9% of those with arthritis) also reported that they were under medical care and/or taking medication for arthritis. Employees with arthritis were older, predominantly female, and reported a higher number of comorbidities. Although all four domains of the WLQ (physical, time, mental, and output) were impacted by arthritis, the greatest productivity effect, as expected, was on physical work tasks. Health risks also play a role in the relationship between arthritis and presenteeism, with high-risk individuals reporting 7%-10% additional loss of productivity compared to lowrisk individuals. In addition, those who reported receiving medication and/or treatment for arthritis had a 2.5% excess productivity loss independently attributed to their arthritis, which equals approximately 1,250 US dollars per employee per year, or 5.4 million US dollars to the corporation. This arthritis effect was discernible in those with low and moderate levels of health risk, but was not as evident in those with high health risks; in that group, health-associated decrements in productivity were much larger. Arthritis is associated with work productivity loss. Disease management programs should focus on pain management and arthritis-associated health risks and comorbidities in order to significantly decrease arthritis-related losses in on-the-job productivity.

Participation in employer-sponsored wellness programs before and after retirement.

OBJECTIVES: To evaluate wellness program participation before and after retirement. METHODS: This retrospective cohort design compares 3 groups of employees: 1998-1999 retirees (N=6065), 1994-1995 retirees (N=5862), and 21,176 employees who were still active as of 2002. Participation was compared over 2 time periods for high-intensity and low-intensity programs. RESULTS: Significantly different participation rates were found among the 3 groups specific to program intensity. Participation before retirement is associated with higher participation after retirement regardless of program intensity (OR=3.8 for overall participation). CONCLUSIONS: Wellness programs can attract retirees, especially if they participated before retirement and are offered a variety of programs.

Who are the intended beneficiaries (targets) of employee health promotion and wellness programs?

There is nearly no downside to clinically and economically effective health management programs since each stakeholder is a beneficiary: the family, the employee, the employer, the community, and the state. These programs drive both the cost and the revenue sides of the economic equation.

The Future of Health Promotion in the 21st Century: A Focus on the Working Population.

The purpose of this article is to synthesize developments from various disciplines including the medical, wellness, psychology, and sociology fields to shed light on where health promotion is headed in the next 25 years. Lifestyle medicine practitioners will continue to play a large role in helping people achieve the highest levels of wellness, which does not simply mean the absence of disease. New research identifies the important roles of many diverse factors such as relationships, lifestyle behaviors, emotional outlook, positive environment, mind-body connection, use of technology, and work styles, which can help each person achieve the fullness of life, vitality, and flourishing that characterizes a high level of well-being.

The association of health status, worksite fitness center participation, and two measures of productivity.

OBJECTIVES: We sought to examine the associations between participation in a worksite fitness center and worker productivity. METHODS: A modified Work Limitations Questionnaire (WLQ) and employees' short-term disability claims were used as productivity measures with multivariate logistic regression models to control for health risk, age, gender, and work location. RESULTS: Nonparticipants in a worksite fitness center were more likely to report health-related work productivity limitations for time management (odds ratio [OR] = 1.62, 95% confidence interval [CI] = 1.09-2.41), physical work (OR = 1.58, CI = 1.03-2.43), output limitations (OR = 2.24, CI = 1.01-2.12), and overall work impairment (OR = 1.41, CI = 1.00-1.96) than fitness center participants. Fitness center participation also was associated with 1.3 days fewer short-term disability days per year per employee (P = 0.02) and 0.39 fewer health risks (P = 0.01). CONCLUSIONS: These results support the association of worksite fitness center participants with improved worker productivity and fewer short-term disability workdays lost.

The association of health risks with on-the-job productivity.

OBJECTIVE: Decreased on-the-job productivity represents a large yet poorly characterized indirect cost to employers. We studied the impact of employee health risk factors on self-reported worker productivity (presenteeism). METHODS: Using a brief version of the Work Limitation Questionnaire incorporated into a Health Risk Appraisal, 28,375 employees of a national company responded to the survey. The association between health risks and work limitation and each of the four domains was examined. Percentage of lost productivity also was estimated. RESULTS: Ten of 12 health risk factors studied were significantly associated with self-reported work limitations. The strength of the associations varied between risks and the four domains of work limitation. Perception-related risk factors such as life dissatisfaction, job dissatisfaction, poor health, and stress showed the greatest association with presenteeism. As the number of self-reported health risk factors increased, so did the percentage of employees reporting work limitations. Each additional risk factor was associated with 2.4% excess productivity reduction. Medium and high-risk individuals were 6.2% and 12.2% less productive than low-risk individuals, respectively. The annual cost of lost productivity in this corporation was estimated at between 99Mdollars and 185Mdollars or between 1392dollars and 2592dollars per employee. CONCLUSIONS: Health risk factors represent additional causes of lost productivity.