Employee weight management through health coaching.

OBJECTIVE: This study will evaluate the effectiveness of an interactive health coaching intervention at lowering weight. METHODS: The study involved 5405 overweight or obese employees aged 18-85, who entered the program sometime during 2001-2008. RESULTS: Average body mass index (BMI) significantly decreased from 32.1 at baseline to 31.4 at 3 months, 31.0 at 6 months, and 30.6 at 12 months. Decreasing BMI was more pronounced in older age groups and among women, those using weight loss medication, those with higher BMI, and those with higher motivation and confidence to make behavior changes. When the effects of these variables on the decreasing trend in BMI were simultaneously estimated, only baseline classifications of BMI, health status, and confidence remained significant. Change in BMI through 12 months was -0.7% for those with normal weight, -2.0% for overweight, -3.6% for obese, and -7.1% for morbidly obese individuals at baseline. Among morbidly obese individuals, decrease in BMI through 12 months was -7.6% for those with "high" confidence to lose weight at baseline vs -4.4% for those with low confidence. Better health status at baseline was also related to more pronounced weight loss. CONCLUSION: Interactive health coaching significantly lowered BMI among participants through 3, 6, and 12 months of follow-up.

Factors associated with attrition and success in a worksite wellness telephonic health coaching program.

OBJECTIVES: This study identifies factors associated with attrition and improvements in body mass index (BMI) in a telephonic health coaching program. METHODS: A cohort study design was used with 6,129 employees aged 21-88 years, enrolled in telephonic health coaching sometime during 2002 through 2008. RESULTS: Attrition through 3, 6 and 12 months of follow-up was 13%, 17% and 36%, respectively. Those currently making changes in physical activity or nutrition had the highest BMI (kg/m2), lowest levels of exercise and the poorest overall health at baseline. They were also most likely to continue with health coaching through 12 months. Those not ready to make changes at this time or having maintained an appropriate level of physical activity or nutrition for more than six months were least likely to continue with health coaching through 12 months. They also had the lowest BMI, highest levels of exercise and the best overall health. Among those continuing with health coaching through 12 months, the percent decrease in BMI between baseline and 12 months was: 1.5% for normal weight, 2.7% for overweight, 4.1% for class I & II obesity and 7.2% for class III obesity; 4.3% for high confidence to lose weight, 3.5% for medium confidence to lose weight and 3.1% for low confidence to lose weight; and 3.8% for very good or good general health, 4.5% for average general health and 6.8% for poor/very poor general health. CONCLUSIONS: Attrition in the telephonic health coaching program is greatest among those least in need of behavior change. Of those who continued in the program, the greatest decrease in BMI occurred in those in greatest need for behavior change. KEYWORDS: Behavior change, BMI, interactive health coaching, readiness to change, self-efficacy, weight.

The effects of an intensive lifestyle modification program on sleep and stress disorders.

BACKGROUND: To determine if a lifestyle change program can modify behavior to reduce sleep and stress disorders. METHODS: Analyses are based on 2,624 individuals aged 30 to 80 years from the Rockford, Illinois metropolitan area who completed a lifestyle evaluation at baseline and again after four weeks, following participation in a 40-hour educational course given over a four-week period. Participants receive instruction on the importance of making better lifestyle choices related to making long-term improvements in nutrition and physical activity and they learn ways to improve sleep and reduce stress in their lives. RESULTS: Significant percent decreases were observed in the number experiencing selected sleep or stress disorders from baseline to four weeks later for "sleeps restlessly" (-59%), "suffers from insomnia" (-64%), "feels under pressure" (-37%), "easily emotionally upset" (-52%), and "feels fearful or depressed" (-61%). Experiencing a selected sleep or stress disorder after four weeks among those who had the disorder at baseline was significantly more likely in those not physically active and/or not having lowered their BMI after four weeks. Changes in alcohol consumption and smoking did not significantly contribute to changes in the disorders. Those who failed to lower their coffee/tea use after four weeks were significantly more likely to have a sleep disorder and be easily emotionally upset. CONCLUSIONS: Changes in lifestyle behaviors after attending an educational program significantly reduced sleep and stress disorders in as little as four weeks, primarily explained by decreasing BMI and/or increasing exercise.

Financial impact of health promotion programs: a comprehensive review of the literature.

PURPOSE: The purpose of this review is to summarize the literature on the ability of health promotion programs to reduce employee-related health care expenditures and absenteeism. SEARCH PROCESS: Using key words in a literature-searching program, a comprehensive search was conducted on the following databases: MEDLINE, Embase, HealthSTAR. SPORTDiscus, PsycINFO, SciSearch, ERIC, and ABI Inform. STUDY INCLUSION AND EXCLUSION CRITERIA: All data-based studies that appeared in peer reviewed journals in the English language. Theses, dissertations, or presentation abstracts that were not published in peer reviewed journals were excluded. The initial search identified 196 studies, but only 72 met the inclusion criteria and were included in the review. DATA EXTRACTION METHODS: Summary tables were created that include design classification, subject size, results, and other key information for each study. DATA SYNTHESIS: Both the nature of the findings and the overall quality of the literature were evaluated in an attempt to answer two questions: Do individuals or populations with high health risks have worse financial outcomes than individuals or populations with low health risks? Do health promotion programs improve financial outcomes? MAJOR CONCLUSIONS: There are good correlational data to suggest that high levels of stress, excessive body weight, and multiple risk factors are associated with increased health care costs and illness-related absenteeism. The associations between seat belt use, cholesterol, diet, hypertension, and alcohol abuse and absenteeism and health care expenditures are either mixed or unknown. Health promotion programs are associated with lower levels of absenteeism and health care costs, and fitness programs are associated with reduced health care costs.

Health promotion programs, modifiable health risks, and employee absenteeism.

This literature review demonstrates that the health risks and failure of employees to participate in fitness and health promotion programs are associated with higher rates of employee absenteeism. When determining how to manage absenteeism, employers should carefully consider the impact that health promotion programs can have on rates of absenteeism and other employee-related expenses.

Relationship between frequency of aerobic activity and illness-related absenteeism in a large employee sample.

Frequency of weekly aerobic activity was compared with annual illness-related absenteeism in 79,070 adult US adult workers. Weekly exercise, days per week of aerobic activity (> or = 20 minutes), and absenteeism consisting of days per year and grouped as 1 to 3, 4 to 6, and 7+ days were recorded. After controlling for confounding variables, chi-squared values and odds ratios were calculated. A significant (chi 2 = 280.37) relationship was found between absenteeism and exercise. Differences (P < 0.05) in absenteeism were found between no exercise and all frequencies of weekly exercise. One day of exercise was associated with lower absenteeism when compared with no exercise, and 2 days of exercise was more favorable than one. No differences were found between any other combinations (2 to 3, 2 to 4+, 3 to 4+ days) of exercise frequency and absenteeism. These data suggest a significant relationship between exercise frequency and illness-related absenteeism.

Improving exercise behavior: an application of the stages of change model in a worksite setting.

Randomized trial of 527 corporate employees was conducted to evaluate an exercise intervention based on the transtheoretical model and tailored to individual stages of change. No significant difference in physical activity by stage was evident at baseline among three treatment groups. At follow-up, the group receiving a staged-based message increased activity by 13% and a significant difference was evident in the magnitude and direction of movement across stages, suggesting that tailored messages to stages of change may be an effective strategy for physical activity interventions.

Health care costs of worksite health promotion participants and non-participants.

Total and lifestyle-related medical care costs for employees of a major corporation participating in a worksite health promotion (WHP) program over a three-year period were compared with the costs for non-participants in a cross-sectional study. The study population consisted of 8,334 active employees based in the Cincinnati headquarters of The Procter & Gamble Company. Adjusting for age and gender, participants (n = 3,993) had significantly lower health care costs (29% lower total and 36% lower lifestyle-related costs) when compared with non-participants (n = 4,341) in the third year of the program. Similarly, in the third year of the program, participants had significantly lower inpatient costs, fewer hospital admissions, and fewer hospital days of care when compared with non-participants. No significant differences in costs were found between participants and non-participants during the first two years of the WHP program. Conclusions drawn from this study are that long-term participation in a WHP that includes high-risk screening and intensive one-on-one counseling results in lower total and lifestyle-related health care costs, as well as lower utilization of hospital services.

The relationship between perceived stress and self-reported illness-related absenteeism.

PURPOSE: To investigate the association between perceived stress and illness-related work absenteeism. DESIGN: A standardized health profile questionnaire developed by Johnson & Johnson Advanced Behavioral Technologies, Inc., was used to collect demographic and personal health data between June 1988 and January 1993. Chi-square, odds ratio, and stepwise regression tests were used to analyze perceived stress and self-reported absenteeism data. SETTING: Worksite health promotion programs in 250 U.S. companies. SUBJECTS: Subjects consisted of 79,070 employees. MEASURES: Stress data, grouped as low, moderate, and high, were correlated with absenteeism data grouped by annual days missed (None, 1 to 2, 3 to 4, and 5+). RESULTS: Significant relationships were found (p < or = .05) between high stress and absenteeism for both genders. Female workers reported higher stress levels and absenteeism than men. Those with high stress were 2.22 more likely to be absent 5+ days per year than those with low stress. Work, finances, and family were the highest stress sources. Greatest absenteeism predictors were health, legal, social, and financial stress. CONCLUSIONS: These data primarily represented self-selected white workers and may not apply to all employees. However, if high stress relates to absenteeism, these data may provide valuable information for program design in stress management.

Relationships between leisure time physical activity and perceived stress.

This study investigated the relationship between physical activity during leisure time and perceived stress among working adults (N = 32,229). Data were gathered on physical activity, perceived stress, current health status, age, gender, life changes, ongoing problems, number of techniques used for stress reduction, and number of personality traits related to Type A behavior. To control for confounding variables Mantel-Haenszel summary risk estimates were used. Employees who expended more than 3.0 Kcal/kg(-1) . day(-1) in physical activity during leisure time were 0.78 and 0.62 times less likely to have moderate and high perceived stress, respectively. Working adults participating in moderate amounts of these activities have about half the rate of perceived stress as nonparticipants.

The relationship between smoking, cholesterol, and HDL-C levels in adult women.

The purpose of this study was to determine the independent relationship between smoking quantity and cholesterol (TC) and lipoprotein levels (HDL-C) in women. A total of 805 female subjects were grouped as: non-smokers, ex-smokers, light smokers, moderate smokers, and heavy smokers. TC and HDL-C were examined before and after controlling for the coexisting risk factors of age, body composition, fitness level, dietary fat intake, family history of coronary artery disease, oral contraceptive, and alcohol use. Preliminary analysis demonstrated significant differences (p < .01) in TC between heavy smokers and all other groups and significant differences in HDL-C between heavy to moderate smokers and ex- and non-smokers. After adjusting for confounding variables, the differences in TC and HDL-C remained unchanged between the groups. It was concluded that heavy to moderate smoking was independently associated with higher TC and lower HDL-C levels, and that smoking abstinence or smoking cessation may be associated with healthier lipoprotein profiles in adult women. Based on these findings, it was recommended that employers consider the provision of health promotion programs including seminars, behavioral modification workshops, as well as financial incentives for employees to stop smoking.

Adolescent sexual behavior and associated variables.

PIP: Proportionally more adolescents are having sexual intercourse and at younger ages. It has been reported that 11.6 million teens in the US between ages 13-19 years have had sexual intercourse. Many, however, do not use contraception, even though the prevalence of condom use has increased over the last ten years. The authors analyzed survey data to identify sexual activity among adolescents by grade, gender, number of partners, and contraceptive use, and to determine the association of intercourse with condom use, alcohol consumption, smoking, and AIDS/HIV education. 56.8% of 568 9th-12th grade respondents reported having had sexual intercourse: 33.5% in 9th grade, 58.9% in 10th grade, 68.5% in 11th grade, and 71.6% in 12th grade. Although more males than females reported having had sexual intercourse, no significant difference was found between males and females in each grade level on the number of lifetime sex partners or sex partners for the previous three months. 25% reported using alcohol during last sexual intercourse, 5% indicated using both alcohol and other drugs, and 22% reported that no contraception was used or that they were not sure if anything was used. Sexually active respondents were significantly more likely to consume alcohol and to smoke. The authors also found no significant difference for use of condoms between those who had AIDS/HIV education and those who had not, except that those who had AIDS/HIV education were less likely to have multiple partners. 42.5% of all sexually active respondents reported using a condom. Only 38.5% of those exposed to AIDS/HIV education in schools reported using a condom during last intercourse compared to 30% of those not exposed to such education.^ieng

Influence of a mobile worksite health promotion program on health care costs.

The continued rising cost of health care has prompted some business to invest in mobile worksite health promotion programs, which screen employees for health risk and pursue risk reduction through counseling, health education, and referral to medical treatment. The purpose of this study was to examine the influence of a mobile worksite health promotion program on health care costs. We conducted a five-year retrospective study on 1,325 city employees insured by the City of Mesa, Arizona. Of these, 340 had participated in the CIGNA Health-plan mobile worksite health promotion program for two years. The participants were age-matched and sex-matched with 340 control subjects who were also employed and insured by the city. We analyzed participant and control group health care costs for two years before and two years after program initiation. Repeated measures analysis of variance (2 x 2 MANOVA) indicated a significant decrease in health care costs in both groups (P < .0063). The control group had a 7% decrease, while the participant group decreased 16%. Further analysis showed specific reductions in general sickness, outpatient and inpatient claims, and total claims use. Costs for substance abuse/psychological treatment and for emergency care did not decrease. Benefit-to-cost ratio for the entire program resulted in a $3.6 savings for every dollar spent. Mobile worksite health promotion programs can be effective in reducing employee health care expenditures among both program participants and nonparticipants.

Mobile Work Site Health Promotion Programs can reduce selected employee health risks.

This study examined the effect of participation in a mobile work site health promotion program (MWHPP) on selected health risks. Measures of blood pressure, cholesterol total and total/high-density lipoprotein ratio, percent body fat, and submaximal fitness were taken at baseline, 6-, 12-, and 18-month intervals from 113 employed adults. Significant reductions (P < or = .01) were observed in all variables measured. Further analysis of the number of employees who went from high risk to low risk demonstrated a significantly reduced risk of hypercholesterolemia, cholesterol total/high-density lipoprotein ration, and obesity (average significant chi 2 = 9.3, P < or = .05). It was concluded that participation in MWHPPs can significantly reduce several major cardiovascular risk factors. MWHPPs are relatively inexpensive compared with in-house health promotion programs and are one of the most cost-effective methods of reducing employee health risk.

Employee physical activity: how does it compare to the nation?

1. Working adults exercise as much as the rest of society. 2. The amount of physical activity declines with age until 55, at which point increases were observed. 3. Marriage appears to have the largest effect on reducing the amount of physical activity a person gets. 4. Males are 1 1/2 times more likely than females to be vigorously active.

Cardiovascular fitness and absenteeism in 8,301 employed adults.

Abstract The purpose of this study was to determine the extent of the relationship between cardiovascular fitness and absenteeism in the workplace. A total of 8,301 adult males and females who were employed by corporations which participated in a health screening program were used in the study. Absenteeism due to illness, demographic variables, and smoking status were assessed using a written questionnaire, while body fat was measured using skinfold calipers and cardiovascular fitness was assessed using a step test. Results indicated that high levels of cardiovascular fitness were associated significantly with low levels of absenteeism. The relationship remained strong after adjusting for differences in age, gender, income, cigarette smoking, and percent body fat. The association was stronger in females than males.