John Muir, the famous naturalist, wrote: “When one tugs at a single thing in nature, he finds it attached to the rest of the world.” It’s a concept that’s long overdue but now fully ensconced in the field of population health management. Employee health management (EHM) practitioners, in particular, are coming to understand that the environments in which health promotion interventions occur are a primary determinant of the effectiveness of the interventions. What’s more, many now fully acknowledge that the sustainability of healthy lifestyle improvements in diet, exercise, or tobacco use is fundamentally linked to our surroundings. Indeed, in last week’s “HEROForum12”, a conference featuring EHM solutions, a third of the session titles included references to culture. Moreover, no matter what the topic, the phrase “building a culture of health” was stated at nearly every session.
Given this inexorable trend in EHM, there are two recently published articles that deserve to be read side by side. First, dig into Thomas Reinke’s article from Managed Care: “Employers, Others Not Sold on New Anti-Obesity Drugs.” Reinke, a contributing editor, offers thoughtful contrasts between the weight loss and co-morbidity improvements that the two recently approved weight loss drugs have produced and the recommendations of the American Diabetes Association (ADA) and the U.S. Preventive Services Task Force (USPSTF). Bottom line: both science-driven, consensus-based bodies conclude that nature’s favored approach to weight loss works. That’s 12–26 intervention sessions per year focused on diet and exercise, according to the USPSTF. The ADA recommends a 7 percent reduction in weight and 150 minutes of activity per week to manage diabetes. Weight loss drugs are not recommended by Mother Nature, the ADA, or the USPSTF.
But don’t stop with Reinke’s concrete exposition if you’re among those awaiting a pill to solve obesity. In a letter this month in the New England Journal of Medicine, a Four Year Follow up after Two Year Dietary Interventions, Schwarzfuchs and colleagues report significant weight loss and “overall persistent and significant reductions from baseline” in LDL, triglycerides, and total cholesterol levels. This is a follow up on a 2008 weight loss study that I’ve cited more often than any other research since. I reference it first, because it offers an edifying contrast between three different diets; second, because it’s among very few weight loss studies with long-term monitoring (six years!) and impressive results to share, but, third and foremost, I cite Shai and colleagues because of the context in which the study occurs. Though the authors underplay this attribute of the intervention, the diets occur at a worksite that is as close as a researcher can find to a captive audience: live-in workers at a power plant in Dimona, Israel. The authors seem downright coy (usually forbidden in the turgid NEJM) when they conclude that their findings “may be difficult to generalize to other free-living populations.”
Still, even in free-living populations, weight loss has been shown to be possible and sustainable. Weight loss research at StayWell, underscores how vital program completion is relative to sustainable weight loss. In support of this, new approaches to employee engagement are proving effective in improving consumer activation for better use of health care resources and improved health outcomes. Mother Nature continues to offer the best medicine and that includes a healthy dose of culture change.
Paul E. Terry, PhD, is CEO of StayWell Health Management