Posts from — May 2009

Program available is consistent with scientific and medical care recommendations for weight loss, reflects a multi-disciplinary approach which offers four components: behavioral, exercise, diet, and maintenance, and is in accordance with the document Guidance For Treatment Of Adult Obesity. It includes:

• Screening to verify that the attendant has no medical or psychological conditions which would make weight loss inappropriate, and to identify the attendant’s level of health risk, classifying participants not only on excess body weight, but also on the basis of associated medical conditions and central heath risk.
• Referral for participants who are morbidly obese who would require health care guidance for weight loss.
• Informed consent, explanation of potential physical and psychological risk from weight loss and regain, likely long-term success of program, full cost of the program, credentials of the employee.
• Identification of contributing factors to colleague’s weight status, serving as the basis for an individualized weight loss plan which includes the weight intention and plans for nutrition, exercise, and behavioral components.
• Weight intention of participant is reasonable based on personal and family weight history not solely on height and weight charts; initial weight loss intention does not exceed loss of 10% of body weight, 1-2 pounds per week.
• Explanation of unsafe weight loss methods.
• Daily calorie level is adjusted to meet each attendant’s recommended rate of weight loss.
• Daily caloric intake is not less than 1,000 calories; if less, physician monitoring is needed.
• Food plan designed so participants can select foods which meet 100% of all the Recommended Daily Allowance (RDA) except for calories. Nutritional supplementation can be used to achieve RDAs, however must not greatly exceed RDAs.
• Nutrition education encouraging permanent healthful eating habits based on The Food Guide Pyramid.
• Participant involved in meal planning and food selection.

The protein, fat, carbohydrate, and fluid content of the diet plan meet safety recommendations:

Protein   Between 0.8 and 1.5 grams of protein per kilogram of intention body weight, but no more than 100 grams of protein a day.
Fat   10 – 30% calories as fat.
Carbohydrate   At least 100 grams per day.
Fluid   At least one liter of water daily.

• Exercise component ought to be a significant portion of the program and be both didactic and experiential.
• Participant is appropriately screened for exercise using a screening questionnaire such as the Par-Q Readiness Assessment (see forms). Instruction on recognizing untoward responses to exercise.
• Participants work towards 30-60 minutes of exercise 5-7 days per week.
• No appetite suppressant drugs.
• Maintenance plan available for continued backing.
• Weight control programs must be conducted by a registered dietitian or by degreed health professionals with training in diet with consultation by a registered dietitian.
• Trained lay leaders may support  if supervised by nutrition professional.

Note: There’s an interactive version of Guidance for the Treatment of Adult Obesity at e-Guidance for the Treatment of Adult Obesity.

A program is needed to support appropriate interpretation of cholesterol screening results, including a caution that a single measurement neither excludes nor establishes a diagnosis of their blood cholesterol.

Follow national ground rules:

Total Cholesterol
Desirable cholesterol   < 200 mg/dl
Borderline cholesterol   200 – 239 mg/dl
High cholesterol   > 240 mg/dl

HDL
Desirable HDL    > 35 mg/dl
Low HDL    < 35 mg/dl

Refer blood lipid evaluation participants to health care as follows:

Total Cholesterol
< 200 mg/dl    Recheck cholesterol in five years, if history of coronary heart disease or if two or more CHD risk factors are detected refers to risk reduction program or health professionals, as appropriate.
200 - 239 mg/dl    If history of CHD or if two or more other risk factors are detected, refer to health care or risk reduction service within two months; if no published history of CVD or less than two other risk factors, reassess blood lipid status within 1-2 years.
> 240mg/dl    Refer to health care within two months.

HDL
> 35 mg/dl   If fewer than 2 risk factors and borderline total cholesterol, refer to risk reduction service, as appropriate. Reassess HDL in 1-2 years.

Give the following:
• The relationship of blood cholesterol, elevated Blood Pressure (BP), and other risk factors.
   o Risk factors include: high Blood Pressure 140/90 or higher or on hypertension medication; current cigarette smoking; family history of premature CHD; diabetes mellitus; age – male > 45 years, female > 55 years or premature menopause without estrogen replacement therapy.
   o Negative risk factor: high HDL 60 mg/dl or greater (subtract one risk factor).
   o Risk factors such as family history, smoking, high fat or other unhealthy diet, and lack of exercise lead to the development of cardiovascular disease (CVD).
• Definitions and causes of high blood cholesterol and HDL, desirable levels, the meaning and limitations of a single measurement, the cause of variability, and the need for multiple measurements prior to diagnosis.
• Wide range of treatment options, including diet (e.g., importance of controlling fat intake less than 30 percent of total calories from fat, less 10 percent saturated fats), less than 300 mg. of cholesterol per day, well-balanced diet, weight maintenance or reduction, exercise, and medication.
• Importance of following prescribed treatment and professional advice.

Appropriate medical or allied health professional trained in measurement of Blood Pressure, referral protocols, and delivering educational messages to participant delivering Blood Pressure programs. These programs are necessitated to follow national guidelines.

• National ground rules for Blood Pressure (BP) protocols:
   o Calibration of Blood Pressure (BP) measuring equipment
   be done at least each year.
   o Two or more measurements of attendant’s Blood Pressure must be taken.
   o Referral of participants with elevated Blood Pressure (BP) readings to personal physician for further assessment.

• Systolic/Diastolic Follow-Up:
   o Normal:   <130 / <85
      Action: Recheck in 2 years
   o High Normal:   130-139 / 85-90
      Action: Recheck in 1 year

• Hypertension:
   o Stage 1 (Mild):   140-159 / 90-99
      Action: Confirm within 2 Months.
   o Stage 2 (Moderate):   160-179 / 100-109
      Action: Refer to source of care within 1 month.
   o Stage 3 (Severe):   180-209 / 110-119
      Action: Refer to source of care within 1 week.
   o Stage 4 (Very Severe):   >210 / >120
      Action: Refer to source of care immediately.

• Appropriate educational messages:
   o Normal:   <130 systolic and <85 diastolic
      Action: No referral. If on treatment, then inform participant that Blood Pressure (BP) is under good control today and ought to continue seeing and following treatment program.
   o High Normal:   130-139 systolic and/or 85-89 diastolic
      Action: Recommend that colleague have Blood Pressure (BP) rechecked within 1 year unless under treatment. Advise colleague that the readings are in a high normal range that needs rechecking. In the interim, suggest that one of the most effective means to reduce Blood Pressure (BP) is to bring weight into normal range and to exercise.
   o High:   >140 systolic and/or >90 diastolic
      Action: Refer to physician for further evaluation within 2 months unless the level is within urgent, emergency, or isolated systolic hypertension levels. If already on treatment, advise colleague of readings and need to get Blood Pressure to a intention of 140/90 or less.
   o Isolated Systolic Hypertension:   140-159 systolic and < 90 diastolic in a colleague 65 years of age or older.
      Action: Advise attendant to inform physician of readings at next visit and consider advice regarding weight loss and exercise if appropriate.
   o Urgent:   180-209 systolic and/or 110-119 diastolic
      Action: Recommend obtaining medical care assessment within 1 week.
   o Emergency:   >210 systolic and/or >120 diastolic
      Action: Get immediate medical care attention.

• Provides the following:
   o Written results, referral instructions, and an explanation of Blood Pressure (BP) levels given to each colleague with individualized counseling, including advice about the interval of time recommended when the colleague must be checked again.
   o Utilizes the recommendations in The Fifth Report Of The Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (BP), March 1994.
   o Written and audiovisual materials that are informative, easy to be aware of, and useful while containing scientifically accurate information.
   o Relationship of elevated Blood Pressure (BP) and other risk factors, such as family history, smoking, high fat and unhealthy diet, lack of exercise, in the development of cardiovascular disease, including stroke, kidney disease, heart attack, and other diseases.
   o Definition and causes of elevated Blood Pressure (BP).
   o Importance of following prescribed treatment.

Health risk screening programs ought to be carried out on a one-on-one basis by trained medical professionals. Health risk measures ought to include the following:

• Blood Pressure measurements – at least two Blood Pressure measurements taken during the assessment episode, using a mercury sphygmomanometers or regularly calibrated aneroids.
• Blood Pressure (BP) treatment status – evaluate whether the attendant is under a doctor’s care, on any medication, on a prescribed diet, or any other type of treatment for hypertension.
• Blood cholesterol measurement – total cholesterol and HDL-cholesterol taken either using a properly tested and maintained table top blood analyzer offering immediate feedback to the client, or sending blood to a laboratory offering feedback using a method that is as effective as immediate feedback.
• Cholesterol treatment status – ascertain whether the client is under a doctor’s care, on any medication, on a prescribed diet, or any other sort of treatment for high blood lipids.
• Obesity – utilize an accepted method for estimating obesity. For example assess participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use Body Mass Index.
   o Identify people 20% or more above their ideal weight.
• Smoking status – evaluate whether the attendant currently smokes cigarettes, whether the client has quit or never used tobacco, and the number of cigarettes used tobacco/day.
• Exercise habits – evaluation questions may be limited to frequency and duration exercise. Do participants exercise in a moderately vigorous fashion at least three times per week for 30 minutes or more.
• Diabetes – whether the client has diabetes, and whether or not it is currently under control. A blood glucose may be also done via finger stick and desk top analyzer. Several manufactures make available cassettes which include blood lipid and glucose measurements.
• Cerebrovascular disease or occlusive PVD – ascertain if the client has had a stroke or other kind of blood vessel disease.
• Family history of cardiovascular disease – determine whether any of the participants’ parents or siblings had a heart attack or sudden death due to heart disease before age 55.
• Coronary heart disease – ascertain if the client has had a heart attack or other sort of coronary heart disease.
• Stress – attendant’s assessment of stress in work and/or personal life. A series of well-tested and validated questions assessing levels of stress are available from the Worker Health Program.
• Participant release form (see forms) – A release form is needed in which the attendant authorizes the program to draw blood for testing to send information to the attendant’s medical provider if medical risks are identified, and to obtain information from the provider about diagnosis and prescribed treatment.
• Participant interest survey – if an assessment of interest has not been collected previously, the assessment exercise must evaluate levels of interest in programs such as: weight management, smoking cessation, fitness or exercise, stress management, nutrition, self-care, blood lipid control.
• Health education messages – the screener must review with the attendant his/her identified health risks and what they mean to the attendant’s overriding health, and give the attendant a written record of the Blood Pressure (BP), total cholesterol, and any other physiological measures taken.
• Referral of participants for treatment – participants with elevated risks must be referred to appropriate sources of diagnosis and possible treatment following nationally or locally recognized instructions for such referral.

Demographic information should include location of the assessment, worksite, client’s name, address, social security number, home and work phone numbers, sex, race, date of birth, relevant job information (e.g., hourly or salaried), department number, and work shift.

Program directors or providers ought to have a background in wellness programming and a professional health-related degree or certification. They ought to have expertise in content areas, planning, promotion, administration, evaluation, and ability to grow a program and tailor the program to the worksite.

Program providers should have a quality assurance program for evaluating the success of service personnel, to evaluate satisfaction of participants, and for personnel training and continuing education.

An overall policy statement should be available from directors and program vendors discussing the following concerns: assurance of confidentiality of health data, referral to medical for at-risk participants, follow-up with referred participants and those at-risk, program assessment on process and outcomes, employer of the workplace for promotion of wellness and changes in corporate culture. A clear contract or letter of agreement for services should be given.

Stay away from being the “best” or doing the “most.” Encouraging workers to be the best or doing the most promotes excessive behavior, discourages others, and creates elitism. The best designed incentive programs are ones which are based on achieving goals/objectives that are attainable by most individuals. Recognition, acknowledgment by top management, or special privileges are examples of great intangible incentives.

Incentive ideas:

• Free or Low-Cost:
   o Certificates
   o Movie passes
   o Recognition in employee newsletter
   o Mugs
   o Water bottles
   o Commendation from management
   o T-shirts
   o Hats

• Moderate Cost:
   o Entertainment tickets
   o Sweatshirts
   o Waist packs
   o Subscriptions to health magazines
   o Health and fitness books
   o Videos

• High Cost:
   o Week-end getaways
   o Dinner for two
   o Clocks
   o Watches

• Others:
   o Cash
   o Gift certificates

Utilizing posters, newsletter articles, and handouts are great means of promoting the program. Other promotional methods to consider are e-mail and announcements at employee gatherings. Ask Worksite Health Promotion Program Committee participants to recruit participants.

Once the program is kicked off you may want to provide an incentive for any employee who recruits another employee to any of the program offerings.

When selecting a program from a vendor you ought to ask the following questions:

• How many worksites have done the program?
• What types of employee population was the program offered?
• What educational materials are used?
• Will the program meet the needs of staff members?
• What are the techniques used to help alter behaviors?
• Does the program help staff members move through stages of readiness to make health behavior changes?
• How do you market the program to workers?
• What follow-up do you support?
• How do you make referrals for healthcare or other supportive services employees may need?
• How do you know the program works?
• How do you measure colleague satisfaction?

When staffing your wellness program you need to consider whether to hire a wellness employee or contract with wellness professionals from outside your corporation.

Small and medium size worksites do not usually have a wellness professional on employee. If your worksite is in this category, you will need to contract with providers outside your organization.

Large companies have several options. They can hire a employee solely for the wellness program, they can contract with outside wellness providers, or they can use a combination of internal employee and outside providers.

When selecting a provider some key questions in the areas of employee, program structure, process, and performance need to be addressed. Each of these key questions is discussed in the following sections.

Staff

Health professionals become wellness professionals when they are trained in the full range of wellness activities. Wellness professionals are generalists who come from a wide variety of backgrounds and schooling. They may be nurses, dietitians, health educators, counselors, exercise physiologists, or have other backgrounds. But in addition to their primary training, they know something about all wellness subject matters, including smoking, stress, exercise, and diet. They also know how to engage and support people in making and sustaining health improvements and have great people skills.

Generally, wellness professionals at worksites fall into three broad categories, wellness screeners, wellness counselors, and wellness instructors.

• Wellness screeners introduce staff members to the program, take health measurements, collect health-related information, support initial counseling, and help staff members define for themselves what they need and want in a wellness program.
• Wellness counselors work with employees after the screening to help them set up and carry out a plan to decrease their risks and improve their health.
• Wellness instructors instruct classes and minigroups on different health subject matters.

A wellness program in a small company can be staffed by a single employee person who fills all three roles. Larger worksites will use different workers to fill these roles.

When choosing employee or choosing among vendors, ask the following questions:

• Do prospective workers have a range of health backgrounds that will provide appropriate expertise in the issues to be addressed?
• Have prospective staff members functioned well as wellness screeners, wellness counselors, and/or wellness instructors?
• Will this employee include employees from the racial and ethnic backgrounds found in your employee population?
• Is each employee member comfortable with the range of backgrounds found in your employee population, and able to communicate effectively with the various social and educational levels of your workers?
• Do workers have a warm, but professional, counseling style when interacting with workers?

An yearly plan for the major wellness programs and activities is a useful management tool. This is an great Employee Health Promotion Program Committee task. Often an activity and wellness theme per month is offered to staff members.

Some corporations choose to follow a National Health Observances calendar which offers advantages. The materials developed by these various national health corporations are very credible. The materials are usually high quality and available no cost or at a nominal cost.

The organization benefits from additional publicity that occurs in various media throughout the neighborhood related to the national observance. For planning suggestions you may want to utilize the HOPE Publications Wellness Resource Developing Guide available for no cost at this Web site.