Commentary: Employers, on average, spend $8,067 in benefits on obese workers — more than double the $3,830 they spend on healthy weight workers, according to a 2014 article in the American Journal of Health Promotion.
Diabetes accounts for $58 billion in indirect employer costs, the result of lost work days, restricted activity, mortality and disabilities. Related expenses, including unplanned employee absences, exceed 9% of total payroll costs, and every dollar spent on medical and pharmacy costs accounts for $2.30 in lost employee productivity.
Unhealthy behaviors can prevent employers from meeting business objectives and employees from performing optimally in the workplace. The Centers for Disease Control and Prevention in Atlanta has identified four health risk behaviors that can be changed. They include lack of physical activity, poor nutrition, tobacco use and overuse of alcohol, which the CDC says, “cause much of the illness, suffering and early deaths related to chronic disease and conditions.”
Contemporary health promotion programs strive to change individual and organizational behavior with policies that support health. These programs can help employers meet employee benefit and health objectives, reduce health care claims and increase employee job satisfaction, recruitment and retention.
Research shows effective behavior change programs are likely to be based on theory and evidence, and built on years of scientific research with results measured within the marketplace. Contrast that with programs based on customer demands, personal preferences or bells-and-whistles technology.
Successful programs are steeped in theory, providing a road map for studying problems, developing appropriate interventions and evaluating successes. Lifestyle behavior change programs can include health coaching, health risk assessments, biometric screenings (such as blood pressure, cholesterol or glucose checks), targeted feedback about progress and incentives to change unhealthy behaviors. Core to excellence in behavior change programs are the following best practices:
Motivate employees. Real behavior change depends on sustained effort, personal engagement and commitment. External, short-term motivators, such as losing weight for a wedding or keeping a New Year’s resolution, provide springboards to change. However, lasting change happens when people realize that the risky health behavior is no longer aligned with core values and beliefs. Typically, people focus on the external triggers for change and are not aware of the underlying disconnect between values and behavior. An effective coach can uncover what matters most, help people understand how these beliefs are related to motivation to change, then reinforce these values throughout the change process.
Organizations can boost motivation with incentive programs and competitions, but supportive policies and creating a health-promoting environment are necessary to cultivate sustained change. Employers can stock healthy foods in the cafeteria, design team competitions that build social support and involve employees in planning health and wellness programs.
Create incremental goals. Employees engaging in behavior change tend to focus on the endgame, such as losing 30 pounds. Successful behavior change depends on setting incremental goals and short-term action plans. There are benefits to taking small steps toward change. The action steps are building blocks toward the long-term goal. When incremental goals are set, it is easier to get started and success and rewards are experienced sooner. Each success builds self-efficacy leading to higher motivation and confidence. Incremental goals are a way to get timely feedback about progress. If an employee sets a 15-pound weight loss goal, an incremental plan to lose one and a half pounds over a 10-week period provides a way to gauge success along the way. It is also important to take the right action steps based on the evidence. Those who realize the most success set SMART (specific, measurable, attainable, realistic and time-based) goals.
Establish a personal bond. People who have support are more likely to be successful. Friends and family are often a great source of support; they can be cheerleaders, provide distractions, help with chores or become a partner in the change process. Health coaches can offer a unique type of support. Behavioral health coaches can offer expert advice, facilitate change and engender accountability. This relationship paves the way for the coach to use cognitive behavioral techniques to identify and remove personal barriers to change.
Also see: “Study links health coaching to weight loss.”
Adept at breaking down resistance to change, skilled coaches provide course correction and individual assistance to program participants. Coaching activities often include asking questions to bring ambivalence and resistance to the surface; identifying activities that deliver results; uncovering internal motivations and keeping them high; reinforcing and adjusting incremental goals; using communication — including phone conversations, emails and texts — to stay in touch; providing answers and support to employee participants.
Barriers to behavior change
Eliminating personal barriers lies at the heart of any effective behavior change program. Attempts to lose weight or quit smoking quickly fizzle because of unidentified barriers to personal change.
Beliefs about the material and psychological costs of taking action create perceived barriers to change that can be addressed with reassurance, incentives and correcting misinformation. Individual barriers that undergird this resistance vary from employee to employee, often manifesting in positive associations to negative behavior — finding solace in comfort food or smoking cigarettes to relieve stress. External messages that suggest health goals can be achieved through short cuts and gimmicks — drugs, herbal remedies or all-gain-no-pain exercise equipment — also create other barriers to positive behavior change.
Also see: “Outcomes-based wellness programs see little growth.”
Social cognitive theory (SCT) is an interpersonal behavior change model that describes behavior as being a result of the interaction of environment, behavior and personal factors. According to the theory, an individual’s strengths related to these factors will facilitate change, and challenges are barriers to change. The SCT theory outlines three factors that affect the likelihood of personal change: self-efficacy, specific goals and expectations for positive results. Employees with a sense of self-efficacy or confidence to perform new behaviors can make changes even in the face of obstacles. Those without it lose motivation, avoid challenges and put little effort into change.
Tips to employers
Employers have much to gain from investing in the health of their employees and their dependents, and they have much to lose if they don’t. With health care costs continuing to rise and employees expected to shoulder a greater portion of those costs, a well thought-out program — one that promotes health and rewards results — can be key to productivity and retention efforts.
Also see: “Connecting the wellness dots.”
While employee benefit programs differ employer to employer — with some focused on cost containment and others on employee satisfaction, talent attraction or retention — they all share something in common. Regardless of objective, the chances of success can be seriously hindered by unhealthy behaviors.
Employers seeking to help their employees improve personal health can access a variety of solutions, including programs that foster lasting behavior change. Interventions based on health behavior theory are not guaranteed to succeed, but they are much more likely to produce desired outcomes.
Employers embarking on a behavior change program should become educated about problems and solutions. They should know what ideal outcomes look like and questions to ask when looking for programs. They also should work with vendors able to demonstrate how to interpret and use evidence-based models and practical applications.
Etta Short, MS, is director, clinical development and support at Alere Health, an Optum company.
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