Worksite Wellness ProgramsWorksite Wellness Programs

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

• Screening to verify that the colleague has no medical or psychological conditions which would make weight loss inappropriate, and to identify the colleague’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 medical 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 objective and plans for nutrition, exercise, and behavioral components.
• Weight objective of colleague is reasonable based on personal and family weight history not solely on height and weight charts; initial weight loss objective 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 colleague’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 ought to 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 food plan meet safety recommendations: Protein Between 0.8 and 1.5 grams of protein per kilogram of objective 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 important portion of the program and be both didactic and experiential.
• Participant is appropriately screened for exercise using a evaluation questionnaire such as the Par-Q Readiness Assessment (see forms). Instruction on recognizing untoward responses to exercise.
• Members work towards 30-60 minutes of exercise 5-7 days per week.
• No appetite suppressant prescriptions.
• Maintenance plan provided for continued support.
• Weight control programs ought to be conducted by a registered dietitian or by degreed health professionals with training in nutrition with consultation by a registered dietitian.
• Trained lay leaders may assist 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 evaluation results, including a caution that a single measurement neither excludes nor establishes a diagnosis of their blood cholesterol. Follow national standard procedures: Total Cholesterol Desirable cholesterol < 200 mg/dl Borderline cholesterol 200 – 239 mg/dl Hypercholesterolemia > 240 mg/dl HDL Desirable HDL > 35 mg/dl Low HDL < 35 mg/dl Refer cholesterol evaluation participants to medical 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 medical care or risk reduction service within two months; if no stated history of CVD or less than two other risk factors, reassess cholesterol status within 1-2 years. > 240mg/dl Refer to medical 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. Offer the following:

• The relationship of blood lipids, elevated Blood Pressure, and other risk factors.
• Risk factors include: elevated 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.
• Negative risk factor: high HDL 60 mg/dl or greater (subtract one risk factor).
• 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 elevated blood lipids 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., effect of controlling fat intake less than 30% of total calories from fat, less 10% 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 care or allied health professional trained in measurement of Blood Pressure, referral protocols, and delivering educational messages to colleague conducting Blood Pressure programs. These programs are needed to follow national standard procedures.

• National standard procedures for Blood Pressure protocols
• Calibration of Blood Pressure calculating equipment

be done at least each year.

• Two or more measurements of colleague’s Blood Pressure ought to be taken.
• Referral of participants with elevated Blood Pressure readings to personal physician for further evaluation.
• Systolic/Diastolic Follow-Up
• Normal: <130 / <85
• Action: Recheck in 2 years
• High Normal: 130-139 / 85-90
• Action: Recheck in 1 year
• Hypertension
• Stage 1 (Mild): 140-159 / 90-99
• Action: Confirm within 2 Months.
• Stage 2 (Moderate): 160-179 / 100-109
• Action: Refer to source of care within 1 month.
• Stage 3 (Severe): 180-209 / 110-119
• Action: Refer to source of care within 1 week.
• Stage 4 (Very Severe): >210 / >120
• Action: Refer to source of care immediately.
• Appropriate educational messages
• Normal: <130 systolic and <85 diastolic
• Action: No referral. If on treatment, then inform colleague that Blood Pressure is under good control today and ought to continue seeing and following treatment program.
• High Normal: 130-139 systolic and/or 85-89 diastolic
• Action: Recommend that colleague have Blood Pressure 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 lower Blood Pressure is to bring weight into normal range and to exercise.
• 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 objective of 140/90 or less.
• Isolated Systolic Hypertension: 140-159 systolic and < 90 diastolic in a colleague 65 years of age or older.
• Action: Advise colleague to inform physician of readings at next visit and consider advice regarding weight loss and exercise if appropriate.
• Urgent: 180-209 systolic and/or 110-119 diastolic
• Action: Recommend obtaining medical care evaluation within 1 week.
• Emergency: >210 systolic and/or >120 diastolic
• Action: Obtain immediate medical care attention.
• Provides the following
• Written results, referral standard procedures, and an explanation of Blood Pressure levels given to each colleague with individualized counseling, including advice about the interval of time recommended when the colleague ought to be checked again.
• Utilizes the recommendations in The Fifth Report Of The Joint National Committee on Detection, Assessment and Treatment of High Blood Pressure, March 1994.
• Written and audiovisual materials that are informative, easy to understand, and useful while containing scientifically accurate information.
• Relationship of elevated Blood Pressure 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.
• Definition and causes of elevated Blood Pressure.
• Importance of following prescribed treatment.

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

• Blood Pressure measurements – at least two Blood Pressure measurements taken during the evaluation episode, using a mercury sphygmomanometers or regularly calibrated aneroids.
• Blood Pressure treatment status – ascertain whether the colleague is under a doctor’s care, on any medication, on a prescribed diet, or any other sort 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 elevated cholesterol.
• Obesity – utilize an accepted method for estimating obesity. For example evaluate participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use Body Mass Index.
• Identify people 20% or more above their ideal weight.
• Smoking status – evaluate whether the colleague currently smokes cigarettes, whether the client has quit or never smoked, and the number of cigarettes smoked/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 cholesterol 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 – ascertain 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 – colleague’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 colleague authorizes the program to draw blood for testing to send information to the colleague’s medical care provider if medical care risks are identified, and to get information from the provider about diagnosis and prescribed treatment.
• Participant interest survey – if an assessment of interest has not been gathered previously, the evaluation activity must evaluate levels of interest in programs such as: weight control, tobacco cessation, fitness or exercise, stress management, nutrition, self-care, cholesterol control.
• Health education messages – the screener must review with the colleague his/her identified health risks and what they mean to the colleague’s central health, and give the colleague a written record of the Blood Pressure, 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 standard procedures for such referral.

Demographic information ought to include location of the evaluation, worksite, client’s name, address, social security number, work and home phone number, 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 workplace. Program providers ought to have a quality assurance program for evaluating the performance of service personnel, to evaluate satisfaction of participants, and for personnel training and continuing education. An central policy statement ought to be available from directors and program vendors addressing the following concerns: assurance of confidentiality of health data, referral to medical care for at-risk participants, follow-up with referred participants and those at-risk, program evaluation on process and outcomes, company of the worksite for promotion of wellness and changes in corporate culture. A clear contract or letter of agreement for services ought to be provided.

Incentives can be used to increase participation rates, help with completion or attendance at programs, and to help individuals shift or adhere to healthy behaviors. The purpose of the incentive is to encourage workers to adopt positive behaviors or maintain an existing positive behavior. Everyone who achieves a objective or maintains a behavior ought to receive something. Many businesses also support incentives merely for participating in events. 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 and 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
• Certificates
• Movie passes
• Recognition in employee newsletter
• Mugs
• Water bottles
• Commendation from management
• T-shirts
• Hats
• Moderate Cost
• Entertainment tickets
• Sweatshirts
• Waist packs
• Subscriptions to health magazines
• Health and fitness books
• Videos
• High Cost
• Week-end getaways
• Dinner for two
• Clocks
• Watches
• Others
• Cash
• Gift certificates

A major issue in wellness programming is attracting workers to take part and maximizing participation. When introducing a program, a letter briefly explaining the program signed by the president or CEO is a great endorsement. Utilizing posters, newsletter articles, and brochures are good means of promoting the program. Other promotional methods to consider are e-mail and announcements at employee meetings. Ask Worksite Wellness Program Committee members to recruit participants. Once the program is kicked off you may want to support 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 provided?
• What educational materials are used?
• Will the program meet the needs of workers?
• What are the techniques used to help change behaviors?
• Does the program help workers 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 medical care or other supportive services workers 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 company. 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 company. Large businesses 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 nutrition. They also know how to engage and support people in making and sustaining health improvements and have good people skills. Generally, wellness professionals at worksites fall into three broad categories, wellness screeners, wellness counselors, and wellness instructors.

• Wellness screeners introduce workers to the program, take health measurements, collect health-related information, support initial counseling, and help workers define for themselves what they need and want in a wellness program.
• Wellness counselors work with workers after the evaluation to help them establish and carry out a plan to lower their risks and improve their health.
• Wellness instructors teach 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 support appropriate expertise in the subject matters to be addressed?
• Have prospective workers functioned well as wellness screeners, wellness counselors, and/or wellness instructors?
• Will this employee include workers 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 Worksite Wellness Program Committee task. Often an activity and wellness theme per month is provided to workers. Some businesses choose to follow a National Health Observances calendar which offers advantages. The materials developed by these various national health businesses are very credible. The materials are usually high quality and available free or at a nominal expense. The company benefits from additional publicity that occurs in various media throughout the community related to the national observance. For planning recommendations you may want to utilize the HOPE Publications Wellness Resource Planning Guide available for free at this Web site.