Monday, August 12, 2013

Small steps to better health

Mollie McGinnis, mind-body coordinator at CoxHealth Fitness Centers, leads an outdoor yoga class for staff members. As wellness efforts ramp up this fall, leaders are planning free classes, walking clubs and nutrition demonstrations for staff and the public. 

Last fall, the Wellness department at CoxHealth conducted personal health assessments for a record number of employees, with more than 4,000 staff members participating. The results offer the most comprehensive view of our organization’s overall physical health we have ever had. Wellness leaders say our numbers are similar to those of the businesses the Wellness department serves as corporate clients – unfortunately, we’re all suffering from the same major risk factors: obesity, diabetes and high blood pressure.

Our local results reflect a national epidemic, which has become so widespread that the American Medical Association recently designated obesity as a disease. The causes are complex, ranging from genetics, to sedentary lifestyles, to an environment that encourages obesity. That complexity means that any simple solution is likely to be no more effective than the quick fixes pitched in late-night infomercials.

There is good news, though: The problem presents a real opportunity to improve community health and even small changes can make a difference.

When “Blue Zones” author Dan Buettner spoke to audiences in Springfield in June, he put it this way: We have to stop looking for a “silver bullet” solution to America’s obesity problem and instead consider “silver buckshot” – small actions, on both the personal and community level, that can nudge us in the right direction.

Leaders at CoxHealth are embracing that approach and our Wellness department is expanding its offerings this fall. The goal is to surround all of us with convenient ways to get active and eat healthier.

“The idea is to create a culture of wellness – we want to provide opportunities to people if they want to improve their health, whether it’s smoking cessation, nutrition or just well-being,” says Jason Bauer, manager of corporate wellness. “People know the right things to do, we just have to put opportunities in front of them and remove the barriers.”

The Wellness department is expanding walking clubs, coordinating free activities on the weekends and hosting seminars in CoxHealth cafeterias. Those opportunities will support what Buettner advocates: making small environmental changes to encourage people to move a little more and eat a little better.

Buettner and other experts have observed that obesity is an epidemic because our culture – with readily available fast food and limited options for walking and biking, for example – makes it easy to be overweight. It’s an environment that Dr. Dan Sontheimer, CoxHealth’s chief medical officer, calls “obesogenic.”

Individual willpower can only do so much in that kind of environment. For individuals, families and communities, making a dent in obesity will require making healthy choices just as convenient as unhealthy ones.

Dr. Sontheimer says seeing obesity as a disease will help health care providers get out of the traditional mode of “diagnose, treat and cure” and into approaches that treat obesity as an ongoing health condition.

“Obesity is a disorder that really requires ongoing, lifetime treatment,” he says. “If you hit a goal weight, you have to maintain all of those lifestyle changes or the weight will come back.”

Our personal health assessments show that 71 percent of participating employees have a body mass index (BMI) higher than 25 (overweight), and 44 percent have a BMI greater than 30, making them clinically obese. While obesity may not seem as urgent as other conditions, the health risks are real.

From a purely medical perspective, those extra pounds place a real strain on the body: of the wellness participants, 47 percent have high blood sugar and 41 percent have elevated blood pressure.

Dr. Sontheimer offers a simple analogy: the heart is designed to pump for an optimal body size. If the body grows beyond that size, it’s like adding capacity to a swimming pool without increasing the size of the pump.

“If you decided to make your pool larger, you’d probably replace the pump, but our bodies can’t do that,” he says.

The heart will do its best to keep up, but over time, that strain will lead to problems.

It’s not just the heart that is stressed. Obesity works directly against the body’s efforts to control blood sugar. The pancreas provides the insulin required to regulate glucose in the bloodstream, but the presence of more fat can make the body insulin resistant, meaning that the pancreas must supply more insulin to handle the same amount of glucose. Over time, the pancreas will fail, leading to the need to supplement with insulin.

The good news: incremental improvements make a difference.

“Most diabetics can lower their insulin resistance by losing 10 percent of their current body weight,” Dr. Sontheimer says. “Everybody thinks about some ideal weight they need to reach, but just losing 10 percent of your weight is a good goal that can improve your blood pressure and the way your body handles sugar.

“It may just move you 1 point on BMI, but you’ll see a tangible difference.”

To begin losing weight, Dr. Sontheimer says incorporating more movement into your daily routine is a good first step. We’ve all heard that we need to move more, but that doesn’t necessarily mean jumping into a workout routine. Incremental changes count here, too: walking more and taking the stairs can change the body even before the scale starts to move.

“You can become fitter while weighing the same,” Dr. Sontheimer says. “It’s important to just break the sedentary cycle and increase your activity. If you haven’t started losing weight, but you can climb more stairs than you used to without getting winded, that’s a serious improvement.

“Muscles use glucose and even a 20-minute walk can help reduce your blood sugar.”

When it comes to changing your diet, every little bit helps there, too. We all eat things we know aren’t good for us. Dr. Sontheimer says we should think about what we would be willing to adjust: Would we consider cutting back on sweets? Limiting sodium? Adjusting portion sizes?

Bauer and Dr. Sontheimer say that the key to a successful wellness program is engaging people around the changes they are willing to make.

The Wellness department at CoxHealth is working to expand healthy opportunities on CoxHealth campuses, with walking clubs, nutrition demonstrations and poker walks like this one held at Burrell Lake in June. 

That’s exactly what the Wellness department will be working to do this fall with the more than 6,500 employees who’ll be receiving personal health assessments. 

Bauer notes that this year, wellness coaches will be looking at the results and working directly with the participants who need the most support. Participants with a combination of risk factors will meet with coaches. Together, they’ll look for ways they can support the employees’ efforts to be healthier. Bauer says the coaches will serve as personal wellness coordinators for program participants. 

“Our coaches are going to be able to connect employees with resources, such as dietitians and staff at the Diabetes Center,” he says. “Our coaches will be centralized coordinators for getting people the help they need – like ‘account managers’ for wellness.” 

While coaches work one-on-one with employees, the Wellness department is undertaking several efforts to create a culture of wellness for all of us at CoxHealth. A few of the highlights: 

Sample Saturdays: Free, public wellness events at CoxHealth and in the community that focus on natural movement. So far, there have been yoga classes, group strength classes with the Meyer Center and Crossfit classes with local partners. Bauer says the events are designed to introduce new kinds of exercise and connect community members around fitness activities. A list of upcoming events can be found at 

Wellness Wednesdays at Cox South and Lunch and Learn at Cox North: Presentations on diet, exercise and wellness during lunch at the CoxHealth cafeterias. The full schedule of upcoming events is coming soon to the intranet. 

Random Acts of Wellness: A monthly, in-person recognition of employees who are demonstrating healthy lifestyle habits. Wellness staffers will present vouchers and healthy snacks to enhance CoxHealth’s culture of wellness. 

Tuesday Trek: Tuesday Trek is a walking club for CoxHealth employees occurring once a month led by a member of the wellness team. Wellness leaders will have a mapped out course and meet in the same location each time. The events will begin in August. 

Bauer and the wellness team are also working on a book club and a number of wellness challenges in the coming months, such as stair-climbing challenges and jumping-jack competitions. The idea is to create fun activities that encourage employees to move more and have fun while doing so. Also, keep an eye out for “wellness champions,” staff members from throughout the system who will be inspiring their co-workers and coordinating departmental wellness activities. 

Bauer and Dr. Sontheimer say that if we can make health and wellness a part of the way we work every day, we can improve our personal lives and our ability to be a leader for the general public. 

“We have a tremendous opportunity to not just serve as a center for the treatment of illness, but as a model for developing a healthy community,” Dr. Sontheimer says. 

“That starts with our own community. We are getting healthier and that’s going to drive us as we work to be the best to foster health for everyone we serve.” 

3 steps to get started 

Improving wellness can seem like a daunting task, but it doesn’t have to be. Dr. Dan Sontheimer says incremental improvements make a difference, and they’re the best way to start a cycle of positive change. His tips: 

1. Start small: Increase your movement. Working out doesn’t have to mean distance running or hitting the gym six days a week – all movement counts: walk a little more; take the stairs. 

2. Tweak your diet: Rather than getting overwhelmed with a diet plan, look for one thing you’d be willing to change. Maybe it’s dropping soda, or reducing sodium, or choosing fruits and nuts as snacks. Change one habit and build from there. 

3. Create little rules: Experiment with changing your behavior by setting rules. Trying “no snacking after dinner,” or “no desserts during the week” can add up to improvements. You can find what works for you and what doesn’t and you can make adjustments.