“We need to invest in prevention and wellness programs to help Americans live longer and healthier lives.” These words, spoken by President Obama in a town hall speech in Green Bay, Wisconsin, on June 11 of this year (White House Press Office 2009), hit a chord with fitness professionals, who probably nodded their heads in agreement. The statement is obvious, yet carrying it out can prove elusive. “That’s exactly what I’ve been trying to do my entire career,” you may be thinking. But the fact remains that people worldwide are fatter and sicker than ever.
There is one big, glaring dichotomy: fitness professionals think in terms of wellness and prevention, whereas the culture revolves around disease management and treatment. One is primary care, the other tertiary. In simple terms, prevention (primary care) is action, and treatment (tertiary care) is reaction. How often has a client come to you because she was referred by a doctor, physical therapist or other medical specialist, or because she thought it was time to lose weight and get in shape? Now compare this to the number of times someone has said to you, “I’m in fine health, and I want to stay that way.” Most of us have experienced the former (treatment) far more often than the
Here is the harsh reality: obesity is associated with a 36% increase in healthcare spending (more than smoking or problem drinking). Private U.S. companies report that obesity costs them an estimated $45 billion annually in medical expenditures and work loss (Barrington & Rosen 2008). Metabolic syndrome, a cluster of conditions that occur together, increasing the risk of heart disease, stroke and diabetes, is increasingly prevalent throughout the world. Considering the consequences of these concerns, it is time for fitness professionals to help move the cultural understanding of “health” toward self-responsibility and prevention.
Shifts and Challenges
Even though the statistics regarding fitness levels and health are extremely discouraging (see the sidebars), there is still much to be hopeful and enthusiastic about, especially with the level of attention now being paid to preventive care by our president and government. As Patricia Amend enthusiastically writes for the International Health, Racquet & Sportsclub Association (IHRSA) in “Promoting Our Healthcare Agenda,” “It would appear that our industry’s time has finally arrived” (Amend 2009). She mentions former presidential candidate Senator John McCain’s statement that people should work out in health clubs as a form of preventive care, plus the example that President Obama sets with his daily basketball regimen, as examples of the emphasis our nation’s leaders are placing on health care (Amend 2009).
Helen Durkin, executive vice president of public policy for IHRSA, noted the implications right away. “This is a real opportunity . . . To make the most of it, we’ve joined with large coalitions of health care–related organizations to ensure that wellness, health-promotion, and disease prevention programs play an important role” (Amend 2009). Notice the emphasis on prevention, rather than treatment.
Even though policymakers and others are more willing than ever to change the way we look at health and health care, quite a few challenges exist that need to be recognized and dealt with. As with any difficult issue, these are simply challenges awaiting solutions. In order to create solutions, we need to know what it is we’re solving.
One huge issue is the obesity rate. In the July 2009 report “F as in Fat 2009: How Obesity Policies are Failing in America,” Trust for America’s Health (TFAH) & the Robert Wood Johnson Foundation (RWJF) reported that adult obesity rates had increased over the previous year in 23 states. Not one of the 50 states saw a decrease. The report concluded that policies promoting physical activity and good nutrition are not being adopted or implemented at levels high enough to turn the crisis around (TFAH & RWJF 2009).
Depending on where you live, the obesity epidemic may appear overwhelming or manageable (even though more than 20% of adults are obese in every state except Colorado). So, if you live in Colorado, it’s just 18.9%, while those of you in Mississippi have your work cut out for you, as the rate there is 32.5%. Alabama, Tennessee and West Virginia are not far behind, with obesity rates over 30% (TFAH & RWJF 2009). What’s more, the picture for Baby Boomers is bleak. In every single state, the rate of obesity is higher among 55- to 64-year olds than it is for those 65 and older, a trend that has significant implications for Medicare costs (TFAH & RWJF 2009).
Jeff Levi, executive director of TFAH, is direct. In a few succinct phrases, he states both the challenge and the solution: “There isn’t a magic bullet. We don’t have a pill for it. It’s not going to be solved in the doctor’s office but in the community, where we change norms.”
With rising food costs and cuts in safety-net programs, even the economic crisis has affected the obesity epidemic (TFAH & RWJF 2009). Compounding the problem, anxiety, stress and
depression are also linked to obesity. Poverty can be seen as another factor, as calorie-dense foods are cheaper than fruits and vegetables and there is a lack of access to quality grocery stores. The challenges are many and complex. And yet, depending on your interests and abilities, there is a lot you can do to cultivate a preventive, long-lasting approach to wellness.
Come to Where They’ve Built It
Either add to or change what you’re doing now and you can
alter the culture through the ripple effect (throw a stone in the water and the ripples spread out far and wide). The “F as in Fat 2009” report lists six things that should be done as part of a collaborative effort among businesses, communities, schools and families (TFAH & RWJF 2009):
- Provide healthy foods at schools.
- Increase the availability of affordable healthy foods in all communities.
- Increase physical activity in schools (frequency, intensity, duration).
- Improve access to safe and healthy places to live, work, learn and play.
- Limit screen time.
- Work with employers to provide workplace wellness programs.
Pick the one(s) from this list where you can make an impact, and devise a plan. In many instances, especially until legislation and insurance plans catch up, you may find yourself working on a volunteer basis, which should be calculated into your overall financial needs. But if you think “outside” of personal training or group exercise (which can certainly address some of the points above), you might discover other ways to put the new vision into effect. Why not start a letter-writing campaign to your school system or grocery store? Or challenge your clients to a “screen turn-off week”? You could vote with your money and patronize farmers’ markets or “buy” a share from a local farm.
There are many challenges, but waiting for people to come to us is old school. Going out and emphasizing prevention is new school. Let’s say you agree that it’s time for a cultural shift and are ready to do your part. “But,” you lament, “it’s hard to get people through the door, especially those who most need our help.” Well, move the door!
If you decide to stick with what you know best—exercise—go to where you are needed. If you live close enough to an area that has limited options for physical activity, go and offer your services at a place of worship, community center, adult education center or school—anywhere people gather. Let them know that you are out of your comfort zone and you want them to join you there. Create new norms and expectations.
Laura Islas, a certified personal trainer in Milford, Michigan, did exactly that. She saw a need and opportunity at her church and adapted her boot camp program to fit the congregants’ needs. “I wanted to reach people who might not have been reached in a typical venue. The majority of the class participants are nonexercisers. Many of the women would never have attended a fitness program elsewhere. Some are embarrassed by their weight, some feel too old for a gym, and many simply cannot afford a gym or haven’t learned the value of incorporating exercise into their lives.
“To make the workout palatable to all types of people, the only required equipment is a mat or towel. We use only body weight exercises for strength training,” states Islas. To help her clients take ownership of their health, Islas makes it mandatory for them to commit to attending the sessions. And even though she started offering the classes for free, some participants now hire her on a one-on-one basis, having come to see the “inherent value of exercise,” as she puts it.
By meeting these clients where they were—physically and mentally—Islas has had success reaching a population that would never have stepped through a gym door. Participants felt safe trying exercise at their place of worship, with their friends and a teacher they knew and trusted. What’s more, Islas is a perfect example of self-responsibility, as she did for herself first what she is now helping others to do: “In 2002 I weighed 199 pounds and was fat, depressed and had a variety of obesity-related problems. On my own I managed to lose 65 pounds.” Islas also thinks in terms of prevention and changing the culture in her community: “If each one of us shared a little of our skills or excess with others, none of us would . . . be a burden on society.”
What can you do? A fun team event might involve a group of trainers going to an underserved area and doing a full day of assessments and recommendations. Maybe you’d gain new clients, maybe not, but it would get you some great publicity and community goodwill. You could even bring a nutrition expert with you, or at least some information about healthful eating. (For a comprehensive article about promoting good nutrition, see “The Latest Nutrition & Physical Activity Policies” by Natalie Digate Muth, MD, MPH, RD, in the July–August 2009 issue of IDEA Fitness Journal.)
The suggestion to team up with a doctor, chiropractor, physical therapist, massage practitioner or other health professional has been around for a long time, but have you done it yet? Again, with the idea of going to the people, it makes sense to expand your reach. Whether you’re a trainer or a group instructor, an independent contractor or a club employee, be creative. Even if your only reward is the promise of an eventual drop in insurance costs due to improved health rates for the country, that is still progress. Jeff Shackelford is a certified personal trainer in Portland, Oregon, who decided to build a partnership with his chiropractor. Together they offer a Makeover Challenge: the chiropractor gives educational talks at his office that emphasize the value of exercise and good nutrition; Shackelford is responsible for the follow-up.
“As you know,” Shackelford says, “even with a plan, most people falter on their own. These chiropractors see over 500 patients a week. One thing [my chiropractor] can’t do, outside of the talks, is the daily follow-up and accountability. That is where I help. Between the talks, guidance and materials that clients receive, the idea is that they will have created new (and proper) habits once the challenge is complete. I train them to be independent of me. I’ve found that once people are more knowledgeable, they will accomplish [what they need to] on their own.”
Part of the culture of wellness is about creating solutions and forming links between people. This makes it easier for individuals to bridge the gap between wanting to have a healthier lifestyle and knowing what to do. Through your current work, you may identify a need and get an idea that leads you in a new direction; one that touches lives in different, yet still healthy, ways.
Based in Charleston, South Carolina, Chris McNeil figured out a unique way to bring health a little closer to people. “I was running fitness studios and saw the need to promote healthy dining to the community and get exposure for the business as well. I knew that one of the biggest challenges for clients trying to lose weight was dining out. They felt like they had to quit going to restaurants in order to achieve their fitness goals. Since our society enjoys the celebration and social aspects of dining out, I knew it wasn’t realistic to expect them to eat only at home. So I created FitMenu. Health-oriented businesses become sponsors of restaurants that agree to provide healthy menu items. People can then search our website (www.fitmenu.net) for items that are low-fat, low-sugar, high-protein, high-fiber, low-sodium or vegetarian, and feel confident knowing that the restaurant will have foods they can eat.”
In the process of expanding FitMenu nationwide, McNeil has even stepped away from running training studios to focus full-time on his project. “It is my mission to show people that there is really no sacrifice in eating healthily—it is just being conscious.”
If you enjoy the corporate environment, now is an excellent time to move into corporate wellness. If you are prepared with
information that shows how companies can save money by
using your services, you can have a stable and rewarding career. A recent survey of about 500 human resource managers by Towers Perrin (2009) found that many employers are not cutting back on their company wellness programs, even with the economic downturn, because they see the value in investing in wellness. “This is an opportune time for employers to focus on wellness,” says Dave Guilmette, managing director of the Towers Perrin Health and Welfare practice.
If you decide to move into the corporate realm, consider your strengths and preferences. Do you prefer to work in person or on the phone? One-on-one or with groups? Would you rather stick only with training or group exercise? Do you want to move into management? Are you willing to obtain additional training,
licenses or degrees? Are you more of a people person or a program person? Do you like observing results? Running budgets?
Working from Cleveland, Michael O’Donnell, PhD, MBA, MPH, editor-in-chief of American Journal of Health Promotion and chairman of Health Promotion Advocates, sees all kinds of possibilities for fitness professionals over the next few years,
especially for those who wish to build on their skills. “Most people who are in this industry like working directly with others. So maybe consider going into behavioral coaching, which is more than fitness; it includes life planning. It’s an obvious extension to fitness, and I think the need for coaches is going to expand. You could work for health plans and providers, face to face or on the phone. Adding nursing skills is another wonderful opportunity. In this new era, think about moving beyond one-on-one training to managing programs. Keep in mind that there is a big difference between worksite and provider programs, so meet people in these fields and find out what they do all day, so you can pick something that suits your preferences.”
Public Policy: From Sickness to Wellness
Iowa senator Tom Harkin is a senior member of the Senate Health, Education, Labor and Pensions Committee and chairman of the Senate panel that funds medical research and health care. In an op-ed he wrote June 25 of this year (Harkin 2009), he put forth his case for “shifting America from sick care to genuine wellness,” through the Prevention and Public Health section of the proposed healthcare bill.
“I view this legislation as our opportunity to recreate America as a genuine wellness society—a society that is focused on prevention, good nutrition, fitness and public health . . . We have systematically neglected wellness and disease prevention. Currently in the United States, 95% of every healthcare dollar is spent on treating illnesses and conditions after they occur. But we spend peanuts on prevention . . . Right now, some 75% of healthcare costs are accounted for by heart disease, diabetes, prostate cancer, breast cancer and obesity. What these five diseases and conditions have in common is that they are largely preventable by changes in nutrition, physical activity and lifestyle” (Harkin 2009). (See the sidebar “Be Heard” for more on how to get involved.)
On June 8, 2009, Trust for America’s Health and the Robert Wood Johnson Foundation released a new public opinion survey, which finds that Americans rank prevention as the most important healthcare reform priority. In simple terms, the public is ready to make a change! The time is now! According to a recent survey by Watson Wyatt and the National Business Group on Health (2009), more than two-thirds (68%) of employers are “very or somewhat supportive of reforms that advance the consumer-oriented model and emphasize greater individual responsibility.”
With employers, public policy, public awareness and even the U.S. president on our side, this is the perfect time to lead the world to a cultural emphasis on wellness, prevention and personal responsibility!
- Between 1999 and 2005, hospitalizations of children aged 2–19 with a primary or secondary diagnosis of obesity nearly doubled, from 21,743 to 42,429 (Trasande 2009).
- Costs for hospitalizations of children aged 2–19 with a primary or secondary diagnosis of obesity went from just under $126 million in 2001 to almost $238 million in 2005 (in 2005 dollars) (Trasande 2009).
- About 32% of children aged 2–19 (about 23 million) were overweight or obese in 2003–2006, compared with 29% in 1999, which indicates that child obesity rates are high, but leveling off (Hellmich 2008).
- The percentage of children who were overweight or obese in 1980 was 5%–7% (Hellmich 2008).
- Obesity affects children throughout their bodies, in ways that include dislocation of hip growth plates, bowed knees, flat feet, pain in weight-bearing joints, type 2 diabetes, polycystic ovarian syndrome (in girls), problems with the digestive tract (fatty liver, constipation, acid reflux, gallstones), high LDL (bad) cholesterol, low HDL (good) cholesterol, high blood pressure, high triglyceride levels, abnormal blood clotting, sleep apnea, asthma, shortness of breath (with exertion), poor self-esteem, depression and increased pressure on the brain (which can cause headaches and double vision) (Hellmich 2009).
- Nearly 20% of American preschoolers are obese, with the rate being even higher (over 30%) among Native American preschoolers (Anderson & Whitaker 2009).
- In a 2007 survey of Australian children, rates of overweight or obesity among 2- to 3-year-olds were 17% for boys and 14% for girls; among 4- to 8-year-olds, the rates were 13% for boys and 15% for girls (Boxall 2009).
- Today’s children eat about 350 more calories a day than kids ate in the 1970s (Shute 2009).
- To lose the additional 350 calories, kids would need to walk an additional 150 minutes per day (Shute 2009).
- Obesity rates exceed 25% in 31 states and exceed 20% in 49 states and Washington, DC (TFAH 2009).
- Two-thirds of American adults are either obese or overweight (Reuters 2009).
- Medicare spends anywhere from $1,400 to $6,000 more annually on health care for an obese senior (65+) than for a nonobese senior (TFAH 2009).
- Adults eat about 500 more calories a day today than they did in the 1970s, the approximate equivalent of a hamburger (Shute 2009).
- To lose the additional 500 calories, adults would need to walk an additional 110 minutes per day (Shute 2009).
Here are some facts to help you prepare for a future in corporate wellness.
- Due to the recent economic and financial situation, 60% of companies have either changed or plan to change their healthcare strategy (Watson Wyatt 2009).
- Companies that have maintained lower healthcare cost increases over the past 4 years have five key components in common—offering appropriate financial incentives; delivering information effectively; providing quality care; using metrics and evidence; and maximizing health and productivity (National Business Group on Health 2009).
- Companies that have succeeded in controlling healthcare costs have saved nearly $60 million since 2004, with financial incentives and effective delivery of information being the two (of five) most important factors (Watson Wyatt 2009).
- The median healthcare expense per U.S. employee in 2008 was $7,173 (Amend 2009).
- According to the U.S. Department of Health and Human Services, companies save $1.49–$4.91 in health-related expenses for every dollar spent on wellness programs (Tahmincioglu 2009).
- Obesity costs U.S. companies $45 billion annually in medical expenditures and work loss (Barrington & Rosen 2008).
- In 2008, more than 40% of U.S. companies implemented obesity-reduction programs (Barrington & Rosen 2008).
- Employers are paying 29% more for health care in 2009 than they spent in 2004 (Towers Perrin 2009).
- Fifty percent of companies have or will introduce or increase investments in wellness and health promotion in 2009 and 2010 (Tahmincioglu 2009).
- Thirty-two percent of companies have or will introduce or increase financial incentives, such as bonuses or premium discounts, for wellness or health promotion activities in 2009 and 2010. Another 30% are considering this action (Tahmincioglu 2009).
- Forty-five percent of companies say they are considering introducing or increasing penalties for nonparticipation in wellness or health promotion activities (Tahmincioglu 2009).
If you need a few clever quotes to help make your case, consider these:
“As I see it, every day you do one of two things: build health or produce disease in yourself.”
—Adelle Davis, author of Let’s Eat Right to Keep Fit (Signet 1970)
“Every patient carries his or her own doctor inside.”
“Fitness—if it came in a bottle, everybody would have a great body.”
“It is amazing how much crisper the general experience of life becomes when your body is given a chance to develop a little strength.”
—Frank Duff, missionary
“Make your own recovery the first priority in your life.”
—Robin Norwood, author of Women Who Love Too Much (Tarcher 1985)
to the American Medical Association
When it comes to making a cultural shift in how we view health, a number of items come into play. Legislation is important, being a role model is important, and there is also the “cool” factor of wanting to be part of the trend. Access to information and the right health “tools” (gyms, nutritious food, transportation, money, time) is obviously essential, and concerns about health insurance (or lack thereof) also affect our cultural attitude toward wellness. Fitness professionals are influential in most of these areas, but there is also language, which is very powerful.
In the old days (up to now), our common language centered around treating illness, fixing problems, reducing stress/injury/weight, curing disease and other “back-end” terms. Now, our language is focusing on “front-end” terms, such as prevention, wellness, care, health promotion, living, productivity and control. With so much uncertainty in the world today, associating fitness with positive language is far more motivating and empowering to people who are searching for something good in their lives!
Take a look at the language you use with clients, in your advertising, with peers and colleagues, even with family and friends, and see what words you can use to promote the new cultural emphasis. Share your empowering words with other IDEA members at www.ideafit.com.
Anderson, S., & Whitaker, R. 2009. Prevalence of obesity among U.S. preschool children in different racial and ethnic groups. Archives of Pediatrics & Adolescent Medicine, 163 (4), 344–48.
Barrington, L., & Rosen, B. 2008. Weights and measures: What employers should know about obesity. The Conference Board. Research Report 1419. www.conference-board.org/UTILITIES/pressDetail.cfm?press_ID=3365; retrieved June 29, 2009.
Boxall, A. 2009. Obesity prevention in young children: What does the evidence say? Parliament of Australia: Parliamentary Library. www.aph.gov.au/Library/pubs/bn/2008-09/ObesityChildren.htm; retrieved June 29, 2009.
Harkin, T. 2009. Shift in America from sick care to genuine wellness. The Yahoo! Newsroom. http://news.yahoo.com/s/ynews_ts408; retrieved June 29, 2009.
Health Affairs. 2009. Obesity-related hospitalizations for children and youth nearly doubled between 1999 and 2005. www.healthaffairs.org/press/mayjun0923.htm; retrieved June 29, 2009.
Hellmich, N. 2008. Child obesity rates high but “leveling off.” USA Today. www.usatoday.com/news/health/weightloss/2008-05-27-obesity-children_N.htm; retrieved July 23, 2009.
Hellmich, N. 2009. Study: Hospitalizations related to childhood obesity nearly double. USA Today. www.usatoday.com/news/health/weightloss/2009-07-09-childhood-obesity_N.htm; retrived July 23, 2009.
Reuters. 2009. Preschool obesity rate stable at 1 in 7: Study. www.reuters.com/article/healthNews/idUSTRE56M70M20090723; retrieved July 23, 2009.
Shute, N. 2009. On parenting: Today’s kids are fat. Why? They eat more. U.S. News & World Report. http://health.usnews.com/blogs/on-parenting/2009/05/11; retrieved June 29, 2009.
Tahmincioglu, E. 2009. Getting paid to get on that treadmill: Some companies find that healthy workers are better for the bottom line. http://today.msnbc.msn.com/id/31569493; retrieved June 29, 2009.
Towers Perrin. 2009. Health care cost survey reveals high-performing companies gain health dividend. www.towersperrin.com/tp/showdctmdoc.jsp?country=usa&url=Master_Brand_2/USA/News/Spotlights/2009/Jan/2009_01_15_spotlight_2009_HCCS.htm; retrieved June 29, 2009.
Trasande, L., et al. 2009. Effects of childhood obesity on hospital care and costs, 1999-2005. Health Affairs, 28 4, 751–60.
Trust for America’s Health and the Robert Wood Johnson Foundation (TFAH & RWJF). 2009. F as in fat 2009: How obesity policies are failing in America. www.healthyamericans.org/reports/obesity2009/; retrieved July 23, 2009.
Watson 2009a. Watson Wyatt and the National Business Group on Health. 2009. Companies remain confident in future of health benefits, National Business Group on Health/Watson Wyatt survey finds. www.businessgrouphealth.org/pressrelease.cfm?ID=128; retrieved June 29, 2009.
White House 2009. Remarks by the president. White House Press Office. www.whitehouse.gov./the_press_office/Remarks-by-the-President-in-Town-Hall-Meeting-on-Health-Care-in-Green-Bay-Wisconsin/; retrieved June 29, 2009.
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