A Healthy Discussion

A highly publicized and controversial study from the Centers for Disease Control may present an opportunity for HR to start a conversation about "realistic health goals." One large healthcare organization is doing just that.

Tuesday, January 15, 2013
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Will a recent and widely reported meta-analysis from the Centers for Disease Control and Prevention undermine workplace-based weight-loss programs?

The meta-analysis, published in the current issue of the Journal of the American Medical Association, reviewed data from nearly a hundred large epidemiological studies to determine whether the correlation between body mass and "normal" or "healthy" weight used by public health authorities is actually supported by published medical research.

The study, by Katherine M. Flegal and her associates at the Atlanta-based CDC and the National Institutes of Health, found that all adults categorized as overweight, and most of those categorized as obese, actually have a lower mortality risk than "normal-weight individuals." The study notes that if the government were to redefine normal weight as one that doesn't increase the risk of death, then about 130 million of the 165 million American adults currently categorized as overweight and obese would be re-categorized as normal weight instead.

Some experts say the headlines generated by the study may be misleading.

"I don't fully agree with what has been publicized about the study," says Jen Sacheck, associate professor of nutrition at Tufts University and co-author of the book Thinner This Year.  "Unfortunately, the American public hasn't been told about all the qualifiers within it."

For example, the study examined body mass index, which doesn't look at where in the body fat tissue is concentrated, she says.

"Central adiposity around our mid-section has a heck of a lot more to do with adverse health outcomes than simply being overweight," says Sacheck. "The study didn't say how healthy the people in the overweight profile were -- what their lipid profile looked like, for example."

It's also important to note that being thin doesn't necessarily correlate with being healthy, she says. "You can be overweight and still be very healthy and fit," she says.

Sacheck is concerned about any sense of complacency the study could generate, considering that two out of every three Americans are overweight. "It's really important for HR to stress that this study had nothing to do with health, and that being healthy and fit does reap enormous benefits," she says.

"We live in a society where physical activity has basically been engineered out of our lives, where it's easier to eat crummy but convenient food," she says. "We have to work at being healthy."

Wellness programs should emphasize the quality of life derived from being fit and eating healthy foods, says Sacheck.

And, greater longevity doesn't necessarily correlate with greater health, says Dr. Michele Dodds, vice president of health and wellness at ComPsych, a Chicago-based provider of employee-assistance programs.

"Obesity brings with it increased risks for diabetes, cardiovascular disease and certain types of cancer," she says. "The CDC study only looks at length of life, not quality of life."

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That said, extra weight can actually be helpful when one is battling a disease like cancer, she says. "You need calories to fight off a disease like this, and if you're underweight at the time of diagnosis, you can end up being in a poorer health situation," she says.

In fact, the CDC's study is helpful in that it supports "non-extreme behavior," says Dodds.

"We have to get away from this 'all or nothing' mentality," she says. "It's a great time to have a conversation about realistic goals for health. Having good health doesn't mean you have to be a vegan triathlete."

At the sprawling MD Anderson Cancer Center in Houston, the organization's brand-new Healthy Bites program is designed to encourage its 19,000 employees to "take on realistic modifications to their diet," says Mary Ellen Herndon, MD Anderson's employee wellness dietician.

Healthy Bites is a nutrition challenge that asks employees to make one healthy change to their diet each month in order to achieve a "well-balanced, cancer-fighting eating routine," says Herndon.

"We were looking for a way to engage people who don't usually participate in our health and wellness programs," she says. "We know from research that small changes, made one at a time, can lead to bigger, more impactful changes down the road. Practicing this step-by-step approach means these changes will be more likely to stick."

Although the ideal BMI for healthy adults lies between 18.5 and 25, most companies that use BMI as a biometric target for employees to achieve in order to qualify for premium discounts and other benefit programs set the target higher -- as well they should, says Dr. Russell Robbins, senior clinical consultant at Mercer in Norwalk, Conn.

"They're setting a program for everyone," he says. "It's important to recognize that some people struggle with their ideal weight, and to reward them for making an effort."

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