Want more productive employees? Give them cleaner air

As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH:

In late 2015 a massive gas leak broke loose in the Aliso Canyon oilfield near Los Angeles. The gas leak turned out to be a bit of a false alarm from the Los Angeles Unified School District’s perspective, but due to parental concerns the School District and the Southern California Gas company installed improved, high-performance air filters in every classroom, office, and common area in the eighteen schools within five miles of the gas leak at the end of January 2016.

Ironically, by the time the filters were installed three months after detection of the gas leak, the excess methane from the gas well was into the upper atmosphere and not directly affecting the health of the students. The quality of the air in the Porter Ranch area of the San Fernando Valley where the gas leak happened is quite good by California standards, and the air inside the schools met criteria set forth by the Clean Indoor Air Act.

But an enterprising economist took advantage of the new air filters—which reduced whatever pollution was present in the schools by roughly 90%–to conduct an observational study we call a “natural experiment.” He compared standardized test scores before and the two years after the air filter installation in schools that got air filters to scores in schools that were just outside the five-mile radius and which did not get air filters. He controlled for all the usual “confounders” that investigators try to rule out as hidden causes, like demographics and ZIP code that might indicate exposure to different learning environments or levels of air pollution at home.

They’re equivalent to the effect of decreasing class size by a third or switching students to charter schools.

In following the students over time he found that math scores went up by 0.20 standard deviations and English scores went up by 0.18 standard deviations. The effect was durable over time. That is, the benefit of the cleaner air didn’t go away. These numbers are huge. They’re equivalent to the effect of decreasing class size by a third or switching students to charter schools. And at roughly $1,000 per classroom per year, new air filters are a tiny fraction of the cost of either of those interventions.

What does this have to do with your workplace? The effect does not seem to be limited to schools. As Matthew Iglesias points out, similar results have been seen in several other settings, including farm workers, baseball umpires, and packing plant workers.

At the time of the writing of this post I cannot find real-time numbers for Wichita’s level of 2.5 micrometer air pollution (PM2.5), the most important number for health. But the air in the San Fernando Valley from this study compares roughly to that in Topeka and Kansas City, KS, both of which have shown a PM2.5 density of roughly 35-65 mcg/m3 in the last 24 hours, indicating that workers in urban Kansas settings may benefit just as much as school kids in Los Angeles.

Others have tried unsuccessfully, due to ongoing litigation, to determine exactly which filters were installed in the schools. But a press release indicates that the filters were likely Blueair’s 503, 550E, 555EB, 603, 650E, and Pro XL models, which all use “electrostatic and mechanical filtration to remove 99.97% of harmful particles from the air, down to 0.1 microns in size.” So if you’re considering this step in your workplace, these seem to be the appropriate specifications to aim for. You’ll make your employees healthier, and you may find you make them more productive.

For First-Rate Care, Seek Second Opinions

As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH:

Imagine that tomorrow as you brush your teeth you notice a small lump in your neck. You see your doctor, who diagnoses a nodule on your thyroid gland. She sends you immediately to a surgeon who tells you that you need to have your thyroid gland removed. A thyroidectomy is a big operation, and this is all moving so fast, and you’ve crossed that gauzy boundary from “person” to “patient” in a matter of days. What do you do?

Many of us would seek a second opinion, one of the most time-honored rituals in medicine. A patient, unsure of the accuracy of a diagnosis or the veracity of a treatment plan seeks a second physician to confirm or refute the findings or recommendations of the first physician.

Do second opinions work?

Second opinions—whether they’re a matter of a second radiologist or pathologist reviewing images or slides or an endocrinologist reviewing the case above—have a demonstrable impact on the care delivered to a patient. A commonly cited number is that 30 percent of patients can expect their diagnosis or treatment plan to change with a second opinion, but I’m unable to find the original source of that number. A 2014 systematic review in Mayo Clinic Proceedings, though, found that between 10 and 62 percent of second opinions yield a “major change in the diagnosis, treatment, or prognosis” of a patient.

So it is no surprise that surveys have found that nearly one in five patients who saw a doctor in the past year sought a second opinion, and more than half of patients who are cancer survivors sought a second opinion at some point during their cancer care.

It just makes financial sense: an insurer—or you, the employer, if you’re self-insured—would rather not pay for a $5,000 thyroidectomy when a second consultation and thyroid ultrasound, which cumulatively cost only a few hundred dollars and which likely leaves your neck unscarred, would suffice. 

Second opinions appear to help the mental health of patients, not just the accuracy of their diagnoses. An Australian study found that the opinion of a second oncologist gave more than half of cancer patients greater confidence in their diagnosis and treatment plan. A study of neurology patients found that patients were most satisfied with the amount of information and emotional support provided by the neurologist offering the second opinion.

Do insurance providers pay for them?

The majority of insurance plans cover second opinions. It just makes financial sense: an insurer—or you, the employer, if you’re self-insured—would rather not pay for a $5,000 thyroidectomy when a second consultation and thyroid ultrasound, which cumulatively cost only a few hundred dollars and which likely leaves your neck unscarred, would suffice.

Medicare covers second opinions if “a doctor recommends that you have surgery or a major diagnostic or therapeutic procedure,” and if the opinions of the first two physicians differ, will cover a third opinion. And many state Medicaid programs have or have had mandatory “Second Surgical Opinion Programs,” which require patients to obtain a second opinion before surgery as a condition of their coverage.

In Kansas, Medicaid managed care providers Sunflower, United Healthcare, and Aetna all cover second opinions. However, some managed care plans and HMOs do not cover second opinions. Some states, including California and New York, have laws that guarantee HMO members the right to a second opinion. Kansas, to our knowledge, does not have such a law.

Some self-insured employers such as Wal-Mart have taken the leap to insist that their employees go to “Centers of Excellence” for all high-risk procedures like spine surgery and bariatric surgery. The purpose of these trips is not just to get the procedure done; Wal-Mart and others want to know if the procedure is necessary in the first place.

What can employers do to help?

Startups have emerged to help with this process. The telemedicine company 2nd.md advertises heavily on the internet, but we are unaware of the quality of their care or their costs. Docpanel.com provides radiology-specific second opinions. The company best known to me is Grand Rounds, a company which now serves primarily in care coordination, but whose focus was once the connection of patients with specialists to confirm and explain high-burden diagnoses. [disclosure: I once interviewed for a contract position at Grand Rounds, but I have no relationship with the company]

But there is likely no need to go directly to a new vendor. Check with your insurance provider or third-party administrator to confirm that your employees have access to second opinions, and educate your employees about their options. The Patient Advocate Foundation has a brief handout that may be helpful. A delicate balance must be struck: it is usually a mistake to interfere in the relationship between a patient and a trusted practitioner (see our prior post on HyVee and stem cells). It is not a mistake in the slightest, though, to give patients the opportunity to seek out additional opinions in case of uncertain diagnoses or complex treatment plans. The first doctor’s feelings may be bruised in some cases; I’ve been on both ends of that relationship. That’s okay. Those hurt feelings may be the cost of doing business for getting a more accurate diagnosis, a more up-to-date therapy plan, or a more realistic prognosis. And those can potentially have real health benefits to your employees and real dollars-and-cents benefits to your bottom line.

Should Specialists Be Paid Fee-For-Service?

As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH:

How did the fee-for-service model originate?

Once upon a time, legends say, if you could not afford to pay your doctor cash, you could pay him with commodities like grain, chickens, Brussels sprouts, or milk. Whatever goods or currency were exchanged, we called this model “fee for service.” For decades it has been the dominant model in American medicine, and it defines the patient-doctor interaction as fundamentally transactional: the doctor gets something in return for the advice/diagnostics/prescription/procedure she provides you. So historically the way to increase your income as a doctor was to simply increase volume: the more patients you saw, the more money you made.

Quality was generally measured, if at all, by the likelihood of a patient returning to see the doctor. In cases of possible patient harm, doctors tried to hold one another accountable by reviewing peers’ cases and participating in meetings such as “Morbidity and Mortality” (M & M) conferences to catch obvious errors. Working within a model that so rewarded quantity of care over quality of care, it comes as no surprise that doctors may miss half of indicated care, and that somewhere between a fifth and a third of the care that doctors provide may not be indicated at all.

A move towards quality over quantity

We are gradually moving away from “fee for service.” With the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a rare bipartisan bill, doctors can earn significant bonuses or incur significant penalties from Medicare by meeting or failing to meet certain benchmarks of quality of care.

We’ve long experimented with capitated Medicare Advantage plans that seek to incentivize private insurers to find cost savings and quality opportunities. And around half of payments from private insurers are now thought to be tied to some degree of value-based payment, or “pay for performance.” The goal of this change is to incentivize not just quantity of care, but quality as well.

We’ve even seen a modest rise in doctors operating outside the insurance system in so-called “Direct Primary Care” practices. These doctors ask for a modest recurring fee—usually $50-$100 per month—in exchange for unlimited access, with the underlying assumption that by limiting their patient panels (in part by eliminating administrative overhead), quality will inherently rise.

Should specialists be paid fee-for-service?

It was in this line of thinking that investigators recently undertook an examination of costs associated with specialty care in Canada. Canadian specialist physicians seeing patients with diabetes and chronic kidney disease can be paid under an American-style fee for service system, or they can be salaried with potential benefits tied to the quality of care they provide. *Disclosure: Justin Moore, MD, is a diabetes specialist by training*

Researchers compared the costs and quality of care associated with each one, and the results were surprising: diabetic patients were 12% more likely to have a hospital admission or an emergency department visit for a diabetes-related condition if they were seen by a salaried physician rather than a fee-for-service physician, although the difference was not quite statistically significant (1.63 admissions or visits per 1000 patient-days in salaried docs vs 1.47 in fee-for-service docs).

A lazy interpretation of this might lead you to believe that the salaried physicians, having their paycheck guaranteed, simply didn’t see the patients in clinic frequently enough. But the researchers actually found the opposite: patients seen by salaried docs had 13% higher rates of follow-up visits and procedures (and their associated costs) than the fee-for-service docs, although again, the numbers didn’t quite reach statistical significance (1.74 visits per 1000 patient-days in the salaried docs vs 1.54 visits in the fee-for-service docs).

From this data–admittedly in a Canadian system that differs in many important ways from our own–editorialists concluded that “It would appear that salary-based payment does not have the same association with reduced quantity of care provided for specialist physicians who treat chronic diseases as it does in some primary care settings.”

The lesson to be taken from this study seems to be, as it so often is, that we should proceed with caution. While primary care may be in some ways best delivered in a salaried model, for now a fee-for-service payment model may remain preferable in specialty care. When designing your benefits, or when thinking of innovative ways to contain costs in your high-utilizing employees, this might be worth keeping in mind.

Is “Social Media Hygiene” The Next Frontier In Workplace Wellness?

As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH:

Social media takes up an inordinate amount of our time. A recent report by Activate Consulting found that, when multitasking with consumer internet and media activities are accounted for, the new “normal” day is 31.5 hours:

The amount of time we spend on these platforms is not likely to go down. According to that same Activate Consulting report, the number of social media networks an average person participates in is projected to almost double in the next four years, from 5.8 to 10.2 per user.

And in spite of snarky comments—many of them, yes, on social media—about the habits of millennials or Generation Z, it is Gen X workers in their forties and fifties who are the heaviest social media users, at almost seven hours per week, rising about 17 minutes per year.

All this virtual communication may be bad for us. Studies that are now several years old show that the more Facebook you use, the worse you are likely to feel. As anyone who has ever been accidentally pulled into an email argument that could have been solved with a single two-minute face-to-face conversation can tell you, in email and on social media in particular, we may abandon social norms in response to feedback from other users, since the algorithms that drive the platforms reward content that is highly emotionally charged. Tweets that use the greatest amount of moral-emotional language are the most likely to be retweeted or liked. Facebook posts that display not only disagreement, but indignant disagreement, are more likely to be liked or shared.

Why is this?

Researchers believe that virtual conversations lack the “advanced analogue cues” that in-person, video, or phone conversations have. Without clues like body language, tone of voice, and facial expressions, we have a hard time discerning the true intent or meaning behind innocuous statements.

What can be done?

A randomized trial by Stanford investigators showed that people who were paid to deactivate their Facebook accounts—as compared to people paid to continue their usual activity—were happier and reported increased well-being, decreased political polarization, and increased time spent with friends and family. And, presumably because of the drug-like effect of social media platforms, people who were paid to discontinue Facebook experienced apprehension at re-starting, just as a former smoker may be nervous about going outside around other smokers at break time.

But because of the strong network effect of social media, asking employees to cancel their accounts is probably unrealistic. Instead, we should look for healthier ways to use the platforms. After sifting through the mainstream medical literature, here are some of our tips:

1. Encourage your employees to use social media as a bridge to in-person connection and real experiences, preferably outdoors and definitely away from screens. Using social media this way to connect to other people you’ve lost touch with may even have profound professional benefits.

2. Create this bridge to in-person connection by changing the way you approach social media. Do not seek “likes.” Do not like other people’s posts, even though that may seem rude at first. Instead of passively scrolling through your Twitter, Instagram, or Facebook feed and hitting the “like” button, intentionally reach out to people. One study found that even one week of increased composed, directed social media posts to friends and family increased happiness. Another study compared this strategy to simply “liking” or sharing posts on Facebook. People who received targeted, composed messages from friends or family felt better; those who simply got “likes,” status updates, or shared posts experienced no change.

3. Encourage employees to enforce “sacred spaces” where no devices are used, in order to reclaim conversation and non-verbal advanced analog cues. At home this may mean the kitchen, the dining room, and the bedroom, since even the presence of a device on the table may alter conversations, and looking at bright screens before bed can disrupt sleep (to say nothing of sex). As technology researcher Sherri Turkle famously said, “The greatest favor you can do to your sister, mother, lover, professor, student, is put away your phone.”

4. While you’re at it, encourage employees to delete all social media apps from their phones and use social media only on a device they have to seek out, like a desktop computer. If that seems too severe a step, encourage them to go to their phone’s settings and kill notifications from all social media.

Are there strategies you’ve tried, either at home or in the workplace?  We’d love to hear them!

Your Doctor Is Your Real Financial Planner

As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH:

The last time you spoke to your financial planner, I suspect the first question she asked you was some version of “Where would you like to be in ten years?” Or twenty, or thirty. Maybe you told her that you wanted to have your house paid off, or to be out of debt, or to be retired, or to have enough savings to send your kids to college.

The last time you went to the doctor, though, I’m willing to bet your conversation was more…retrospective. Medical students are taught to use open-ended questions to initiate a visit, so he probably asked something like “What brings you in today?” And if you’re like most people your answer wasn’t “I want to make sure I’m happier and healthier ten years from now than I am today.” Instead you probably led with whatever complaint was bothering you that day: a rash, a sore joint, shortness of breath. This doesn’t mean you were doing it wrong. Doctors exist to relieve suffering, after all. The Hippocratic Oath states in part that “I will apply, for the benefit of the sick, all measures which are required.”

``Where would you like to be in ten years?`` isn't just a question that should come from your financial planner. It should come from your doctor, too.

But if you’ll allow the slight stretching of a metaphor, what if your interactions with your health care professional sounded more like your conversations with your financial professional? Because the person that is most in charge of your financial future may not be your financial advisor. It’s more likely your doctor. Here are some hard truths at the intersection of medicine and finance:

• Illness and injury are the number one cause of bankruptcy in the United States, contributing to almost two-thirds of cases.

• The risk of illness goes up as income falls, and more than two-thirds of Americans with incomes below $40,000 say they could not scrape together $400 in an emergency.

• Medical debt is the number one reason to get a call from a collection agency, and a sixth of Americans have an unpaid medical bill on a credit card.

• One-third of cancer patients have to ask friends or family for money to finance their treatments.

• Health insurance does not necessarily protect against catastrophic loss of savings if you get sick: the ACA, for all its good, did little to reduce medical bankruptcies.

• And the expense of medical treatment may actually make outcomes worse. Filing for bankruptcy is associated with a 79% increase in the risk of death in patients with cancer.

So “Where would you like to be in ten years?” isn’t just a question that should come from your financial planner. It should come from your doctor, too.

What if we applied a financial planning rubric to health and wellness? Once the shock wore off from your doctor asking you where you wanted to be in ten years, what would you say? If you were diabetic, you might first answer that you wanted to avoid the complications of diabetes: you wanted to keep your vision, you wanted to keep all your toes, and you wanted to avoid having to go on dialysis for kidney failure. These are all perfectly good answers, but they suffer from low expectations. They’re a little like telling your financial advisor that you want to avoid bankruptcy and avoid having the bank repossess your house.

What if you were more ambitious? What if you said that, in addition to all those, you wanted to run a 5k with your granddaughter, or dance at your son’s wedding without being out of breath? What if you said you wanted to be able to carry your infant grandson up and down stairs without fearing a fall? Fortunately, just as the best financial strategies tend to be simple, the best health strategies are simple, too. Just as the financial advisor would hopefully come up with a plan to start putting money away, your doctor would work with you to make a shared decision on how to get to the last dance at that wedding a few years from now. The financial advisor might tell you to maximize deposits into tax-deferred annuities, while the doc might work with you to start scheduling “deposits” of physical activity. Just as your financial advisor might tell you to knock off the daily trips to Starbucks, your doc might tell you to knock off the bright screens in your eyes for an hour or two before bed (and, hopefully, would tell you to take it easy on the #PSL).

The next time you have a meeting with employees about their health benefits, ask them what they think of this philosophy. After all, the Hippocratic Oath also says, “I will prevent disease whenever I can, for prevention is preferable to cure.” And more powerfully, “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.”  Also remember that as an employer, you have the opportunity to help your employees stay healthy by offering real food at work instead of processed foods, providing a wellness program in a box, or by helping to shape the environment in which your employees live.

A Big Reason Why American Health Care is so Expensive

As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH:

How much health care gets wasted?

Recently, researchers from insurance company Humana and the University of Pittsburgh published a review of sources of and current levels of waste in the US health care system. They estimated that waste in the current system amounts to roughly a quarter of all health care spending: $760 billion to $935 billion annually. This waste was accounted for in six “domains”:

1. Failure of care delivery. This is waste that comes from the lack of adoption of best care practices, like patient safety initiatives.

2. Failure of care coordination. Think of patients being re-admitted to the hospital because of a gap in the system that held up their home health care, or unnecessary emergency department visits.

3. Overtreatment or low-value care. If you’ve ever received an antibiotic for what was almost definitely a viral upper respiratory tract infection, this applies to you. Somewhere between one fifth and one third of all health care delivered does nothing to improve the health of the recipient.

4. Pricing failure. Because of the perversity of the US health care system, with its lack of transparency and effective markets, we simply pay more for everything in medicine—from doctors to nurses to MRI scans—than people pay in other countries.

5. Fraud and abuse.

6. Administrative complexity. This is the result of inefficient and misguided rules. As a physician, the example of this that is closest to mind is the paperwork that accompanies prior authorization requests, which is different for almost every insurance company. It takes a lot of manpower to navigate the complexities of a system in which dozens of insurance policies within a practice all have different rules and procedures for payment.

Which of these domains was the biggest offender? Which one is responsible for the biggest chunk of that $760-935 billion annual bill for waste?

Administrative complexity

And it wasn’t particularly close: administrative complexity was thought to account for about $265 billion of waste in and of itself. Number two was pricing failure at $240 billion, and in third place was failure of care delivery at $165 billion.

The authors of the review helpfully scoured the medical literature looking for solutions and potential savings from each of the domains, and they found some interesting nuggets. Integration of behavioral and physical health, for example, was thought to have the potential for $31.5-58.1 billion dollars in savings annually in reducing failures of care delivery. Insurer-based pricing interventions, such as the State of Maryland’s All-Payer Model, were thought to be worth $31.4-41.2 billion annually.

But, you must be thinking, what about that juicy slice of savings from administrative complexity, the biggest cause of medical waste of all? If you scroll through the article to that row, you see this:

What does this mean, “Not Applicable”? This means that, in a thorough review of the existing medical literature, the authors of this review could not find a single example of a high-quality study looking at the effect of an intervention to decrease administrative complexity.

I understand if you need to pause reading in order to flip your desk.

Now understand: this does not imply that no efforts are being made to reduce complexity. The American College of Physicians, one of the largest professional organizations in medicine, has championed a reduction in administrative tasks in health care for several years now. Other organizations have advocated for using artificial intelligence to approve or deny prior authorization requests on first pass without the doctor even needing to submit a form.

But to date, none of these efforts has produced a high-quality paper showing compelling cost reduction. And most of these efforts have taken place in the patient care milieu. We’re curious if any employers have encountered or experimented with ways to reduce administrative waste. If you have a good story, please share it with us.

Are Sugared-Beverage Bans an Effective Employer Wellness Strategy?

As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH:

Health impact of sugared beverages

Sugared beverages account for the majority of excess calories Americans take in. Accordingly, a person’s intake of sugared drinks tracks very neatly to his or her risk of diabetes and cardiovascular disease. Even artificially sweetened beverages are linked to early death, possibly through their effect on the bacteria, or “microbiome” growing in our intestines. But getting people to drink less of them is a vexing problem. Countries and cities including Mexico, Philadelphia, and Berkeley, California, among many others, have experimented with taxing sugared drinks, with mostly health-positive results. New York City under Mayor Michael Bloomberg attempted to limit the size of sugared drinks that could be sold to sixteen ounces or less, a move that was eventually blocked by the courts. And banning sugar-sweetened beverages in schools has not reduced consumption, at least in survey data.

Is banning the sale of sugared beverages effective?

Recently the we’ve seen the results of a sugared-drink sales ban implemented by the University of California at San Francisco (UCSF) in 2015 (students and employees were still able to bring drinks on-campus). Investigators followed the habits and health indicators of 202 volunteer subjects before and after the prohibition. Ten months after the ban, subjects’ consumption of sugared drinks was down by almost half: 48.5 percent. Even though the participants still drank a large quantity of sugared drinks after the ban—18 ounces a day, on average—they saw dramatic improvements in health. They lost almost an inch from their waists, and the fraction of the study population who decreased their drink intake the most saw improvements in insulin resistance, the phenomenon that leads to diabetes.

Obstacles to overcome

So the science of limiting sugared drinks at the worksite seems sound, at least in terms of reducing the risk of employee illness. But major obstacles threaten such policies: first, the happiness of workers is likely to be affected, at least in the short-term. Employees may rebel against a workplace culture they perceive as too paternalistic. This viewpoint was exploited by tobacco companies during the implementation of smoking bans in the recent past. This is where an honest outreach program to employees would be worthwhile: we know that excess sugar intake is linked to depression, and that improved dietary habits can profoundly improve mood in depressed people. Sharing these stories with employees in an engaging way that shows light at the end of the sugared-drink tunnel may help. After all, a decade after widespread smoking bans, norms have shifted to the point that a re-introduction of smoking in worksites and restaurants would be met with fierce opposition.

Second, your company may have a contractual arrangement with beverage vendors. This is particularly true of institutions of higher learning. However, possibly sensing the movement of the tide away from sugared drinks, beverage companies are frantically working to offer healthier alternatives and the National Automatic Merchandising Association, the trade organization for vending companies themselves, has pledged to make at least a third of its offered products meet the standards of at least two of the healthy food standards set by Partnership for a Healthier America, the Center for Science in the Public Interest, the American Heart Association, Centers for Disease Control and Prevention, or the USDA’s Smart Snacks. So leaving vending on-site but reducing or eliminating sugared drinks is a potential compromise.

Has your worksite attempted to change the availability of certain snack foods or sugared drinks? The Kansas Business Group on Health would love to hear about your experience.

Ho Ho How to Avoid Holiday Weight Gain

As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH:

You can already see it coming: the weight we all gain over the holidays is as predictable as the weight we try to take off for the summer. A few years ago researchers used WiFi-enabled “smart scales” whose buyers were aware that their weights would be used for research to track the weights of American, German, and Japanese subjects for one year. The scales are important: people frequently misreport their weight, or they change their diets when they know they’ll have to report somewhere to be weighed. By having the scale in their house and wirelessly communicating with the database, the investigators hoped to reduce this bias. For any given holiday the researchers compared the maximum weight at no more than 10 days after the start of the holiday to the weight that was measured 10 days before the holiday.

The results? In all three countries, the participants’ weight rose in the 10 days after Christmas Day, compared with the 10 days before Christmas (+0.4% in the U.S., +0.6% in Germany, and +0.5% in Japan). The raw amount of weight gained wasn’t large: only 1.3 pounds for an average American. But the researchers pointed out that since the population of this study—people who spent ~$150 on a scale—is probably wealthier and more motivated toward weight loss than average, the results of the study probably underestimate the effect on the general population. For example, the average worker gains 2-3 pounds per year (half of that between Halloween and New Year’s Day, naturally) and weights in this study had gone down to pre-holiday levels within six months or so.

So: what can we do to help our employees prevent this weight gain in the first place?

An interesting answer comes from two groups of researchers who elected to try a “weight prevention” approach rather than a traditional weight loss approach. First, investigators at the University of Georgia developed a program they called Holiday Survivor for state employees. Participants were divided into teams and were instructed by a worksite wellness professional on self-monitoring and regular weigh-ins from the end of October to mid-January. Efforts were put toward increased awareness of food intake and physical activity through self-monitoring, but the program was geared not toward teaching new knowledge, but instead to build social support for positive behaviors. Each team of four employees received points for participating in weekly program activities like a healthy potluck, a 5 km run/walk, or “lunch and learns,” and for completing weigh-ins. Individual participants also received points on two occasions for providing proof of food logs (not the logs themselves). In early January a prize ceremony was held to celebrate team and individual achievements.

In spite of the emphasis on weight maintenance, the employees lost an average of 4.4 pounds (from 196.7 in October to 192.3 pounds in January).

A second group of investigators in the U.K. randomized workers in a variety of jobs to either get a pamphlet on the dangers of holiday weight gain (without dietary advice) or to get instruction on recording their weight at least twice weekly (ideally daily), ten tips for weight management, and pictorial information about the physical activity calorie equivalent (PACE) of holiday foods and drinks (that is, information such as “13 minutes of running for a can of sugared soda”). The goal was for participants to gain no more than ~1 pound of their baseline weight.

Over the holiday season the group getting the pamphlet alone gained on average 0.8 pounds, while those weighing frequently, getting tips on weight management, and informed of the PACE of holiday foods lost 0.27 pounds.

The Kansas Business Group on Health generally takes a prosaic view of traditional worksite wellness practices. We tend to believe that true health is hard to define and harder to measure, and that improvements in health are rarely as simple as old-fashioned carrot-and-stick rewards or punishment. But this strategy of proactively engaging employees to manage a known occupational hazard (the holiday season) is novel and promising. If any members have had similar luck we’d love to hear about your strategies!