Public health in US

Public health in US

Obesity has been regarded as a significant public health threat with serious implications for the health and well-being of the population (Ogden, Flegal, Carroll, & Johnson, 2002). Globally, approximately 1.6 billion adults (age 15+) were classified as overweight and of those at least 400 million were obese (World Health Organization, 2005). The World Health Organization projects these statistics to increase, with approximately 2.3 billion adults all over the world overweight and more than 700 million obese by 2015. In the United States, obesity prevalence doubled among adults between 1980 and 2004. Over 72 million people, or over one-third of adults, were obese in 2005-2006. This included 33.3% among adult men and 33.2% among adult women (U.S. Department of Health and Human Services, 2007). The Healthy People 2010 objectives included efforts to reduce the proportion of adults who were obese to 15% (U.S. Department of Health and Human Services, 2000). Estimated obesity prevalence among U.S. adults in 2007 indicated that no state met the Healthy People 2010 objective.

The U.S. Department of Health and Human Services also indicated the increased risk obesity has on a variety of physical consequences including cardiovascular disease, high blood pressure, high cholesterol, type 2 diabetes, stroke, certain types of cancer, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems. The psychological factors related to obesity, including depression and low self-esteem, cannot go unmentioned as serious implications exist.

Although all individuals are at-risk when considering these behavioral and environmental factors, employees who work in a variety of worksettings, particularly office jobs and manufacturing companies, have been identified as having an increased risk for obesity. There has been a high correlation between the behavioral and environmental factors known to contribute to obesity, and those behaviors common in worksites (Gates, Brehm, Hutton, Singler, & Poeppelman, 2006). Inactivity related to many of the jobs, the lack of availability of healthy food choices, and space and time related to participation in physical activity all directly correspond to an increased risk of obesity. It is important to remember that most unhealthy behavioral choices are usually the product of habit, cultural norms, time, or ignorance and therefore are appropriate targets for worksite wellness programs (The Wellness Council of America, 2006a).

Obesity prevention

Supported by the American Medical Association (Goutham, 2008), four well-recognized behaviors have the capability of offsetting the development and treatment of obesity. These behaviors include participating in at least 60 minutes of moderate to vigorous physical activity per day; limiting screen time (television, video game, and computer use) to less than two hours per day; increasing water consumption in relation to the amount of sweetened beverages consumed; and eating five or more servings of fruit and vegetables daily. Determinants of obesity considered modifiable, prevalent, and relatively easy to change should directly relate to the treatment and prevention of obesity in adults. According to the Partnership for Prevention (2001), prevention holds “the promise of improving American lives; making them longer, healthier, and more productive” (p. 1). The role of worksites in the prevention efforts has not gone unnoticed. The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity (2001) identified the importance of individuals, families, communities, schools, organizations, government, the media, and worksites to work together to build solutions to prevent and control overweight and obesity. The prevention of weight gain and the maintenance of a healthy weight in people with a healthy weight or modest weight loss in overweight individuals tends to be easier, less expensive, and potentially more effective than the treatment of obesity after it has fully developed (Partnership for Prevention, 2001).

The prevention of weight gain and the maintenance of a healthy weight in people with a healthy weight or modest weight loss in overweight individuals tends to be easier, less expensive, and potentially more effective than the treatment of obesity after it has fully developed (Partnership for Prevention, 2001).

PURPOSE Therefore, the purpose of this article is to present ten practical steps to implementing a worksite health promotion program, and give specific examples for obesity prevention. In addition, significant lessons for obesity prevention programs in worksite settings will be highlighted. WHY WORKSITE WELLNESS?

Worksite wellness programs have been in existence for quite some time. In the 1970s, the occupational safety and health movement (OSH) and the worksite health promotion movement (WHP) were driving forces behind the initiation of these programs. The popularity of worksite wellness programs was also influenced by the culture change regarding fitness, the industrial health care burden, and research revealing the cost of unhealthy employee behaviors (Reardon, 1998). It was then that the approach towards health shifted to one of wellness as opposed to merely the absence of disease.

LESSONS LEARNED FROM WORKSITE WELLNESS PROGRAMS

Three levels of worksite wellness programs have been described: level one addresses awareness, level two concerns lifestyle change, and level three relates to the environment (Reardon, 1998; Rees & Finch, 2004). Awareness programs aide in delivering knowledge in the form of classes, posters, and health fairs without follow-up. Levels two and three aim to change behavior through knowledge dissemination and follow-up. All three levels have been implemented in varying degrees across worksites and have exhibited success. A review of the literature was conducted to gain salient lessons from several worksite wellness programs which specifically targeted nutrition and physical activity behaviors related to obesity prevention (Table 2). A participatory approach has been successful in empowering employees, and increasing the “buyin” of the program (Thompson, Smith & Bybee, 2005). Gates et al. (2006) used a community-based participatory research (CBPR) model to bring together individuals in academia, certified health educators, and managers from manufacturing companies to aid in planning and implementing environmental approaches to decrease obesity. According to Polacsek, O’Brien, Lagasse, and Hammar (2006), the CBPR approach involved community members as equal partners.

From the worksite wellness programs targeting behaviors

In Participatory approach employees and increasing the buy in of the program.It result to improved commitment from both the employers and employees involved thus resulting to greater sustainability.By using theory the successful behavior change and helps focuse on the needs attitudes and values of the target population. From comprehensive and intergrated programs we achieve greater impacts.Inclusion of culturally appropriate material and programming.Through including one one one outreach and motivation leads to more successful than addition of facilities and programs alone.Incoporating  challenge activities  also leads to increased motivation to continue with the program.

There are several steps to implement to worksite wellness program

To establish a planning commetee

Assess the interest and the needs of the corporate leaders and other employees

Develop mission statement ,goal and objectives and design and design the program

Develop a time line and budget

Select incentives

Aquire resources

Promote the program

Implement the program

Evaluate the program

Modify the program

There are several challenges of worksite wellness programs

limited purchasing power, which made the provision of health promotion services particularly difficult for worksites with only a few employees. A proposed solution was for employers to take advantage of community agency programs and services and by collaborating with other small worksites (Birken & Linnan, 2006). Participation rates in worksite health promotion programs generally have been low. Most worksite statistics indicate that enrollees in worksite health promotion programs tend to be salaried employees whose general health was better than average. Employees working in administrative support, service, crafts, and trades often had greater health risks and higher rates of illness and injury than professional and administrative workers did, making exclusion of those workers from worksite health promotion programs a concern (Thompson, et al., 2005; U.S. Department of Health and Human Services, 2000). The characteristics of participants taking part in various programs are important in understanding the potential for program success. The 2004 National Worksite Health Promotion Survey reported the common barriers or challenges to worksite health promotion programs were: lack of interest among employees (63.5%); lack of staff resources (50.1%); lack of funding (48.2%); lack of participation among high-risk employees (48.0%); and lack of management support (37.0%). Employees may have been disinterested for a variety of reasons: skepticism of such programming; angry if programs were prioritized ahead of addressing work conditions; and afraid of employer “intrusion” or an attempt to “control” their health (Birken & Linnan, 2006). These need to be addressed when designing and implementing a worksite wellness program. When targeting obesity prevention, specific barriers employees have cited include: lack of time, inadequate access to convenient and affordable physical activity areas/nutritious food, lack of knowledge or motivation. In the worksite setting, addressing these barriers and including means to overcome them will increase the likelihood of success of the program. Table 4 gives specific suggestions related to overcoming some of these barriers.

Overcoming barriers related to obesity

Lack of time is overcome by physical activity company fitness challenges instate flexible work schedule so employees can participate in weight loss programs. Inadequate access to covalent physical activity areas this provide worksite showers and lockers and helps providing healthy snacks in vending machines in break rooms and at company events. Activities provide contract with health plans that offer free or reduced cost membership to health clubs this may lead to individual and group counseling to struggling with weight loss. Lacking knowledge is another problems  it can be overcome by offering health risk appraise to all employees and follow up with sedentary employees it offers a health risk appraisal to all employees and follow up with those at risk.