5

Worksites

Key Points Highlighted by Individual Speakers

  • The Hy-Vee grocery chain in the upper Midwest has instituted a multifaceted campaign that blends services for its employees with services for its customers while bringing those programs to scale at the community level. (Eddy)
  • General Mills also has taken a multifaceted approach, ranging from healthy cooking classes, to stress management, to improving the health of its employees and customers (Halber )
  • Initiatives such as countering the sedentary nature of modern work, increasing access to fruits and vegetables, connecting the workplace with the community, and promoting health equity can be undertaken in most worksites. (Pronk)

Three speakers addressed obesity solutions in worksites. Helen Eddy, assistant vice president of health and wellness for Hy-Vee, Inc., spoke about that grocery chain’s campaign to improve the health of not only its employees, but also its customers and the community. Julia Halberg, chief medical officer for General Mills, Inc., described the company’s multifaceted approach to promoting weight management and overall health among its employees and customers. Finally, Nico Pronk, vice president and chief science officer for HealthPartners, Inc., in Minneapolis, talked about interventions that have broad applicability in most worksites.



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5 Worksites Key Points Highlighted by Individual Speakers • The Hy-Vee grocery chain in the upper Midwest has instituted a multifaceted campaign that blends services for its employees with services for its customers while bringing those programs to scale at the community level. (Eddy) • General Mills also has taken a multifaceted approach, ranging from healthy cooking classes, to stress management, to improv- ing the health of its employees and customers. (Halberg) • Initiatives such as countering the sedentary nature of modern work, increasing access to fruits and vegetables, connecting the workplace with the community, and promoting health equity can be undertaken in most worksites. (Pronk) Three speakers addressed obesity solutions in worksites. Helen Eddy, assistant vice president of health and wellness for Hy-Vee, Inc., spoke about that grocery chain’s campaign to improve the health of not only its employees, but also its customers and the community. Julia Halberg, chief medical officer for General Mills, Inc., described the company’s multifac- eted approach to promoting weight management and overall health among its employees and customers. Finally, Nico Pronk, vice president and chief science officer for HealthPartners, Inc., in Minneapolis, talked about inter- ventions that have broad applicability in most worksites. 31

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32 CURRENT STATE OF OBESITY SOLUTIONS HY-VEE: AN EXAMPLE OF SUCCESS Worksites can have a powerful influence not just on those who work there but also on customers and on businesses associated with the site. For example, said Eddy, the Hy-Vee grocery chain has instituted a multifaceted campaign that blends services for its employees with services for its custom- ers while bringing those initiatives to scale at the community level. Hy‑Vee operates 235 retail stores in 8 states, along with 150 convenience stores and 240 pharmacies. It employs 70,000 people and is the largest private employer in the state of Iowa. Health and wellness is a strategic platform at Hy-Vee. The company seeks to provide a healthy work environment for its employees and to make the healthy choice the easy choice for its cus- tomers. “We are committed as a retailer and as an employer to providing affordable, accessible solutions to our customers, to our employees, and to other businesses,” said Eddy. Eddy noted that the most important health decisions most people make begin in the aisles of grocery stores with the foods they choose to take home. Hy-Vee has more than 200 registered dietitians on staff serving 225 of its retail stores and more than 200 chefs who help teach employees and customers how to cook healthy, affordable food. It offers nutrition coun- seling, recipes, free grocery store tours, cooking classes, education classes, health coaching, signage throughout the stores designed to encouraged healthy choices, newsletters, websites, and forums. It uses a nutritional scoring system on shelf tags throughout its stores and educates people on how to use the system. It provides healthy checkout lanes, dietitian’s choice sections, and natural and organic foods within the stores. It conducts out- reach activities in the community, in schools, and in other businesses, and it has sponsored more than 500 community gardens. The company’s head- quarters has free fresh fruit in break rooms, standing workstations, and healthy options in the cafeteria, and is moving to smaller plates as a way to control portion size. It offers a 10-week behavior modification program called Hy-Vee Begin that includes pre- and postprogram biometric screening of health risks. It also offers these strategies, such as biometric screenings, to other businesses in its communities. In addition, Hy-Vee is focused on fitness and movement. It has a fitness center at its headquarters and at one of its stores, and sponsors events such as races and triathalons for children and a 10-week activity and weight loss challenge for its customers. The company seeks to “get our employees and our customers and other businesses up and moving,” said Eddy. As an employer, the company recognizes its need to address the driv- ers of its own health care costs. It is a self-insured private company with an annual budget of $123 million for providing insurance coverage and health care to its employees. Because of the programs it has implemented,

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WORKSITES 33 its insurance costs per employee average only $6,400 per year, compared with a national average of $10,000 to $12,000 per employee per year. The company returns these savings to its employees in the form of 1-month insurance premium holidays, which it has been able to offer in 5 of the past 6 years. The company uses a carrot, not a stick approach to engage its employ- ees, said Eddy. Under the Live Healthy Hy-Vee1 program, employees can participate annually in a biometric screening and health risk appraisal. If they then complete two healthy activities, they receive a health insurance premium discount of $700 per year. The company also is considering using biometric results to identify employees at risk for such conditions as meta- bolic syndrome and requiring them to complete Hy-Vee Begin. Finally, Hy-Vee has been engaged in a public–private partnership through Iowa’s Healthiest State Initiative, which is seeking to make Iowa number one among states in well-being by 2016. One emphasis of the initiative is the needs of small businesses. More than half of the workforce in the United States is employed by small businesses, and these companies need to have access to turnkey strategies and community resources if they are to help their employees and customers stay healthy. GENERAL MILLS: A MULTIFACETED APPROACH General Mills, Inc., which is a founding member of the Healthy Weight Commitment Foundation, also has been focusing on the education of its employees and customers. According to Halberg, it has been emphasizing the energy equation—“calories in and calories out”—because that reso- nates with people, is easy to understand, and is actionable. But different people respond to different approaches, she noted, which calls for a mul- tifaceted campaign. Subsidizing healthy foods, encouraging employees to eat the rainbow and smaller portion sizes, having healthy foods in vending machines, providing onsite fitness centers in some locations, and offering healthy holiday cooking classes are among the options the company makes available to its employees. General Mills also has onsite lactation rooms for breastfeeding women, a measure that provides for healthy babies and helps mothers lose some of their pregnancy weight. General Mills’ employ- ees span three generations, Halberg noted, and many employees have been with the company for decades. “We have a lot of opportunities to work with them and find formulas that work,” she said. Stealth health strategies also are effective. For example, General Mills has taught its employees about chair yoga and stretches that can be done during a meeting without anyone noticing. Treadmill working stations 1  For more information, see http://www.livehealthyhy-vee.org (accessed April 29, 2014).

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34 CURRENT STATE OF OBESITY SOLUTIONS and designated walking paths are available for employees. The company’s clinics emphasize prevention, because chronic disease is handled well in the community, but opportunities for prevention can be overlooked. For example, a preventive cardiologist is available to offer lipid management, a dermatologist has detected numerous melanomas over the years, optom- etrists check vision, and a dentist and hygienist are available for dental exams and cleaning. For the food it manufactures, General Mills has adopted an approach developed by its Bell Institute of Health and Nutrition, which entails reduc- ing unhealthy components, including fats, sugars, and salt, slowly and care- fully while maintaining taste. “No matter how healthy food is, if it does not taste good, people will not eat it,” noted Halberg. Another emphasis of General Mills is resiliency and stress management. People can learn to be more resilient, said Halberg. General Mills therefore has designed programming both to build strong managers and to help employees develop the resiliency they need while at work. For example, mindful meditation is used to help employees innovate. Some departments have adopted flexible shared workspaces that allow professionals to sit and work where they need to be, giving them the flexibility to collaborate more easily with other team members and use their workspace more efficiently. General Mills has a renowned art collection, and it is working with its part-time curator to develop tours that can help with stress management. Employees soon will have an app with which they can scan a piece of art- work, learn about the artist, and put work behind them for a few minutes. Finally, General Mills has been working to eliminate health disparities through the General Mills Foundation and its connection to the community. It provides grants to nonprofit programs, such as the company’s Champions for Healthy Kids, through which donations of more than $5 million since 2002 have served nearly 1 million youth, and the Presidential Youth Fitness Program, for which a $10 million commitment over 6 years is empowering students to achieve active, healthy lives. In addition, more than 80 percent of the company’s employees volunteer. “For those of us fortunate to work in a company like General Mills, we can give back, and feel good about it, but also learn about the different populations that we serve,” Halberg concludes. TRANSPORTABLE WORKSITE INITIATIVES Pronk cited several initiatives that, like those of Hy-Vee and General Mills, can be undertaken in most workplaces. The first consists of efforts to counteract the sedentary nature of work. As work has become more sedentary, prolonged sitting time has become a significant risk factor for increased weight. Sit-stand devices for employees, while not designed to

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WORKSITES 35 produce weight loss per se, can yield better mood states, greater energy expenditure, less upper back and neck pain, heightened workplace produc- tivity, and increased movement that may aid in the prevention of weight gain. HealthPartners’ Take-a-Stand Project has demonstrated the feasibility as well as the effectiveness of this program in changing the work environ- ment of employees, involving management, and improving workers’ psy- chosocial environments.2 The second initiative entails increasing access to and consumption of fruits and vegetables. A recent review of half a million employee health assessment results found that only 17.5 percent of employees were consum- ing five or more servings of fruits and vegetables per day. Employees stated that the high price of salads was a significant barrier to their purchase. Accordingly, HealthPartners tested an organizational policy intervention that reduced the price of salad bar purchases in a corporate cafeteria by 50 percent, a measure that more than tripled salad bar sales.3 Policies that make the price of salads advantageous compared with other choices in cor- porate cafeteria settings therefore may significantly increase consumption of healthful foods, Pronk said. The third initiative Pronk described involves connecting the workplace with the larger community. For example, a simple tactic to support employ- ees in finding better food options is to send them a text right before lunch reminding them to seek out healthy foods. Apps also can help employees find healthier food options in restaurants wherever they may be. A business case needs to be made for employers to allocate resources to such efforts, suggested Pronk. But he emphasized that connecting the workplace with the community can help support the sustainability and scalability of an intervention. Finally, Pronk mentioned the role that employers can play in promoting health equity. Employers have data on many issues, including the health sta- tus of their employees. These data could help identify populations subject to disparities and suggest ways of reducing those disparities. 2  More information is available at http://www.cdc.gov/pcd/issues/2012/11_0323.htm (ac- cessed April 29, 2014). 3  More information is available at http://www.cdc.gov/pcd/issues/2013/12_0214.htm (ac- cessed April 29, 2014).

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