Health & Wellness Coaching As Essential

by Dr. Michael Arloski

“Individuals do best if they understand that health is vitality and energy, not just the absence of disease, and that they are their own self-leaders in charge of improving or maintaining their own health status and influencing the health status of their families.” Dee Edington – Zero Trends: Health as a Serious Economic Strategy.

Wellness and health coaches are increasingly being seen as a key component of company wellness programs. The trend toward individualization of welln ess has been building over the last ten to fifteen years and is stronger than ever. The paradigm shift towards a coach-centric programming approach continues to grow. Now, in a landmark book, (Zero Trends: Health as a Serious Economic Strategy, 2010) Dee Edington, wellness pioneer researcher and director of the University of Michigan Health Research Center, lays out for us the evidence-based best way to allocate a company’s wellness resources and indentifies wellness and health coaching as one of three essential components.

Health & Wellness Coaching As Essential

In the health promotion field, the room goes silent and everyone is all-ears when Dee Edington speaks. If Edington is not the “Father” of the HRA (Health Risk Appraisal), his work over the last thirty years has certainly told us more about these instruments and how to milk every last bit of value out of them than anyone else.

“The health risk appraisal (HRA) system is core technology to integrate health into the culture of a company.” (Edington, 2010) He sees these systems requiring three essential components: 1) the HRA questionnaire and profile itself, 2) biometric screening and 3) health coaching. He sees coaches being of value whether the client is identified as low or high risk, or dealing with a chronic illness. The real value of an HRA is only realized when there is a good method of helping the person understand it’s meaning and implications for their health. This is where an individual coaching session, or better yet, series of sessions excels.

Keeping Healthy People Healthy

Health and wellness coaching is often provided to employees as a benefit and is delivered by one of a number of different providers. The coaching my be a service of: a disease management and/or wellness coaching company that is a part of the employee’s health insurance; a contracted wellness coaching company; a contracted independent wellness coach; or employees of the company’s wellness program that have been specifically trained as wellness coaches. Whenever benefits are provided the immediate concern is cost. How much wellness coaching, and who gets to see the wellness coach?

It is tempting to look at the 20% of the employee population who are at high risk and consume 80% of the healthcare costs and target them for our wellness coaching efforts exclusively. These “high risk” individuals appear very visible to the wellness programmer’s eye. Many of the high risk group often already have some sort of “lifestyle disease” (as the World Health Organization calls them) or chronic illness, and they often use more sick days, and drive up the cost of healthcare, especially for a self-insured company. However, this is exactly the time to look at Edington’s evidence.

The problem, Edington says, is migration. Our three neat categories of low, medium and high-risk individuals are not static. People “migrate” from one category to another and they tend to migrate in mostly one direction, from low to higher, and healthcare costs migrate right with them. “Therefore, when a program focuses solely on high-risk individuals—and we certainly need to pay attention to those folks—it can only be successful to a certain extent. While a practitioner is focusing solely on his or her high-risk population, they’re missing all of the individuals who move from low or medium-risk to high-risk. In the end, they have more people who became high-risk than people who reduced their risk.” (Edington 2004). So we end up with more high-risk people despite our attention to those in the high risk group to start with. Sounds a lot like the Parable of the Waterfall (Why don’t we go upstream and see why these folks are falling in?”) doesn’t it? Edington likes to say that while the 20/80 “rule” is true enough, it is extremely flawed as a health management strategy. Bottom line: make coaching available to all. Keep the healthy people healthy.

“Everyone can use a coach!”

Dee Edington – Zero Trends: Health as a Serious Economic Strategy. P. 132.

A new study that provides a snapshot of a typical American workplace observed that chronic job stress and lack of physical activity are strongly associated with being overweight or obese. Unexpectedly, researchers also found that a diet rich in fruits and vegetables did little to offset the effect of chronic job stress on weight gain among the employees, who were mostly sedentary. Instead, exercise seemed to be the key to managing stress and keeping a healthy weight. University of Rochester Medical Center researchers conducted the study of 2,782 employees at a large manufacturing facility in upstate New York, but the results could be applicable to almost any job situation in which layoffs, or lack of control at work, is a major concern.

The Journal of Occupational and Environmental Medicine published the research in January 2010. Lead author Diana Fernandez, M.D., M.P.H., Ph.D., an epidemiologist at the URMC Department of Community and Preventive Medicine, said her study is among many that associate high job pressure with cardiovascular disease, metabolic syndrome, depression, exhaustion, anxiety and weight gain. It's time to improve corporate policies that better protect the health of workers, she said. "In a poor economy, companies should take care of the people who survive layoffs and end up staying in stressful jobs," Fernandez said. "It is important to focus on strengthening wellness programs to provide good nutrition, ways to deal with job demands, and more opportunities for physical activity that are built into the regular workday without penalty."

Over and over, Fernandez's team heard the same story from the upstate workers: After spending the day sitting in stressful meetings or at their computers, they looked forward to going home and "vegging out" in front of the TV. Anecdotally, researchers also discovered that when pink slips were circulating, the snacks highest in fats and calories would disappear quickest from the vending machines. Some workers said they did not take the time to eat well or exercise at lunch because they were fearful of repercussions from leavi ng their desks for too long. Approximately 32 percent of adult men and 35 percent of adult women are obese in this country. When the prevalence of overweight and obesity are combined, 68 percent of adults fit the category (72 percent prevalence among men; 64 percent among women), according to a recent report in the Journal of the American Medical Association.
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