Make Time or Forget It

If I don't make time to get in a workout and let the day get away from me, it's easier to say forget it.  Other things become a priority and being a high energy morning person, I dread afternoon workouts.  It doesn't mean I skip it, but I somehow don't feel the same when I'm dragging.  I'm determined not to let myself down and push through.  It's on me when I miss my morning exercise appointment and my consequence is not feeling my best.  My fault, I own it and learn from it.  

There will be times when missing a morning can't be helped and that's acceptable.  It's those days where "other things" seem to snowball into the afternoon and I'm left still needing a sweat session.  I have learned to plan better, make time and not skip a workout.  Without a plan, it's just a wish, right? Without making the time, it's not going to happen, right?

We go through life making so many excuses on how we don't have time. Really?  I love that quote "someone busier than you is working out right now" and it's the truth.  We must start owning our excuses and just say it's something we don't want to do.  Now that's the beginning of a revelation. Why wouldn't you want to take time to take care of your health?  What's so burdensome about moving your body for a few minutes and eating awesome healthy food?  It's not about time at all, but your feelings toward working out and eating right.  Honesty is always the best way to create change.

The continued truth remains if something is important to you, it gets done. Everyone has time to hit up daily social functions, watch hours of TV and surf the web but when it comes to one hour of exercise, the "busy button" rears it's ugly head.  Give the offer of meeting for a drink, and suddenly a burst of energy occurs.  Unfortunately an unhealthy epidemic is happening because too many people are "forgetting it."  Those who exercise and eat right on a consistent basis are in the minority.

If we continue to not make time for exercise, we will eventually be making time for illness. The same applies to eating right because we are what we eat.  No exercise and eating processed crap leads to problems and reality TV shows.  This has become a horrible fact. Straight talk, but we need to start making the time!

New great articles on my about.com site!  "Want Less Fat and More Muscle? Eat Protein for Breakfast" and "Celebrity Nutrition Tips to Stay Lean and Muscular."

Read My Articles on About.com

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Be Well and Stay Healthy!

Testing the Insulin Model: A Response to Dr. Ludwig

Dr. David Ludwig, MD, recently published a response to my critique of the carbohydrate-insulin-obesity hypothesis.  This is good because he defends the idea in more detail than I've encountered in other written works.  In fact, his piece is the most scientifically persuasive defense of the idea I can recall.

Before we dig in, I want to emphasize that this is science, not tribal warfare.  The goal is to arrive at the best answer, rather than to win an argument.  I'm proceeding in good faith, based on my belief that Ludwig and I are both serious people who care about science and human health, and I hope my audience will do the same.  That said, let's get to it.

Read more »

The Latest Health Wonk Review Is Up!

The 10th Anniversary Edition of the Health Wonk Review is now up at Joe Paduda's Managed Care Matters.  The review summarizes and links some of the better postings of health-policy bloggers, with topics that range from (angry) unionizing docs to the proximity of hospitals to stockpiles of (explosive) ammonium nitrate.

Since ten years qualifies as an eon in web-time, the HWR must be doing something right.

Enjoy!

Fitness is All Day Long

Being a fit person is not a temporary condition but fills our entire day and life. The motivation to get in shape may have initiated with bikini season or an event but the lasting results should carry us the rest of this journey.  Some may give up the "fitness ghost" and settle back into old unhealthy habits, but that's not the way it's supposed to work.

Fitness is all day long and lifelong.  Personally, I enjoy a morning workout when my energy is highest and after a strong cup of coffee.  This kick starts my day, I feel great and it prepares my mind and body for the remainder of my 24/7 fitness shift.  My workout is not the only part of staying lean and muscular.  I have lots of healthy food ready to go and I stick pretty hardcore to a 90/10 nutrition plan.  I may relax some on the weekend shifting down to 80/20 to allow for the treats I enjoy, but never overboard.  I am a firm believer of drinking lots of water and easily down a gallon per day and yes, it means lots of bathroom visits.  My only downfall is not getting enough sleep which I lovingly blame on menopause, because the effort is there.

My personal share about fitness being all day long is showing the importance of thinking and incorporating what it takes to be a fit person.  I would be a hypocrite if I didn't walk the talk of what I teach daily to my clients and passionately write about online.  Fitness doesn't end at the workout, but includes the 23-hours after sweating your butt off. Don't think you'll be able to down pizza, beer, and donuts on the regular and call yourself a fit person.  Being fit all day long includes the type of food you eat, what you drink, how you think, getting quality rest, and balance of work and play.   When fitness becomes a habit, the healthy behavior is done without thought and going through the motions comes naturally. This is not about playing pretend or faking it because you know the truth.  In fact, those who are close to you will know the life you lead because as a fit person, there comes admiration from others. You become a motivator without even knowing it and may even be asked how you are able to maintain your healthy lifestyle.  Welcome to my world!

Read my recent articles on about.com to help you adopt a fit lifestyle.  Great suggestions would be:

Resolve to Get Fit and How to Make it Happen
Read the Article!

What Newbies Need to Know About Getting Lean
Read the Article!

Am I the Only One Struggling with Fitness Results
Read the Article!

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Be Well and Stay Healthy!

Ten Questions Publicly Traded Company Boards Should Ask about Employee Wellness

The Board reviews a company

health promotion program

As follow-up to this post about the peer-reviewed evidence linking company-sponsored employee wellness programs and total shareholder return (TSR), the Population Health Blog offers ten questions that these companies' boards of directors should consider when reviewing the topic with their management team:

1. Does the company have a wellness, health promotion, disease prevention or condition management program in place?  If not, why not?  If it does, what is the vision and strategy?

2. In addition to internal measures of "return on investment," are the costs of the program(s) worth the impact on total shareholder return (TSR) and will this pass muster with the due diligence of activist investors?

3. Do other companies competing in the same industry have wellness, health promotion, disease prevention or condition management programs? How have they fared?

4. Have the program(s) been subject to external review, such as Mercer, C. Everett Koop or CHAA? 

5. If the company is self-insured, what are the expectations about the impact of the program(s) on health insurance claims expense?

6. Is the programs' impact on recruitment, morale or productivity being assessed?  How, and can the results be subject to an internal audit or to third-party outside review?

7. How are regulators' and employees' concerns about discrimination or privacy being addressed?

8. Does a "Chief Health Officer" exist?  If not, why not?  If yes, does the job description include any oversight responsibility of employee health?

9. Who on the board can act as a lead in providing the necessary oversight of any of these programs?

10. Is low-cost, scalable digital technology "mHealth" being leveraged? How?

Image from Wikipedia

The Link Between Corporate Wellness Programs and Total Shareholder Return

While employer-sponsored wellness, health promotion and disease prevention programs have been linked to "human capital," talent recruitment and retention, improvements in employee morale, reductions in absenteeism, reductions in presenteeism and bending the curve of claims expense, should shareholders care?

After all, according to President Obama's latest State of the Union Address, corporate America's pursuit of profits have resulted in greater automation, less competition, loss of worker leverage and "less loyalty to their communities." According to that narrative, employees are just another commodity on the road to total shareholder return.

Well, according to an expanding body of peer-reviewed scientific literature, shareholders should care.

The latest example of why is this publication by Ray Fabius and colleagues that appeared in the January issue of the Journal of Occupational and Environmental Medicine.

First, some background.  The Corporate Health Achievement Award (CHAA) was created by the American College of Occupational and Environmental Medicine (ACOEM) to recognize companies' workplace health and safety programs.  It relies on a thousand point-based assessment system of multiple standards in four categories of 1) Leadership, 2) Healthy Workforce, 3) Healthy Environment (including Safety) and 4) Organization.  Many of the companies that have participated in CHAA are household names.

In this study, the authors tracked the stock market performance of companies that applied for the CHAA from 1997 through 2014.  As the Population Health Blog understands it, all the privately held companies as well as those that scored 175 or lower in Organization and lower than 350 combined in the Workforce and Environment categories were excluded from the analysis. Of the remaining publicly companies, those scoring at or above the 37.5 median percentile in the four categories described above (defined as high CHAA achievers) were placed in six hypothetical stock portfolios of 5 to 22 companies.  The authors then mapped out what would have happened with a January 2001 investment of $10,000. As each year passed, new high scorers were added to "rebalance" the portfolios, while the stock of repeat high scorers were added.

The results? While the benchmark Standard and Poor's (S&P) return over the study period was 105%, the portfolios easily exceeded that with returns that ranged from just from over 200% to 333%. 

This study builds on other studies that used the CHAA as well as other wellness award programs including Mercer's HERO Employee Health Management Best Practices Scorecard and the C. Everett Koop National Health Award.

Now that's total shareholder return.

In another demonstration of why peer-review is so important, Dr. Fabius and his colleagues correctly point out that correlation is not the same as causation. As a result, there is no evidence that importing wellness programs into other companies will translate into better stock performance. In addition, elementary statistics tells us that corporate wellness and TSR won't necessarily correlate over shorter periods of time for individual companies.

Bottom line? The PHB doesn't think investors in public companies are necessarily interested in "causation" as they are in market signals. It stands to reason that a commitment to company wellness is an important signal about where to put their money. 

Which raises three questions....

1) This was raised by Fabius et al: should investors or regulators demand that companies publicly report whether they have employee wellness programs?

2) Should companies invest in a "Chief Health Officer?"

3) Why isn't corporate wellness part of the national conversation about capitalism in America?

Coda: For additional reading, see this link on the ten questions about employee wellness that should be asked by boards of directors.

Image from Wikipedia

The Latest Health Wonk Review is Up!

Hank Stern over at his InsureBlog naturally celebrates 11 years of blogging by hosting the latest Health Wonk Review, The Happy New Year Edition.  Check it out for the latest health policy insights that you won't get anywhere else.

Enjoy!

No Matter What You Do, It's Still About the Lifestyle

Trying to achieve the so-called "perfect" body causes people to take drastic measures whether from detox cleanses, extreme caloric restriction, surgical change of normal organ function, to outward cosmetic procedures.  All those methods don't mean a thing if a healthy lifestyle is left out of the equation.

No matter what you do, it's still about the lifestyle.  Extreme measures without learning how to buy, cook and eat healthy foods combined with regular exercise will be wasted time and money.  If you are currently doing one of those popular restricted calorie shake diets and the end of that program comes...what then?   Let's say you have had some fat cells sucked out and after surgery you are still hitting the pizza and donuts...what then?  If you have had a stomach organ band placed and still continue to eat fries and drink soda...what then?   The point is what have you learned? The point is you will return to the weight and size (or larger) than you were prior to going drastic. This write is not to be judgemental or offensive, but to open your eyes to what it means to get healthy.  Nothing inside a packaged shake mix or on an elective surgery table is going to provide health and fitness.  What will create health is your daily choices about food and exercise and creating a habit that becomes a lifestyle.

The belief that quick fixes can stand alone to create the hot body of your dreams is a fantasy.  If product companies or surgeons are telling you drinking some magic or getting something snipped will do it, they are wrong and I will go as far as to say negligent in feeding you a load of BS. Are you really so impatient to not gift yourself the time to learn how to eat right and enjoy awesome workouts? This is what it will take to get healthy and the desire is there, otherwise you would not be seeking out a way to get results.  Regardless of what you do, you will need to maintain it with a healthy lifestyle.

If you are serious about getting fit and staying healthy, it is time to slow down and realize you will need to make changes in how you think and live.  I would grab a piece of paper and begin a healthy lifestyle list.  What are some simple things you could do right now to get you motivated and moving in the right direction? Build on your list and follow-through with your thoughts. Short-term goals could be replacing processed foods in your house with healthy selections, adding exercise 3 times per week, or losing 5lbs.  Realize a healthy lifestyle is about daily progress and not perfection.  Be patient, don't compare to others, and celebrate each daily victory!

Helpful articles are on my about.com site and will provide all the tools you need to adopt a healthy lifestyle.  Check out my article on "What Newbies Need to Know About Getting Lean" or "5 Things You Can do Right Now to Reach Your Fitness Goals" .  These are just a sampling of the great information at your fingertips.

Helpful Articles for You on About.com

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Stay Healthy! Darla Leal
fit over 50

Always Hungry? It's Probably Not Your Insulin.

David Ludwig, MD, recently published a new book titled Always Hungry? Conquer cravings, retrain your fat cells, and lose weight permanently.  The book is getting widespread media coverage.  Ludwig is a professor of pediatrics at the Harvard Medical School and a professor of nutrition at the Harvard School of Public Health.  He's a pediatric endocrinologist, but his primary focus is research, particularly the impact of nutrition on hunger, calorie expenditure, and body weight.  Although I sometimes disagree with how he interprets evidence, he has made significant and useful contributions to the scientific literature in these areas, and I also support his efforts to find policy solutions to curb the intake of sweetened beverages and other junk foods.  In the grand scheme of things, he's an ally in the fight to improve the American diet.

Ludwig has written several high-profile op-ed pieces in recent years, both in the popular press and in scientific journals (1, 2).  He argues that our understanding of eating behavior and obesity may be all wrong, and that our focus on calories may be leading us away from the true cause of obesity: hormonal imbalance.  And the primary culprit is insulin.  You might recognize this idea, because it's similar to the one that science journalist Gary Taubes developed in his book Good Calories, Bad Calories.

According to this view, overeating is irrelevant.  We gain fat because our insulin levels are too high, leading our fat tissue to take up too much fat, and other tissues to take up too much glucose, causing our blood energy levels to drop and resulting in fat gain, hunger, and fatigue.  The ultimate cause of the problem is the rapidly-digesting carbohydrate and sugar we eat.  This idea is encapsulated by Ludwig's quote, "Overeating doesn't make you fat.  The process of getting fat makes you overeat" (3).

Here are eleven facts that may make you question this line of reasoning:
Read more »

HIA Practitioner Workshop in the U.S.A. in March

SOPHIA's HIA Practitioner Workshop (formerly HIA of the Americas) will take place March 7-8, 2016 at The California Endowment in Oakland, CA. The Workshop is intended for current practitioners of Health Impact Assessment interested in strategic field building. Attendees at the two-day workshop will learn and share ideas through presentations, and further the practice of HIA in small working groups.

Registration is now open through February 1, 2016. Please click here to submit your registration form.

The objectives of this two-day workshop are to:
Build a community of HIA practitioners by offering an intimate forum to network and share ideas and tools that elevate the practice of HIA; and
Promote excellence in HIA by sharing best practices, tackling challenging HIA related issues, and disseminating resources and work products developed by the working groups.

Please visit the SOPHIA website for the draft agenda, more details on registration, location and past workshops. We hope you can join us!

How Much do You Know About Your Own Brain?

We tend to believe we're aware of what's happening in our own brains, and also in conscious control of our behavior.  But a growing body of neuroscience and psychology research demonstrates that most of what happens inside the brain-- including the processes that cause us to select and execute behaviors-- is beyond our conscious awareness.  This has important implications for our eating behavior, body weight, and health, as I explore in my upcoming book The Hungry Brain.

Let me give you a straightforward example that illustrates how little of our brain's activity we're aware of.  It focuses on information processing by the visual system, which is one of the best-understood systems of the brain.  I drew the basic facts of this example from a recent talk by the accomplished neuroscience researcher Marcus Raichle, who studies patterns of activity in the human brain.

Read more »

Don't Bite Off More than You Can Chew

The thing about getting healthy is doing a good job balancing both healthy eating and exercise.  Nutrition plays a huge role in the equation and eating too much is off the charts for a large percentage of the populous.  Portions are out of control and people are literally biting off more than they can chew.  Super-sized plates draped with enough food to feed an army are common in restaurants and don't get me started on the "all you can eat" buffet.

I love the famous quote "eat to live, don't live to eat" because this gold nugget of information is absolutely true.  This is not saying to not indulge occasionally and doing so in proper portion size is not going to break our fitness banks.  However, stuffing our faces to the point of having to roll to the sofa in a food coma is an upsetting example of living to eat.

Calories people!  What it comes down to is the basic science of chemistry and calories.  When we eat too much, fat is stored.  Eat too little, weight is lost.  Eat just right and we maintain.  Sounds like the "Three Little Bears" but you get the drift.   The quality of calories are also important.  We may eat "junk food" in very small portions and within the calories great for our body, but our inside would look like crap.  Further, we would feel like crap.  This is called being "skinny fat".

When calories from quality "real" food are consumed at the right portions for our body, then health is realized from the inside out.  However, eating too many calories from healthy foods will result in weight gain if we are taking in more than we are burning off.  It would be more difficult of course if most of our carbs came from veggies, but let's say we are chomping down tons of oats, wheat pasta, brown rice and yams...well now that's a whole different thing.

Size does matter when it comes to any food we eat and biting off more than we can chew is not good regardless if the calories are coming from healthy or unhealthy sources.  Portion control is one of the old new secrets to achieving a healthy body. Nothing magic to shutting our mouths at the "food trough" when we feel satisfied.  Start paying attention to portion size, don't go back for seconds, and listen to body signals of satiety.

Great reads on my about.com site! I have just published an article on how "Preventing Insulin Resistance is the New Trend in Health and Fitness" even over weight loss.  It is a growing concern affecting people of all ages and until insulin levels are mastered, fat and weight loss will continue to be a struggle.

Preventing Insulin Resistance...Read the article!

Other great reads to help with fitness goals:

Why You May Need More Calories

Diet Mistakes Women Make Trying to Gain Muscle

Diet Mistakes Men Make Trying to Gain Muscle

Eat Healthy, Feel Healthy and Look Amazing

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2016 is the Breakout Year for mHealth: Savings vs. Value

In this post, the Population Health Blog predicts how and why mHealth will be covered by more commercial health insurers in 2016, and why the retail "over the counter" mHealth market outside of insurance coverage will also continue to grow. 

 

While you're reading, consider this simple question: What are the revolutions per minute (RPMs) of your automobile's engine as you ascend from stationary idling to freeway speed?

 

The Definition of mHealth: "the delivery of healthcare services via mobile communication devices." Other definitions can be found here.  Elements include handhelds, wireless communications, software, hardware, networking, social media, sensor technology, apps and cloud-based services. The World Health Organization says it's global and much is still in its infancy.

 

Three Population Health Blog predictions for mHealth in the United States:

 

1) 2016 will be a breakout year, because both the savings and value propositions will be clarified.

 

What does the PHB mean by this? 

 

The ultimate question for health services buyers, payers, providers and patients is whether mHealth technology is: 

 

Substitutive: achieving savings from displacing present or future high cost services,

 

or

 

Additive: co-existing with present, or increasing future utilization.

 

The same is true for many pharmaceuticals, population health programs and the medical home.   

 

2) Faced with the reemergence of unsustainable health care cost inflation, commercial health insurers will deploy today's premium to sponsor tomorrow's substitutive mHealth cost reductions.

 

Commercial insurers will look for mHealth that is "S³" or Smart, Synergistic and Scalable.

 

1. Smart: addresses the tailored needs of selected population segments; instead of being all things to all patients, think focusing mHealth on high risk patients with special needs. 

 

2. Synergistic: enhances, not replaces other incumbent resources, such as one-on-one care management or outreach telephony.  

 

3) Scalable: uses the economies of scale to provide a lower-cost service to larger numbers of consumers.  As more patients in a select population use mHealth, the cheaper it becomes. 

 

3) But.....Value-driven mHealth will also flourish in the direct-to-consumer, over-the-counter or retail market for three reasons:

 

1) Consumer notions of value: 

 

Interest in personal wellness, a cultural belief in the pervading merits of technology and the allure of every more innovative gadgetry will continue to outpace the underlying mHealth abandonment rate.

 

2) As Obamacare acquaints consumers with real healthcare costs, #mHealth will be viewed as a relative bargain.

 

Comparatively pricey physician encounters, emergency room visits or a hospital stays - especially for Bronze Plan enrollees - will only increase consumer appreciation for  mHealth's "over the counter" benefit-to-cost ratio: for a few extra bucks, why not have that weight-loss, blood-pressure, medication-management app or wearable, especially when you already have a handheld smart device and the bandwidth?

 

3) Some commercial insurers will "cover" wellness #mHealth, not because their actuaries support it, but because their customers (purchasers, brokers and consumers) demand it. 

 

"Coverage" will be in the form of a volume-based discount pricing borne by the consumer, not a value-based benefit covered by the insurer. If it increases customer loyalty/"stickiness," all the better.

 

Plus there's the mHealth "X-Factor." mHealth sponsors and their allies will collect, sell and use consumer data for marketing and surveillance.   The PHB calls it mining and monetizing. 

 

Back to the tachometer: Even though its dashboard displays it, the PHB doesn't know the vehicle's RPMs either. Aside from  the use of the tachometer by some car enthusiasts  to optimize manual gear shifting, it adds little to car performance or safety. 

 

Yet, it's standard and in the dashboard of just about every automobile being sold in the U.S.A.  Could gadgets, wearables, apps and mHealth physiologic monitoring become the healthcare tachometer?  Useful to a critical few and standard for everyone else?

 

So, What is the the Basis of the PHB's Predictions?

 

Growth potential:

 

None other than Eric Topol says "Until now, most of the effect of the digital era in the practice of medicine has been confined to electronic health records. But that is about to undergo a radical transformation in the next 5 years." As in $50 billion by 2020.

 

If you think it's all about "Fitbit" or managing diabetes, think again. How about promoting mindfulness, monitoring medication compliance, home-based high-risk pregnancy monitoring, in-home safety for the frail elderly, heart rhythm management, and home-based "pervasive" monitoring. Plus, mHealth style technology is being used outside of healthcare, such as in the automobile, for elite athletes and to promote safety in high-risk worksites

 

S³  = Savings

 

Smart: Here's a just-published JAMA study of a randomized clinical trial (RCT) that showed text-prompts had an clinically relevant impact on blood pressure in a group of select persons with coronary heart disease. Here's an rigorously conducted RCT that showed persons with Type 1 diabetes mellitus achieved better blood glucose control.  How about socioeconomically vulnerable patients with diabetes? Or patients with heart failure being discharged from a hospital?  The list of special populations with special needs goes on and on.

 

Synergy - This exhaustive peer-reviewed publication examining the merits of wellness mHealth for weight management, physical activity promotion, tobacco cessation, and cholesterol control shows that there's little evidence that it's better than existing therapies over the long-term.  Rather, the greatest promise appears to be in complementing existing interventions.  By the way, synergy does not mean overwhelming the system with data, but assisting the system with insight.

 

Scalable: While economists, policymakers and pundits legitimately worry whether bigger is better for healthcare in general, health system C-suites and boards of directors and their consultants are counting on information technology to drive economies of scale.  Papers like this and this suggest mHealth can be a part of that, especially if it can mitigate manpower constraints.

 

And an easy way to assess whether the insurer  really believes that it's sponsoring an S³ initiative is asking whether it pays for a handheld device for consumers that don't have one

 

Value:

 

Consumerism? Call it "the quantified patient." Here's a telling survey that shows the abiding faith in health information technology and a lack of privacy concerns.

 

 Bargain? The title of this peer-reviewed paper says it all" "It's like having a physician in your pocket!"

 

 Insurer discounts? The same thing happened to health club memberships.

 

The X-Factor: CIOs everywhere agree that they're not only apps, but software "vacuuming up data."

 

Image from Wikipedia