One out of two Americans will require treatment for diabetes or prediabetes-at an annual cost of $3.35 trillion-less than 10 years from now, according to a report issued by UnitedHealth Group. Will the rising cost of medical care, whether paid individually or collectively through government, trigger a change in behavior? Will individuals trim their bodies to fatten their wallets?
While the diabetes report with its startling statistics is making headline news in the United States, a less dramatic but no less useful report is providing insight into worrisome health perceptions and unhealthy behaviors of our northern neighbors.
The percentage of Canadians who are overweight or obese has risen to 60 percent, slightly less than the United States' rate of 68 percent. And like the children in the United States, Canadian youth are getting fatter: one in four is overweight or obese compared to one in three in the United States.
But unlike residents of the United States, Canadians have enjoyed publicly funded healthcare provided either free or at minimal cost. As healthcare costs have risen in Canada, however, the financial burden has started to shift from the government and employers to individuals.
In 2005, Canadian residents paid for an estimated 20 percent of their healthcare costs, with employers and governments picking up the balance. According to projections in a 2007 Sun Life Financial healthcare and benefits trends report, in 2015, individuals may be responsible for as much as 34 percent of healthcare costs, and this number will continue to increase.
Can a Strategy of Prevention Work?
The most obvious way to keep healthcare costs from continuing to rise is through prevention of illness. Not only does prevention ensure optimum health for individuals, it is also the key to affordability for individuals, employers and the government. Less obvious, however, is how to encourage individuals to make daily choices that result in optimum health.
In an effort to understand the health perceptions and behaviors of Canadian residents, Sun Life Financial, a Toronto-based international financial services organization, undertook a study of nearly 4,000 Canadian residents, ages 18 to 80. The respondents were asked 45 questions on topics ranging from current behaviors to barriers preventing healthy choices.
Participants were asked to note which of six healthy behaviors they engaged in:
The study of the respondents engaged in three or more unhealthy behaviors. For example, they didn't exercise, they didn't maintain a healthy weight and they smoked.
The study also found that 81 percent of those surveyed believe that common diseases are completely or mostly preventable. Yet despite this belief, almost two-thirds (63 percent) have adopted a pattern of unhealthy behaviors. Their actions indicated a major disconnect between behaviors that are in their best interest and behaviors that increased their health risks.
When asked who was responsible for their choices, 96 percent of the respondents accepted some responsibility; however, most felt the responsibility was somewhat shared in varying degrees with their employer, the government, and their doctor or healthcare provider.
The question then arises: if the respondents knew their behaviors were not healthy and that they had the primary responsibility for the choices they were making, why not change? Why not simply adopt healthier behaviors? The majority (61 percent) cited a lack of willpower.
When respondents were asked to cite their resolutions, the majority of the goals involved improving their health. But the level of follow-through was impressively low: 8 out of 10 respondents had not kept their resolutions. Why not? Once again, 76 percent cited a lack of willpower as the cause.
In addition to analyzing responses, researchers also sought to categorize the respondents into five health profiles:
Within the entire group, however, less than half of those surveyed (45 percent) made health the number one priority, citing shortages of time, knowledge and money as barriers toward a healthy lifestyle
When does health become a priority?
Given the insights from the study, I asked Lori Casselman, assistant vice president, group benefits, at Sun Life Financial, to share the latest ideas on how attitudes and behaviors can be shifted so that health becomes a priority. How can willpower be strengthened? Casselman cited two significant ways to influence employee choices.
First, new education and lifestyle change tools are being implemented that rely on technology. In increasing numbers, high-performing companies are relying on e-learning programs and social networking tools to encourage healthy behaviors among employees.
Second, employers find that incentives increase participation in programs promoting healthful behaviors. Incentives are provided in a variety of ways, from gift certificates to weekend getaways, health spending account credits to gym memberships. Because of the success of incentives in increasing participation, the use of incentives is growing dramatically.
Can these and other tools shift the behavior of the majority of employees? Will financial incentives, lifestyle change programs and education be sufficient to strengthen individual willpower? Or is the issue more deeply rooted than that?
In explaining why some people succeed in making changes and others fail, Dr. James Gordon, author of Unstuck, asserts that "It's not that some people have willpower and some don't. It's that some people are ready to change and others are not."
Is Dr. Gordon's discerning insight on target? Because if he is right, in addition to focusing on how to beef up individual willpower, we also need to figure out how to encourage entire communities in Canada and the United States to get fit and lose weight while medical care is still affordable.
Focusing on community programs rather than individual efforts can produce large scale shifts in values.
As a community fitness organizer, I know that pioneering technology used for weight loss and fitness events in geographic communities can be applied to corporate communities. Support for the corporate programs is also available through online groups. Both efforts can create synergy by shifting the focus from individual effort to group effort, from personal willpower to teamwork and accountability.
For the majority of us, if we trimmed our bodies, we would ultimately fatten our wallets. But to achieve maximum leverage with the greatest number of individuals in the shortest possible time frame, we'll have to move beyond personal financial rewards. To overcome won't power with willpower, we need to go beyond individual effort and tackle the issues of fitness and weight as a community, whether that community is physical, geographic or online. And we need to execute this shift quickly, while medical care is still affordable.
Follow Carole Carson on Twitter: www.twitter.com/CaroleCarson
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Not many years ago hardly anyone was fat and they didn't have many gyms and very few ran or exercised.
The idea that "a rising tide lifts all boats" is catching on. I've been in touch with the leaders of over 300 weight loss events since I pioneered our community's fitness event eight years ago.
Most people "buy" into that formula. However, it implies willpower and deprivation. Thus most dieters fail when following that formula.
By reading the comments on this post, it's clear that there are many ways and methods to establish a healthy lifestyle.
In addition to education (getting the knowledge), you have to want it.
Ken Leebow
http://www.HighSatiety.net
Our local community centers and schools should promote good nutrition and health through free programs. It should be part of our national health care program.
Did it have a lasting impact? Today, the percent of children at risk for obesity has dropped from 33 percent, the national average, to 18 percent. The stories of individual transformations are heartwarming, and community groups are working to improve school lunches, build walking paths and trails, and so on.
Then I was an accidental organizer of the event. Today I am quite intentional about helping other communities change their default setting to fitness.
How can people eat healthy food when McDonalds, Burger King, etc is everywhere? And sometimes a more cost effective option?
When we take a moment to distinguish between real, whole foods and food-like junk based on refined white dusts like sugar and white flour, we finally have clarity about this awful epidemic. Our lack of "willpower" is just a weaselly way of saying WE'RE ADDICTED.
Chemically addicted, yes, just like alcoholism and drug addiction, but to certain psuedo-foods of modern invention our caveman bodies were not designed to metabolize, Refined sugars have only been part of the western diet for a few hundred years, and HFCS for about 30. Now we eat a whopping 156 pounds of refined sugars a year. A teaspoon of sugar used to be a once-in-a-lifetime treat!
We will solve this crisis if we stop tripping on the false concept of "willpower" and acknowledge -- as many fantastic research studies have already done -- that processed food and drinks, particularly sugar-based ones, trigger ruthless, persistent addictions rooted in neurochemical changes in the brain, including loss of dopamine receptors and a powerful opiate response.
Please read more about conquering sugar and refined food-related addictions in the free booklet at www.thealientmakesusfat.com. Education, diet, and exercise mean nothing unless we yank the hypodermic sugar needles out of our arms.
Eating Plans. Everyone “knows” that a healthy diet is a low fat, high fat, low carb, high carb, high protein, low protein, high fiber, low fiber, salt-free, GFDF, vegan, lacto-octo vegetarian, pescatarian, fruitarian, paleo, USDA pyramid, SCD, Atkins, South Beach, Blood Type, blah blah diet. Right?
Exercise. Everyone “knows” that a proper exercise program will: cause weight loss, cause weight gain, improve health, damage health. Everybody know that a “proper” exercise program is: jogging, marathons, triathlons, walking, swimming, jumping rope, yoga, weight lifting, contact sports, HIIT, 30 minutes a day, 30 minutes a week, 30 minutes a month, blah, blah program. Right?
Detoxification Colonics, liver flushes, gall bladder flushes, fasting, liquid diets, bladder cleanses, saunas, blah, blah protocol. Right?
My guess is that if I compared my version of a healthy lifestyle to that of the author of this article, there would be very little agreement.
So, when there is something strange in your neighborhood, who you gonna call? Ghostbusters?
I chose nature - for answers as to what constitutes a healthy lifestyle. It is an experimental program, outlined in “The Wellness Project,” being followed by a small group to see what happens if we follow nature’s clues, ignoring the Western, Eastern, mainstream and alternative health gurus. Stay tuned.
Roy Mankovitz, Director
http://www.MontecitoWellness.com
A research organization
Eating Plans. Everyone “knows” that a healthy diet is a low fat, high fat, low carb, high carb, high protein, low protein, high fiber, low fiber, salt-free, GFDF, vegan, lacto-octo vegetarian, pescatarian, fruitarian, paleo, USDA pyramid, SCD, Atkins, South Beach, Blood Type, blah blah diet. Right?
The above demonstrates the confusion that exists and there's a broad spectrum of eating plans that can work. From vegan to paleo, and everything in-between, a healthy eating/lifestyle plan can be established.
Ken Leebow
http://www.HighSatiety.net
A recent newspaper headline: :First lady's anti-obesity drive shows results on many levels"
Next to it: Strokes rise among young, middle aged." Did you say "Results" ???
But diabetes is the ultimate ticking time bomb that will bring us to our knees. And all we do is talk.
Well, Nero supposedly whistled as Rome burned. Ranveig Elvebakk, MD, author "The Food Tree"
I'm looking forward to the topic's explosion onto the scene.
Never.
Ever.
And HFCS is poison and is definitely implicated here...just a teaspoon, or what is termed a serving, is the same as ingesting the sugars from 100 or more ears of corn...something the human body most definitely is not meant do to, not all at once in one swallow.
Life style and dietary choices are definitely an issue of individual responsibility. However the costs of healthcare are a societal issue, regardless of the funding arrangement. Those costs affect all of us. So there are things that society can do to reduce the costs/impact of obesity. Simply hoping that obesity rates will level out is effectively doing nothing on a societal level.
"Participants were asked to note which of six healthy behaviors they engaged in:"
None of which include the words sugar or calories.
Manufacturers even misrepresent the sugar content of food by changing its name. If they had to call sucrose, fructose and syrup (and other deceptive forms) by a single name, such as sugar, that would significantly move sugar up the list of contents on processed foods. If they had to list calories instead of grams from all forms of sugar (per serving), the nutritional information would be much more useful. But we know that corporate lobbyists will fight this.
I think that personal responsibility should be promoted by increasing public awareness of the sugar content in our diets, because I think that sugar content has the greatest impact on obesity. The effect of reducing dietary sugar could even inspire people to get more exercise.
Ken Leebow
http://www.HighSatiety.net
First, the American Academy of Pediatrics puts the blame for the childhood obesity epidemic on the built environment, aka suburbia. If you live in a walkable community, your chances of being obese are much less. And if Canada is following the suburban sprawl model of construction, they’re going to have the same problems with obesity.
Second, while I applaud any effort for Canada to incentivize wellcare, there’s a near insurmountable problem south of the border. In the US there has been a problem with getting insurers to undertake the kind of preventive medicine known to help head off diabetes. Your for-profit insurance company will pay for a diabetic amputation or dialysis when the kidneys fail. But insurers don’t want to be known as ‘diabetes friendly’, so they won’t pay for preventive care (endocrinologists, dietitians, counseling), and most aren’t paying for the kinds of perks Ms. Carson describes.
The point that needs to be made is that most obese people are uncomfortable. They can’t sleep well; they get winded easily; they’re really uncomfortable in summer weather. Unfortunately most of them don’t know they can change this.
Ken Leebow
http://www.HighSatiety.net