TABLE OF CONTENTS. The Cost of Diabesity Employer Solutions... 4 Provide a Worksite Weight Loss Program Tailored for Diabetes...

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2 TABLE OF CONTENTS The Cost of Diabesity... 3 Employer Solutions... 4 Provide a Worksite Weight Loss Program Tailored for Diabetes... 4 Provide Healthy Food Options at the Workplace... 4 Make it Easy to Increase Physical Activity... 5 Provide a Culture of Stress Management... 5 Provide a Specialized Tobacco Cessation Program... 5 Conclusion... 6 About Us... 7 Offset the Cost of Diabesity. 2

3 The Cost of Diabesity Obesity is a problem employers cannot ignore. If current trends continue, by 2030, 42 percent of the U.S. population will be obese and 11 percent will be severely obese. This will mean an increase in obesityrelated health costs of $550 billion between now and Today, 15 million adults in the U.S. are severely obese, incurring healthcare costs that are almost eight times higher than non-obese employees. According to the American Diabetes Association, 105 million Americans have diabetes or prediabetes, and unless we change course, by 2050, this number will rise to 1 in 3 American adults. 1 The association between obesity and Type 2 diabetes is well known. More than 80 percent of individuals diagnosed with Type 2 diabetes (formerly classified as adult onset diabetes ) are overweight or obese. The term diabesity was coined in 1980 by Ethan A. H. Sims, MD, in a study out of the National Institutes of Health, to describe the close relationship between type 2 diabetes and obesity. I don t suggest diabesity is a single disease entity, Sims said in the report. There are several obesity syndromes, and there are certainly also several subtypes of diabetes. There tends to be, however, a cluster of characteristics we call diabesity that can be distinguished from insulin dependent diabetes or childhood onset obesity. It is a progressive disorder in adults. 2 Obesity causes insulin resistance, a condition where the hormone insulin (produced by the pancreas) is not able to move sugar effectively from the bloodstream into the cells. Eventually, when the pancreas is unable to produce enough insulin to overcome the insulin resistance, blood sugar starts to rise and diabetes is diagnosed. In genetically susceptible individuals, insulin resistance combined with too little insulin secretion leads to diabetes. Obesity also increases inflammation throughout the body, which is a primary cause of many of the complications of diabetes, including cardiovascular disease, nerve damage, blindness, and kidney disease. Research and education are essential if we are going to stem the tide of the diabetes epidemic and reduce the public health burden. Type 2 diabetes is very costly to treat and, because of its correlation with obesity, is one of the major drivers of the $190 billion in annual U.S. healthcare expenditures associated with obesity. The good news is individuals can reduce complications of diabetes or prevent its onset by engaging in certain lifestyle changes managing weight, eating a healthier diet, staying active, managing stress, and quitting smoking. As an employer, you can provide the kind of supportive environment to encourage these healthier behaviors. Offset the Cost of Diabesity. 3

4 Employer Solutions Provide a Worksite Weight Loss Program Tailored for Diabetes Being overweight causes both insulin resistance and inflammation. As fat cells accumulate, so do certain immune cells within the fat; the result is chronic inflammation. The more overweight a person is, the more excess fat accumulates in organs such as the liver and muscle, which results in insulin resistance. In contrast, by losing as little as 5-10 percent of his or her total weight, a person will significantly improve his or her insulin resistance, thereby lowering the risk for diabetes. Not only can losing weight prevent the onset of diabetes, it helps lower blood sugar (reducing the need for costly medication) and reduces the risk of complications for people who already have the condition. Weight loss also reduces inflammation-causing chemicals in the bloodstream, potentially reducing the damage to blood vessels and other organs that lead to diabetes complications. Yet those with diabetes can find weight loss especially challenging. Diabetes medications can cause weight gain and food cravings, there are unique risks associated with physical activity in some people with diabetic complications, and depression is more common. All of these factors make weight loss more difficult, but you can help by providing your employees access to expert help. By offering a weight loss program with dedicated resources for those with diabetes, you ll provide the support they need to safely reduce calorie intake and increase physical activity, provide assistance monitoring their glucose readings, and provide referrals to physicians if changes need to be made to medications. While diabetes disease management programs can help patients keep in touch with their healthcare teams and closely monitor their blood sugar, such programs have not been proven to lead to weight loss or effective long-term behavior change. Provide Healthy Food Options at the Workplace In addition to helping to manage weight, eating a healthy diet has a major impact on insulin resistance and inflammation. Making changes in these areas greatly reduces the risk of developing diabetes and improves diabetes management. Foods high in fat (especially animal fat) and refined sugar cause insulin resistance and inflammation. Foods high in fiber and micronutrients (vitamins and minerals) reduce them. Eating lots of vegetables, fruits, and whole grains provides a feeling of satiety (feeling full ), which makes it easier to stick to a lower-calorie eating plan, and also improves the body s response to insulin by doing so. Make healthy the only option at your worksite: remove junk food from vending machines and replace them with fruits and vegetables. Revamp your cafeteria. Employees who have diabetes should be watching their carbohydrate intake, so providing nutritional information on both carbohydrate and fat content of foods served in your cafeteria, along with calories, can help those with diabetes manage their blood sugar more effectively. Overhaul your events catering services. Show your employees that healthy food can taste good and is more satisfying. Offset the Cost of Diabesity. 4

5 Make it Easy to Increase Physical Activity Getting regular exercise also has a major impact on insulin resistance and inflammation. Both aerobic and resistance exercise lower insulin resistance, improve blood sugar control, and reduce inflammation, so consider subsidizing gym memberships for your employees. Of course, setting up employee walking groups, encouraging staff to use the stairs, and making sure that your worksite campus is walkable will also help your employees make small daily changes to their physical activity levels. Several studies have shown greater time spent sitting, independent of weekly physical activity, increases the risk for developing diabetes by percent. 3, 4 Provide a Culture of Stress Management Stress plays a big role in diabetes management. People with diabetes find that their blood sugar tends to be higher when they feel stressed. That s because with chronic stress, the body secretes the stress hormone cortisol, which raises blood sugar to prepare the body for a fight or flight response. It also interferes with the immune system, allowing chronic inflammation to develop unchecked, and promotes insulin resistance. Practicing stress management every day is essential, so equip your workforce with techniques that will help them lower their blood cortisol levels and avoid the negative effects of stress on diabetes control. Consider hosting deep breathing workshops, onsite yoga classes, and campus-wide stretch breaks. Only regular stress management practice has been shown to lower stress hormone levels, so also make sure that your corporate culture is one that supports a healthy work-life balance: vacation days, regular breaks, and flexible work schedules should not only be allowed, but encouraged. Provide a Specialized Tobacco Cessation Program Quitting tobacco is one of the most important things tobacco users can do for their health. If a tobacco user has diabetes, it s even more important to quit. People who smoke have impaired insulin action and significantly elevated levels of inflammatory chemicals in their blood. Quitting improves insulin resistance and dramatically reduces the risk of diabetes complications. Find a tobacco cessation program that will offer the kind of personalized support to accommodate individuals with pre-existing conditions and help employees design a quitting plan that makes the most sense for their lifestyles. Offset the Cost of Diabesity. 5

6 Conclusion If you provide your employees with a supportive environment in which to practice healthy lifestyle changes, you will not only improve the health and productivity of your entire workforce you ll also help prevent the progression of diabesity, a public health concern of great importance. CITATIONS 1 Obesity and severe obesity forecasts through Finkelstein EA, Khavjou OA, Thompson H, Trogdon JG, Pan L, Sherry B, Dietz W. Am J Prev Med Jun;42(6): Successful Diet and Exercise Therapy Is Conducted in Vermont for Diabesity. JAMA. 1980;243(6): doi: / jama Sedentary behaviors and health outcomes among adults: a systematic review of prospective studies. Proper KI, Singh AS, van Mechelen W, Chinapaw MJ. Am J Prev Med Feb;40(2): Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a meta-analysis. Grøntved A, Hu FB. JAMA Jun 15;305(23): Offset the Cost of Diabesity. 6

7 About Us Alere Wellbeing Alere Wellbeing brings together science, technology, and personal interaction to help people recognize and modify unhealthy behaviors to avoid chronic illness and live longer, more vital lives. Alere Wellbeing s evidence-based programs address modifiable health risks that contribute to chronic disease: tobacco use, poor nutrition, physical inactivity, and stress. Current clients include 27 state governments and more than 600 health plans and employers, 77 of which are in the Fortune 500. Alere Wellbeing is known and respected for its pay-for-performance business model, intense focus on scalable service quality, dedicated account management, continuous program improvement, and transparent reporting of measurable outcomes at the individual participant and aggregate population level. Alere Wellbeing has contributed to more than 100 published research studies and maintains collaboration with the American Cancer Society and an active research program funded by the Centers for Disease Control, American Legacy Foundation, and the National Institutes of Health. Learn more about Alere Wellbeing Weight Talk Program The Weight Talk personal coaching program is designed to achieve measurable, sustainable weight loss. Unlike self-help weight loss products, the Weight Talk program is delivered through regular phonebased coaching sessions with a dedicated coach, registered dietitian, or fitness specialist. The experience is highly personalized, deeply supportive, and proven effective. Participants set realistic weight loss goals and then learn how, through small, tailored changes across multiple behaviors, to achieve and maintain a healthy weight for the rest of their lives. Participants can expect a reduction in weight by at least 5 percent, increased knowledge and confidence, and significant improvements in nutrition, activity, stress, blood pressure, cholesterol, and overall health. Learn more about the Weight Talk program Quit For Life Program Offered in collaboration with the American Cancer Society, the Quit For Life Program has been the nation s leading evidence-based tobacco cessation program for more than 25 years. The Quit For Life Program employs an evidence-based combination of physical, psychological and behavioral strategies to enable participants to take responsibility for and overcome their addiction to tobacco use. Learn more about the Quit For Life Program For more information on best practices, weight loss programs, tobacco cessation programs, or Alere Wellbeing, please us at wellbeingsales@alere.com or call us at Offset the Cost of Diabesity. 7

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