Obesity/Weight Management Employer Survey and Interview Project

Obesity/WeightManagementEmployer Survey and Interview ProjectOpportunities and Challenges for PromotingObesity Prevention and Controlamong Small to Mid-Size Employers2011

Overarching Themes Discussion 21Employers Are Engaged. 21Wellness is the Subject. 23Leadership is Critical. 23Safety and Health are Linked. 25Targeted Information and Resources are Needed. 26Conclusions 29Recommendations 31Endnotes 34Appendix A: Survey Results 35Appendix B: Interview Summaries 65

Executive SummaryA person’s place of work is an important componentof his or her social and physical environments. It caninfluence the individual’s choices and can provideresources to support those choices. 1 A workplace thatemphasizes employee health is likely to have policiesthat promote healthy behavior, such as incentives oraccess to health resources. 2Many large businesses have recognized the adverseimpact of obesity on their employees, and haveinvested resources in worksite strategies to increasephysical activity and improve the diets of theiremployees. Small and medium-size businesses havebeen less engaged in these efforts. One reason forthis lack of engagement is that small and mediumsize businesses are less likely to have the resourcesto provide worksite supports that improve physicalactivity and nutrition and reduce obesity. However,most employers in the United States employ less than500 people, making small to mid-size employers akey audience to engage concerning workplace healthprograms. In 2007, the U.S. Census statistics reportedthe following about employer size: 54% had lessthan 100 employees, 25% had between 101 and 500employees, 7% had between 501–1000 employees, andthe remaining 13% had more than 1000 employees. 3The National Business Coalition on Health (NBCH),working in collaboration with the Centers for DiseaseControl and Prevention (CDC), and the NationalSafety Council (NSC), developed and implementeda survey to help understand business attitudes andneeds concerning obesity prevention and control.The purpose of the project was to gather informationfrom the business/employer community, particularlysmall (1 to 500 employees) and mid-size (501 to 1000employees) companies, about their needs, interests,opportunities, and challenges in implementingworkplace obesity prevention strategies. These findingswill help identify ways to communicate the threat thatobesity presents to the current and future workforceand what actions employers can take to address thisissue. In order to support these efforts, the findings willalso inform the development of a set of obesity-relatedtools and resources for employers to use to engage inobesity prevention and control activities.Employer responses represented the following themes:E Employers are already addressing obesityand wellness in the worksite. Employers aremore active in wellness activities that addressobesity than they realize. The results showed thatmany employers are already investing in obesityprevention, and even those that are not doing so areinterested in learning what they might do, how to doit, and how to measure success.E Obesity prevention/weight management shouldbe framed as an overall healthy lifestyle issue,i.e., as part of a broader wellness and healthpromotion program. Overweight/obesity can be asensitive issue for employers and employees. Whendeveloping a program, employers may be reluctantto place too much emphasis on overweight/obesitydirectly, and prefer to communicate the importanceof maintaining a healthy weight as part of a largerwellness program that strives to improve ormaintain overall health and well-being. Employersare also seeking a balance between the role they canObesity/Weight Management Employer Survey and Interview Project 1

play in instituting organizational policy and supportand emphasis on employees’ personal responsibilityfor health and safety. In addition, they do not wantto be seen as overly invasive or intrusive.E Leadership is necessary at all levels. A recurringtheme present in the responses is the need forleadership. The importance of leadership is nota new issue, but the findings suggest that a wayto secure leadership interest and commitment isto embed and integrate the issue of overweight/obesity and weight management into both healthand safety functions, issues which respondents sawas linked. Employers are already committed to thesafety of their employees, and this focus can beleveraged to add obesity prevention programs intothe worksite.E Resources and partners are needed. Mostemployers are actively seeking information from avariety of sources to start or improve their wellnessprograms (including components related tooverweight/obesity). However, existing resourcesoften do not effectively support the smallestemployers. In addition, respondents showed apreference for organizations that currently workmost closely with the individual employer. Thishands-on approach provides opportunities todevelop new information and relationships withorganizations at the community level.The next step in this work will be to translate thefindings into materials targeted to the variousstakeholders of worksite health: policymakers,employers and/or management, state and local publichealth practitioners, and employees. More specifically,these findings will help guide the development of aset of actionable tools and information that will helpstimulate employer, employee, and other stakeholderengagement in obesity prevention and control efforts.The goal is to communicate to small and medium-sizebusinesses the threat obesity poses to their currentand future workforce, what actions they can take toaddress this topic within their businesses, and howtheir engagement in community initiatives may help tocontrol the costs of obesity.2National Business Coalition on Health

BackgroundOver the past thirty years, the number of overweightAmericans has reached epidemic proportions. More thantwo-thirds of all adults and one-third of all children inthe United States are now overweight; of these, 34% ofadults and 17% of children and adolescents are obese. 4A newly released study in The Lancet analyzes the risingrate of obesity in terms of the burden from associateddiseases — diabetes, cardiovascular diseases, andcancers. It shows increasing trends in both the numbersof obese persons and the associated cost, with modelingto demonstrate the economic benefits that effectiveprograms and policies would have on the population. 5No state has met the nation’s Healthy People 2010goal to lower obesity prevalence to 15%. The numberof states with an obesity prevalence of 30% or morehas increased from 0 states in 2000 to nine statesin 2009 and to 12 states in 2010. Healthy People2020 discusses obesity with a primary objective ofaddressing nutrition and weight status and includesspecific recommendations for worksites. 6 Obesity islinked to many conditions that result in increased healthcare costs. 7 Obesity-related conditions include heartdisease, stroke, type 2 diabetes and certain types ofcancer, some of the leading causes of death. Individualswho are obese have 30 to 50 % more chronic medicalproblems than those who smoke or drink heavily. In2008, medical costs associated with obesity wereestimated at $147 billion; the medical costs paid bythird-party payers for people who are obese were$1,429 higher than those of normal weight. 8 With highobesity rates in the United States, associated healthcare costs can directly affect employer profits.The total cost of obesity to U.S. companies, accordingto the U.S. Department of Health and Human Services,is estimated at $13 billion a year, including healthinsurance costs ($8 billion), sick leave ($2.4 billion),life insurance ($1.8 billion), and disability insurance($1 billion). 9 Roughly 8 % of private employer medicalclaims are a result of problems associated with beingoverweight or obese, according to a study in the policyjournal Health Affairs. 10 Another study found thatobesity-related disabilities cost employers an averageof $8,720 per claimant every year for wage-losscoverage. In addition, obesity has a strong impact onworker injuries. 11A study published in the October 2010 Journal ofOccupational and Environmental Medicine revealedthat work-related factors may impact the total costof obesity among U.S. full-time employees evenmore than direct medical costs. 12 The Duke Universityresearch team reported the total per capita cost toemployers of obesity among U.S. full-time employeesto be a staggering $73.1 billion. For the first time, theresearchers reportedly factored in the total value of lostjob productivity as a result of obesity-related healthproblems (presenteeism) and absence from work(absenteeism). The study included data from the 2006Medical Expenditure Panel Survey and the 2008 U.S.National Health and Wellness Survey in the evaluationof individuals who were normal weight, overweightand obese, using body mass index calculations (BMI).While presenteeism was determined to represent thegreatest cost among employees at a healthy weight,researchers found that obese workers accounted for aObesity/Weight Management Employer Survey and Interview Project 3

PurposeThe purpose of this project was to assess the business/employer community’s needs, interests, opportunities,and challenges related to workplace obesity prevention.The findings will inform the development of a set oftools and resources that will assist employers withemployer engagement in obesity prevention andcontrol activities. The target population of the projectwas small (fewer than 500 employees) and mid-size(501 to 1000 employees) employers.The major project objectives were to:E Determine whether small to mid-size employers areaware of the business case for obesity prevention inthe workplace;E Gage employer levels of awareness, knowledge,and actions/current initiatives focused on obesityprevention in the workplace; andE Ascertain employer needs to inform development oftools and resources for small and midsize employersto engage in obesity prevention and controlactivities.Obesity/Weight Management Employer Survey and Interview Project 5

ApproachNBCH, CDC, and NSC developed a work group thatoversaw design and implementation of this project.NBCH led this project, with input and review from workgroup members throughout all stages. The workgroupdeveloped a survey and two interview guides (onefor employers indicating that they had a program inplace and one for those with no program) to assessthe business/employer community’s needs, interests,opportunities, and challenges relating to workplaceobesity prevention. The target population includedsmall to mid-size employers and those who work withthese employers — business health coalition leaders.The survey included a set of questions to surveyemployers and NBCH coalition leaders with an emphasison small employers with 1 to 500 employees andmedium-size employers with 501 to 1000 employees.The questions focused on four main domains:Employer demographics;E What information about workplace obesity andprevention is of most value to employers;E Information sources and communication channelsfor information about workplace obesity andprevention; andE Community partnerships.A set of questions was drafted and tested with a smallsample of business coalitions and employers beforefinalization. The survey was announced via materialssent to NBCH and NSC members, including materialsfor NBCH members to send to their members. Thesurvey was then released to all NBCH and NSC membersusing member email contact information from NSC orNBCH. NBCH and NSC sent reminders as follow up topotential participants. Both NSC and NBCH tailoredcommunications to their specific memberships.Findings and observations from the survey informeddevelopment of two interview guides for usein nine telephone interviews to gather more indepthinformation about topics from the survey.More specifically, the purpose of the interviewswas to address in more detail issues related to theorganization’s perspective on obesity prevention andcontrol in the workplace. The interviews were aimed atgathering additional information about the structure ofemployer obesity programs, communications, messagesand information, and partnerships. Survey respondentsvolunteered for the telephone interviews through aquestion on the survey affirming their willingness toparticipate and providing contact information.The survey responses were used to select a diversegroup of interviewees based on employer size,industry, geographic location, and whether or not theyhad indicated having an obesity program. The nineinterviewees represented seven employers (two fromone employer representing safety and human resourcesin separate interviews) and one coalition. Volunteerswere contacted via email to set up appointments fortelephone interviews. The draft summaries of eachconversation were shared with the correspondinginterviewee for any corrections or additions, with editsincorporated into final summaries for each interview.The workgroup reviewed both the survey results andthe interview summaries to identify the findings andthemes for a framework for this summary report.6National Business Coalition on Health

Findings DiscussionFindings from the survey and interviews are describedin this section of the report under the four majorcategories, with details for each question in theAppendix.E Employer demographics,E Information about workplace obesity and preventionthat is of the most value to employers,E Information sources and communication channelsfor information about workplace obesity andprevention, andE Community partnershipsHighlights and discussion of these are shown in thefollowing sections with accompanying figures to providethe survey results in charts for comparison and contrast.Demographics and CurrentObesity ProgramsThis section provides results and findings that addressemployer size and industry type, current status andtime in place for any existing worksite obesity and/orobesity prevention programs, elements that comprisethe program, and employer readiness to take action —for current or new initiatives. Sections include:E Respondent Job CategoriesE Employer SizeE Employer Industry TypesE Existence of Workplace Obesity and PreventionProgramsE Length of Time Obesity Program in PlaceE Elements of Wellness ProgramsE Employer Readiness to Take ActionRespondent Job Categories. The survey was designedto capture a diversity of participants and to help identifythose individuals within companies who are most directlyinvolved and have the most knowledge about theirworkplace health and wellness programs. Not only wouldthese individuals be in the best position to address theissues relating to obesity prevention and control in theworkplace, but would also be the likely target audiencesfor new information or products aimed at engagingemployers around the topic of healthy weight.Survey respondents represented a number ofdifferent positions and a broad range of job levelsand categories, with most relating to either safety orhuman resources. Respondents’ job titles reflected thediversity of the industries, personnel, and companysize. For example, one “president,” several “medicaldirectors,” a “journeyman lineman,” an “aircraftmaintenance crew chief,” and “union safety liaison”were among the responses.Results show a mix of respondents heavily weightedto those with environmental health and safetyresponsibilities (see Appendix A). Actual jobObesity/Weight Management Employer Survey and Interview Project 7

esponsibilities associated with a job title indicatedsignificant variance of the structure and administrationof workplace wellness programs. For example, wellnessdirectors may report into the Human Resourcesfunction while those in the safety and environmentalfunction may report to a business unit leader withlittle or no coordination with the corporate HumanResources function. Respondents noted this disconnectbut stated that their employers are making effortsto better integrate health and safety functions withhuman resource benefits and other areas responsiblefor wellness programs. For example, one safetyleader is also working to support the human resourcebenefits function in the company as part of his jobresponsibilities. This type of alignment allows a broaderapproach to employee wellness, including weightmanagement programs. The importance of the role ofthe environmental health and safety function is furtherdiscussed as a theme from the study.Employer Size. Over half the respondents wereinclusive of the targeted small employer community(59.2% identified as having 500 or less employees),and 73% were small and mid-size. Responses alsoFigure 1: Employer Respondents by Size21.0%Very Small (1–100 employees)11.2%38.2%Small (101–500 employees)Midsize (501–1000 employees)15.8%13.8%Large (1001–5000 employees)Very Large (5000+ employees)Figure 2: Employer Respondents by Industry TypeManufacturingTransportation, Warehousing, and UtilitiesConstructionPublic AdministrationProfessional, Scientific, and Technical ServicesEducation ServicesRetail/Wholesale TradeHealth Care and Social AssistanceAgriculture, Forestry, Fishing, and HuntingMinig, Quarrying, and Oil & Gas ExtractionFinance and Insurance17.6%11.7%5.7%5.5%4.0%4.0%3.1%2.9%2.9%2.1%36.2%0% 10% 20% 30% 40% 50%8National Business Coalition on Health

included those from several large employers. While thelarge employers were not within our target population,they allowed for comparison between small and largeemployers. Respondents’ employer size appears welldistributed,with a bigger proportion of large employerscompared to the employer size distribution reportedby the U.S. Census. The U.S. Census statistics showthat 2007 business enterprises included the followingproportions of employers by size: 54% with fewer than100 employees, 25% with 101 to 500 employees, 7%with 501–1000 employees, and 13% with greater than1000 employees.Employer Industry Types. When employers werebroken into industry sectors, the participantsprimarily represented the following three sectors: 1)manufacturing; 2) transportation, warehousing, andutilities; and 3) construction. Together, these threesectors correspond to 65.5% of respondents. Overall,the survey had a mix of industries as shown in Figure2. The industry categories are identified by NorthAmerican Industry Classification System (NAICS).That allows a broad view of employers with a range oflocations and types of job categories.Existence of Workplace Obesity and PreventionPrograms. Questions were designed to assess whetheremployers currently had a program designed to helpprevent or control overweight/obesity in the workplace.Per the survey results, companies were split almostevenly on whether or not they had an obesity programin place, although more employers, overall and byindividual size category, reported not having a programdesigned to specifically prevent or control overweight/obesity (see Figure 3). The presence or absence of aworksite obesity prevention and control program wassimilar regardless of employer size with the exceptionof very small employers:E Mid-size employers reported the presence of anobesity program at similar levels to large employers.E Smaller employers were the least likely to have anobesity program in place; just over one third of verysmall employers reported that they have an obesityprogram (37.5%), and nearly two-thirds reportedthat they did not have a program (62.5%).One variable that may be associated with the numberof employers reporting that they did or did not havean obesity-related program is how they define sucha program. Respondents demonstrated a lack ofconsistency in what constituted an obesity preventionand control program. Some employers conductedobesity prevention-type education and activities, suchas fitness classes or nutrition education, but did notrefer to them as obesity programs. Interview resultsreinforced this finding, with interviewees suggestingthat employers think about addressing the issue ofoverweight/obesity very broadly, incorporating awide range of activities such as: worksite employeeparticipant weight management initiatives, educationfor employees about obesity and weight managementwithin the framework of healthy lifestyles, health planprovidedbenefits, and a full health assessment with acoach or follow up support for specific conditions.Figure 3: Current Program—Percentage of Responding Employers by Size500450400350300250200150100500YesNoTotalVery Small Midsize Very LargeObesity/Weight Management Employer Survey and Interview Project 9

Length of Time Obesity Program in Place Per thesurvey results, the dominant amount of time workplaceobesity programs have been in place was from one tothree years across all employer sizes (Figure 4). Largeemployers reported the highest number of matureprograms of 10 or more years and the fewest numberof programs of less than one year. Small companies(101 to 500 employees) reported the highest numberof new programs (in place less than one year). Theinterviews reinforced that no matter how long theemployer’s program has been in place, employers areseeking more knowledge that can be applied to theirprograms. The programs described demonstrate thatmany programs begin with a focus on employee healtheducation and evolve to include other elements ofcomprehensive program described in Healthy People.Elements of Programs. Survey participants reportingthat they who offered obesity programs were queriedabout what specific elements comprised their program.The objective was to determine the robustness ofthe programs and whether they are consistent withcriteria outlined for comprehensive wellness program inHealthy People, such as:E Are they annual health fairs at the worksite or dothey involve strategies aimed at both the individualand organizational levels?E Do they include or are they integrated withemployee benefits or other programs at theworksite like disease management, safety, or EAP?Respondents were asked about the following elements:E Are there Health education segments such asseminars, classes, webinars?E Does the program include links to related employeeservices (e.g., referral to EAP)?E Is the program integrated with features such assupportive physical and social environment forhealth improvement (e.g., stairwells, kitchen formeal preparation, supportive policies, and incentivesto encourage employee participation), and tofoster the employer’s “health culture” (e.g., healthpromotion is a part of business’ mission statement)?Figure 4: Length of Time Obesity Program in Place by Employer Size60%55%50%45%40%35%Very SmallSmallMidsizeLargeVery LargeAll Employers30%25%20%15%10%5%0%-5%< 1 year 1–3 years 4–7 years 7–10 years 10+ years10National Business Coalition on Health

E Employee screenings with adequate treatmentand follow up (e.g., Health Risk Assessmentand biometric screenings (e.g., blood pressurescreening) with follow-up)The responses indicated that for those employers withprograms:E Seventy percent have health education.E Eighty-three percent have links to employeeservices (83.4%).E Eighty percent have employee screenings.E Forty-two percent have integrated their program asa part of overall health.Figure 5 shows consistent results across all sizes ofemployers. The fact that so many employers alreadylink their program with other services and providehealth education is positive. However, the resultshighlight a challenge: integrating health promotion intothe business and workplace culture. The interviewssuggested that cross-functional collaboration withinthe organization might improve the level of integration.Each of the elements discussed above might beconsidered on an individual employee level but alsoin relation to an integrated approach for a workplaceculture of health. The relevance of the elements isindicated in Figure 6, which shows the individualemployee level and the organization level that isnecessary to achieve integration for a workplaceculture of health.Figure 5: Health Promotion Elements in Place by Employer Size1009080706050403020100Health EducationLinksIntegrationScreeningsVery Small Midsize Very LargeFigure 6: Elements of Wellness ProgramsIntegration into Workplace CultureIndividualEmployee HealthAssessment& EducationLinks toRelatedPrograms& ServicesSupportiveEnvironment& PoliciesWorkplaceCulture ofHealthObesity/Weight Management Employer Survey and Interview Project 11

A workplace culture of health provides the supportiveenvironment and policies that encourage individualemployees to maintain their own health with supportfrom an integrated approach of health screenings andassessments, preventive services and chronic diseasemanagement in conjunction with the health plan,commitment to safety at work and off the job, andpolicies that align with employee health and safety.Employer Readiness to Take Action. Employersresponded as follows regarding their readiness toaddress overweight/obesity in the workplace:E Almost a third of employers are “somewhat” ready(32.9%) to address healthy weight in the workplace.This is higher than the percentage of employerswho report being “very” or “completely” ready(28.6%) to take action and less than the percentageof employers who report they are “not ready” or“not very ready” (38.5%) to address the issue ofoverweight/obesity in the workplace.E The largest firms are the most completely ready totake action.E Within each size category, a plurality of employersare at least somewhat ready to take action (27%–42%), indicating that there is a recognized need andinterest in improving the weight status of employeesin these firms.Respondents who identified themselves as a wellnesscoordinator were more likely to at least be “somewhat”ready to take action as compared to other job functionsresponsible for workplace health. Stage of readinessvaried with those employers interviewed as well. Oneemployer with a long-established program was lookingfor better ways to measure results that will supportprogram sustainability; another indicated the need formore attention to health conditions that might affectsafety. There still appears to be a gap in understandingthe connection between health conditions and obesity/overweight, which may influence the level of readiness.E On average, smaller firms are less ready or not readyto act than are ready to take action.Figure 7: Employer Stage of Readiness toTake Action Results by Employer Size60%55%50%45%40%35%30%25%20%15%10%5%0%-5%Not ReadyNot VeryReadySomewhatReadyVery ReadyVery SmallSmallMidsizeLargeVery LargeAll EmployersCompletelyReady12National Business Coalition on Health

Factors and Information ofImportance to EmployersQuestions related to what is of value and importanceto employers are described below in the followingcategories:E Importance of Selected Improvement FactorsE Barriers to Developing or Enhancing a WorksiteObesity ProgramE Sources and Uses of Information by EmployersE Product Utility to EmployersE Employer CommunicationsSelected Improvement Factors Importance toEmployers. Given that less than 50% of participatingemployers who report having an obesity preventionand control program and over 60% indicated a level ofemployer readiness to act and to help build supportfor initiating a worksite obesity program or enhancingan existing program, there appears to be a need forinformation for employers. Questions were posedthat related to what types and sources for informationwould be of most value to employers.Respondents were asked about the importance ofseveral issues in terms of understanding the effectsand impact of overweight/obesity on the workforce(Figure 8). Factors related to improvements in workerhealth, safety, and direct medical costs were ratedas most important, followed by those factors relatedto productivity (absenteeism and presenteeism) andbuilding a culture of health. Less important issues werereturn on investment, incentives, company image,improvements in community health, and specificstrategies and actions to take to impact obesity. Theleast important issue was shareholder value, which maysuggest that no metrics exist that can easily quantifyobesity’s impact on shareholder value.The survey team recognized that employer selectionof safety as a top improvement factor may have beeninfluenced by the number of respondents who are inenvironmental health and safety functions, althoughit was also highly rated by others. Additionally, somerespondents may have interpreted the “safety” choiceas not only safety at the worksite and home but safetyin health care settings — avoidable medical errors orhealth acquired infections.Figure 8 shows the alignment of top choices in whichfactors are most important. These may also reflect thecurrent state of measurement of cost.Figure 8: Importance of Selected Improvement Factors to EmployersVery ImportantImportantModerately ImportantOf Little ImportanceNot Important at All100%90%80%70%60%50%40%30%20%10%0%DirectMedical CostSafetyImprovementin WorkerHealthProductivityCreating aCulture ofHealthObesity/Weight Management Employer Survey and Interview Project 13

Employer Ranking for Importance of EmployeeSafety. Employers are most concerned with improvingthe health and safety of their employees, as well as thereducing the costs involved with poor health (directand indirect for medical and productivity).E Small employers (86%) assigned slightly higherimportance than mid-size (83%) or large (79%)employers to the need for information related todirect medical cost.E Small (86%) and mid-size (85%) firms also assignedslightly higher importance than large employers(74%) to information related to work productivityand health.E Regardless of employer size, all employers areconcerned with the safety of their employees andreported that information regarding employeessafety is important (Figure 9)Interestingly, the 5th highest average score was givento creating a culture of health. This indicates thatemployers understand that leaders need to promotetheir programs — whether within safety, wellness, orhealth care benefits — using multiple strategies andintegration such as employing workforce-wide policyand environmental support interventions that are moreimpactful that single interventions. Larger employerswere slightly more likely (large — 82% and very large —85%) than very small (73%) and small (80%) employersto ascribe a high level of importance to information oncreating a culture of health.Issue Importance, Employer Role, and Information.Employers were also asked about their level ofagreement with a series of statements about theirlevel of knowledge and strategies regarding obesityprevention and control in the workplace (Figure 10).The strongest agreement came in response to thefollowing statements, shown by weighted average(5 = highest score):E 4.19 - Addressing overweight is an important issue.E 3.90 - Employers also believe they have a role toplay in finding effective solutions.E 3.77 - Availability of tools and information for thegeneral health of employeesE 3.66 - Availability of tools and informationspecifically for weight management.E 3.63 - Importance of community-basedorganizations and partnershipsE 3.54 - Understanding of the causes and drivers ofobesityE 3.49 - Health of the broader community isimportant.Employers are less certain that they understandthe causes and drivers of overweight/obesity inthe workplace and have information necessaryto make organizational decisions to inform theFigure 9: Employer Ranking for Importance of Employee Safety1009080706050403020100Not ImportantNeutralImportantTotalVery Small Midsize Very Large14National Business Coalition on Health

development of workplace obesity prevention andcontrol programs. Interviews confirmed the need foremployer information, especially for use with seniormanagement, to “make the case” and to show howprograms that address wellness, including obesity/weight management, can show results and are beingutilized by competitors and other businesses. Twoemployers interviewed indicated that because theirbusiness units are located in states with lower rates ofobesity, they did not feel there was a critical need toactively address obesity at the current time.A majority of employers indicated that tools andinformation on obesity were available to them to supporttheir programs. They also indicated that there is greatvalue in engaging in community partnerships. Theseperspectives highlight the need to further refine existingtools, develop new tools, and/or promote strongerrelationships with community-based organizations.E There was a high level of agreement among allemployer sizes that addressing obesity is animportant issue and that the employer has a role toplay in finding solutions.E Small and mid-size employers are less familiar withthe causes and drivers of obesity than are largeemployers.E Community partnerships may be more importantto small and mid-size companies who need to relymore heavily on the resources and expertise ofothers to support their worksite programs than dolarge employers.E Small and mid-size employers are less likely tosay they have sufficient information to makegood decisions and take action on obesity in theworkplace. Information may not be tailored to thespecific needs of small companies or may need toreflect another approach.This is supported when employers were asked if toolsand information (general and specific to obesity) areavailable to them. Although all employers reporteda high level of agreement with the statement, smalland mid-size employers believed that there is lessavailability of information, tools, and resourcesspecifically tailored to their needs.Figure 10: Issue Importance, Employer Role,and Information by Employer SizeSmallMidsizeLargeAddressingobesity is animportantissue.Employershave a role inpromotingemployeehealth.I understandthe causesand drivers ofobesity.Employershavesufficientinformationto makedecisions.Tools andinformationto promoteemployeehealth areavailable tocompanieslike mine.Communitypartnershipsareimportant.Obesity/Weight Management Employer Survey and Interview Project 15

Barriers for Employers to Take Action. Severalimportant barriers were noted by respondents, yet.from the background research and current information,these barriers would appear surmountable (Figure 11).The main barriers included:E Lack of employee engagement,E Lack of time for employees to participate, andE Lack of staff to manage the programs.Additional commonly reported barriers included alack of financial resources, lack of employee data onoverweight/obesity, difficulty discussing the topic withemployees, lack of knowledge about where to start orwhat to do, and legal concerns (such as the Americanswith Disabilities Act or the Health Portability andAccountability Act). The least common barriers werelack of leadership support, lack of space, and lack ofclear evidence or data.Even though there is compelling evidence that obesityhas an impact on the workplace, the most significantbarrier is employee engagement.E Lack of employee engagement is the top rated barrier;it is always or very often a problem for employers(57.3%). Symptomatic of the difficulty in engagingemployees are other highly rated barriers such as: Lack of employee time to participate (54.3%of employers rated this as always/very often abarrier.), Difficulty in discussing the issue of overweight/obesity with employees (44.1% of employersresponded that this issue was always or veryoften a barrier.)E In terms of organizational support that could assistwith better employee engagement, the three barriershighly rated by participating employers were: Lack of staff time (54.2% rated as always/veryoften a barrier.), Lack of financial resources (42.9% rated asalways/very often a barrier.), Lack of knowledge in where to start/what to doin terms of addressing overweight/obesity in theworkplace (41.4% rated as a persistent barrier.).Lack of leadership support was only mentioned as asignificant barrier by 32.3% of responding employers.While still high, this shows that many businessleaders understand and are supportive of activities toaddress workplace obesity. Interviewees expandedon this topic, saying that their employer does notwant to be intrusive or overbearing to overweight/Figure 11: Barriers to Developing orEnhancing a Worksite Obesity ProgramAlwaysVery Often50%45%40%35%30%25%20%15%10%5%0%Lack of Lack ofEmployee Time forEngagement Employeesto ParticipateLack ofStaffDi culty inDiscussingObesity withEmployeesLack ofFinancialResourceLack ofKnowledgein where tostart/whatto do16National Business Coalition on Health

obese employees in any way. This was noted by allthe interviewees with a common solution to have anyweight management or obesity program as part of anoverall wellness program which would not single outthose employees with weight issues.Information Sourcesand CommunicationThe survey also addressed what the sources are foremployer information and uses of that information,Employers Obtaining Information: Sources and Uses.A majority of employers reported not seeking outinformation on overweight/obesity in the last 12 months(53.3% v. 46.7%).E Very small (60%) and small (52%) employers werethe least likely to have sought out information withinthe past year.E Mid-sized employers were the only size category ofemployers who reported seeking out overweight/obesity information within the past year more oftenthan not (52% v. 48%).The responses here closely mirror the responsesregarding the presence or absence of a program toaddress overweight/obesity. This would appear tosuggest that those already with programs are seekingupdated information. Interviews support this notion ofseeking to improve programs including better ways tomeasure the program’s effectiveness.When employers do seek out information onoverweight/obesity, they most frequently reach out tohealth plans/providers/pharmacists (70.4%), vendors/consultants (51.9%), and the CDC (49.4%). A largenumber of employers also accessed information fromnonprofit organizations such as the American DiabetesAssociation, and state or local health departments.The interviews reinforced employer use of NSC forinformation about overweight/obesity. There are somedifferences in which organizations are most frequentlyused, based on employer size as shown in Figure 12.E Small (80%) and very large (74%) employers werethe most likely to utilize information provided by ahealth plan, provider, or pharmacist.E Mid-size employers were the least likely to usehealth plans or vendors when accessing informationcompared to other sizes of employers.E The largest employers were the most likely to utilizevendors and consultants for information, presumablybecause organizations of that size have the resourcesto procure programs and services from them.E Larger employers were more likely to access theCDC for information compared to small and mid-sizeemployers.This suggests that the outreach to employers needs toincorporate and address their engagement with healthFigure 12: Top Organizations as Sources of Information by Employer Size90%80%70%60%50%40%30%20%63%80%56%58%74%35%53%42%63%59%40%46%44%50%59%Very SmallSmallMid-SizeLargeVery Large10%0%Health Plan/Provider/PharmacistVendor/ConsultantCDCObesity/Weight Management Employer Survey and Interview Project 17

plans and vendors or consultants. These employersmay need to have access to unbiased information fromother organizations to complement what they receivethrough their plan, vendor, or consultant relationships.Employers note that some of the information may comefrom CDC and other credible resources; however, thereis still a need to look at the sources vendors and plansuse to inform their employer customers.Employers use the information that they seek out fora number of purposes. The most common use of theinformation obtained is to:E Educate employees (84.2% of respondents),E Reference (70.4%),E Provide data to others (65.0%),E Improve or design programs (57.9%), andE Educate decision makers (43.3%).Given the number of employers without a workplaceobesity program, references and educational resourcesfor decision makers are essential. However, allemployers would benefit from tools and information tobetter engage employees.Only a little more than a third of employers (36.7%)reported that they use the information from externalorganizations for decision-making or setting policy.This indicates that either employers prefer to baseorganizational decisions on internal data or that thedata and information provided by these organizations isnot sufficiently relevant to be usable.E Very small employers (43%) are the least likelyto use the information they seek out to design orimprove their programsE Very small employers (33%) are also the least likelyto use the information they obtain for the purposesof making decisions or setting policy. Both of thesefindings indicate that the information currentlyavailable does not adequately address the needs ofworksites with fewer than 100 employees.Product Utility to Employers. Respondents were askedabout the types of products they would find to be mosthelpful to initiate workplace obesity prevention andcontrol program or support their ongoing activities.Overall, web tools were viewed as the most useful,with an average score of 3.66 out of 5. Other usefultools included checklists (average score of 3.38),intervention templates or models (average score of3.37), a business case (average score of 3.34), andcertificates, certification or recognition (average score of3.33). The least useful products for employers were casestudies (average score of 3.12) and publications in trade,professional, or scientific journals (average score of 3.13)The web tools query did not distinguish between webtools for employees versus those for the employer.Interviews reinforced the need for, not only web toolsand information, but also for other forms of accessto and delivery of information. Employers need thisinformation since many employees do not have accessFigure 13: Percent of Employers Reporting Productsare “Useful and Very Useful” by Employer SizeVery SmallSmallMid-SizeLargeVery Large80%70%60%50%40%30%20%10%0%Web tools Checklists InterventionTemplate/ModelBusinessCaseCertificate,Certification,RecognitionResourceList/Inventory18National Business Coalition on Health

to intranet or Internet at the worksite. Intervieweesdescribed many differences in types of work andworkers, including language, education, ethnicity,and similar factors. These employers seek programsand information that are equally useful across theirpopulation and are customizable for their employee’sneeds. For example, interviewees in the environmentalhealth and safety function mentioned their regularinteraction with employees through training, safetyprogram updates, and ergonomic reviews. Safetydirectors have time in regular staff meetings forshort education programs such as the NSC “5 minuteprogram.” The NSC 5 minute program is built aroundfully scripted cards, which make it easy for anyone toconduct a safety meeting on a variety of subjects whichare designed as 5 minute education topics. This type ofturn-key resource is a useful tool for employers.Interviewees remarked on their use of these tools withspecific reference to one program that expands thesafety concepts to home and outside the work place.Again, the smallest employers found the least utilityamong the top products, possibly due to the lack ofrelevance of these products to their specific needs andcircumstances.Employer Communications. Lastly, respondentswere asked about the communications channelsand methods that would be most useful to them indisseminating information regarding workplace obesityprevention and control programs.The highest rated means of communication in terms ofutility were:E Direct education from a provider or health plan(average score of 3.89 out of 5),E Electronic communications (average score of 3.80)such as the Internet, andE Training or demonstrations (average score of 3.72).The high response for Internet and web may reflectthe growing use of webinars as an education andtraining tool. These responses are followed by print(average score of 3.60) and meetings or conferences(average score of 3.46). The publications and reportsfor print may include studies and downloadableinformation from the web, since these are commonlyused mechanisms. The lowest ratings according to therespondents were for social media (average score of3.00) and media in general (average score of 3.04).One interviewee helped to initiate an employer groupin the local area that meets regularly for networkingand sharing specifically on wellness programs andservice, showing the value of in-person informationexchange. This type of learning was also mentionedas an important component by other employersinterviewed. Two interviewees noted their owninternal programs that bring all the safety directorstogether corporate-wide for a sharing and networkingopportunity with education and learning in an annualcompany safety conference. Small employers (64%)found direct education to be the least useful amongall sizes of employer while mid-size employers foundthis form of communication to be the most useful(80%). Large employers also rated this item highlyuseful (79%). Interviews reinforced that each workplacesetting needs to use mechanisms that are appropriatelydesigned for their employee’s needs.E Among all employer size categories, mid-sizeemployers found the Internet or web most useful(77%), compared to very small (60%), small (61%),large (74%), and very large (63%) employersE Large employers (84%) rated training anddemonstrations the highest among all employersizes. This may be due to greater resourceavailability to pay for courses and conferenceparticipation where training occurs.E No employer of any size rated the use of socialmedia or news media in general as “useful” or “veryuseful” higher than 42%.Community-BasedOrganizations andEmployer PartnersThe last set of questions asked employers about theirlevel of participation in community partnerships as wellas the opportunities and barriers that accompany theserelationships. This segment of the report addresses thecurrent state of community partnerships, employeridentifiedbenefits of partnership, and a significantbarrier associated with time and resources.Obesity/Weight Management Employer Survey and Interview Project 19

Existing Community Partnerships. Respondentsindicated:E Overall, less than 20% are currently working withcommunity-based organizations or communitycoalitions for assistance or support on theirworkplace obesity activities.E Very large employers (31%) were the most likelyto have these types of partnerships, but this stillrepresented less than a third of the very largeemployer respondents.E Very small (13%) and small (16%) employers werethe least likely to have developed partnerships withcommunity-based organizations around obesity orhealthy weight.The results from this question led to more in-depthdiscussion in the interviews. One interviewee was veryaware of community-based programs and organizationsand has in fact built the employer-sponsored wellnessprogram using these as assets to address a wide rangeof education and support needs. This interviewee alsomentioned the local public health department as oneof the resources. Other interviewees had little or nocontact with community organizations but were awarethat other employees, such as those in public relations,do have contact. No one noted any link for corporategiving or volunteerism support to health or wellnessspecifically except for sponsorship of an event. Oneinterviewee commented that those sponsorships hadbeen cut back with the downturn in the economy.Benefits of Partnerships. Respondents notedseveral benefits of partnerships in both enhancing ordeveloping workplace obesity prevention and controlprograms. The three highest ranked responses were:E Access to useful data and information (averagescore of 3.73 out of 5),E Ability to have greater impact than I could have onmy own (average score of 3.69), andE Enhanced ability to meet the needs of the workforceor clients (average score of 3.64).Other responses were closely clustered in a midpointarray with the lowest ranking for enhanced ability toaffect public policy (average score of 2.87). Employersize did not seem to influence which benefits weremost important to employers. This suggests that thevalue of partnerships is understood, despite the factthat few respondents indicate current communitybasedorganization collaboration. This was supportedby the interviews with the exception of one employerrespondent who uses external organizations as valuedpartners in the employee wellness program. Thesepartnerships, however, are only able to be accomplishedat the corporate headquarters location. In othercompany worksites, there has not been an easy way toaccess or learn about local community resources.Time and Resource Barrier. The biggest barriers topartnering with community-based organizations arethe time and resources needed (58.1% of respondentsrated this as “always” or “very often” a barrier).The interviews support this view but perhaps moresignificant is the fact that few employers haveestablished relationships with these communityorganizations. This may be part of the reason for thetime and resource barrier since the process wouldinclude identification of potential partners as wellas building those relationships as part of the overallprocess. Other barriers include:E 34.2% of employers report insufficient influence inpartnership activities as “always” or “very often” abarrier.E 32.2% of employers report an inability to identifyor access appropriate partners as “always” or “veryoften” a barrier.20National Business Coalition on Health

Overarching ThemesDiscussionEmployers may be discouraged from devotingsignificant time and resources to developing healthpartnerships with community organizations becauseof the time it takes to build a good working andtrustworthy partnership, a lack of awareness of who inthe community to reach out to, and the belief that theemployer’s participation does not have the impact thatis necessary to engage and maintain the relationship.Several overarching themes emerged from the surveysand interviews. These themes are discussed below inthe following groupings:E Employers are currently engaged or ready tobecome engaged in addressing obesity at theworksite.E Wellness — not obesity — is the subject.E Leadership is critical.E Safety and health are linked together.E Information and resource guidance are needed.Employers Are Engaged.The survey shows that employers are nowinvesting in obesity prevention and those that arenot yet doing so are interested in what they mightdo, how to do it, and how to measure success.47.5% of the respondents responded affirmativelyto having a worksite obesity prevention and controlprogram. This clearly shows a significant commitmentto address obesity and weight management at theworksite. Additionally, 60% of survey respondentsstated they are “somewhat to completely ready” toaddress healthy weight. The current investment alsodemonstrates that initiatives might be viewed ascontinuum as shown in Figure 14. These illustrativeexamples were demonstrated through the interviews.The current understanding is that obesity and weightmanagement are viewed as an important issues andthat employers believe they have a role in addressingthem. Almost half (46.7%) of respondents haveobtained information on obesity/weight managementwithin the past 12 months. A majority of respondents,84.2%, obtaining data indicated using the informationto help educate employees, for reference, or use withothers, suggesting work to promote and developsupport for employer initiatives.Many myths and barriers were identified. Addressingperceived barriers may be achieved, in part, byObesity/Weight Management Employer Survey and Interview Project 21

Figure 14. Continuum of Program Evolution IllustrationNascentMatureNo program orprogram throughhealth benefit programinsurer or administratorbut not at worksiteEmployee educationfocused on lifestyle,wellness, physicalactivity or educationenhanced with "lunch& learn" or othereducation optionsHealth assessment,weight managementsupport, nutritioneducation,encouragement forphysical activity atworksiteWorksite programintegrated withsafety, health benefitscoverage, communityengagement, andmeasurement (initialparticipation moving tosavings in health costs,productivity, etc.debunking the myths. The least significant barriersidentified were a lack of clear evidence or dataindicating the obesity has an impact on the workplace,lack of leadership support, and lack of space. Thesemost significant barriers included:E Lack of employee engagement,E Lack of time for employees to participate, andE Lack of staff.These barriers often relate to commonly heldperceptions in the employer community. While all ofthese barriers represent challenges, the interviewsshowed that a small staff can develop and implement awellness program with leadership support and creativeapproaches such as the use of community resourcesand methods to engage employees. A large staff andbudget are NOT essential, which was made clear fromthe interviews; the focus of new information productsshowing employers successful examples of firms thathave overcome them would be helpful to debunk mythsthat without large staffs or spacious accommodations,effective programs cannot be implemented.A clear message from “the lack of time” to participatewas also noted in the interviews with a comment that“the goal is to build healthy practices into the workday” as well as outside the workplace. Interviews alsodemonstrated that some success has been achievedalready in getting employees to participate. Oneinterviewee described a 12 week, focused program onweight management and healthy lifestyles that hadbroad participation across the company, including theestablishment of teams. This program even trackedresults. Unfortunately, there was not a continuation ofthe effort to sustain the positive momentum or buildon this initial success. Yet, this program demonstratedboth the ability to achieve employee engagement andtime to participate with the corporate sponsorship. Thisexample of corporate sponsorship, encouragement,and leadership support would seem to overcome theperception that incentives are needed for all programs.Interviews also showed creative incentive approachesthat build on methods already in place using a creditsystem or other approach. Other examples have beendemonstrated by employers — especially as theymove along the continuum to a workplace or companyculture of health. This suggests the need to developthese examples into concise replicable descriptions fordissemination and use.Several interviewees noted small staffs as a barrier, butwere at the same time working on ways to add moresupport through alliances with worker safety teams orother convening and leadership opportunities within thework setting. The lack of staff has also been addressedby the use of community resources and partnershipsthat were also discussed in interviews. In fact, thisapproach of working community partners — publichealth, community-based activities and services thatcomplement the goals of the program, not-for-profitorganizations such as the American Heart Association— was recognized as being very valuable to theexpansion of the program especially among smallerworksites. This community network integration isinhibited by the fact that these are not standardrelationships for either employers or the community22National Business Coalition on Health

organizations. These relationships are currently nottypically present.A potential barrier to these partnerships — especially asthey might involve government agencies such as publichealth — is the fact that some of these organizationsare associated with regulation, enforcement, or lack offlexibility to meet workplace needs. This needs to beaddressed in the communication channels and languageused by both employers and potential partners. Oneexample is the use of “policy” and “environment.” Policyshould not imply regulation and environment shouldbe considered both in terms of the worksite setting,especially with safety, but also with the larger context ofemployer location and community attributes.Interviewees proved not only their high level of interestand current accomplishment but that they all want toimprove on what has already been done — no matterthe stage or complexity of these current programefforts. For example, one noted that they are lookingfor “outcome” measures to move beyond the currentparticipation and cost avoidance measures they areusing with their current, broadly based and wellsupportedwellness program across the company.Wellness is the Subject.Obesity/weight management should be framedas an overall healthy lifestyle issue as part of alarge wellness and health promotion program, notas a stand-alone activity.Some employers provide incentives to encourageparticipation. There is a need for new information totarget the motivational aspects of change and describethe availability and easy access to both worksite andcommunity resources. One interviewee indicated thathe has used educational opportunities for employeesto identify safety at home as well as at the workplace.This indicates the understanding of the need to addresshome as well as work.Those who reported they had obesity programsmost often have their programs integrated with otherwellness programs, even though respondents did notanswer that they have integrated programs, with safetybeing a primary linkage for many employers. Fromthe safety perspective, interviews showed concernabout weight appropriate equipment and other issuesrelated to obesity that may affect employee safety.Safety is an issue in which personal responsibility isstressed in terms of awareness of the environment,taking preventive action, and reporting incidents.Employers tend to view overall health and wellness,including weight management, in much the same way.While both health and safety are viewed as areas ofpersonal responsibility, the fact that employers statedstrongly they had a role to play in promoting andsupporting employee health indicates that materialsand information that are developed need to strike abalance between individual employee messages andstrategies and those directly to the work environmentand organization. Employers seem to be doing morethan they realize or giving themselves credit for acrossall employer size categories.Leadership is Critical.Many respondents who reported not having an obesityprogram did offer physical activity and/or nutritioncomponents which directly or indirectly addressobesity. This indicates that employers more readilyidentify with a comprehensive approach to wellnessrather than a specific disease or risk factor emphasisand are underreporting the level of activity to impactobesity currently in place at the worksite. Respondentsto the survey and reinforced through the interviewsrealize the gains for both employers and employees inaddressing obesity/weight management BUT within anoverall wellness program.Making health a part of the normal work day with quickand easy approaches was clearly noted in the interviews.This reinforces the goal of making healthy choices theeasiest choices, whether at the worksite or elsewhere.Leadership is a recurring issue but the findingsstrongly suggest a way to secure the leadershipcommitment is to embed the issue of obesity andweight management in both health and safetyfunctions.This is reflected as follows:E Employers have a significant level of engagementin safety for their workers. This is evidenced by thedirect engagement of employer senior managementin safety activities, reporting on safety to seniormanagement, and the level of understanding of thelink of safety to obesity and weight management byObesity/Weight Management Employer Survey and Interview Project 23

those individuals in the safety function. All of thesefactors were demonstrated in the interviews.E Highest ranked reasons to address obesity/weightmanagement were worker health, safety, and directmedical costs — all of which affect the bottom lineand are of concern to executive leadership.E Addressing obesity was identified as an importantissue, with employers having a role but needinginformation to take action and to make the case.E Lack of employee engagement, staff, and employeetime were more highly rated as barriers than waslack of leadership support and clear evidence ordata suggesting that while leadership is important,other factors need to be addressed — all of whichalso need leadership support as well.E Business case information was identified as a usefulproduct for employers, pointing toward the needfor data that will support the development andsustainability of interventions to address obesity/weight management. The interviews furthersupported the ongoing need to measure andevaluate their programs and develop additionalmeasures and methods to support the business casefor program sustainability.E Responses about the value of communitypartnerships showed that access to data andinformation, having a greater program impact, andan ability to meet workforce needs are all highlyimportant benefits that these partnerships couldprovide, but the underdevelopment of such partnerrelationships suggests a need for greater leadershipto make this happen.The low ranking of the importance of shareholder valueas related to obesity/weight management hints thatnot only is there a lack of metrics related to shareholdervalue, but also that this may be an essential needin both engagement and sustainability of worksiteinitiatives related to obesity and weight management.Ongoing leadership at each worksite to both promoteand model healthy practices is important and extendsbeyond the company owner or president to other seniorleaders that are part of C Suite as well as leaders at theworksite level such as mid-level managers. Intervieweesnoted that they need to reach out to and engage eachworksite and look to the potential of building on currentsafety committees as one way to achieve this goal.This building approach would complement existingsafety culture advancement. One interviewee is alreadyactively involving external partners to provide subjectmatter expertise and content for the wellness programand has led the formation of a peer group with otheremployers and health organizations — including localpublic health officials. Business-led coalition directorsalso provide this opportunity for learning, sharing, andnetworking through employer roundtables, conferences,and meetings. This peer to peer interaction is replicableat multiple levels.Another form of leadership that was mentioned inseveral interviews was knowledge about what otheremployers are doing. For example, intervieweesobserved that their senior management is eager tohear about programs and initiatives that are being usedby their competitors and other employers — especiallyas these actions may affect competitiveness. Havinga compendium of employer examples of programsand initiatives with results may enhance the businesscase discussion. Smaller employers may be interestedin peer mentoring opportunities because they cannotexpend resources on coordination and logistics.Leadership is a critical element to getting beyond therecognition of a need and an interest in addressingobesity/weight management to taking action.Education and communication needs to focus on whatis important to these employer leaders to get themengaged and they should be delivered through thechannels they prefer. Employer leadership can leveragethe cumulative impact by promoting all employeesto become engaged but also by advancing the initialcross-functional efforts to integrate for harmonizingapproaches across the workplace.A comment from an interview does put the executiveleadership issue in perspective: Interest in the bottomline and obtaining more business dominates themanagement team. This underlines the need to get theright messages and information to this audience in asuccinct and to the business point, manner. Executivestake time to listen to what impacts the bottom line. Thisalso recognizes that information or tools developedto educate and enhance the skill levels of worksitepractitioners and those involved with planning,implementing, and evaluating their program will notresonate with senior leadership, even if providinginformation and reporting to senior leaders is a functionof the worksite coordinator or practitioner.24National Business Coalition on Health

Safety and Healthare Linked.The significance of the link between safety andhealth, organizationally, programmatically, andthematically, was revealed in the study.Survey respondents in the environmental health andsafety function represented 58% of respondentsso naturally, one would anticipate that safety mightbe a theme and, while providing some bias to theresults, indicates an important leverage point forworksite obesity prevention and control because manyemployers are already steeped in a culture of safety.The interviews helped expand on the significance of thesafety function related to obesity/weight managementand wellness in general as well as the potential linkboth to senior management and human resourceshealth program functions. All employers must complywith regulations on worker safety and many have asafety function that is staffed. This makes the link tosafety significant for any wellness or health promotionprogram by building on what already exists. Employeeservices and screenings, such as health assessmentsand testing for occupational health-related needs maybe part of the safety function and could be expandedto incorporate obesity. The safety theme is furtherestablished by the fact that the safety was identifiedas one of the three top areas of importance, along withworker health and direct medical cost.The interviews reinforced the connection to theenvironmental and safety function as an importanttheme. Interviews identified the following activities thatcould be leveraged:E Company-wide meetings for the safety functionofficials with sharing of best practices andexperience,E Recognition programs for employee safety,including paid time off for a period with noaccidents,E Safety directors are already seeking to build onwellness program efforts sponsored by humanresources,E Safety engagement by key senior managementincluding chief executive officers,E Established safety teams and employee meetings,E Training associated with safety,E Safety directors already promoting overall healthand safety off the job, andE Attention to safety in corporate reportingAll of these comments suggest that the environmentalhealth and safety function may be well- suited toengage in obesity/weight management as part of overallemployee health and safety. Workplace injuries andillnesses have a major impact on an employer’s bottomline. It has been estimated that employers pay almost$1 billion per week for direct workers’ compensationcosts alone. The costs of workplace injuries andillnesses include direct and indirect costs. Direct costsinclude workers’ compensation payments, medicalexpenses, and costs for legal services. Examples ofindirect costs include training replacement employees,accident investigation and implementation of correctivemeasures, lost productivity, repairs of damagedequipment and property, and costs associated withlower employee morale and absenteeism.According to a report by Goldman Sachs in October2007, companies that did not adequately manageworkplace safety and health performed worsefinancially than those who did from November 2004to October 2007. Investors could have increasedtheir returns during this period had they accountedfor workplace safety and health performance in theirinvestment strategy. 18 In a report by the AmericanSociety of Safety Engineers in June 2002, there isa direct positive correlation between investment insafety, health, and environmental performance and itssubsequent return on investment. 19The project interviews suggest that the leadershipfrom the “C” suite — chief executive officers, chieffinancial officers, chief operating officers, etc. — couldbuild on their safety commitment with the appropriateknowledge and education about the value ofaddressing obesity/weight management as one aspectof wellness overall. This leadership would also be ableto support the joint collaboration that would be neededby current groups that could actually implement andObesity/Weight Management Employer Survey and Interview Project 25

The small number of employers currently havingpartnerships in the community implies that when thevalue of partnerships is acknowledged, it becomesan area that could help with both sustainability andincreasing the number of employers who addressobesity/weight management or wellness overall.Partnerships were addressed in more detail in theinterviews and the degree of current partnershiparrangement mirrored the survey results, with followingsnapshots emerging:E Little or no outreach to employers by organizationsassociated with health or health conditions includingpublic health,E Use of vendors or health plans for services related toobesity and wellness,E Few examples available to employers about the useof partnerships and community relationships forprogram building and implementation,E Limited experience dealing with any governmentorganization, usually with government in a regulatorrole or policy suggesting more regulations,E Lack of examples from employers with suchpartnerships,E No training or mentorship to learn how to buildthese relationships,E Not enough time to establish partnerships andcomplete other job tasks,E Absence of employer models that develop andsustain relationships such as partnerships otherthan for traditional business-related products andservices,E Deficiency of links from health environmentand safety, wellness, or human resource roles topositions in the company such as public relationsthat may be engaged with community partners orhave access,E Multi-location employers with no way to link toservices or information in local communities for allworksites to support common programs and accessfor all employees. The company which has builttheir wellness program using community resourcesand linkages, including the employer networkinggroup, does a great job in the headquarters locationbut has no access to similar services in otherworksite locations.E No access to what is occurring in the local communityto make employees aware of opportunities suchas farmers markets, community recreation sites orprograms, or local classes or servicesThese observations mean that there is much thatcould be done in the area of partnership to provideinformation and tools to help employers and to alignwith community population health improvementinitiatives. Of course, this also means that theseorganizations need to be prepared to deal withemployers. Actions this information evokes include:E Development of information about current employerpartnerships as case and “how to” examples,E Building this program example into coalitionemployer education meetings or networkingopportunities,E Educational materials in the right tone for employersand employees,E Use of credible organizations to develop andpromote new tools and resources. This may need toaddress regional and national organization capacityif the issue of multiple work sites is in question.E Realization that time is also a scarce resource so anytools and information need to be concise, easy-touse,and actionable.Another area of concern is addressing employeedifferences — not just in terms of motivational needsbut also other lifestyle impacts from culture, ethnicity,or other factors that may be influencing healthylifestyle changes or adherence. Community partnersmay be able to help with this in many ways that helpreflect and support their diversity.Community partners can be well-suited to helpingthe employer emphasize policy, environmental andsystems changes that, over time, will make the workenvironment more health promoting and make healthchoices easier for individuals.28National Business Coalition on Health

ConclusionsInformation and insights provided by the employerrespondents indicate a wide variety of needs thatemployers need to be addressed in order to facilitategreater implementation of workplace obesity programs.E Employers need better information about howobesity relates to employee safety and to otherrelated health conditions; they also need anindication of the associated cost burden. All appearto want more and better guidance for new programsand improvements for existing programs.E Employers of all sizes already have a variety ofwellness program components — even if obesityis not a focal point — and are interested in learningmore that can be applied in their workplace. Thesurvey shows that employers are now investingin obesity prevention and those that are not areinterested in what they might do, how to do it, andhow to measure success.E Making the connection between safety and wellnessis fundamental to addressing a healthy workforce.Employers consistently mentioned the significanceof the safety function related to obesity/weightmanagement and wellness in general, as well asthe potential link to both senior management andhuman resources health program functions.E Obesity and weight management programs needto be an integrated part of a wellness program.Obesity should be a part of a continuum of issuesthat are addressed in a healthy lifestyle supportcurriculum.E Employers would welcome information and toolsthat would help them to engage employees intheir own health and wellness, including obesity,and make use of much of the educationalinformation that is already available through manysources, including health plans and the CDC. Themotivational aspect for employees to participateand achieve better health outcomes is a criticalfactor for employers to begin, improve, and sustainworksite support initiatives.E Flexibility is a crucial element for employersin adoption of wellness or obesity programs.Employers recognize the diversity of theirworkforces and want to provide information andservices that are useful and actionable. Additionally,flexibility in what an employer can do needs to bedemonstrated, coupled with the resource intensityand likely return on investment.Obesity/Weight Management Employer Survey and Interview Project 29

E Employers need information to demonstrate notonly what they can do but also how they and theirworkforce will benefit, however, that informationneeds to be appropriately targeted to multipleaudiences within the workplace, including seniormanagement, wellness coordinators, health andsafety personnel, and employees. Measurement isimportant with a range of approaches that matchthe action and development of the program.E Community alliances and partnerships withcommunity organizations are not widely included inprogramming by the employer, yet would be seenas a valuable resource. Support in establishing theserelationships and ready access to information aboutcommunity programs would be essential.E Employers learn from what other employers aredoing or have done. Peer groups and other waysto share experiences are a basic necessity. Bestpractices and evidence from other employerexperience needs to be demonstrated while alsobeing customizable for another employer.E Given that employer resources are limited, theyneed employee engagement programs, educationalactivities, and assessment strategies that are easy toimplement, concise and easy-to-use.E Examples of what employers have done that workswould be beneficial. These examples might varyby employer size, industry, and location as well asprogram or strategy.E Communication samples need to reflect employeediversity, health literacy, mediums for distribution,and ability to encourage employees to take action.Communication modes may be through meetings,web, newsletters, worksite announcements orposters, or social media so the range of samplesand application with information on what is mosteffective with which audiences would be useful. Themost preferred communication channels appear tobe more personal, hands-on interactions, especiallyamong small employers, prompting some thinkingabout how best to engage this group such asidentifying and accessing localized resources.30National Business Coalition on Health

RecommendationsRecommendation 1Figure 15: Medical Complicationsof ObesityDevelop information that meets employers’need to demonstrate the importance of andcommunicate about obesity-related activities.Informational resources for employers should addressthe costs associated with obesity/weight managementand the solutions in terms of the return on investment.Cost information should also address employee safetyand health conditions associated with that issue. Thecosts need to be reflected in terms of both direct andindirect dollars, e.g., health and productivity.Employers also need descriptive information thatexplains the relationship of obesity to other conditionsand health risks in order to better understand the fullimpact of obesity and the relevance of cost data aboutthe associated conditions. Concise visuals, such as inFigure 15, could help make the information easier tocommunicate.This graphic displays the complications and conditionsassociated with obesity. Adding associated safetyfactors would be useful as well. Such communicationswould help leadership understand the magnitude of theissue and could also inform employee communications.Source: Adapted from Yale University Rudd Center for Food Policyand ObesityObesity/Weight Management Employer Survey and Interview Project 31

Recommendation 2Help Employers address barriers and providesolutions for successful implementation ofworkplace obesity programs.Employers of all sizes are now engaged or ready tobe engaged in obesity-related workplace activitiesbut need assistance in addressing barriers andimplementing solutions. The most significant barriersidentified by this study were the lack of employeeengagement, the lack of time for employees toparticipate, and the lack of staff. Information about bestpractices and lessons learned from their peers at eachstage of program development and evolution wouldbe beneficial. Employers need examples of successfulways to engage employees and flexible options toadapt the approach to their own worksite. Offeringeducational opportunities that showcase employerexamples is an effective way to communicate withdecision makers at all levels.Linking obesity to safety is one potential solution togaining leadership support and to instill a greaterfocus on employee health into a company’s policiesand actions. Peer-to-peer learning is also valuablefor facilitating the use of safety concerns in orderto increase focus on workplace obesity, as otheremployers may have relevant approaches or programsthat could successfully be adopted at other worksites.Focusing on safety may also be significant to theworkplace obesity programs since many employershave safety groups at each worksite who mightserve as the local champions for a wellness program,as well as a source of valuable information andinsights as to what might work best to gain greateremployee engagement. Given the relative lack ofemployer-community partnerships and the employeracknowledgement of their value, there is great potentialto help employers be more successful by accessingthis resource. This is especially meaningful given thatover half of employer health care benefit costs areassociated with family members of employees. Further,employees are only at the worksite for a third of theday — and at are at home and in the community theother two thirds of the time. Resources, such as thoseprovided by many community-based organizationsthat allow individuals to make health part of theirnormal routine, are important. Further, identification ofcommunity-based resources will also help to addressthe lack of resources within a company. This is true notonly for smaller employers but also for large companieswith worksite locations that are small.Recommendation 3Make tools and information easy to use andunderstand.When presenting information to employers aboutworkplace obesity, present it in formats and languagethat are common in the business sector. For example,Figure 16 below shows the quality improvementprocess cycle in a clear, concise manner that couldeasily be incorporated into a brief executive memo orPowerPoint presentation. This figure would help theemployer understand how the quality improvementprocess would help them address a problem (likeworkplace obesity) through identification of costsand potential solutions, planning for implementation(including leadership support development atthe needed levels), program implementation, andmeasurement and results reporting.Provide employers with easy-to-use tools that willhelp them capture results and return on investment.Evaluation and measurement tools should includeexamples and “how to” information for all stagesof program evolution. Examples from employerswho have successfully implemented these conceptsand programs are especially important in showinghow policies and management goals can align withemployee health and productivity.32National Business Coalition on Health

Figure 16: Common Business Processes: The Quality Improvement CycleIndividual IdentifyEmployee Costs HealthAssessment & Potential& Education SolutionsIndividual ResultsEmployee Reporting HealthAssessment & Program& ModificationEducationIndividual LeadershipEmployee Support HealthAssessment for SolutionImplementation& EducationIndividualProgramEmployeeMeasurementHealth&AssessmentAssessment& EducationIndividual EmployeeEmployee & Management HealthEducation Assessment & SolutionImplementation& EducationObesity/Weight Management Employer Survey and Interview Project 33

Endnotes1. Sepulveda M, Tait F, Zimmerman E, Edington D Impact ofChildhood Obesity on Employers Health Affairs 29, No. 3(2010); 513–5212. IBID3. Data on Small Business http://sba.gov/advocacy/849/121624. Flegal, KM, Carroll, MD, Ogden, CL, Curtin, LR. Prevalenceand Trends in Obesity among US Adults, 1999–2008.Journal of the American Medical Association 2010;235–241.5. Wang C, McPherson K, Marsh T, Gortmaker S, Brown MHealth and economic burden of projected obesity trendsin USA and UK. The Lancet, Vol. 378, Issue 979, p 815–825,Aug. 20116. Healthy People 2020. http://www.healthypeople.gov/20207. Finkelstein EA, Trogdon TG, Cohen JW, Dietz W. AnnualMedical Spending Attribulable to Obesity: payer andservice specific estimates. Health Affairs, 2009: 5:p822–8318. Finkelstein E, Fiebelkorn I, Wang G. The costs of obesityamong full time employees. American Journal of HealthPromotion 2005: 20: 45–519. IBID10. Op.Cit. Finkelstein et al11. Ostebye T, Dement J, Krause K Obesity and Workers’Compensation: Results from Duke Health and SafetySurveillance System Arch Intern Med Vol 167, April 23,200712. Op Cit Sepulveda et al Impact of childhood obesity onemployers13. Geler AB, Foster DG, Womble LG, et al. The relationshipbetween relative weight and school attendance amongelementary school children. Obesity 2007; 15: 2157-216114. Op Cit Finkelstein et al The costs of obesity in theworkplace15. Mokdad A, Ford E, Bowman B, Dietz W, Vinicor F, BalesV, Marks J Prevalence of Obesity, Diabetes, and ObesityRelated Health Risk Factors, 2001. JAMA, January 1, 2003.Vol.289, No.116. IBID17. http://www.census.gov/econ.smallbus.html18. Goldman Sachs JBWere Finds Valuation Links inWorkplace Safety and Health Data. Goldman SachsJBWere Group, (2007, October).19. American Society of Safety Engineers. White PaperAddressing the Return on Investment for Safety, Health,and Environmental Management Programs. http://www.elcosh.org/en/document/63/d000047/asse-white-paperaddressing-the-return-on-investment-for-safety%252Chealth-and-environmental-%2528sh%2526e%2529-management-programs.html (June 2002)34National Business Coalition on Health

Appendix ASurvey ResultsWhich of the following best describes your role/function? N=515Role/function % NHuman Resources 20.6 106Wellness Coordinator 6.4 33Environmental Health and Safety 58.4 301Employees/Union Representative 4.1 21Management/Operations 9.3 48Employer/Owner 0.8 4Employer Coalition Director 0.4 2Numbers may not add to 100% due to rounding.What is the total number of employees in your organization? N=500Employer Size % N1 to 100 employees very small employer 21.0 105101 to 500 small employer 38.2 191501 to 1000 midsize employer 13.8 691001 to 5000 large employer 15.8 795000 + very large employer 11.2 56Numbers may not add to 100% due to rounding.Obesity/Weight Management Employer Survey and Interview Project 35

Your organization’s industry type N=421Industry Type % NAgriculture, Forestry, Fishing, and Hunting 2.9 12Mining, Quarrying, and Oil and Gas Extraction 2.9 12Retail/Wholesale Trade 4.0 17Accommodation and Food Service 0.2 1Professional, Scientific, and Technical Services 5.5 23Transportation, Warehousing and Utilities 17.6 74Health Care and Social Assistance 3.1 13Real Estate, Rental and Leasing 0.0 0Management of Companies and Enterprises 0.7 3Public Administration 5.7 24Finance and Insurance 2.1 9Information 0.5 2Construction 11.7 49Educational Services 4.0 17Manufacturing 36.2 152Administration and Support 1.2 6Waste Management and Remediation Services 1.4 6Arts, Entertainment, and Recreation 0.2 1Numbers may not add to 100% due to rounding.Do you have a program(s) designed to help prevent orcontrol overweight/obesity in the workplace? N=516% Yes % NoTotal Respondents (N=516) 47.5 52.5By Employer Size (N=499)Very small (

How long has your worksite overweight/obesity program been in place? N=248Length of Time < 1 year 1–3 years 4–7 years 7–10 years 10+ yearsTotal Participants (N=248)Total14.7%N=3746.8%N=11625.6%N=644.4%N=118.1%N=20By Employer Size N=239Very small (

When thinking about the potential impact of overweight/obesity on the organization, how important to you isinformation on each of the following items to understandthe effect of overweight/obesity on the workforce?The total responses for each selection in this question are below followed by each selection with responses byemployer size. The subsets of responses have been shown with responses combined for not at all important andof little importance into not important, moderately important shown as neutral, and important and very importantshown as important.Total ResponsesNot importantat allOf littleimportanceModeratelyimportantImportantVeryImportantAverageRatingA. Direct Medical Cost N=509 0.8% 2.4% 13.8% 32.0% 51.1% 4.30B. Productivity N=504 1.0% 3.6% 12.9% 45.0% 37.5% 4.14C. Absenteeism N=505 1.0% 4.6% 16.4% 43.6% 34.3% 4.06D. Presenteeism N=505 0.8% 4.8% 17.8% 43.6% 33.1% 4.03E. Creating a culture of healthN=5081.0% 2.6% 16.9% 42.1% 37.4% 4.12G. Improvement in WorkerHealth N=5080.6% 2.4% 8.3% 41.3% 47.4% 4.33H. Related Risk Factors N=505 0.8% 3.2% 19.4% 41.8% 34.9% 4.07I. Return on investment N=506 1.6% 6.9% 19.6% 38.9% 33.0% 3.95J. Incentives N=503 3.0% 15.5% 33.4% 33.8% 14.3% 3.41K. Shareholder value N=495 17.2% 16.8% 28.5% 23.2% 14.3% 3.01L. Company image N=503 5.0% 14.3% 31.0% 30.6% 19.1% 3.45M. Improvements in CommunityHealth N=5043.6% 14.3% 31.7% 34.1% 16.3% 3.45N. Strategies and ActionsN=5091.8% 6.3% 25.5% 43.4% 23.0% 3.80Responses by Employer SizeA. Direct Medical Cost(e.g. medical insurance benefits and payments, pharmacy benefits,disability payments, and workers’ compensation)Not Important Neutral Important Total RespondentsTotal Participants (N=509) 16 70 423 509By Employer Size N=493Very small (

B. ProductivityNot Important Neutral Important Total RespondentsTotal Participants (N=504) 23 65 416 504By Employer Size N=488Very small (

F. SafetyNot Important Neutral Important Total RespondentsTotal Participants (N=507) 16 40 451 507By Employer Size N=491Very small (

J. IncentivesNot Important Neutral Important Total RespondentsTotal Participants (N=503) 93 168 242 503By Employer Size N=488Very small (

N. Strategies and ActionsNot Important Neutral Important Total RespondentsTotal Participants (N= 509) 41 130 338 509By Employer Size N=493Very small (

The total responses for each selection in this question are below followed by each selection with responses by employersize. The subsets of responses have been shown with responses combined for strongly disagree and disagree into“disagree.” strongly agree and agree into “agree.”Responses by employer sizeA. Addressing overweight/obesity in my workplace is an important issue.Disagree Neutral Agree TotalTotal Participants (N= 509) 20 57 430 509By Employer Size N=492Very small (

D. My employees are knowledgeable regarding weight and weight management.Disagree Neutral Agree TotalTotal Participants (N=507) 164 167 169 507By Employer Size N=490Very small (

H. Community-based organizations/community coalition (i.e., non-profit groups whichprovide health, educational or other basic human services to individuals in thecommunity) and partnerships are important to support my worksite program.Disagree Neutral Agree TotalTotal Participants (N=564) 59 174 258 504By Employer Size N=488Very small (

As an employer, how much of a barrier is each of the following todeveloping or enhancing your worksite overweight/obesity program?Total Responses by BarrierBarrier Always Very Often Sometimes Rarely NeverAverageRatingA. Lack of financialresources N=50615.6% 27.3% 35.8% 17.4% 4.0% 2.67B. Lack of staff N=505 15.4% 38.8% 29.9% 12.5% 3.4% 2.50C. Lack of leadershipsupport N=5049.3% 23.0% 33.5% 25.8% 8.3% 3.01D. Lack of time foremployees to13.6% 40.7% 34.0% 9.9% 1.8% 2.45participate N=506E. Lack of space N=506 11.0% 24.7% 25.3% 31.7% 7.4% 3.00F. Lack of clear evidenceor data indicatingobesity has an impact6.0% 21.9% 30.1% 30.9% 11.2% 3.19on the workplaceN=502G. Lack of employeedata on overweight or8.2% 27.8% 31.6% 23.1% 9.3% 2.97obesity N=497H. Lack of employeeengagement N=49913.8% 43.5% 34.7% 6.6% 1.4% 2.38I. Difficulty in how todiscuss overweightor obesity with10.6% 33.5% 34.7% 16.5% 4.8% 2.72employees N=502J. Lack of knowledge ofwhere to start or what12.1% 29.3% 32.5% 18.4% 7.7% 2.80to do N=505K. Laws and regulations(HIPPA, ADA, EEOC,etc.) N=49212.2% 24.6% 34.8% 21.7% 6.7% 2.86Barriers by Employer SizeBarrier: FinancialEmployer Size Always or very often Sometimes Rarely or never TotalVery small (

Barrier: Lack of staffEmployer Size Always or very often Sometimes Rarely or never TotalVery small (

Barrier: Lack of employee data on overweight or obesityEmployer Size Always or very often Sometimes Rarely or never TotalVery small (

During the past 12 months, have you obtainedinformation about overweight/obesity to inform thedevelopment or improvement of your program?Total Participants (N=508)Yes46.7%N=237No53.3%N=271By Employer Size (N=491Very small (

Centers for Disease Control and PreventionBy Employer Size N= 231Response CountVery small (

The total responses for each selection in this question are below followed by each selection with responses byemployer size.Information Use: For ReferenceEmployer Size Response Percent TotalVery small (

Information Use: To educate employeesEmployer Size Response Percent TotalVery small (

Please rate how useful each of the following products wouldbe to support your worksite overweight/obesity program.ProductNot usefulat allOf littleuseModeratelyusefulUsefulVeryUsefulRatingAverageCase studies N=248 5.2% 20.6% 36.7% 31.9% 5.6% 3.12Business case N=246 4.5% 16.3% 31.7% 36.2% 11.4% 3.34Trade, professional, or scientificjournal article N=2462.8% 21.5% 43.3% 26.4% 6.9% 3.13Web tools N=247 0.4% 7.7% 30.0% 49.4% 12.6% 3.66Social media tools N=246 2.8% 20.3% 40.2% 31.3% 5.3% 3.16Check lists N=245 0.8% 15.5% 35.5% 40.8% 7.3% 3.38Resource lists and inventoriesN=2461.6% 18.7% 39.8% 30.5% 9.3% 3.27Turn-key programs N=246 4.1% 17.5% 33.7% 37.4% 7.3% 3.26Intervention templates ormodels N=2421.2% 13.6% 43.0% 31.4% 10.7% 3.37Certificates, certification, orrecognition (e.g. award) N=2422.9% 17.4% 36.4% 30.6% 12.8% 3.33The total responses for each selection in this question are below followed by each selection with responses byemployer size.Product: Case StudiesEmployer Size Not useful & little use Moderately Useful Useful & very useful TotalVery small (

Product: Web ToolsEmployer Size Not useful & little use Moderately Useful Useful & very useful TotalVery small (

Product: Intervention templates or modelsEmployer Size Not useful & little use Moderately Useful Useful & very useful TotalVery small (

Communication Means: Training or DemonstrationsEmployer Size Not useful & little use Moderately Useful Useful & very useful TotalVery small (

Communication Means: News MediaEmployer Size Not useful & little use Moderately Useful Useful & very useful TotalVery small (

How important to you is each of the following partnership benefits indeveloping or enhancing your worksite overweight/obesity program?Partnership BenefitNot at allimportantOf littleimportanceModeratelyimportantImportantVeryimportantRatingAverageEnhanced ability toaddress overweightor obesity N=485Development of new skillsor expertise N=485Heightened publicprofile N=478Increased utilizationof my expertise orservices N=482Acquisition of usefulknowledge about services,programs, or people inthe community N=485Access to useful data andinformation N=484Enhanced ability to affectpublic policy N=483Development of valuablerelationships N=481Increased staffing orcapacity N=479Enhanced ability to meetthe needs of my workforceor clients N=485Ability to have a greaterimpact that I could haveon my own N=485Ability to make acontribution to thecommunity N=484Acquisition of additionalfinancial support N=4811.4% 7.6% 34.4% 47.0% 9.5% 3.551.6% 7.8% 29.5% 49.7% 11.3% 3.614.2% 25.3% 36.2% 29.7% 4.6% 3.054.4% 18.9% 38.2% 31.3% 7.3% 3.181.6% 9.1% 28.9% 49.9% 10.5% 3.591.4% 5.2% 26.7% 52.9% 13.8% 3.737.2% 31.1% 34.2% 23.0% 4.6% 2.873.5% 12.9% 34.5% 38.9% 10.2% 3.396.1% 22.5% 34.9% 26.7% 9.8% 3.121.9% 7.8% 30.7% 43.7% 15.9% 3.641.9% 7.4% 27.4% 46.6% 16.7% 3.693.9% 18.2% 36.8% 34.5% 6.6% 3.225.6% 16.2% 29.3% 32.6% 16.2% 3.3858National Business Coalition on Health

The total responses for each selection in this question are below followed by each selection with responses byemployer size.Partnership Benefit: Enhanced ability to address overweight/obesityEmployer SizeNot important &little importanceModeratelyimportantImportant &very importantTotalVery small (

Partnership Benefit: Access to useful data and informationEmployer SizeNot important &little importanceModeratelyimportantImportant &very importantTotalVery small (

Partnership Benefit: Enhanced ability to meet the needs of my workforce or clientsEmployer SizeNot important &little importanceModeratelyimportantImportant &very importantTotalVery small (

As an employer, how much of a barrier is each ofthe following to partnering with a community-basedorganization on worksite health programs?Barrier to partnering Always Very often Sometimes Rarely NeverRatingAverageDiversion of time andresources away from otherpriorities or obligationsN=478Insufficient influence inpartnership activities N=470Viewed negatively dueto association with otherpartners or the partnershipN=473Awareness of partner’sprograms and servicesN=467Ability to access partners(e.g. unsure who tocontact, invitation to joinpartnership) N=472Partner organization is notfocused on worksite healthissues N=458Partner’s responsivenessto my questions or needsN=457Insufficient credit given tome for contributing to theaccomplishments of thepartnership N=461Conflict between my joband the partnership’s workN=45721.3% 36.8% 32.6% 6.9% 2.3% 2.327.0% 27.2% 42.3% 19.6% 3.8% 2.863.4% 9.5% 30.0% 42.9% 14.2% 3.555.8% 21.8% 44.5% 22.3% 5.6% 3.007.4% 24.8% 42.8% 19.9% 5.1% 2.905.5% 16.4% 38.6% 27.7% 11.8% 3.244.8% 14.2% 39.8% 31.9% 9.2% 3.263.9% 8.7% 26.7% 34.1% 26.7% 3.715.3% 13.8% 35.4% 27.8% 17.7% 3.39The total responses for each selection in this question are below followed by each selection with responses byemployer size.Partnership Barrier: Diversion of time and resources away from other priorities or obligationsEmployer Size Always or very often Sometimes Rarely or never TotalVery small (

Partnership Barrier: Insufficient influence in partnership activitiesEmployer Size Always or very often Sometimes Rarely or never TotalVery small (

Partnership Barrier: Partner’s responsiveness to my questions or needsEmployer Size Always or very often Sometimes Rarely or never TotalVery small (

Appendix BInterview SummariesEmployer A1. Could you begin by telling us a little more aboutyourself?This Midwest coalition is a 501(c) (3) not-for-profitorganization made up of member businesses whichhave a stake in the health and welfare of theiremployees. The coalition is a “mixed-model” coalition,which means that our members represent purchasers,also known as employers, as well as providers of healthcare, such as hospitals, health plans, consultants andpharmaceutical companies. Member businesses rangein size from 2 to 2,500 employees and together, theyrepresent over 30,000 covered lives.Goals for the organization include:E Provide leadership to purchasers on issues relatingto health care cost and quality (patient safety),productivity and wellnessE Convene and facilitate market accountabilityand share best practice guidelines for healthimprovement outcomes and measurementE Provide health care education and information topurchasers through the use of resources and toolsE Coordinate community engagement inopportunities to improve the health status ofthe regional area through partnerships andcollaborationE Support wellness initiatives and healthy lifestyles inthe tri-state area2. Did you consult with others to complete theonline survey? NO3. Tell me about your obesity prevention program.Few employer members of the Coalition have eitherwellness or disease management (targeting preventionand management of selected chronic conditions)programs. None address obesity specifically. Mostprograms that employers have are delivered throughtheir health plans. These health plan-based programsappear to be weak even when an HRA with biometrics is used with nurse follow- up. The programsdo not have robust interventions. Employers wantto understand what return on investment might beexpected and measured.Two members do have premium dollar incentives foremployees to take a health assessment with biometrics.This incentive can produce a cumulative possible $700,depending upon the individual health assessment.E Monitor and disseminate federal, state and localhealth policy informationObesity/Weight Management Employer Survey and Interview Project 65

4. From your own experience, what is the processyou have used or observed for what youconsidered when deciding how and what todiscuss with your employer members and withtheir employees?We have created a Wellness Roundtable as aneducation and sharing opportunity for employers. Thistakes the employers beyond health fairs and begins tohelp establish goals. Our expectation is that with thisformat, employers will learn from each other and fromthe information and tools we provide as part of theongoing education.We have also conducted a member employee surveyto help assess general experience and perceptions thatemployees of our employer members had about theoverall health care system, their doctors and hospitals,trusted information resources and other questionsrelated to their experience with physicians, hospitals,and pharmacists. Information from the survey thatwould be helpful for any discussions or considerationsabout programs to address weight management orobesity includes:E 27% of participants said they participate in anemployer sponsored wellness program.E 84% have a strong interest in health living/wellnessprograms.E 99.8% feel they are “responsible for their ownhealth.”E 95.5% trust physicians as a source of information.E 46.3% trust their employer as a source of healthinformation.E 54.5% trust health plans as a source of healthinformation.Results of the survey have been shared with eachparticipating employer. The information above is basedupon the aggregated responses from all employees.5. Can you discuss why you feel there is a disconnectbetween the perceived need to address obesityas an important health issue and the lack ofaction(s) taken?There is a need to take the discussion from the abstractto reality. For example, a presentation on the impactobesity/overweight has on overall health and life —including quality of life — expectancy would helpindividuals understand the effects of obesity in termsof overall health and health risks.Employers are also reluctant to address issues thatmight be sensitive to employees or be perceived asdiscriminatory. This sensitivity is exacerbated by theAmericans with Disability Act and other regulatoryrequirements. Additionally, physicians do not assumeresponsibility for addressing obesity with patients inlarge part due to the fact that they do not want to maketheir patients angry. With the high level of confidencethat employees indicate with information from theirphysicians, this reluctance on the part of physicians hasa significant impact. We have information from a recentsurvey with physicians wherein 90% of primary careproviders stated they were not responsible for suchconditions as obesity.Employers have a general understanding of the issuesrelated to wellness and obesity but want the ROIinformation. How obesity relates to chronic healthconditions, what health issues are associated withobesity, and understanding the difference in claim costsfor an obese employee compared to a lean employeewould help employers to become more engaged.Critical to address wellness and obesity specifically isthe education of key decision makers/influences (theC suite specifically) regarding healthy behaviors andself-management with how this affects the businessbottom line.The issue of obesity and overall health status needsto be framed as a policy and environmental issuewith impacts to the economy of the community. Thiscommunity-based approach would support a webbasedapproach for individuals (and employees) tounderstand the personal gains with healthy weight andthat this is not just for employer gains.6. What do you think the main benefits oradvantages are for your coalition and youremployer members by having a workplaceobesity program?A workplace obesity program would indicate a broaderunderstanding of health related conditions and theneed for supportive environments to help individualsmaintain healthy lifestyles.7. From the potential sources of information, whatdo your members use and why?66National Business Coalition on Health

Employers rely on health plans for much of theinformation they receive and through the coalitionespecially with the Wellness Roundtable.8. Very few employers are working with communitybasedorganizations around obesity and healthissues according to survey responses. Hasyour organization formed partnerships aroundemployee health generally and/or obesityspecifically?The Coalition has numerous relationships within thecommunity on health-related issues. This is critical tosuccess for an obesity program. Some examples thatare currently underway with Coalition participation thatwould complement employer actions include:E RWJF funded program sponsored by the local Yto address childhood obesity through the schoolsystemE Local food chains are engaged in “community basedrecipes” where all the ingredients for a 10 minutehealthy meal are featured with an emphasis on freshvegetables.E School program that is putting fruit in the classroomfor snacks for childrenAdditional potential initiatives might include a spotlighton community officials with a personal story of howthey put “health” into their own personal busy scheduleeach day.The Coalition is considering using a web-based tooldeveloped by another business-led coalition as acommon framework for employers. Recognition that“trusted sources” of information and “trust” differis another element to consider. With physiciansconsidered a trusted source, more steerage andattention to overweight/obesity would add value tohealth outcomes.9. What do you think are the main benefits oradvantages for an employer to address obesity inthe worksite? What are the main disadvantages orchallenges?Advantages relate to employee productivity and costsfor health care plus a healthier work force for the future(when addressing children, etc.). Challenges are ingaining senior management (C suite) support, as wellas building grass roots, community-wide efforts.10. From the survey, we learned that most employerspolled feel obesity is an important health issue,but less than half reported they currently have aprogram in place to address the issue. Can youdiscuss, from your perspective, why you feelthere is a disconnect between the perceived needand action taken?The top 5 conditions of most concern to employers are:cardiovascular health, diabetes, mental health, obesity,and skeletal/muscular conditions. The connectionwith all of these conditions would help employersunderstand the complexity of obesity and the waysin which it can contribute to other health problems.Actions are limited for reasons cited:E No C suite buy-in or understanding and may tend tobe critical without compassion or a holistic view,E Concerns about discrimination (especially with anyone condition such as obesity),E Strong sense that the community — policy andenvironment — needs to be engaged and supportivein general of healthy weight and healthy lifestyles,E Physicians do not feel a sense of responsibility aboutweight management for patients.E Complexity of a condition such as obesity thatinvolves behaviors, mental health, etc.,E Need to understand the connection of obesity withother conditions, andE Need to reach beyond the employee and worksite tofamily and communityHealth plans, brokers, and consultants also need to beengaged. The coalition can foster these relationships atthe local level but the messages and education need tobe at the national level to be effective.11. Many employers find it difficult to initiate aconversation with their employees about healthyweight and obesity prevention and control. Fromyour own experience, walk us through the processof what you consider or would consider whendeciding how and what issues to discuss withemployees?Start with the education about how obesity affectsthe body and contributes to many health conditions,Obesity/Weight Management Employer Survey and Interview Project 67

then move on to successful ways to address weightmanagement and what resources are available at theworksite, within the health plan services, EAP, andin the community. Have a champion (respected andinfluential person) speak from experience if possible.Organizations with fewer than 100 employees needcommunity-based programs since they do not havestaff to devote to this issue.A central resource such as an RN with the coalitioncould also provide support. Another outreach toemployers might be a shared resource for healthassessments, with biometric measures that includean extensive lab report with enzyme tests and othersbeyond the normal cholesterol, etc.12. Think for a moment about the main sourcesof obesity-related information you chose inthe survey why did you seek out this sourceof information (e.g., referred to it by another,credible source, existing relationship)?Information sources include NBCH, CDC, health plans,and public health. For employees, we found in oursurvey that their information sources are:Source Respondents %Doctors or Medical ProfessionalsRelativeFriendCo-workerWebsiteTelevisionCommunity ResourcesYour EmployerHealth Plan54.5%46.3%44.8%42.6%95.5%7.2%60.4%43.2%34.6%13. The survey indicated that very few employerspolled are actively working with communitybasedorganizations around obesity and healthissues. Has your organization formed partnershipsaround employee health generally and/or obesityspecifically?Our coalition is very engaged with other communitybasedorganizations and has been for years. This is aclose community and we work effectively together. Wereally need to have the senior management and businessleadership understand the benefits to the communityand their individual businesses that collective actionwould bring. The community is small enough to knoweach other. Additionally, we have worked togetherthrough a HRSA grant and we have a “one stop” accesspoint for all human services information and referrals.This includes a Medicaid evaluator that quickly assesseswhether an individual is eligible for Medicaid. Thecounty is also working on tracking the impacts to thecommunity. The coalition director spends 25% of hertime engaged in and representing employers in thesecommunity groups and initiatives. The community alsoworks on health measures every 3 years and has datacollected through the school physicals program on theobesity by the school.Employer B Interview14. Could you begin by telling us a little more aboutyourself?The interviewee is an Environmental Safety Specialist,Environmental Health and Safety Department at alarge university in the southern United States. Thecampus size is over 5500 acres with an undergraduatestudent population of 39,000 students and graduatepopulation of 9,400 students. Other campuslocations are in the state and outside the UnitedStates. Approximately 1,900 men and women servein a uniformed Corps of Cadets. There are 16,000employees. The community where the main campus islocated has a population of about 170,000.The Interviewee is an environmental safety specialistwith accident investigation skills as well as CPR andfirst aid training skills. Primary responsibilities focus onoccupational safety and not health. The organizationalstructure for programs that impact health is led bythe risk management function with human resourcesfor the benefit programs. Much of the focus for riskmanagement has been on biological safety with thelabs and campus-based research programs. Riskmanagement controls the funding for programsrelated to health. The Environmental Health and SafetyDepartment has developed safety teams and focusedon worksite injuries with over 3000 workers targetedas high risk jobs.15. Did you consult with others to complete theonline survey? No16. Tell me about your obesity prevention program.The University does not have an obesity program orany wellness program. The logistics of the campus68National Business Coalition on Health

make any program difficult as well as the diversenature of the workforce. A nearby hospital-basedprogram was made available but received very littleparticipation.17. From your own experience, what is the processyou have used or observed for what youconsidered when deciding how and what todiscuss with your employees?With a significant number of long service employees,we would need to make the case for what benefitthere is for these employees to address their ownhealth issues, including weight management. Attitudesseem entrenched with no compelling rational tochange behaviors that may be unhealthy. Thosehealth conditions related to safety could be handledin University requirements for departments. Forexample, while not required by OSHA, the Universitycould adopt standards for equipment such as laddersto make certain that these items are appropriate forthose employees using them including weight strength.Obesity and wellness in general would need to beaddressed from the health outcomes aspect with apersonal lifestyle approach.18. Can you discuss why you feel there is a disconnectbetween the perceived need to address obesityas an important health issue and the lack ofaction(s) taken?Long established methods and programs have notaddressed health-related issues for employees. Withthe University mission focused on its core businessof education and research, workforce health andproductivity have not been a central focus.Smaller employers may find, with the exception of cost,more of a real team and cohesive effort if a wellness orobesity program were introduced. Larger employerslike the University have more dispersed approaches.For example, we have a number of safety teams sinceall departments must have a safety team but only 22of the teams have been set up with guidance from thecorporate level with safety specialists. Departments donot appear to have an incentive through performanceor other measures. More success has been achieved bythe safety specialists in targeting special groups withspecific needs.The University environment is like a city within a city,even including its own utilities system that is run by theUniversity. The variation in demographics and types ofemployees reflects this system. Large scale programsare difficult due to cost factors and complexity foraccess and implementation. We have implementedsuicide prevention classes which are now very wellaccepted.We do not have a worksite employee clinic.19. What do you think the main benefits oradvantages are for your employer members ofhaving a workplace obesity program?The advantages for the University to address obesitywould be in reductions in lost work time and illness,increased productivity and related attitudes andenergy, and overall mental health. There is moreinterest by baby boomers and older workers in healthwhich could help influence a “culture of health.” Ifthe University could connect its research programsoutcomes to actual application in the employeepopulation as part of findings’ dissemination, perhapswe would see more internal interest.20. From the potential sources of information, whatdo you use and why?Any information from the National Safety Council ishighly regarded and utilized. The “5 minute topic forsafety” is especially a good resource. Safety specificnewsletters and web-based information are also part ofthe regular review.21. Very few employers are working with communitybasedorganizations around obesity and healthissues according to survey responses. Hasyour organization formed partnerships aroundemployee health generally and/or obesityspecifically?Not for health or obesity. However, the Universityhas an active Community Volunteer Program wheretime is given for employees and students are askedto volunteer as well. This involves online signup basedon a specific arranged activity including fund raising.This is a way for the University to “give back” to thecommunity and involves planned events. Events haveincluded support for specific tasks for neighborhoodsor identified needs as well as a chili festival toraise money for children’s programs. Perhaps thisvolunteerism could be aligned with health and wellnessfor the community, including the University itself.22. What do you think are the main benefits oradvantages for an employer to address obesity inthe worksite? What are the main disadvantages orchallenges?Obesity/Weight Management Employer Survey and Interview Project 69

Discussed in prior questions.23. From the survey, we learned that most employerspolled feel obesity is an important health issue,but less than half reported they currently have aprogram in place to address the issue. Can youdiscuss, from your perspective, why you feelthere is a disconnect between the perceived needand action taken?Discussed in prior questions. Setting realistic goals andincentives that have been demonstrated to be effectivealong with positive reinforcement would be a goodstart.24. Many employers find it difficult to initiate aconversation with their employees around healthyweight and obesity prevention and control. Fromyour own experience, walk us through the processof what you consider or would consider whendeciding how and what issues to discuss withemployees?Having a top level manager or director level persontake the lead for each department would bemeaningful if tied in to department staff meetings.Director level emails and announcements are well- readby the workforce. An approach that shows a long termcommitment, hands-on support and caring wouldbe effective. Subpopulations such as engineers andscientists might need to have a special communicationapproach with more science and evidence.25. Think for a moment about the main sourcesof obesity related information you chose inthe survey. Why did you seek out this sourceof information (e.g., referred to it by another,credible source, existing relationship)?NSC is a credible source along with conferences andexpos as well as peers.26. The survey indicated that very few employerspolled are actively working with communitybasedorganizations around obesity and healthissues. Has your organization formed partnershipsaround employee health generally and/or obesityspecifically? NoSee questions above about community volunteerismand “give back.”Employer Interview C27. Could you begin by telling us a little more aboutyourself?Interviewee #1, Safety Director, with responsibility forenvironmental health and safety.Additionally comments provided by Interviewee #2,Human Resources. Julie is one of a corporate staff of5 in Human Resources . HR services a workforce of1200 employees in 34 locations in 8 states with mostsignificant populations in the Northeast. The companyhas historically not entered into issues that involveemployee’s personal lives. Employer is an independentwholesale distributor and manufacturer, providingproducts and services for the building and remodelingprofessional located in northeastern United States. Thecompany states: “we take our responsibilities seriously.We are committed to our employees, our customers,the homeowners who enjoy our products as well as ourbusiness partners. We pride ourselves on being sociallyresponsible in preserving natural resources as well asgiving back to the community.” This is demonstratedby the company’s commitment to safety and the newlyestablished wellness program.28. Did you consult with others to complete theonline survey?No. Interviewee #1 provided a reference to the HumanResource Department for any further details on thewellness program. Interviewee #1 is well-acquaintedwith the Wellness program introduced by HR, both asan employee as well as from the perspective of his roleas safety director.29. Tell me about your obesity prevention program.What kinds of activities (education programs,policies, workplace supports such as stairwellimprovements, onsite fitness facilities ormenu labeling in the cafeteria, benefit design,incentives) does your organization offer toemployees? How often?The approach to obesity or weight management isincluded in an overall wellness program that wasintroduced earlier this year. The wellness program isdesigned to initially provide education to employees tohelp them understand and maintain their own healthstatus as well as to begin to address health care costsover time. The program, developed and administeredthrough the corporate headquarters office, involves70National Business Coalition on Health

employee education delivered via posters, paycheckstuffers, email and written communications as well asthrough staff meetings. A major focus is developed foreach month, beginning with a walking challenge andprovision of pedometers to each employee. Employeeparticipation is being tracked and employees arebeing asked to submit weekly information about theirparticipation in that period. The program is not nowtied to any premium or other monetary incentives.The program is being introduced from corporateheadquarters with site specific roll outs over time thatinclude a site champion. We have had a smoke-freeenvironment — including company vehicles — and atobacco cessation benefit in effect already.We have also had an increase in attention to food atmeetings, with a change from pastry items to fruit orother healthy choices. There is not a corporate policy.There are no onsite cafeterias. This change in meetingpractice behavior does reinforce and align with thewellness program. Management is supportive.Wellness and the introduction of a wellness programhave been a topic within HR for over 4 years. Costof health care is the driving issue that led to thedevelopment of a small budget for 2011 to introducea modest wellness program. This approach does nottarget only obesity but is set up to address a spectrumof wellness components. The tag line for the program is:Healthy choices, healthy livesBeginning in January 2011, the program was announcedand all employees received introductory educationalmaterials with notification that new information wouldbe provided monthly with a topic for the month.This was done to generate interest and begin toestablish program recognition. A letter from seniormanagement introduced the program, which affirmsthe level of support this program receives. Initialmetrics for success are based on interest generatedand participation in education programs or events.Current resources, in addition to the modest budget,are two corporate human resource staff who workon this program in addition to their other tasks andresponsibilities. The program is designed to be rolledout over a period of time with education and grassroots efforts. Monthly campaigns are communicatedthat target a topic such as healthy heart in February— Heart Month. Employees were provided with apedometer in May as part of a walking promotionprogram. Employees who go to their physician fora physical exam (no results directed by focus are ongoing to the doctor for this basis assessment) areeligible for a drawing done monthly. Incentive rewardsare typically $50 or $100 gift cards for gasoline. Theintent is to build the program over several years and tomeasure results as part of the process for expansion.30. Many employers find it difficult to initiate aconversation with their employees around healthyweight and obesity prevention and control. Fromyour own experience, walk us through the processof what you consider(ed) when deciding how andwhat to discuss with your employees?The approach used with our program was to addresswellness as an overall approach so that we wouldaddress a spectrum of health-related issues fromprimary prevention through healthy lifestyle behaviorsto identification of and care management for those whomay already have chronic conditions. We have providedpedometers to employees with the introduction of aWalking Challenge program, for example. We havenot directly addressed obesity or overweight but thebenefits of physical activity such as walking. We seethis wellness program as a long term effort that willfocus on different health issues and activities overtime. With our commitment to safety, we see the linksthat will be further developed as the program evolves.We want to use examples of safe work practices, suchas appropriate use of step ladders, and carry thatsafe practice outside the worksite to prevent falls andinjuries.31. Switching gears to think about other employers,from the survey, we learned that most employerspolled feel obesity is an important health issue,but less than half reported that they currentlyhave a program in place to address the issue. Canyou discuss, from your perspective why you feelthere is a disconnect between the perceived needand lack of action(s) taken?Obesity and weight management, while important foroverall health — and the impacts to employers for bothdirect and indirect cost impacts — do not show up incompany health cost data. The impacts and conditionsthat may relate to obesity — diabetes, cardiovascularconditions, and even depression — are the conditionsthat are in cost data, for example. Understanding the linkmight help to overcome the disconnect. Also, increasedinformation from credible sources and studies abouthow wellness links to safety would be valuable. Forexample, is there information that shows the evidencebetween health status and worksite injuries?Past experience with no results may also be a problem.For example, a couple of years ago, employees hadObesity/Weight Management Employer Survey and Interview Project 71

access on a voluntary basis to a health assessmentthrough the health plan. There was no link to a premiumor other incentive to participate. The program includedaccess to a phone resource with a health professionalbut did not appear to have any impactful follow-up oroutreach to the employee by the health plan.Another issue may be that many think that a largebudget and staff are needed to start a wellness orobesity or similar program. If the program roll outis planned over a longer time period, the resourceplanning can be considered as well. We have initiallyapproached the effort with a small budget and limitedresources. Employees are very receptive and appreciatethe program and the fact that the company is trying tohelp. Employees understand the financial impact issues— and have experienced this with the impact to ourindustry in the current economic downturn.The need for flexibility in any communication/educationeffort or program is also a consideration. For example,we use posters, payroll stuffers, emails, etc. , yet mustbe attentive to the fact that production workers donot have access to email at the worksite. We alsoeffectively use production staff meetings to introducenew and reinforce existing information about programsand policies. This suggests the need for a combinationof approaches which may be a daunting complexityfor some employers. We recognize the diversity of ourworkforce and want our programs to be valuable to allemployees.32. What do you think are the main benefits oradvantages for your organization of having yourworkplace obesity program?An obesity program, as part of the overall wellnessinitiative, would help address cost and also be part ofan approach that could help differentiate the companyas a preferred employer. Other companies appear tohave established themselves in such a category, inpart due to the programs and support the employerprovides for health and wellness.33. Think for a moment about the main sources ofobesity related information you chose in thesurvey. Why did you seek out this source ofinformation?Trusted sources that are available through myprofessional organizations such as NSC and NIOSH. Thisinformation helps to keep me up-to-date and informedfor my job. I also seek out information that is useful tolink both work and out of work injuries to wellness.34. The survey indicated that very few employerspolled are actively working with communitybasedorganizations around obesity and healthissues. Has your organization formed partnershipsaround employee health generally and/or obesityspecifically (YES/NO)? Thinking about thesepartnerships…The relationship with community organizations hasbeen limited. One example of a successful communityprogram with respect to safety was done in an areawhere a community center sponsored and conducteda safety training and education program for workers.This program was conducted without our companyinvolvement. Since the target population for thiscommunity program originated from a country wherethe government was distrusted, this communityapproach was a valuable alternative since local areapersons were known and trusted. A similar modelmight be very effective, especially to deal with nutritionand food preparation, for example.With small populations in many locations and a verysmall staff — located in a central site — the idea ofworking with local community organizations is achallenge. Coordination for such involvement would becomplex and time-consuming. Additionally, companiesstrive to have similar equitable programs and servicesfor all employees which would mean we could needto assess each program or service by site –anotherresource issue with a very small HR staff locatedcentrally.One idea might be to have company-sponsored teamsfor community events such as walks, etc. We havejoined the State Council on Wellness; this might bea good way to discuss community as well as otherinformation and experience.Employer Interview D35. Could you begin by telling us a little more aboutyourself?Interviewee is Director of Environmental Health,Safety, and Quality for the a major division of aninternational engineering and architecture companyproviding a complete project lifecycle capabilities –planning, designing, building, upgrading, expanding,modernizing, renovating, retooling, optimizing, andoperating infrastructure and facilities. In addition, thisemployer can decommission, decontaminate, and72National Business Coalition on Health

demolish facilities, restoring the environment for newuses. The company has about 24,000 employees. Thecompany has 9 business groups. Corporate has a healthand safety director with a link to this interviewee in hisrole in his business group.The division the interviewee works in has about 50employees. This group works on projects such asdecommissioning and cleaning up old weapon sites.Interviewee’s role is to oversee projects in a consultingcapacity for clients and to provide support for thesafety program within his division. The commitmentto safety is significant, including this statement ininformation about the company:Health. Safety. Security. Environment. These arethe pillars of Target Zero, our comprehensiveoperational and educational program that spansall company projects and offices. Target Zero isabout a safe work environment, fostering a 24/7culture of safe behavior, and a continual drivetowards no adverse environmental impact. Italso extends to security and asset protection,ensuring that staff, project sites, and clientand company information and properties areproperly safeguarded.This commitment is demonstrated in part by themonthly health and safety leadership meetings withall employees. John’s division leadership as well as thecompany president is very supportive. The goal simplystated is: no injuries, no harm to the environment.In April, all the safety groups corporate-wide werebrought together by conference call with all thebusiness group leaders to share ideas and objectives.This is a way to learn about best practices across thecompany.36. Did you consult with others to complete theonline survey? NO37. Tell me about your obesity prevention program.We do not have an obesity program in this division orat the corporate level. The interviewee has brought tohis group off-the-job safety information and education.In addition, he has provided training for ALL 50employees for CPR, AED and First Aid as part of theprogram. Information for education has included radonat home and working at heights, among other safetyrelatedissues.Human Resources sponsors brown bag lunches aroundhealth topics. There is a fitness center on site and aWeight Watchers group. Programs made availablethrough corporate are adapted to the specific needs ofthe business group.38. From your own experience, what is the processyou have used or observed for what youconsidered when deciding how and what todiscuss with your employer members and withtheir employees?The worksite meetings are a very effective way todeliver information and have reinforcement of theimportance by senior leadership. Gaining the supportof the division president is important. The monthlymeetings include an awareness topic, such as “healthyliving” in May. By direct interaction with employees,John and his staff provide support for such needs asergonomics and accommodations such as a specialwork station that allows an employee to stand whileworking at his/her computer. All employees have anergonomic evaluation by the local safety manager withaccess to online training as well. Senior managementvisible support is very important.39. Can you discuss why you feel there is a disconnectbetween the perceived need to address obesityas an important health issue and the lack ofaction(s) taken?The goal to not be intrusive and to be anaccommodating employer is demonstrated bycommuter hours, flexible work schedules, time off formedical appointments, and accommodation for backto work with part time hours, etc. The state where thecompany is headquartered and this division is locatedhas less obesity that some other states and moreopportunity and encouragement for outdoor andphysical activity.40. What do you think the main benefits oradvantages are for your coalition and youremployer members by having a workplaceobesity program? Not applicable.41. From the potential sources of information, whatdo your members use and why?Interviewee uses information from numerous sourceswith NSC being a major supplier with an example citedas “how to properly set rear view mirrors for yourcar” as one that was well-received when provided toObesity/Weight Management Employer Survey and Interview Project 73

employees. Others have included workplace violenceand security issues. Intranet and web information areeffective mediums with employees since many are onsite projects.Learning from other employer practices is alsovery valuable. This can be from local meetings orobservations at client sites.42. Very few employers are working with communitybasedorganizations around obesity and healthissues according to survey responses. Hasyour organization formed partnerships aroundemployee health generally and/or obesityspecifically?The company does support and work with communityentities but that is directed from another functionalarea.43. From the survey, we learned that most employerspolled feel obesity is an important health issue,but less than half reported they currently have aprogram in place to address the issue. Can youdiscuss, from your perspective, why you feelthere is a disconnect between the perceived needand action taken?The need in the headquarter’s state does not seem tobe great as stated previously. Most employers would bereluctant to be intrusive with their employees.44. Many employers find it difficult to initiate aconversation with their employees around healthyweight and obesity prevention and control. Fromyour own experience, walk us through the processof what you consider or would consider whendeciding how and what issues to discuss withemployees?Addressing how living healthy, including diet andphysical activity, would be a positive way to approachweight and other health issues as well. Another mightbe “safety in life,” if this could be related directly tosafety.45. Think for a moment about the main sourcesof obesity related information you chose inthe survey. Why did you seek out this sourceof information (e.g., referred to it by another,credible source, existing relationship)?NSC has provided useful program ideas and tipsincluding a “5 minute” discussion component aboutvarious issues. By putting health issues into the safetycontext, this is very useful.46. The survey indicated that very few employerspolled are actively working with communitybasedorganizations around obesity and healthissues. Has your organization formed partnershipsaround employee health generally and/or obesityspecifically (YES/NO)? Thinking about thesepartnerships…Not known. Business groups work within theirrespective communities but no direct knowledge onthis issue.Employer Interview E47. Could you begin by telling us a little more aboutyourself?Interviewee has been employed by the company forthree years and became Wellness Manager, which is inthe Human Resources Department, 6 months ago. Priorto that, interviewee was in the safety function.The Wellness Program was established several yearsago for all United States locations. Salaried andnon-union employees who are eligible for companyprovidedbenefit programs are automatically eligibleto participate in the Wellness Program. Manufacturingand other locations with labor negotiated workersare eligible if the union negotiates to be part of theprogram. The Wellness Program provides opportunitiesfor participants to receive incentives which requirelabor negotiation.This employer is headquartered in the northernMidwest and is in the Consumer Foods manufacturingand marketing branded products to retail andfood service customers in the United States andinternationally. Commercial Foods manufactures andsells a variety of specialty products to food serviceand commercial customers worldwide. The companywebsite includes a search option to identify productnutrition with such options as low fat, low cholesterol,sodium controlled, etc. The website also includes thefollowing statement on corporate responsibility:At ….., our corporate responsibility program isa natural extension of our mission statementand operating principles. We have identifiedthree strategic planks that reflect and articulate74National Business Coalition on Health

our values as a responsible corporate citizen:Good for You, Good for the Community andGood for the Planet. Within each of these threeplanks, we focus on material initiatives, thosethat we believe will be impactful to our businessand stakeholders, and represent our role in theindustry and marketplace. (Source: CorporateWebsite Corporate Responsibility Statement)48. Did you consult with others to complete theonline survey? No49. Tell me about your obesity prevention program.What kinds of activities (education programs,policies, workplace supports such as stairwellimprovements, onsite fitness facilities ormenu labeling in the cafeteria, benefit design,incentives) does your organization offer toemployees? How often?We have a vendor-administered wellness program thatis open to all salaried and non-union employees anddependent spouses who are eligible for benefits. Unionemployees are eligible, subject to their bargaining unitprogram negotiation. The program, which is voluntary,allows participants to earn points as wellness creditswhich are then paid out to employees in the followingyear as premium reductions. All of the points arepresently based upon participation.The program encourages a worksite preventivescreening (at sites with 100 or more employees) usingthe vendor program. The screening includes a healthassessment plus biometrics with counseling. Thehealth assessment is also available online and paperif requested in both English and Spanish. Outreachis provided if a participant’s results suggest that aconsultation with the individual’s physician is meritedsuch as for screening results out of the normal range.The health assessment and screening each providepoints for participation. Results from the assessmentare provided to the participant with informationabout programs and opportunities to address issuesidentified. Additional support is available througha health advisor, health coach, and specific diseasemanagement programs for participants who areoutside of the norm areas. Participation in eachprogram is voluntary.We recently changed wellness program vendors tobe able to address measurement of program resultsbeyond the participation level. Objectives for the nearterm are to move toward outcomes measurementand improved reporting on results. Lost time data isnot available for the salaried workforce and has notbeen used in program measurement for the hourlyworkforce. An additional near term goal is to find achampion for each location to help stimulate increaseduse of the program and ownership at the local worksite.HR has two staff for the program and is working formore outreach to the safety function staff for increasedcollaboration on the program that would support eachfunction. We also established a voluntary employeeweight loss program internally that features theprepackaged foods that the company manufacturestargeted at nutrition and portion control.50. Many employers find it difficult to initiate aconversation with their employees around healthyweight and obesity prevention and control. Fromyour own experience, walk us through the processof what you consider(ed) when deciding how andwhat to discuss with your employees?The wellness program is addressed as a lifestyle issueand promoted as a voluntary program that reinforcesthe fact that the company cares about the health of itsemployees. Incentives for the program are valuable yetadd to the complexity of program implementation withemployees who are covered under union bargainingagreements.51. Switching gears to think about other employers,from the survey, we learned that most employerspolled feel obesity is an important health issue,but less than half reported that they currentlyhave a program in place to address the issue. Canyou discuss, from your perspective why you feelthere is a disconnect between the perceived needand lack of action(s) taken?The major issue is concern with confidentiality andnot being intrusive with personal lifestyle and health.These are some suggestions about what might help toengage more employers:E Employer examples and case studies includingthose employers with unions,E Management performance and measurement,especially dashboard examples,E Reporting examples for management andemployees to show results and value of program,E Design features that address sustainability (whetherdirectly in the program or in how the program issupported by managers and senior management,etc.),Obesity/Weight Management Employer Survey and Interview Project 75

E Sample policies and other tools especially asadaptable for smaller worksite locations,E Examples and approaches for program refreshmentand sustainability,E Outcomes measurement examples and information,andE Peer group access with networking opportunities52. What do you think are the main benefits oradvantages for your organization of having yourworkplace obesity program?The wellness program includes weight managementand obesity so does not single out any one health issue.Programs demonstrate the fact that the company caresabout employee health and, with appropriate metrics,can demonstrate cost effectiveness.53. Think for a moment about the main sourcesof obesity related information you chose inthe survey. Why did you seek out this sourceof information (e.g., referred to it by another,credible source, existing relationship)?Information sources are from the wellness vendor,networking, and organizations such as WELCOA orWELCOM.54. The survey indicated that very few employerspolled are actively working with communitybasedorganizations around obesity and healthissues. Has your organization formed partnershipsaround employee health generally and/or obesityspecifically (YES/NO)? Thinking about thesepartnerships…The company has no relationships with communityorganizations. The wellness program does providepoints for employees who submit a request usinga wellness program request form, who participatein community events such as the Breast CancerAwareness Walkathon, Heart Health Walk, or otherhealth improvement related programs. The companyhas no systematic way to identify and adviseemployees about these events.Employer Interview F55. Could you begin by telling us a little more aboutyourself?Interviewee, Compensation and Benefits Administrator,has a Master’s in health promotion and moved to thisposition after having been responsible for the wellnessprogram at a larger employer. Interviewee’s trainingand former position bring a wealth of expertise tothe company since interviewee understands and hascontacts with community-based health resourcesand experience working with wellness programs thatprobably far exceeds that of the average benefits staffperson.Company is a provider of fuel transportation with about200 employees with locations from Michigan to theGulf coast. Headquarters are in the Midwest.56. Did you consult with others to complete theonline survey? No57. Tell me about your obesity prevention program.What kinds of activities (education programs,policies, workplace supports such as stairwellimprovements, onsite fitness facilities ormenu labeling in the cafeteria, benefit design,incentives) does your organization offer toemployees? How often?The wellness program is supported from the executiveoffice with both funding and buy in. The companyhas an approach that is family-oriented with acommitment to help take care of its employees. Thisphilosophy allowed the development of the wellnessprogram. A Wellness Committee was established witha designated employee from each location. No safetypersonnel are directly involved in the wellness programpresently. The program includes obesity and weightmanagement. The program is built on the mindbody-spiritconcept so no one issue such as obesityis singled out. The program exemplifies the fact thatcompartmentalization is not realistic since one area ofhealth prevention and wellness often leads to another.For example, tobacco cessation may have an impact onweight management or depression may be part of theissues that need to be addressed for obesity.The company has tobacco-free work place policiesthat reinforce the wellness program. This programfor tobacco-free extends not only to worksites, but tocompany vehicles.76National Business Coalition on Health

Program features include an online health assessmentwith screening at the corporate location for metrics.Points can be earned for participation for up to $120per year. The incentives are paid via a reloadabledebit card that is also used for other companyaward programs such as safety or other recognition.Resources for the program include those providedby the insurance company as well as communitynonprofits such as the American Heart Association,American Lung Association, etc. who have educationprograms and information that can be made availableto employees. The local Health Department has aregistered dietician who has been able to supporteducation and a Quit Line for tobacco cessationsupport.Since the company has a fully insured health benefitsprogram, program success is measured in terms ofcorporate culture and participation. Measurement is atthe aggregate level.58. Many employers find it difficult to initiate aconversation with their employees around healthyweight and obesity prevention and control. Fromyour own experience, walk us through the processof what you consider(ed) when deciding how andwhat to discuss with your employees?We want to be supportive but not intrusive withemployees plus reach out to the dependents ofemployees, recognizing that health benefits andprograms have a link to home. The wellness programhas been put in that context and as a holistic approach.Recognition of the dispersed locations of employees isalso a strong consideration since the company wouldlike employees to have access to the same types ofprograms and opportunities.59. Switching gears to think about other employers,from the survey, we learned that most employerspolled feel obesity is an important health issue,but less than half reported that they currentlyhave a program in place to address the issue. Canyou discuss, from your perspective why you feelthere is a disconnect between the perceived needand lack of action(s) taken?Employers look at health issues, including obesity, as apersonal issue. While concerned about employee healthand well-being, employers do not want to be viewedas “big brother.” Another barrier is the perception thata large budget and resources are essential to addresswellness. Leveraging community resources to addresswellness does not appear to be a well-developedapproach and many employers do not know what theseresources are in their community.Ideas that might help increase the number ofemployers who have programs include:E Thinking about a wellness program and healthyworkplace culture as a continuous qualityimprovement process,E Measurement, especially for smaller employers,and moving away from cost avoidance as the majorapproach,E Ways to build “health” into the work day with quickand easy approaches,E Examples of how management models the behavior,E Understanding the impact of obesity-related healthconditions, etc., andE More information about the mind body connectionfor behavior change including motivation and stagesof change/readiness to change60. What do you think are the main benefits oradvantages for your organization of having yourworkplace obesity program?The wellness program reinforces the company caringand support for employees that affect the companyculture and employee morale. Cost savings in terms ofdirect and indirect costs are also a component — evenif the employer cannot extract all of the data for exactmeasurement. (These savings have been demonstratedby other employers.)61. Think for a moment about the main sourcesof obesity related information you chose inthe survey Why did you seek out this sourceof information (e.g., referred to it by another,credible source, existing relationship)?Credible sources include CDC as well as the entitiessited previously. New information is needed targeted atthe motivational aspects of change and easy to accesscommunity-based resources.62. The survey indicated that very few employerspolled are actively working with communitybasedorganizations around obesity and healthissues. Has your organization formed partnershipsaround employee health generally and/or obesityObesity/Weight Management Employer Survey and Interview Project 77

specifically (YES/NO)? Thinking about thesepartnerships…Working with community resources is critical forour wellness program, as noted above. This is morecomplicated in non-headquarters and smaller locationswhere the network and access to resources are notreadily and easily identified.In addition to these program resources, this intervieweewas instrumental in establishing an ongoingnetworking group for local employers called theWellness Forum. This group allows employers to learnfrom each other about best practices, share resources,and other information that helps each employer to startor continue a program for wellness. This group sharesacross industries with both private and public sectorinvolvement along with schools. Using a “LinkedIn”type format, networking and communication form thebasis for an ongoing dialogue with quarterly meetingshosted at various sites — public health department,hospitals, employer worksites, etc. This discussionopportunity recognizes that each employer has uniquecharacteristics, challenges, and opportunities soreplication of a successful program with one companymay require adaptation for another employer.Employer Interview G63. Could you begin by telling us a little more aboutyourself?Interviewee, RN, MSN, is the nurse and on-sitehealth care link for employees at one major locationin the Northwest for an aerospace and companyheadquartered in the Midwest. The company has18,000 employee located at 60 facilities in 22 statesand internationally. Products are for aerospace,armament, missiles, and security and sporting.Interviewee is responsible for support for worksiteinjuries, first aid, and on-site health questions fromemployees at a facility with 850 employees, that is alsoexpanding. There are no obesity or wellness programsin place. Interviewee has been an employee for 1.5years and found out about the survey through the localstate National Safety Council group.The company has a social responsibility report thataddresses community involvement, environmentalstewardship, ethics, and safety. One statement in thisreport from the President and CEO is:“We recognize the health of our communitiesis critical to our success, and we supportorganizations and causes that help strengthenthe fabric of our community.”This is currently addressed through corporatecontributions and employee volunteerism. Prior to theeconomic downturn, the company did more with thecity recreation programs, etc.64. Did you consult with others to complete theonline survey? No65. Tell me about your obesity prevention program.The company has no obesity or wellness program. In2010, the company did sponsor a 12 week program toencourage appropriate nutrition and physical activity.Teams were set up and results tracked over the 12 weekperiod. There has not been follow-up or expansion ofthis one time program. The company does addresswellness in its overall employee benefit education.Interviewee is trying to introduce a change in herbusiness unit to move towards a culture of health.66. From your own experience, what is the processyou have used or observed for what youconsidered when deciding how and what todiscuss with employees?With sponsorship from Senior Management, meetingsin each business unit that have a component on healthylifestyles and wellness might be an effective means toreach employees. Another effective way would be tohave coordinators at each worksite.67. Can you discuss why you feel there is a disconnectbetween the perceived need to address obesityas an important health issue and the lack ofaction(s) taken?The major focus at the company is on building thebusiness and retaining/securing contracts. The statewhere this business unit is located is a healthier statethan others and health is not a foremost issue. The mostsignificant issue is successful business in the currenteconomic downturn. Targeted education to seniormanagement would need to occur to gain their supportand other industry or employer examples to helpshow what can be done and results would be neededespecially as these link to overall business success.78National Business Coalition on Health

68. What do you think the main benefits oradvantages are your employer by having aworkplace obesity program?Major advantages in having such a program, preferablyfor wellness and not limited to obesity, would includefewer injuries at work and home, less lost work timeincluding both absenteeism and presenteeism, andhealth insurance premium reductions.69. From the potential sources of information, whatdo you use and why?Information used and accessed most is that from CDC,non-profits such as the AHA, and from safety sources.Internally, the company has an intranet but thatmay not be highly used on a regular basis. Effectiveways to deal with higher management is via email.Short messages to managers might also be effective.Interviewee noted that information on sustainabilityof programs as well as competitor or like industryexamples, cost/benefit information, and information onwhat neighboring worksites are doing would be helpful.70. Very few employers are working with communitybasedorganizations around obesity and healthissues according to survey responses. Hasyour organization formed partnerships aroundemployee health generally and/or obesityspecifically?No partnerships. Only ones known to have been inplace are discounts to local gyms. Interviewee has nothad experience with these organizations.Employer Interview H71. Could you begin by telling us a little more aboutyourself?Interviewee is the Safety Coordinator at a productmanufacturing facility for a diversified manufacturer.Products include:E Locking systems for a wide variety of applicationssuch as office furniture, cabinetry, motorcycles,postal boxes, vending machines, and computers,E Ergonomic computer support products includingkeyboard arms and flat panel monitor mounts, andE Gauges and exhaust systems for high-performanceboatsMajor company locations are in the South and Midwest.Interviewee’s responsibilities are with all aspects ofworker safety — training, policy development andimplementation, investigations and audits, purchaserequests related to safety equipment, and evolvingsupport for the Human Resource benefits function.This location in the Midwest has about 200 employees.Overall, the company has about 600 employees.72. Did you consult with others to complete theonline survey? NO73. Tell me about your obesity prevention program.The company does not have a program on obesity.Employees on their own have started a weightmanagement group that includes weekly weigh-insand a competition, with a winner every 16 weeks whoreceives a gift card. This has all been developed byemployees on their own.74. From your own experience, what is the processyou have used or observed for what youconsidered when deciding how and what todiscuss with your employees?Weight management and obesity are viewed aspersonal issues for the employee and the companyfinds it a challenge to address such personal issues. Wedo provide information and education about health andhealth issues such as obesity but feel that employeesmust make their own decisions.Observationally, we do not seem to have much of aproblem in our workforce at this site.We do talk about health as part of our ergonomicsdiscussion with employees when we also encouragestretching and walking, etc. Providing education toemployees and their families about how good healthhelps an individual both at work and at home wouldbe a part of an approach where we might want tonote that behaviors and health status that affects thecompany and work also may affect the employee andhis/her home life.E Precision ball bearing slides for office furniture,appliances, tool boxes, ATM’s and server racks,Obesity/Weight Management Employer Survey and Interview Project 79

75. Can you discuss why you feel there is a disconnectbetween the perceived need to address obesityas an important health issue and the lack ofaction(s) taken?As described above, the issue is personal to theemployee. Since we do not seem to have much of aproblem with our workforce, we do not see this issueas having a significant impact on our insurance costs orproductivity. Additionally, we have a diverse workforceand want to respect individual preferences and culturesas well as language.76. What do you think the main benefits oradvantages are for your employer if you were tohave a workplace obesity program?The potential to impact direct and indirect costs mightbe a factor. In the safety area, we do not have accessto information about benefit or claim costs that mightsuggest overweight/obesity is a cost issue or an areafor concern due to the conditions related to obesity. Wehave not seen this as an issue with our safety program.The CEO is engaged in the safety program and we havea strong commitment to safety. This is demonstratedby the ongoing evaluation program for safety thatprovides rewards to employees: 3 months withoutan accident, employees are provided with lunch bythe company at the worksite; 6 months without anaccident, employees are provided with a half day (4hours) of time off. Currently we have logged 3 millionhours with no accidents.Employees are encouraged to speak with coworkers ifthey see an unsafe work practice since peer influenceis very helpful in achieving our goals. We also have anannual meeting with Senior Management to report onsafety and our results. This is part of an annual 3 daytraining and sharing best practices meeting for all ourfacilities. At an annual employee meeting, issues withOSHA, training, etc. are presented and discussed withemployees. In addition, we have a training facility withvideo conference capability as well as individual andgroup training.We might benefit from an approach where we wouldstep back and look at the entire picture with theworkforce to address: is there a problem? We coulduse claims and other data to assess the picture withrespect to employees and families for such conditionsas heart health and diabetes along with any informationfrom health assessments or physical assessments. Thismight include a brief overview of how obesity relatesto other medical conditions. This would provide a morecomprehensive context for the discussion.77. From the potential sources of information, whatdo you use and why?Information sources include OSHA (occupational safetyand health), NEPA (National Environmental Policy),CDC, NSC, specialty organizations such as those fordiabetes, and the Internet. Information is varied andaligns with specific issues such as safety or a healthcondition. Each separate view needs to be put togetherfor a total “picture.” Information from insurancecompanies might also be very helpful.We would welcome more information from CDC andNIOSH that would include:E Education for management,E Education for individuals (nonjudgmental),E Training for safety,E Procurement guidance that supports safety andeffectiveness (ex. education about such items asstepladder weight restriction information),E Non regulatory approaches,E Individual responsibility and choice with educationto show the benefits for healthy choices withexamples with overweight and without, andE Recognize the differences in employer worksitesand needs — “one size does not fit all”78. Very few employers are working with communitybasedorganizations around obesity and healthissues according to survey responses. Hasyour organization formed partnerships aroundemployee health generally and/or obesityspecifically?The company supports the United Way, AmericanRed Cross and other community organizations but hasnot engaged with any community partners for healthissues. If we were to do that, local physicians andhospital or clinic programs might be helpful.There is also a fitness center in the community thatprovides a discount for employees. The city has a walkarea that is a wildlife area near our worksite. Employeesare encouraged to walk or visit the area during lunch orbreaks.80National Business Coalition on Health

79. What do you think are the main benefits oradvantages for an employer to address obesity inthe worksite? What are the main disadvantages orchallenges?Addressed in prior questions.80. The survey indicated that very few employerspolled are actively working with communitybasedorganizations around obesity and healthissues. Has your organization formed partnershipsaround employee health generally and/or obesityspecifically (YES/NO)? Thinking about thesepartnerships…The company has an interest in helping the community.Perhaps a recognition award program for companycommunity efforts would be an effective tool to helpwith this effort for all businesses.Obesity/Weight Management Employer Survey and Interview Project 81

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