Health and the "Bottom" Line

IT WAS A HOT DAY in Orlando, Florida, and I was in my swimsuit. But instead of lounging by the pool, I was sitting, somewhat self-consciously, in an instrument called the BOD POD®. This large, white, egg-shaped machine bears a strong resemblance to Robin Williams's spaceship in the sitcom Mork & Mindy. The physiologist operating the machine asked me to sit as still as possible and breathe normally, which was a little difficult to do because I'm slightly claustrophobic and the egg didn't have a lot of wiggle room on the inside. But sitting still, I learned later, was important for the machine to work. As I sat there quietly, nervously chanting to myself, "Mork calling Orson, come in Orson," to keep from having a panic attack, the BOD POD® was hard at work. This machine, one of the most specialized of its kind, uses air displacement plethysmography technology and is designed to measure body composition. Specifically, it tallies body fat and lean mass and gives accurate estimates of the amount of kilocalories burned daily at a resting metabolic rate and at varying levels (sedentary, low activity, active, or high activity). For trainers who use the device with elite athletes, this is a highly useful tool for helping their clients fuel themselves appropriately, matching calories consumed to calories burned, which typically varies during the course of the day based on their workout schedule.

At the Johnson & Johnson Human Performance Institute (JJHPI) in Orlando, where I was that day, the BOD POD® was being used on a group of corporate executives from all over the world as one of the first activities for their Corporate Athlete course. Technicians were measuring our baseline data, with information from the BOD POD® and a blood draw, to provide all of the participants in the course with a snapshot of their health. JJHPI does this so that participants in the course face the truth about their current physical health situation. For many of us, the detailed information we received about our glucose levels, cholesterol, and vitamin deficiencies was not unexpected. For some of us, though, this information was a bit of a shock, and I was one of those people. My numbers said that I was no longer the Sporty Spice long-distance power runner I was 10 years ago. Instead, I was solidly in the category of having too much excess fat, and I was clearly overweight. Ouch. And so, with a jolt, began my reeducation about health, wellness, and the need to make necessary changes at work, at home, and in all aspects of my life.

I first learned about JJHPI from some of my corporate clients. This Corporate Athlete® course is a program they raved about, and it specifically caters to corporate executives, not elite athletes (though JJHPI trains them too). The Corporate Athlete® program has included employees from Glaxo-SmithKline (GSK), Deere & Company, Pepsico, Estee Lauder, Morgan Stanley, Allstate, and Johnson & Johnson (J&J) on a regular basis. In fact, J&J has sent more than 50,000 employees through the course to date (in several formats) and aims to train many more employees globally as part of its overall health and wellness program. J&J leaders believe in it so much that they bought the company.

JJHPI was cofounded in 1991 by Dr. Jim Loehr, a performance psychologist, and Dr. Jack Groppel, an authority on human performance, fitness, and nutrition. One of Loehr and Groppel's early research findings came from training professional athletes — clients like tennis pros Jim Courier, Monica Seles, and Pete Sampras, golfer Mark O'Meara, Pro Bowl quarterback Jim Harbaugh, hockey players Eric Lindros and Mike Richter, Indy 500 champion Eddie Cheever, Jr., and Olympic gold medal speedskater Dan Jansen. It's an impressive list.

Over time, Loehr and Groppel found that all of the athletes they trained were excellent technically, but the difference between the good and the great players was their ability to manage energy, both in their training and during competitions. Loehr and Groppel started studying energy management at the cellular level, which led them to develop a comprehensive science-based program for exercise, nutrition intake, sleep, and other forms of recovery throughout the day. They also developed a unique, multidimensional (physical, emotional, mental, and spiritual) behavior change model. Athletes, and also the rest of us, need to be high functioning on many levels to give our best performance on the field or in our jobs. And our behaviors on a daily basis can really inhibit or enable our performance. The Corporate Athlete® program focuses in on what those behaviors are and how to modify them.

It is fair to say that the companies sending their senior leaders to the Corporate Athlete® course are seeing a lack of energy and engagement in their employees and in general, and they clearly believe that paying for leaders to attend training is a worthwhile investment, not just in the lives of their people but in the value of their company. Several studies conducted to evaluate the Corporate Athlete® course suggest JJHPI is on to something pretty powerful. When surveyed, graduates of the course suggested they had more energy, better mental health, better emotional well-being, and better general health, even 18 months after they took the course. When course-takers were asked to rate their performance over that time, they said they improved productivity based on worktime missed, time spent actually working, and "the extent to which health is affecting both work productivity and regular daily activities." Considering that most of the people taking the course are generally pretty healthy to start, it's impressive to see these positive changes.

A study performed by GlaxoSmithKline assessed how the Corporate Athlete® training impacted companies at the organizational level. It evaluated the relationship between Corporate Athlete® training and changes in on-the-job behavior, comparing leaders who had taken the course to their peers. Program graduates achieved more favorable assessment ratings on all behaviors, most notably on their "developing people" behavior. Results suggest that investing in leaders in this way may foster a culture of employee empowerment. We'll touch more on the Corporate Athlete® course and some of their specific strategies in Chapter 4 and Chapter 8.

I'LL HAVE WHAT SHE'S HAVING

Leading companies like Google, Facebook, Apple, Next Jump, Under Armour, Aetna, The Motley Fool, Owens Corning, and Johnson & Johnson have learned that to stay ahead and compete, they have to take the health of their employees more seriously than they might have in the past, not just to save costs but also to acquire new talent and take full advantage of the talent they already employ. Healthy employees are more creative, productive, and engaged and are less prone to take sick days and suffer from chronic illnesses. Employees are the engine that keeps companies running. And healthy employees, who are emotionally, mentally, and physically prepared to take on whatever challenge is in front of them, are more likely to make the companies they work for grow and flourish.

Seems pretty simple, right? So why are most workplaces so unhealthy? Did we just fall asleep at the wheel? It turns out that in a way that is true. Without our paying attention, the way we work has changed and our work style is such that our workplaces are no longer supporting our health or productivity. Over the last 50 years, especially, we have become more and more sedentary, staring at electronic devices for long periods of time with very few breaks. And when those breaks are taken, it's typically for a fast-food lunch or a sugary snack from a nearby vending machine. As a result, 70 percent of Americans are overweight (and suffering from a host of diseases associated with it, many potentially fatal), along with having chronic physical ailments including neck, back, and shoulder pain, headaches, and eyestrain. Since work no longer ends when the traditional 9 to 5 workday does, workers suffer from a lack of exercise and sleep, poor nutrition, and stress. And the physical environment they occupy is not exactly helping either. Most workers struggle with poor ergonomics, air quality, lighting, and views to the outdoors, as well as problems with thermal comfort and acoustics. Taken together, all these factors combine to make the hours spent in the workplace the least healthy part of the day.

THE PROBLEMS WE HAVE TO SOLVE

You cannot watch the news today in America without hearing about the cost of health care. In 2013, the United States spent more than $2.9 trillion annually, or 17.4 percent of the gross domestic product, on health care services, more than any other country. A large majority of the cost goes to treating noncommunicable, chronic illnesses like diabetes, heart disease, lung disease, and Alzheimer's. Chronic diseases cause 7 out of 10 deaths and account for 80 percent of dollars spent on health care in the United States. And the rise in such diseases is a quickly growing problem that is contributing to rising health care costs. In 2012, U.S. employers spent $578.6 billion on group health care coverage, which is a 72 percent increase over the $336.1 billion spent in 2000. In addition, a global survey of business executives conducted by the World Economic Forum and the Harvard School of Public Health from 2009 to 2011 identified noncommunicable diseases as one of the leading threats to global economic growth.

Let's look at some of the specific health problems facing us today.

* Obesity

One of the contributors to many of these chronic diseases is being overweight and in particular being obese, now reaching epidemic proportions. Obesity levels in American adults doubled from 1980 to 2012. The problem does not just exist in the United States. Across the countries in the Organization for Economic Co-operation and Development (OECD), 18 percent of the adult population is obese. More than one in three adults in Mexico, New Zealand, and the United States, and more than one in four in Australia, Canada, Chile, and Hungary, are obese. In the United States, obese men incur $1152 more in direct annual health costs than normal-weight men, and obese women incur $3613 more than normal-weight women. Overweight men miss 56 percent more days of work per year than normal-weight men, and overweight women miss 15 percent more days than normal-weight women.

Research shows that as people become overweight and obese, their risk for developing a number of chronic diseases goes up, including coronary heart disease, type 2 diabetes, various cancers (endometrial, breast, and colon), hypertension (or high blood pressure), dyslipidemia (for example, high total cholesterol or high levels of triglycerides), stroke, liver and gallbladder disease, sleep apnea and breathing problems, osteoarthritis (a breakdown of cartilage and bone within a joint), and gynecological problems (such as abnormal periods and infertility). This is truly a frightening list.

* Smoking

Worldwide, tobacco use causes nearly 6 million deaths per year, and current trends show that tobacco use will cause more than 8 million deaths annually by 2030. Even though smoking does not happen inside workplaces (in most industrialized countries, anyway), there are still millions of people racing to the front doors of buildings everywhere to smoke several times a day. According to the Centers for Disease Control, tobacco use remains the leading cause of preventable morbidity and mortality in the United States.

* Musculoskeletal Issues

Pain in our bodies plagues us and is perpetuated by our work. Musculoskeletal disorders (MSDs) and diseases are the leading cause of disability in the United States and account for more than half of all chronic conditions in people over 50 years of age in developed countries. The annual direct and indirect costs for bone and joint health in the United States are $950 billion, roughly 7.4 percent of the U.S. gross domestic product. In the UK, the total number of working days lost due to MSDs in 2013-2014 was 8.3 million, an average of 15.9 days per case of MSDs (out of 526,000 cases that year).

Even if you do not engage in heavy labor, the act of repetitive motion or even lack of motion for long periods can still cause all sorts of problems. Our sedentary behavior is also putting us at risk for cardio metabolic risk factors like diabetes, heart disease, and stroke, and they are causing an increase in the number of cases of deep vein thrombosis (blood clots in the legs), which has been traditionally associated with heavy travel but also is regularly caused by long periods of sitting.

* Stress

Another major contributor to our health issues is workplace stress. Not all stress is bad, but stress overload can negatively affect our mental and physical health, decrease productivity, and lead to burnout. According to a recent survey from the American Psychological Association, 42 percent of adults report that their stress level has increased (36 percent say their stress level has stayed the same) over the past five years. Stress can negatively impact sleep, eating patterns, and our willingness to exercise. It is often caused by changing job requirements, the lack of involvement in decision making, lack of recognition, poor working relationships, poor physical working conditions, or long or erratic work schedules. The World Health Organization estimates that stress costs American businesses $300 billion a year. And that does not include the negative impact on our personal lives.

* Absenteeism and Presenteeism

All this chronic illness has caused increases in absenteeism and presenteeism (which is going to work while being sick or not fully engaged). Walter Stewart, a director of the Center for Health Research and Rural Advocacy at Geisinger Health System in Danville, Pennsylvania, engaged in a yearlong survey of roughly 29,000 working American adults. He calculated the total cost of presenteeism in the United States to be more than $150 billion per year. Another study from the Journal of Occupational and Environmental Medicine found that the on-the-job productivity loss resulting from depression/anxiety, obesity, arthritis, and back/neck pain was 2.3 times greater than the absence-related productivity loss attributed to these conditions. In other words, less time was actually lost from people staying home than from people showing up to work not fully charged.

Human resources groups are scrambling to evaluate company contributions to health insurance premiums for their employees and searching for impactful ways to increase wellness through preventive care, health screening, education, organized activities, incentives, and rewards. But is this really enough? Are we just trying to slap Band-Aids on a chronic health problem, or should we be trying to eliminate these problems in the first place? And can we literally change the way we work — integrate movement, improve our diet, and engage in relaxation techniques — so that we lose weight, reduce stress, increase our productivity, and prevent these chronic diseases and ailments before they even start?

LET'S RETHINK THE WORKDAY

It turns out that despite what some pharmaceutical companies would like us to think, there is no magic pill you can take to turn into Wonder Woman or Superman. But fortunately, the basic elements of keeping us at our healthy best are pretty straightforward. They include getting enough sleep, good nutrition, integrating movement and exercise throughout the day, maintaining healthy stress levels, and working in a healthy environment. It sounds so ridiculously simple, so why is it so hard to achieve? A big reason is that what our minds and bodies need at a basic level is in conflict with our work style. Consider this:

* Sleep. Our bodies need rest, but we have artificial lighting, technology, and work expectations that wreak havoc on our natural rhythms and keep us up all hours of the night. This causes all kinds of health and productivity issues.

* Nutrition. We eat foods at work that have been processed to the point that our bodies do not know how to digest them efficiently. Have you looked at what is in the vending machine at your office?