Many people spend years dreaming about their retirement. Unfortunately, today's workers will likely work longer, suffer greater economic uncertainty, and might have poorer health status compared with retirees in previous generations. Preserving good health during the working years is associated with a more consistent employment record, greater financial resources, and reduced risk of disease. Making smart financial decisions as a younger adult also translates to improved finances in retirement. While many people are aware of these relationships, many continue to make poor health choices. Employers and lifestyle medicine professionals can both work to improve financial well-being in retirement. Employers can offer effective worksite financial wellness programs and promote participation in retirement savings programs. Physicians and other health providers can foster healthy behaviors, encourage preventive services compliance, and help adults foster overall financial and health well-being. Adopting a healthy lifestyle as early as possible would increase the likelihood that today's workers will enjoy financial security in retirement.

The issue of employee productivity has become a major concern for companies. Inefficiency can occur at every stage of production either as poor design, worker limitation, or other factors. It is generally assumed that a healthy worker is more productive than an unhealthy worker. As early as 1776 Adam Smith observed and published in The Wealth of Nations that poor worker health was a detriment to industrial productivity. The objective of this article is to review the literature documenting the gain or loss of productivity related to the health of workers, as well as any lifestyle management strategies that can be used to improve employee health and productivity. The impact of employee obesity, smoking, physical activity, sleep, and behavioral health on productivity will be explored. By identifying and addressing health risks that impair worker performance, lifestyle medicine professionals can demonstrate a significant return on investment by creating a healthier and more productive work force.

The cost of medical care in the United States is increasing at an unsustainable rate. The lifestyle medicine (LM) approach is essential to influence the root causes of the growing chronic disease burden. LM addresses health risk factors in primary, secondary, and tertiary prevention of developing disease rather than limiting resources and medical expenditures on acute care and reacting to illness, injury, and disease. Employers have much to gain financially from such an approach due to their status as the payer of health care costs for their employees, and as the recipient of productivity gains among their employees. This article discusses LM programs delivered at the worksite, including important findings from the University of Michigan Health Management Research Center. Examples of evidenced-based population LM interventions are summarized for physical activity, weight management, and nutrition programs that address chronic diseases such as cardiovascular disease, cancer, and diabetes mellitus. These approaches have the potential to reduce health care cost trends, increase employee performance/productivity, and improve patient health outcomes.

The purpose of this article is to synthesize developments from various disciplines including the medical, wellness, psychology, and sociology fields to shed light on where health promotion is headed in the next 25 years. Lifestyle medicine practitioners will continue to play a large role in helping people achieve the highest levels of wellness, which does not simply mean the absence of disease. New research identifies the important roles of many diverse factors such as relationships, lifestyle behaviors, emotional outlook, positive environment, mind–body connection, use of technology, and work styles, which can help each person achieve the fullness of life, vitality, and flourishing that characterizes a high level of well-being.

Objective: To describe the development of and test the validity and reliability of the Workplace Culture of Health (COH) scale. Methods: Exploratory factor analysis and confirmatory factor analysis were performed on data from a health care organization (N = 627). To verify the factor structure, confirmatory factor analysis was performed on a second data set from a medical equipment manufacturer (N = 226). Results: The COH scale included a structure of five orthogonal factors: senior leadership and polices, programs and rewards, quality assurance, supervisor support, and coworker support. With regard to construct validity (convergent and discriminant) and reliability, two different US companies showed the same factorial structure, satisfactory fit statistics, and suitable internal and external consistency. Conclusions: The COH scale represents a reliable and valid scale to assess the workplace environment and culture for supporting health.

Purpose – The purpose of this paper is to investigate the impact of changes of medical condition burden index (MCBI) and stress on absenteeism and discuss implications for policy/program design. Design/methodology/approach – Sample: US utility employees that participated in Health Risk Appraisals (HRA) during 2009 and 2010 (n=3,711). Methods: the MCBI was created by summing number of medical conditions. Absenteeism was measured from administrative records. Change in MCBI and stress and impact on absenteeism was assessed according to incremental change, by low/high categorizations, and by using multivariate regression. Findings – Incrementally, greater changes in MCBI or stress generally resulted in corresponding absenteeism change. For both MCBI and stress, high categories were associated with greater absenteeism compared to those in low categories. Those remaining in the low MCBI category decreased absenteeism (−0.10 days/year; p=0.01). Changes from low to high MCBI resulted in increased absenteeism (+0.12 days/year; p=0.04. Changes in stress from low to high or from high to low categories resulted in concurrent changes in absenteeism (+0.21 days/year; p=0.04 and −0.31 days/year; p=0.01, respectively). Regression analyses indicated the interaction between stress and MCBI as a significant contributor to absenteeism change. Research limitations/implications – Conclusions: MCBI, stress and their interaction appear to be direct determinants of absenteeism. Companies should consider both physical and emotional health simultaneously in program interventions in order to reduce absenteeism. Originality/value – Unlike most studies illustrating cross-sectional relationships, this study shows how changes in stress and medical conditions relate to changes in absenteeism. The interaction between MCBI and stress in this context is also a novel addition.

The purpose of this article is to synthesize developments from various disciplines including the medical, wellness, psychology, and sociology fields to shed light on where health promotion is headed in the next 25 years. Lifestyle medicine practitioners will continue to play a large role in helping people achieve the highest levels of wellness, which does not simply mean the absence of disease. New research identifies the important roles of many diverse factors such as relationships, lifestyle behaviors, emotional outlook, positive environment, mind-body connection, use of technology, and work styles, which can help each person achieve the fullness of life, vitality, and flourishing that characterizes a high level of well-being.

Objective: Consumer-directed health plans (CDHPs) are popular among employers in the United States. This study examined an employee wellness program and its association with employee health in an organization that recently initiated a CDHP. Methods: This retrospective observational analysis compared the health risks, employer-paid health care costs, and short-term disability absences of employees of a large financial services corporation from 2009 to 2010. Results: The two-time health risk appraisal participants had a significant improvement in the percentage of employees in the overall low-risk category. The average annual employer-paid medical and pharmacy costs did not significantly change. For employees who improved their health risk category, there was a commensurate change in costs and absences. Conclusions: In a difficult economic climate, this organization began a health promotion program for employees as well as a new CDHP benefit structure. No short-term reduction in health care usage or overall health status was observed.

This article explores and reviews the available evidence pertaining to lifestyle, disease, and economic losses in the workplace. The literature shows clearly that higher levels of health risks and behaviors lead to the development of disease and moving to a high-cost status. The data suggest that those individuals with lower health risks and those individuals who achieve a reduction in health risks and unhealthy behaviors result in lower probability of disease and high health care costs. The business case for wellness and prevention is also discussed, as is the concept of investing in health as opposed to a strict focus on health care cost reduction. Furthermore, additional determinants of health such as the social–emotional states and positive characteristics of the individual and of the environment and culture are described. Since health is much more than simply the absence of disease, the members of the College of Lifestyle Medicine are encouraged to expand their interests and research inquiry and efforts in evaluating, supporting, and treating these areas. Physicians play a special role in helping individuals improve their healthy behaviors and knowledge of these lifestyle factors will add significantly to their capacity to serve patients. It is very clear that there are growing research, prevention, and treatment opportunities for members of the College of Lifestyle Medicine. It was demonstrated that there is sufficient evidence that justifies the College of Lifestyle Medicine, as observed by the content and quality of the information shared at the conference in Arlington, Virginia in October 2013.

This article explores and reviews the available evidence pertaining to lifestyle, disease, and economic losses in the workplace. The literature shows clearly that higher levels of health risks and behaviors lead to the development of disease and moving to a high-cost status. The data suggest that those individuals with lower health risks and those individuals who achieve a reduction in health risks and unhealthy behaviors result in lower probability of disease and high health care costs. The business case for wellness and prevention is also discussed, as is the concept of investing in health as opposed to a strict focus on health care cost reduction. Furthermore, additional determinants of health such as the social-emotional states and positive characteristics of the individual and of the environment and culture are described. Since health is much more than simply the absence of disease, the members of the College of Lifestyle Medicine are encouraged to expand their interests and research inquiry and efforts in evaluating, supporting, and treating these areas. Physicians play a special role in helping individuals improve their healthy behaviors and knowledge of these lifestyle factors will add significantly to their capacity to serve patients. It is very clear that there are growing research, prevention, and treatment opportunities for members of the College of Lifestyle Medicine. It was demonstrated that there is sufficient evidence that justifies the College of Lifestyle Medicine, as observed by the content and quality of the information shared at the conference in Arlington, Virginia in October 2013.

This study evaluated the relationships between compliance with oral hypoglycemic agents and health care/short-term disability costs in a large manufacturing company. The retrospective analysis used an observational cohort drawn from active employees of Ford Motor Company. The study population consisted of 4978 individuals who were continuously eligible for 3 years (between 2001-2007) and who received a prescription for an oral hypoglycemic agent during that time. Medical, pharmacy, and short-term disability claims data were obtained from the University of Michigan Health Management Research Center data warehouse. Pharmacy claims/refill data were used to calculate the proportion of days covered (PDC); an individual was classified as compliant if his/her PDC was ≥80%. Model covariates included age, sex, work type, and Charlson comorbidity scores. The impact of compliance on disability and health care costs was measured by comparing the costs of the compliant with those of the noncompliant during a 1-year follow-up. Among these employees, compliant patients had lower medical, higher pharmacy, and lower short-term disability costs than did the noncompliant. After adjusting for demographics and comorbidity, noncompliance was associated with statistically higher short-term disability costs ($1840 vs. $1161, P<0.0001), longer short-term disability duration, and an increase in short-term disability incidence (21.5% of the noncompliant had a claim compared to 16.0% of the compliant, P<0.0001). These results suggest that medication compliance may be important in curtailing the rise of health care/disability costs in the workplace. Employers concerned with the total costs associated with diabetes should not overlook the impact of compliance on short-term disability.

OBJECTIVE:To explore issues related to the aging workforce, including barriers to integrating health protection and promotion programs, and provide recommendations for best practices to maximize contributions by aging workers.METHODS:Workgroups reviewed literature and case studies to develop consensus statements and recommendations for a national approach to issues related to older workers.RESULTS:Consensus statements and actions steps were identified for each of the Summit goals and call-to-action statements were developed.CONCLUSIONS:A national dialogue to build awareness of integrated health protection and promotion for the aging workforce is needed. Workers will benefit from improved health and performance; employers will realize a more engaged and productive workforce; and the nation will gain a vital, competitive workforce.

Objective: Determine whether there is a relationship between level of engagement in workplace wellness programs and population/individual health risk reductions. Methods: A total of 7804 employees from 15 employers completed health risk appraisal and laboratory testing at baseline and again after 2 years of participating in their personalized prevention plan. Population and individual health risk transitions were analyzed across the population, as well as by stage of engagement. Results: Of those individuals who started in a high risk category at baseline, 46% moved down to medium risk and 19% moved down to low risk category after 2 years on their prevention plan. In the group that only engaged through the Web-based technology, 24% reduced their health risks (P < 0.0001). Conclusions: Engaging technology and interactive Web-based tools can empower individuals to be more proactive about their health and reduce their health risks.

OBJECTIVESTo investigate predictors of behavior change intention and discuss potential implications for practitioners.METHODSHealth risk appraisal (HRA) data from 2 organizations were used to develop and confirm a path analysis model for predictors of intention to change behavior.RESULTSLower self-rated health perception and higher ratings of stress corresponded to higher behavior-change intention scores. Stress was associated with poorer health perception.CONCLUSIONSHigher stress and lower perception of health status were directly associated with intention to change behavior. Incorporating stress management and awareness of health perception into health promotion strategies could enhance wellness programs by aligning programs with motivating factors.

Objectives: To investigate predictors of absenteeism and discuss potential implications for policy/program design. Methods: Health Risk Appraisal (HRA) data and self-reported and objective absenteeism (personnel records) were used to develop a structural equation model, controlling for age, sex, and job classification. A Medical Condition Burden Index (MCBI) was created by summing the number of self-reported medical conditions. Results: Higher MCBI and stress were direct predictors of absenteeism. Physical activity was not associated with absenteeism but mediated both stress and MCBI. Conclusions: Because stress impacted both absenteeism and MCBI, organizations may benefit by placing stress management as a priority for wellness program and policy focus. Physical activity was not directly associated with absenteeism but was a mediating variable for stress and MCBI. Measures of stress and physical health may be more meaningful as outcome measures for physical activity programs than absenteeism.

There is an increasing awareness among employers and health care providers that health care needs to be tailored to address the diversity of the workforce. Population-based data have shown significant differences in health behaviors and health risks among different racial/ethnic groups in the United States. The purpose of this study was to examine health risks and changes in health risks over time in an employed population at a financial services corporation. This large financial services corporation is naturally concerned about any disparities in health among employees. The study population consists of employees who participated in the organization's medical plan and also the annual health risk appraisal questionnaire in both 2009 and 2010. Significant demographic differences exist among the four ethnic groups studied: whites, African Americans, Hispanics, and Asians. At baseline, African American employees had a significantly higher average number of health risks measured by the health risk appraisal, but they also experienced the greatest improvement in health risks by time 2. There were differences in the health risk profiles of the ethnic groups, with certain risk factors being more prevalent among some ethnicities than among others. The health care costs were not significantly different among the groups studied here. It is likely that other large employers may also find health risk differences among employees belonging to various ethnicities. Future research in this field should seek to understand the reasons behind differences in health among ethnic groups and how best to address them so that all employees can achieve a high level of health and wellness.