Community Intervention Project

Mitsubishi LiveHealthier Spring ProgramMay 7, 2013

Jessica Lacontora

ARAMARK Dietetic Internship

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OVERVIEW

The population at the Mitsubishi work site is primarily overweight and reliant on

fast processed foods. Most attribute their reliance on fast food to a busy life. These “on

the go” meals make it easier to work 45 hours a week, shuttle kids to and from activities

and keep up with chores. Today, traditional families include working parents with less

time for food shopping, preparation and sit down meals. According to Shanthy and

Vinyard1 one in four adults eat fast food. Moreover, they found the consumption of fast

food was positively associated with overweight status.

Improved health among workers often results in greater productivity, less sick

days and an overall motivated crew. In order to encourage these results Mitsubishi has

employed a LiveHealthier to provide nutritional assessments, education and counseling.

News letters, private counseling sessions and group programs are offered through out

the year. Mitsubishi employees have the opportunity of cash rewards for healthy

behavior.

Having worksite nutrition counselors like the LiveHealthier coach at Mitsubishi is

an important part of meeting the Healthy People 2020 goals that we have set as

Americans. By making healthy choices more simple for on the go people we can help

turn their lifestyle in the right direction. Worksite settings offer the ability to educate large

groups on the importance of nutritional choices for weight loss and chronic disease

prevention. It is important to provided nutritional education as these employees can

spread their knowledge to family and friends having an even greater overall effect on

the US population.

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NUTRITION ASSESSMENT

Food/Nutrition-Related History (FH):

Food and Beverage Intake (1.2)- Those who participate in LiveHealthier at the

Mitsubishi site have been educated to prepare fresh meals and make better fast food

choices but they report many barriers to living well. Food preferences include WaWa,

Wendy’s, Lean Cuisine, McDonald’s, Pizza, and Applebees. Counseling sessions often

include discussion of poor food choices since the last visit in relation to changes in

schedule, biochemical markers, and weight. Food provided onsite by employer often

includes sandwiches or pizza.

Diet History (2.1)- Diet history is obtained at first visit session for new clients as

this population has often used “fad” or “crash” diets. The population has little regard for

preventing disease and (90%) is more concerned about weight loss.

Behavior/Nutrition Visit Attendance (5.1.2)- Recorded to ensure clients are

reimbursed for their efforts according to LiveHealthier program contract.

Physical Activity History (7.3)- Tracked at each session and most clients have

goals set that they often due not meet in relation to busy schedule.

Anthropometric Measures (AD):

Weight (1.1.2)- Clients self-report weight at each visit which is logged in

Registered Dietitian (RD) notes. Weight status is used in the LiveHealthier Wellness

Score. Compared to the US population the employees of Mitsubishi motors are

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relatively healthy as few are obese and they contain minimal disease risk, however, BMI

>25 in 90% of population.

Biochemical Data, Medical Tests and Procedures(BD):

Glucose (1.5), Blood Pressure & Lipid Profile (1.7)- Labs completed twice

annually for those with history or risk and are provided to LiveHealthier coach for

assessment procedure. The majority of the population has borderline high or elevated

blood pressure and cholesterol. This makes them high risk according to LiveHealthier

and grants them 9 visits with the dietitian. Similarly any patient that smokes is

considered high risk. The rest of staff fall under low or moderate risk and are allowed 4

visits with the dietitian. The population has little regard for preventing disease but is

mostly concerned about weight loss.

Client History (CH):

Personal History Data (1.1), & Medical History (2.1)- LiveHealthier is a worksite

wellness program incorporated into the Mitsubishi health insurance to improve and

maintain the health of onsite employees. Medical history details are obtained at a doctor

visit and provided to RD prior to initial session. An RD is assigned to this facility as the

LiveHealthier coach. Every employee is entitled to health care and offered the

opportunity to participate in LiveHealthier for a cash rebate. LiveHealthier participants

can focus on exercise, nutrition or other wellness topics with the dietitian. Generally the

population tries to find time for healthy activities and care about overall wellness.

Employees are given an hour lunch during which some choose to exercise. There is a

large loop (1/4 mile) of the warehouse that many walk 3-6 times daily.

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Very few members of this population have chronic disease which is likely due to

their age (all <60 years old), education status (all High school graduate or higher) and

socioeconomic status (all have employment). The predominate population culture/

ethnicity is american/caucasian. Gender ratio is equal requiring education for risk on

male and female associated disease states. This population is at low risk for housing

and transportation issues.

Religious beliefs do not play a large roll in the wellness of this population. More

influential problems are lack of time, family issues, and lack of food preparation

education. Access to nutritious food onsite is difficult as most do not pack lunch or store

healthy items onsite. Instead, diets of these individuals rely on less nutrient dense,

affordable convenience, ready-to-eat, processed and fast-foods. For lunch many

employees rely on local fast food options. Onsite, they have a kitchen with refrigerator

and microwave that are rarely used. In the office they have an area to purchase salty

and sweet snack foods at a discount price which employees use often. For this reason,

diets are typically higher in fat, sugar, sodium and are lower in fruits, vegetables, whole

grains and low-fat dairy products. This dietary pattern has led to hypertension, elevated

cholesterol levels and difficulty with weight loss goals.

NUTRITION DIAGNOSIS

Nutrition Problem:

Excessive energy intake (NI-1.5) related to food and nutrition related knowledge deficit

as evidenced by BMI >25 in 90% of population, intake of high caloric density foods

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NUTRITION INTERVENTION

There is strong evidence that this population would benefit from a nutrition

intervention that focuses on making better food choices. Education will focus on

emerging trends such as; quick meal preparation methods, saving money by bringing

lunch, saving time by planning ahead, smart choices when eating out, office exercise

options and portion control.

Nutrition Education (1.5)- Recommended Modification

Nutrition Education (1.4)- Nutrition Relationship to Health/Disease

Healthy People 2020:

Launched in 2010 these ambitious goals for the Nation’s health incorporate ways

to help a diverse group of individuals and organizations. Overarching goals include;

attain high quality longer lives free of preventable disease, achieve healthy equity,

create social and physical environments that promote health for all, and promote quality

of life2,3. These goals can be achieved by encouraging collaboration across

communities, empowering individuals toward making better health decisions and

measuring the impact of prevention strategies.

One of emerging trend goal objectives of Healthy People 2020 that addresses

worksite wellness is under the topic Nutrition and Weight Status.

Goal: Promote health and reduce chronic disease risk thorough the consumption of

healthful diets and achievement and maintenance of healthy body weights.

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Objective (NWS-7): Increase the proportion of worksites that offer nutrition or weight

management classes or counseling.

There is no data available on the percent of worksites that offered nutrition in

2010 however there is data available that shows worksite wellness programs decrease

absenteeism and promote weight loss making the concept more poplar today3,4,5.

Acknowledging the need and importance of support and motivation in combination with

education has promoted corporations to latch onto programs like Livehealthier. Onsite

coaches can help employees make better health decisions and improve preventative

care.

This objective uses SMART criteria being that it is specific to worksite weight loss

programs, results are measurable through polling American companies and asking for

current and retrospective, objective can be attained within 10 years and increasing the

proportion of worksites is realistic as this trend is emerging and backed by positive data.

Give brief overview of education

Lesson Plan:

The Spring Wellness Program will be presented to LiveHealthier participants in

the conference room. The program will focus on making healthy choices simple in

relation to fast food, prepping meals at home, portion control and eating on site. The

program will also address hydration, de-stress ideas, sleep, and office exercise. Those

who participate will be provided with informational hand outs on food, exercise and

disease risk from family history. Healthy beverages will are offered and 2 pedometers

will be given as rewards for participation. (See Template in Appendix B)

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Marketing:

The 4 P’s of marketing were used to promote the event.The program (product)

was developed and planned around the consumers response to a pre-survey. There

was no price associated with the program which increased value of the material. The

location (place) of the presentation was on site for convenience. Finally, the

LiveHealthier staff promoted the event through a variety of channels for 2 weeks prior to

the event. Mitsubishi employees are provided with a Nutritional New letter monthly for

free via email. For April the news letter advertised the event and a flyer was posted

throughout the facility by a LiveHealthier team member. The program flyer was placed

near common doorways and in restrooms in order to reach maximal traffic. (Appendix E)

Resources:

The Mitsubishi conference room reserved contained the overhead projector

necessary for the powerpoint presentation. The Mitsubishi office secretary printed the

required materials provided to her in PDF form by email prior to the presentation. Pens,

beverages and cups were supplied by the presenter. The prizes, 2 pedometers, were

provided by LiveHealthier.

NUTRITION MONITORING & EVALUATION

The pre-survey to access interest and and post-survey for evaluation of the

educational session can be located in Appendix C & D. All participants tried the provided

health beverage (carrot juice) and were engaged in the educational discussion. On the

post survey 100% of participants checked that they learned new information in at least

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two subjects. Also, 100% agreed to bring lunch from home more often. Each post-

survey had a quality lifestyle change listed as a new goal for the employee and all were

pleased with the presentation. Goals and objectives were met for this program and

ideas were formed for programs in the future.

Feedback from the post discussion revealed that it would be beneficial if the

program did not occur on lunch break. People did not want to sit and eat a fast food

lunch during the program for a variety of reasons. Participants suggested that providing

a healthy lunch would get the best turn out from staff. More importantly data needs to be

obtained on health success among the employees that participate so that the stats can

encourage other companies to employ services like LiveHealther. Mitsubishi is just one

site that has started to offer nutrition and weight management since 2010 but if their

success are publicize the US can continue to the proportion of worksites offering

nutritional counseling.

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REFERENCES

1. Bowman, SA and BT Vinyard. Fast food consumption of U.S. adults: impact on

energy and nutrient intakes and overweight status. J Am Coll Nutr. 2004 Apr;23(2):

163-8. Accessed April 17, 2013.

2. Center for Disease Control and Prevention. Worksite Health Promotion. Available at:

http://www.cdc.gov/workplacehealthpromotion/ Accessed April 17, 2013.

3. US Department of Health and Human Services. Health People 2020: Nutrition and

Weight Status. HealthyPeople.gov. Updated March 8, 2013. http://

www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=29 Accessed

May 7th 2013.

4. A. Astrup. Management of obesity at worksites: less work for greater success?

American Journal of Clinical Nutrition. 2013 April; 97 (4); 663-4. Accessed May 7, 2012.

5. VanWormer, JJ., Linde JA., Harnack, LJ., Stovitz, SD., and RW. Jeffery. Weight

change and workplace absenteeims in the HealthWorks study. Obesity facts. 2012; 5(5);

745-52. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23108493 Accessed May 7,

2012.

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Appendix A: Mitsubishi Livehealthier Standards

Health Risk Assessment Review:

• Low Risk Participants have a wellness score that falls in the Very Good or Excellent range

• Moderate Risk Participants have a wellness score that falls in the Good range

• High Risk Participants have a wellness score that falls in the Fair or Poor range.

• PLEASE NOTE: if ANY participant has high blood pressure (systolic pressure over 120 OR diastolic pressure over 80), hyperlipidemia (total cholesterol over 200) or is a current tobacco user, they are automatically HIGH RISK

HRA Review should do the following:

• Identify how many sessions the participant needs to complete (4 for low risk, 9 for moderate or high risk)

• Identify the coaching content area of focus for the participant

• Guide your initial coaching session

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Appendix B: Lesson Plan

Mitsubishi LiveHealthier Lesson Plan:

Target Audience: Men and women enrolled in LifeHealthier program who desire to improve their health status

Duration: 50 minutes: 5 min for sampling of healthy beverages, 25 minute presentation, 5 minute exercise demonstration, 5 minute discussion of family tree and disease risk, 10 minutes for questions/sharing. Goal:

Specific Objectives: 1. By the end of the session through the use of a post-test, clients will be able to identify 1 ways they can LiveHealthier (lifestyle change). S: Specific to clients attending the educational program. M: Results measurable through participant’s responses on post-test. A: Objective to be attained within educational session time. R: Improvement in the commitment to live healthier by incorporating lunch from home, more exercise or better fast food choices T: Achieving the objective by the end of the program session is timely.

2. By the end of the session through the use of a post-test, clients will be able to identify the benefits LiverHealthier objectives as it relates to disease risk.

S: Specific to the clients attending the educational session.M: Results measured through participants responses on post-test.A: Objective to be attained within educational session time.R: It is realistic that clients will be able to relate their individual risk for disease to necessary life style modifications .T: Achieving the objective by the end of the program session is timely.

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Specific Objectives(SMART)

Procedure(State how each specific objective will be met)

Learning Activity

EvaluationMethod

IntroductionIntroduce self to participants and explain the purpose for the program, reason I am presenting, itinerary for the class and welcome them to try samples.

Verbal introduction to presentation

Body of Lesson1. By the end of the session through the use of a post-test, clients will be able to identify 1 ways they can LiveHealthier (lifestyle change).

PPT - Simple Choices1. # of food choices mad in 1

day2. Better fast food choices3. Planning ahead to bring

lunch4. Portion control5. Hydration6. Office Exercise7. De-stress/Better sleep

Verbal education.Educational handouts on exercise, packing lunch. Exercise demonstration

Verbal Q&A Post-testPedometer given as prize for participation

2. By the end of the session through the use of a post-test, clients will be able to identify the benefits LiverHealthier objectives as it relates to disease risk.

Family Tree Homework1. How to fill in tree2. What data is significant3. What to look for and discuss

with MD or RD4. Importance of passing

education onto siblings and kids

5. How disease relates to diet and exercise

Verbal education.Educational handout on family tree.

Verbal Q & APost-test

ConclusionSummarize what was discussed during the educational session. Thank participants for attending.

Verbal conclusion.

Take Questions

Materials List: Audio-visual equipment, beverages, cups, PPT, pencils, paper post tests, handouts (Appendix C-I), reserved conference room, 2 pedometers given as prizes.

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Appendix C: Evaluation Pre

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Appendix D: Evaluation Post

1. Please check all for which you have learned NEW information:

______ Better fast food choices

_____ Office Exercise

______ How to prep meals at home

______ Portion control

______ Preventing Disease

______ How to de-stress

______ Overall living healthier

2. Will your increase the amount of days you bring a heathy lunch from home? If no, please state why.

3. Will you increase your exercise in the office after today? If no, please state why.

4. List any lifestyle changes you plan to make after this program.

5. Overall were you pleased with the presentation?

6. Would you attend another Wellness Program? If no, please state why.

Spring Program Results Survey

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Appendix E: Media Advertisement

Simple Choices Spring Wellness Program

Topics•Good FAST FOOD choices

•QUICK office Exercise

•Meals on the Go with BALANCE

•Portion CONTROL for Overeaters

•Recognizing risk from FAMILY tree

•5-min de-STRESS

•Breaking down BARRIERS

When: April 30, 2013

Where: Upstairs Conference Room

Time: 12:30 to 1:30

Other: Bring lunch, questions

and an open mind. Take home recipes.

Beverage samples will be given.

Questions or Comments?Contact Kristen Hamilton: kristen.hamilton@livehealthier.com

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Appendix F: Educational Handout Exercise

Office ExerciseName Goal

Office Exercise Date Weather

Page 1

1: Stand instead of sitting

Burn 50 more calories and hour2: Fidget in your chair

Burn 350 more calories a day3: Laugh often, have good posture and breath deep.

Will tighten muscle & relax your mind

4: Desk Push up

Strengthen arms & chest5: Lunge forward and side to side Strengthen lower body

6: Chair Dips

Strengthen triceps & shoulder

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Page 1

7: Chair Squats

Strengthen lower body8: Good Mourning

Stretch for relief of tension

9: Leg Raises

Tightens legs and core

10: Walk the stairs

Activates leg muscles differently

11: Touch your toes

Relive you lower back and hamstrings12: Arm circles and raises

Stretches and strengthens shoulders

Appendix G: Educational Handout Food

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Simple Choices

Recipes Inside

!

Write down some ideas....

Write a shopping list...

Chicken Pita Cut whole wheat pita in half. Toss Grilled chicken with low fat dressing. Fill both sides with spinach, sliced cucumber and chicken.

Add feta cheese and olives for a Greek delight.

Make a Salad

• Watch out for high calorie dressings

• Make it colorful.

• Use left over meats or beans to add protein.

Bean Burrito

In the center of a large whole wheat tortilla combine beans, salsa,

brown rice, pepper jack cheese and fat free sour cream. Wrap in

foil to keep shape.

Easy add in: Avocado, chicken, fish, sauteed vegetables, hot

peppers, fresh cilantro

Brown Bag It

Sandwich-Pick a whole grain wrap, bread or roll • Add shredded chic, roast beef,

tuna, egg salad, PB&J • Add lots of veggies• Top with mustard, or hummus

On the side• Fruit and peanut butter or cheese• Veggies and hummus or LF dip• Snack Bar• Trail Mix• Baked or Soy Chips, pretzels

To Drink• WATER - infuse with fruit & mint • Unsweetened iced tea• Fruit and Veg smoothie• Juice • Mix and Match!

Recipes

Appendix H: Educational Handout Family Tree

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