Abstract
Context:
Previous studies of the Complete Health Improvement Program (CHIP) have demonstrated short-term improvements in select metabolic and cardiovascular biomarkers in community-based programs. However, less is known about the benefits of an employer-funded lifestyle intervention program.
Objectives:
To determine if participation in employer-provided CHIP would result in improvements in short-term metabolic and cardiovascular biomarkers, and to compare the results of the current study to a larger national study.
Methods:
This observational study evaluated metabolic and cardiovascular biomarker changes in employer health insurance beneficiaries enrolled in CHIP between August 2012 and November 2014. Body mass index; blood pressure (systolic and diastolic); total cholesterol, low-density lipoprotein, high-density lipoprotein, fasting plasma glucose, and triglyceride levels; and weight were measured at baseline and after CHIP.
Results:
Of 160 employees enrolled in CHIP, 115 women and 45 men agreed to participate in the study. Overall, the participants demonstrated significant reductions in body mass index, from a baseline average of 31.5 to a post-CHIP average of 30.5 (P<.001), systolic blood pressure from 124.5 to 119.4 mm Hg (P=.017), diastolic blood pressure from 77.3 to 74.5 mm Hg (P=.046), total cholesterol from 186.0 to 168.8 mg/dL (P<.001), low-density lipoprotein from 112.9 to 99.3 mg/dL (P<.001), high-density lipoprotein from 48.8 to 46.4 mg/dL (P<.001), and fasting plasma glucose from 100.8 to 96.5 mg/dL (P<.001).
Conclusion:
When funded by an employer, CHIP demonstrated short-term improvements in select metabolic and cardiovascular biomarkers. Future studies will analyze these data to determine whether these findings translate into subsequent decreased employee absenteeism and reduced beneficiary health claims.
Many lifestyle-related chronic diseases cause long-term health problems with far-reaching negative consequences. Lifestyle factors are implicated in type 2 diabetes mellitus (T2DM), cardiovascular disease, cancer, and many other chronic diseases.
1 Evidence exists that therapeutic lifestyle modification can prevent, improve, and even reverse many of these chronic diseases.
2-4 The Complete Health Improvement Program (CHIP), a plant-based, whole-food lifestyle modification program, demonstrated reduction in body mass index (BMI), blood pressure (BP), fasting plasma glucose (FPG), and cholesterol.
1,2 The Diabetes Prevention Program found that weight loss by means of lifestyle modification is more effective in management of high-risk T2DM than medication alone.
2 A plant-based diet was also found to be beneficial for patients with cardiovascular disease, obesity, and other chronic diseases.
5
Lifestyle-related chronic diseases have clinically significant negative consequences on individual workplace productivity, leading to increased absenteeism and presenteeism (ie, being present but at suboptimal levels of productivity), which affect the employer's bottom line. Correlations between employee sick days, obesity, and stress have also been found.
6,7 Other studies demonstrate that employer-funded lifestyle intervention programs decrease absenteeism, resulting in a positive return on investment (ROI). In the United Kingdom, a lifestyle intervention program in the workplace reduced absenteeism by more than 1 day per year for each employee, providing a financial benefit for the employer.
8 Large-scale health initiatives can provide cost savings for companies while improving employee health.
9 Workplace wellness programs have been found to decrease a company's health care cost by $176 per person per year and $3.27 for every $1 spent on the wellness program, respectively.
10,11
Although lifestyle modification programs have repeatedly demonstrated short-term benefits for employers and employees, less is known about the long-term impact on health and its relationship to subsequent health claims. The purpose of the current study was to determine if an employer-funded CHIP in a small rural Appalachian college town would result in short-term improvements in metabolic and cardiovascular biomarkers and long-term reductions in health care costs and absenteeism. This article addresses the preliminary short-term results in select biomarkers. We also compared the results of the current study to those of Rankin et al,
13 which examined 5070 people who participated in 176 CHIP classes throughout North America from 2006 to 2009. The study by Rankin et al
13 represented many different locations and demographics and was therefore a good baseline for comparison of the current study.
Participants were beneficiaries of Ohio University health insurance and were recruited to CHIP via announcements in the workplace, churches, and the local media, or from local health care providers. They attended 1 of several informational sessions presented throughout the community on various dates and times, where they received a mixed video and live presentation, had their questions addressed, and were offered an opportunity to enroll. All participants were informed that their results would be aggregated and reported for research purposes. Inclusion criteria were adults who were not pregnant and were beneficiaries of Ohio University health insurance. Approval for the study was obtained from the local CHIP administration and the Ohio University institutional review board.
An intensive lifestyle modification program, CHIP is focused on food and diet, activity and exercise, stress management, and alleviation of unhealthy habits. A thorough review of the history and effectiveness of CHIP worldwide has been published.
12 For the current study, CHIP classes were facilitated by volunteers trained and authorized by the Lifestyle Medicine Institute and CHIP through the Athens CHIP and were administered locally by Live Healthy Appalachia, a 501(c)(3) organization, in Athens, Ohio. Each class was conducted over 8 to 20 weeks and involved 16 to 18 two-hour group sessions between August 2012 and December 2014. In January 2013, CHIP changed from a 16-session format to 18 sessions. Most classes were provided to the community at large, with the Ohio University beneficiaries making up a part of the class. Two classes were designated for Ohio University beneficiaries and were held on campus.
A typical session included an instructional video viewing, a cooking demonstration, group discussion, and an exercise component. The intent of the intervention was to nurture intelligent self-care through enhanced understanding of the epidemiology, cause, and risk factors associated with chronic lifestyle-related diseases.
The primary focus of CHIP was the consumption of plant-based whole foods ad libitum, such as fresh fruits, vegetables, whole grains, legumes, and some nuts. The goal was to keep overall dietary fat content below 20% of the total calories, daily intake of added sugar below 10 tsp, sodium below 2000 mg, and cholesterol below 50 mg. Water consumption (at least 8 glasses/d) and high-fiber food intake (>35 g/d) were encouraged, along with flexibility exercises, a daily walk of 30 minutes or 10,000 steps on the pedometer, and daily use of stress management techniques.
A baseline health screen was performed at the beginning of the course, consisting of BMI, systolic BP, diastolic BP, and levels of total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, and FPG. The results were reviewed with the participants as a group during a class session to help them understand their risk status and to set goals for the program. Before the 12th class session, the health screen was repeated. Personal and deidentified aggregated class health screen results were given to participants to review their individual improvements and how they compared with the group as a whole. A presentation on the meaning of the results and encouragement to continue with the newly acquired lifestyle changes followed.
The course was paid for by Ohio University ($450 per person before April 2013 or $599 afterward) and provided free of charge to beneficiaries who agreed to be part of this study. Those who participated in CHIP but elected not to enroll in this study had 80% of the expense covered. As an additional incentive, participants who attended 14 of 16 or 16 of 18 classes and completed both health screens received a reduction of $10 per month in university health care insurance cost for 12 months ($120 total), even if they did not participate in the study. The cost of the course covered 2 biomedical assessments (performed at the beginning of the course and again before the 12th session), food samples, textbook, workbook, cookbook, water bottle, pedometer, and supplementary reading and reference material.
The biomedical assessments included weight, height, systolic BP, and diastolic BP, which were obtained by medical professionals. Fasting blood samples were collected by trained phlebotomists and analyzed for total cholesterol, LDL, HDL, FPG, and triglyceride levels in a pathology laboratory. Data for each participant were entered into a password-protected proprietary access-based database maintained on the CHIP administration computer at the Live Healthy Appalachia office as part of the CHIP routine and separate from the data collection. For this study, CHIP administration provided identified data on a password-protected Excel (Microsoft Corporation) file.