Post on 28-Sep-2020
The Power of Food
Nutrition and its impact on the prevention and treatment of disease
Jill Verchota-Luce, MPH, RDN, LDHealth Management Consultant – Minneapolis, MN
Diane Andrea, MBA, RDN, LDHealth Promotion Program Consultant - Saint Louis, MO
March 12, 2020
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Diet-related Chronic Disease is on the Rise
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Preventable Chronic Diseases On the Rise
• 6 in 10 adults lives with a chronic disease
o 4 in 10 have 2 or more
• Leading causes of death and disability and drivers of $3.5 trillion in annual health care costs in the U.S.:
1. Heart Disease
2. Cancer
3. Chronic lung disease
4. Stroke
5. Alzheimer’s disease
6. Diabetes
7. Chronic kidney disease3
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Lifestyle Risk Management Opportunities
Common Conditions Modifiable Lifestyle Risk Factors
DiagnosesPhysical
Inactivity
Poor
Nutrition
Tobacco
Use
Chronic
Stress
Inadequate
Sleep
Substance
Abuse
Hypertension
Hyperlipidemia
Type II Diabetes
Musculoskeletal Conditions
Respiratory Problems
Cancer
Gastrointestinal Disorders
Cardiovascular Disease
Behavioral Health/Depression
Obesity
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The Nutrition-Disease Connection
• Nearly 3 out of 4 adults are overweight or obese
• Association between eating highly processed food and increased risk of death in middle-aged adults
• Over 80% of Americans do not eat the recommended amount of vegetables per day
• At least 13 types of cancer are associated with overweight and obesity
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Impact & Cost-effectiveness of
Diet-related Interventions
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Return on Investment
1% reduction in:
Weight
Glucose
Blood pressure
Cholesterol
$83-$103 annually savings in medical costs per person.
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Return on Investment
• Nutrition therapy:
o Improves clinical outcomes
o ↓ medication use costs
o ↓ physician time & hospital readmissions for people with obesity,
diabetes, lipid disorders and other chronic conditions
• Savings of $1.44-$4.16 per pound lost by an employee
• RD-led intervention:
o ↓ lost work days (64%)
o ↓ disability days (87%)8
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Return on Investment
• For every $1 invested in lifestyle modification program for
employees with diabetes, there’s a return of $2.67 in
productivity
• Group nutrition therapy sessions for 6 months resulted in:
o ↓ total and LDL cholesterol levels (by 6%)
o Savings of $4.28 for every $1 spent on nutrition
therapy (much less than the cost of statin therapy!)
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The Role of Food & Dietitians
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The Power of Food!Example: Mediterranean-style eating pattern:
• Fats – olive oil
• Omega-3 rich fatty fish (salmon, tuna, trout, etc.)
• Other protein: poultry, beans, eggs
• Moderate dairy (couple cups per day)
• High in complex carbs & fiber (veggies, whole grains, legumes)
• Red wine in moderation
• Lower in salt and added sugar11
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Employee Interest in Nutrition Services
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Dietitian vs. Nutritionist
• Registered Dietitian, or RD
• Registered Dietitian Nutritionist, or RDN
– Four-year degree specially designed, accredited nutrition curriculum
– Complete extensive supervised program of practice
– Pass a registration exam and continuing education
• Nutritionist
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Dietitians
• Therapeutic diets
• Digestive issues
• Fertility, pregnant or new
mom
• Eating issues
• Gain or lose weight
• Practical lifestyle advice14
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Where to Find a Dietitian
• Inpatient, outpatient hospital
• Telemedicine
• Private practice and health care systems
• Community settings – food assistance programs, public
health program design, grocery stores, nursing homes,
gyms
• Worksite nutrition coaching
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What Does a Visit With a Dietitian Look Like?
• Assessment
• Nutrition diagnosis
• Counseling
• Monitoring and evaluation
• Coordinate care
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Emerging Practice: Functional & Integrative Nutrition
• Beyond prevention and treatment of a diagnosable disease
• Optimizes health and well-being
• Whole-person approach to assess potential root causes of poor health:
o Food
o Lifestyle
o Personal and family history
o Current signs and symptoms
Acknowledges food is more than energy for the body, it’s information for numerous body functions.
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Increasing Employee Access to
Support with Nutrition
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Affordable Care Act: What is covered?
Obesity screening for all adults. Individuals with a body mass index of 30 kg/m2 or higher are recommended to intensive, multicomponent behavioral interventions. These include behavioral management activities (e.g., setting weight-loss goals), improving diet or nutrition, increasing physical activity and strategizing how to maintain lifestyle changes.
Behavioral counseling. Employers must offer or refer adults who are overweight or obese and have additional CVD risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention.
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Affordable Care Act: What is covered?
Diabetes screening. The USPSTF recommends screening
for abnormal blood glucose as part of cardiovascular risk
assessment in adults aged 40 to 70 years who are
overweight or obese. Clinicians should offer or refer
patients with abnormal blood glucose to intensive
behavioral counseling interventions to promote a healthful
diet and physical activity.
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Fully insured – What’s Covered By Your Plan?
• Additional preventive nutrition services will vary by medical
insurance carrier
• Work with insurance broker
• Carriers will have a policy that specifies which nutrition
services are covered as a preventive service. For example:
Adults and children who are obese or
Adults who are overweight with other cardiovascular risk factors
Prescribed by physician
Offered by a provider recognized under the plan (i.e. RD)
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Fully insured – What’s Covered By Your Plan?
1. Does this benefit only cover specific conditions?
2. Are any diagnoses specifically excluded from my nutrition benefit?
3. Do I have unlimited visits or a specific number of visits available each year?
4. Do I need a referral? If so, who can make the referral?
5. Is there a copay to see a registered dietitian nutritionist?
6. Are preventive services covered? For example, does my plan cover screening or counseling for obesity?
7. Given my deductible for the year, including copays and coinsurance, what will I need to pay out of pocket to see a registered dietitian nutritionist?
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Self Insured – More Options
• Incorporate nutrition benefits in your medical plan
(outpatient counseling, bariatric surgery, etc.)
• Vendor solutions (i.e., onsite nutrition coaching)
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Workplace Supports
• Changes to the physical
workspace
• Nutrition coaching (onsite or
telephonic)
• Promotion of local outpatient
health system or private practice
nutrition counseling
• EAP resources24
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Vendor Solutions
• Check carrier resources
• Discuss with EH&B team
• Ask for evidence-based research
• Ask for credentials of individuals that will interact with
employees
• Review vendor with Health Management Consultant
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Food as a Social Determinant of Health
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Social Determinants of Health
Economic
StabilityNeighborhood
and Built
Environment
Healthy People 2020
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Food Insecurity
Lack of consistent access to enough food for an active,
healthy life.
USDA
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Workplace Support
• Educating employees about eligibility for and access to
SNAP programs
• Worksite nutrition and physical activity programs
o Education
o Counseling
o Rewards
o Healthy choices available
o Fitness center discounts
o Physical activity opportunities
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Resources for Hunger
• USDA National Hunger Hotline
• 1-866-3-HUNGRY (1-866-348-6479)
• Why Hunger Hotline to find food pantries
• 1-800-548-6479 by phone or text zip code
• Local county and city health departments
• www.auntbertha.com
• Meals on Wheels
• www.mealsonwheelsamerica.org
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Reputable Nutrition Websites
• American Heart Association – www.heart.org
• American Cancer Society – www.cancer.org
• Academy of Nutrition & Dietetics – www.eatright.org
• USDA – www.choosemyplate.gov
• Harvard Nutrition Source - www.hsph.harvard.edu/nutritionsource/
• ADA Diabetes Food Hub - https://www.diabetesfoodhub.org/
• Healthcare.gov - www.healthcare.gov
• Centers for Disease Control – www.cdc.gov
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Questions?
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you or any other party arising out of this publication or any matter contained herein. Any statements concerning actuarial, tax, accounting or legal matters are based solely on our experience as consultants and are not to be relied upon as
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assumptions, conditions, information or factors are inaccurate or incomplete or should change. Copyright © 2019 Marsh & McLennan Insurance Agency LLC. All rights reserved.