The Power of Food... · 2020. 3. 12. · Emerging Practice: Functional & Integrative Nutrition •...

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

Marsh & McLennan Agency LLC 2

Diet-related Chronic Disease is on the Rise

Marsh & McLennan Agency LLC

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


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


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


Return on Investment

1% reduction in:

Weight

Glucose

Blood pressure

Cholesterol

$83-$103 annually savings in medical costs per person.

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• 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



• 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


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


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


Dietitians

• Therapeutic diets

• Digestive issues

• Fertility, pregnant or new

mom

• Eating issues

• Gain or lose weight

• Practical lifestyle advice14


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


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?

22


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


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


Social Determinants of Health

Economic

StabilityNeighborhood

and Built

Environment

Healthy People 2020


Food Insecurity

Lack of consistent access to enough food for an active,

healthy life.

USDA


https://map.feedingamerica.org/

https://map.feedingamerica.org/


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


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


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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http://www.heart.org/

http://www.cancer.org/

http://www.eatright.org/

http://www.choosemyplate.gov/

http://www.hsph.harvard.edu/nutritionsource/

https://www.diabetesfoodhub.org/

http://www.healthcare.gov/

http://www.cdc.gov/


Questions?

MarshMMA.com

This document is not intended to be taken as advice regarding any individual situation and should not be relied upon as such. Marsh & McLennan Agency, LLC shall have no obligation to update this publication and shall have no liability to

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

actuarial, accounting, tax or legal advice, for which you should consult your own professional advisors. Any modeling analytics or projections are subject to inherent uncertainty and the analysis could be materially affective if any underlying

assumptions, conditions, information or factors are inaccurate or incomplete or should change. Copyright © 2019 Marsh & McLennan Insurance Agency LLC. All rights reserved.

The Power of Food... · 2020. 3. 12. · Emerging Practice: Functional & Integrative Nutrition •...

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