Letter to Clients
The Impact of New Leadership at HealthFitness
This June we announced leadership changes that will allow us to innovate how employees engage in health and more effectively change behaviors that affect your bottom line.

I am thrilled to share that Paul Lotharius, currently president of CoreSource, an operating division within the family of Trustmark Companies, will join HealthFitness as president and chief operating officer. In these roles, he will oversee the day-to-day development, operation and improvement of HealthFitness' results-driven employee health solutions. CoreSource is a provider of benefit administration and health management services.

Paul has more than 20 years' experience in operations and technology management in the health care and insurance industries. From his CoreSource experience, he brings broad knowledge of the payer side of the health insurance industry. He is also very familiar with the latest health care management and wellness trends. I am confident he will be a great addition to our team.

With Paul in place as president and COO, this will provide me with more bandwidth to focus strategically on taking HealthFitness into new markets, seeking potential acquisitions and developing new products. Even with these changes, however, my primary responsibilities as chief executive officer remain unchanged; I will continue to lead the direction and successful operation of HealthFitness, ensuring we measurably affect employee health and productivity for our clients.

These organizational changes mark an exciting time for our company, as they will allow HealthFitness to more aggressively pursue an expansion of our population health management solutions. And we believe this expansion will strengthen our ability to make healthy choices an intrinsic part of each employee's day.

If you have any questions regarding these changes, please do not hesitate to contact me directly or call your HealthFitness regional vice president.

Yours in good health,

Gregg Lehman

Inside HealthFitness
HealthFitness' National Certification of Quality Assurance Accreditation Upgraded
This June, HealthFitness was awarded the upgraded status of Accredited with Performance Reporting (AWPR) from the National Committee for Quality Assurance (NCQA), a private, non-profit organization dedicated to improving health care quality.

NCQA Wellness & Health Promotion Accreditation is a nationally recognized evaluation that purchasers and consumers can use to assess wellness and health promotion programs.

NCQA Wellness & Health Promotion Accreditation standards are purposely set high to encourage wellness and health promotion organizations to continually enhance their quality measures. No other comparable evaluation exists for wellness and health promotion programs.

"This prestigious recognition reflects our ongoing commitment to providing the highest quality health and wellness programs available," said Gregg O. Lehman, CEO of HealthFitness. "Employers are raising their expectations for health and wellness programs. They want innovative and effective options with proven results. The AWPR status proves we can deliver these services."

According to the NCQA's Wellness and Health Promotion Report Card, there are fewer than 20 organizations that have earned accreditation, and fewer than 10 that have earned the upgraded AWPR status. HealthFitness earned NCQA accreditation in 2009 and retains this status until 2012.

To learn more about the NCQA, click here.

No Health Risk Assessment? How This Affects Employee Health
If your company does not provide a health risk assessment (HRA) to employees, you are not alone.

A Kaiser Family Foundation survey found that among employers offering health coverage, only 16 percent give their employees the option of completing a health risk assessment to help identify potential health risks.¹

But what do employers miss by not offering one? The answer is: Plenty.

"Between 3 and 10 percent of HRA takers are ready to change an important health behavior and the HRA then becomes the stimulus for the 'I see' moment that motivates them to change that behavior," Ed Framer, Ph.D., HealthFitness' director of health and behavioral sciences, explained.

Plus, he added, "the HRA helps target health education information and resources to each unique individual. It provides participants with a personal report that includes their current health status and actionable suggestions to maintain or improve that status."

By offering an HRA, a company can also:

• Establish a population baseline for health risks and health behavior strengths
• Provide critical data for demonstrating return on investment that flows from health promotion programming
• Allow targeted invitations to programs, improving the efficiency of their wellness initiative
• Identify the effectiveness of the programs they offer to change health risks and make adjustments accordingly

HealthFitness offers an HRA called INSIGHT® that provides participants with a concise, easy-to-read report about their risks based on the most current health guidelines. To learn more about HealthFitness' INSIGHT HRA, click here.

¹ "Family Health Premiums Reach $13,375 Annually in 2009 Up 5 Percent as Inflation Fell Nearly 1 Percent," Kaiser Family Foundation, accessed June 28, 2010: http://www.kff.org/insurance/ehbs091509nr.cfm

Almost 10,000 Employees Mind Their Health with HealthFitness Seminar
Almost 10,000 participants have attended a HealthFitness Mind Your Health seminar since the program launched two years ago. Mind Your Health seminars provide participants with science-based information designed to raise awareness, educate and provide useful strategies for making positive lifestyle changes. The one-hour sessions, taught by on-site HealthFitness professionals, also deliver actionable health tips in a fun, social environment. Mind Your Health sessions are available in the following topics:

• Back health
• Blood pressure
• Diabetes
• Fitting in fitness
• Healthy eating
• Heart healthy living
• Healthy weight
• Lifestyle and cancer
• Stress management
• Sleep
• Women's health

Interested in offering a Mind Your Health seminar at your location? Talk with your program manager.

Best-in-Class Practices and Awards
Employees Enjoy Losing in Intense Challenge at Freddie Mac Fitness Center
To change lifestyle behaviors, it takes commitment. And to reinforce just how much commitment, HealthFitness staff at the Freddie Mac Fitness Center in McLean, Va., created an intense 15-week competition that is proving effective with driving employee engagement and sustaining results.

Now in its second year, the Team Weight Loss Challenge is targeted to those who want to make sweeping lifestyle changes. Participants must have body fat percentages above a set percentage to be eligible to participate. Men must have at least 22 percent body fat; women, 29 percent. Additionally, participants must regularly meet intense program requirements or they are disqualified.

"Though participation this year was capped at 40, we could have had more than 100 participants," HealthFitness Program Manager Rebecca McIllece said. "This year the program filled up in the first few hours. People were interested in doing the program because of the results that other participants experienced last year."

With the challenge, two-person teams are assigned to a health fitness professional coach, who helps to set goals, review medical history and create a personalized plan for the next 14 weeks. Prior to the program start, participants must complete a fitness assessment, where measurements for body fat and resting metabolic rate are taken.

For the first 12 weeks, participants are required to log four workouts each week. Each week, participants must also participate in weigh-ins and turn in a checklist of when they completed their four classes. A "three strikes" rule applies to participants; the third time they do not meet the requirements, they are dropped from the program.

Points are awarded each week to the teams that lose the most weight. Participants can also earn additional points with bonus challenges, such as writing a 500-word essay on why weight loss is important to them or writing in a food diary.

The team that consistently loses weight throughout the program (instead of crash dieting) and exhibits the most effort by completing weekly bonus challenges wins.

The 2010 program started Jan. 25 and concluded May 28. Of those who participated in the challenge, 92.3 percent lost weight. Of those who lost weight, the average weight loss per participant was 18.1 pounds. The greatest percentage of body fat lost by one participant was 12 percent.

HealthFitness Clients Earn National Recognition for Creative Employee Health Initiatives
HealthFitness congratulates our clients that earned national recognition as "2010 Best Employers for Healthy Lifestyles" by the National Business Group on Health (NBGH).

According to the Washington, D.C.-based NBGH, the annual awards reward "those organizations that have found creative solutions to advancing the well-being of employees."

Best employers were honored in one of three categories: Platinum, for established "Healthy Weight, Healthy Lifestyles" programs with measurable success and documented outcomes; gold, for creating cultural and environmental changes that support employees who are committed to long-term behavior changes; and silver, for employers who have launched programs or services to promote living a healthier lifestyle.

Some of HealthFitness' clients earning this year's recognition and their award categories include:

• Platinum: Cigna
• Gold: Aramark, BD, Cardinal Health, Inc., Johnson & Johnson, NextEra Energy, Inc., WellPoint

Industry Insights
Buzz from Recent Research
New Study Finds Ethnicity Key to Accurate BMI Measurements
A recent study examining diverse populations found current body mass index (BMI) cutoff values fail to identify many women as obese, particularly whites and Hispanics.

The current National Institutes of Health BMI cutoff values for obesity are too high for many reproductive-age women in the U.S. and should be adjusted to account for ethnic differences in body composition to produce proper diagnosis of obesity, according to a study reported in the May issue of Obstetrics & Gynecology.

Researchers found that the current BMI standards misclassify as "not obese" nearly half of reproductive-age women who are defined as obese by the World Health Organization, which uses actual body fat percentage to determine obesity. Of particular concern is the finding that more than half of white women and more than two-thirds of Hispanic women are obese by the WHO standard.

The study's findings provide evidence that a single BMI cutoff value to define obesity is not appropriate for a diverse population and that racial- and ethnic-specific BMI cutoff values are needed. The NIH defines obesity as a BMI greater than 30 kg/m2. Comparatively, the WHO defines obesity as greater than 25 percent body fat in men and greater than 35 percent in women. While this criterion is an accurate gauge, it is expensive and difficult to measure.

The study analyzed 555 women between 20 and 33 based on age, height, weight, BMI and body composition. The subjects included 189 white, 159 black and 207 Hispanic women. The researchers assessed subjects' obesity rates and BMI accuracy using three measurements: the current NIH BMI, the WHO guidelines and the researchers' ethnic-specific BMI cutoff values.

Using the current NIH BMI, 205 women were classified as obese. The obesity rate in black and Hispanic women-46.5 percent and 37.7 percent, respectively-was significantly higher than in white women (28 percent).

However, the WHO guidelines classified 350 women as obese-63.1 percent of the total sample. The obesity rate was highest among Hispanic women at 69.1 percent.

Finally, researchers applied their own ethnic-specific BMI cutoff values and found that 311 women were obese-52.9 percent of whites, 52.8 percent of blacks and 61.4 percent of Hispanics. The values take into account the fact that white and Hispanic women have approximately 3 percent higher body fat than black women for a given BMI.

Currently, NIH BMI obesity rate calculations show that black women have the highest obesity rate. However, these study findings suggest that Hispanic women have the highest rates, based on body fat percentage.

This study does not represent current U.S. health policy. The current NIH recommendations and clinical practice guidelines for obesity are under review with the updated guidelines expected to be released in the fall of 2011. HealthFitness does not know if the NIH will incorporate suggestions from research articles like this one or stay with its focus on BMI. Compared to percent fat, BMI is easy to measure and calculate.

Source: Rahman, M., Berenson, A.B. Accuracy of Current Body Mass Index Obesity Classification for White, Black, and Hispanic Reproductive-Age Women. Obstetrics & Gynecology. May 2010 - Volume 115 - Issue 5 - pp 982-988. http://journals.lww.com/greenjournal/Fulltext/2010/05000
/Accuracy_of_Current_Body_Mass_Index_Obesity.17.aspx

Take a Sneak Peek at New Dietary Guidelines
The 2010 Dietary Guidelines Advisory Committee released a report on June 15 acknowledging that many Americans are unhealthy and declared obesity as "the single greatest threat to public health in this century."

The report, which is based on the latest scientific evidence, was prepared by a 13-member panel of national nutrition and health experts. The final 2010 dietary guidelines will be released later this year by the U.S. Department of Agriculture and Department of Health and Human Services.

In an effort to combat the obesity epidemic, the advisory committee's report highlights the following recommendations and changes:

• Reduce saturated fat from current recommendation of less than 10 percent of total daily energy consumption to less than 7 percent, with more emphasis on calories from more healthful fats, such as nuts, seeds, fatty fish, and vegetable oils.
• Avoid trans fats that come from commercial sources such as cakes, cookies, crackers and margarines, leaving only small amounts from natural sources (red meat and dairy products).
• Reduce sodium intake for the general population from 2,300 milligrams to 1,500 milligrams. This latter value is the current recommendation for high-risk groups.
• Shift to a more plant-based diet that emphasizes vegetables, fruits, cooked dry beans and peas, whole grains, nuts and seeds.
• Increase the intake of seafood and fat-free and low-fat milk and milk products while cutting back on refined grains, added sugars and solid fats, especially those found in sugar-sweetened beverages and desserts.

Source: United States Department of Agriculture. Report of the Dietary Guidelines for Advisory Committee on the Dietary Guidelines for Americans, 2010. http://www.cnpp.usda.gov/dietaryguidelines.htm

Health Care Reform Update: Health Promotion Council to Develop Prevention and Wellness Policies
By executive order, President Obama created the National Prevention, Health Promotion and Public Health Council this June. The council is charged with developing prevention and health promotion policies as part of health care reform implementation efforts.

The council will be led by the U.S. Surgeon General and will include several cabinet secretaries, seven other administration officials and additional appointees made by the President, for up to a total of 25 council members.

Specifically, the council's duties include:

• Develop a national prevention, health promotion, public health, and integrative health-care strategy that incorporates the most effective and achievable means of improving the health status of Americans and reducing preventable illnesses and disabilities
• Provide recommendations concerning the most pressing health issues confronting the United States and changes in federal policy to achieve national wellness, health promotion, and public health goals, including the reduction of tobacco use, sedentary behavior, and poor nutrition
• Propose evidence-based models, policies and innovative approaches for the promotion of transformative models of prevention, integrative health and public health on individual and community levels across the United States

For additional information on the council and deadlines associated with its duties, click here.