The Wellness Club: A Journey to Health Beyond Healthcare

By David G. Adamson

This is the true story of a group of employees in a community health center who started a wellness club to learn more about the typical health topics like exercise, nutrition, and stress reduction. Although they were part of the U.S. healthcare system, they weren’t any healthier than the general population and wondered why. Like workers in every industry, for the past decade they had seen their wages go to higher insurance premiums and deductibles.

Wellness Club presentations and discussions inevitably lead them into controversial territory, starting with the healthcare system itself, which is too expensive and not always effective for the cost, especially when compared to other advanced industrial countries.

And they also discovered that there are powerful corporate and government influences that make it challenging, and at times impossible, for them and their families to be well and prevent the debilitating health conditions they witnessed every day, such as obesity, diabetes, and hypertension.

During weekly meetings, they slowly but surely realized that while it was tempting to blame the national healthcare crisis on soulless corporations and inept government agencies, they shared equal responsibility. Those unhealthy forces had been unleashed in their homes, workplace and communities by their own ignorance, indifference or laziness.

They gathered a lot of cutting edge information about their bodies, food and supplements, relaxation techniques, and different ways to exercise. They learned about organic versus inorganic foods, macronutrients, the lipid hypothesis, vegetable versus animal protein, why not all fats are bad, the vagus nerve, high intensity training, sugar and fructose, body fat, chocolate as an aphrodisiac and tranquilizer, inflammation, willpower, paradigm wars, women and weight lifting, self-efficacy, food cues, phytonutrients, the relaxation response, food labels, Buddha, obesity is not a death sentence, activities of daily living, and many other topics.

They watched lectures on the Web by some of the leading health researchers in the nation, exercise demonstrations by personal trainers, and inspiring stories of people who had successfully changed their lives despite huge obstacles.

The health information came fast and furious, and the book includes direct links to the resources and videos they found inspiring or enlightening.

The most important topic the Wellness Club explored over and over was how to achieve personal change and find a sustainable path to wellness. Members eventually understood they would have to save their own health because no pill or institution was going to do it for them. They learned about changing old habits, social contagion, techniques to avoid poor food choices, and how to seek and find support from other people. It would not be one big painful leap, but a series of steps that would eventually be condensed into ten Wellrules.

Because stories of real people pursuing wellness are interwoven throughout every chapter, parts of the book are funny, some parts sad. Some reached their goals, some failed. Some were too afraid of failure to ever set goals. The pursuit of wellness would create tension between significant others, family members, or co-workers. It would be surprising and disturbing to realize they and their families might have addictions to sugar, fat and salt, and that these were enabled in their homes and workplaces.

The Wellness Club concluded there needs to be a radical re-prioritizing of American values to place long-term public health and well-being above short-term private profits. Meantime, in their private lives many would not wait. They would journey to wellness, despite all odds.

• Language: English
• Publisher: David G. Adamson
• Release date: Apr 23, 2013
• ISBN: 9781301158102

David G. Adamson

David Adamson was the executive director at Mountain Family Health Centers in Colorado, the fastest growing rural health center in the state and leader in health information technology. A long time blogger on exercise and health, he and his wife Cynda are personal trainers and operate Cascade Boomer Fitness in Bend,Oregon.

Book preview

THE WELLNESS CLUB:

A Journey to Health Beyond Healthcare

By

David Adamson

Copyright 2013 David G. Adamson

Smashwords Edition

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Table of Contents

Prologue

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Chapter 15

Afterword

Bibliography

Acknowledgements

About the Author

Prologue

For years I was the executive director at a community health center (CHC) in Colorado where each year thousands of people of all ages went in and out our doors in various stages of improving, stable, or failing health. CHC's provide primary care for over 20 million Americans and have been pioneers in developing new models of high quality healthcare delivery.

If ever there was a time to pursue wellness, now is it. Wellness confers so many obvious personal benefits that it's easy to overlook another very significant one - to avoid the cost, pain, and risk of the U.S. healthcare system.

Our health center offered a chronic disease program in which patients learned how to change their lifestyles to get back on a path to wellness. Every day our staff, just as overweight and sick as the rest of the U.S. population, advised, and in some instances pleaded, with patients to be more responsible for their health. I realized employees in a community health center, starting with top leadership, should walk the talk. But we didn't.

I'd closely followed the Affordable Care Act (ACA) as it ground through Congress and was signed by President Obama. Unlike many of my colleagues in healthcare and most Americans, I read 99% of the one thousand plus pages of it (the Senate version). I earned my living in healthcare so this was more than academic curiosity. The ACA is far from perfect (more about reforming health insurance than reforming healthcare), but it is based on the ideas of some of the best thinkers in healthcare, who fully grasp the gravity of the U.S. healthcare crisis and the serious consequences that await all Americans if is not addressed.

Something buried deep within the numbing government-speak in the ACA caught my eye: The government would provide incentives to establish workplace wellness programs. Workplace wellness programs were already in place in larger healthcare organizations like Kaiser and many major corporations, but not many were underway in small, under-100 employee companies like ours. About the time the ACA became law, like every other company providing health insurance to its employees, our health center had just learned we'd have another hefty annual premium increase. What little revenue we had available for employee raises, or retirement plan contributions, or many other worthy budget items, would have to be diverted to higher insurance costs - again.

So I read up on workplace wellness. Studies have shown that average employer medical costs went down $3.27 for each dollar spent on wellness programs, which is a phenomenal return on investment. Many wellness experiments were already underway in businesses across the country, especially in innovative places like California, with a goal of reducing healthcare costs. In some, employees were paid just for participating or for a health outcome, like lowering their blood pressure. In others, they paid a penalty for not participating or for not losing weight. Others used online games, contests and competitions. Some companies offered programs in which you connect to a wellness coach by phone or internet, and which were probably better than nothing, but seemed too scripted and cookie cutter to be very effective.

However, I also discovered, as should be expected with anything involving the government or insurance, that in order to qualify for discounts on employee health, a wellness program would have to comply with numerous regulations. There was the Americans with Disability Act of 1990, Equal Employment Opportunity Commission, Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the Genetic Information Nondiscrimination Act of 2008. That was just the federal list; the state would add more. And there were all kinds of stipulations on what type or rewards or punishments would be allowed to encourage smoking cessation, exercise, or weight loss. Finding more regulations to adhere to was of no interest to me. Healthcare and health centers are already subject to more regulations than Hollywood stars have drug addictions.

Then I realized employee wellness was too important to wait for the corporate private sector insurance companies, like the one we used and who administer most company wellness programs, to give us much help. For small companies, insurance companies offer little else than access to a website with recipes for low fat cookies. We'd never had any insurance vendor drop by to discuss wellness. From the employer's perspective, the economic rationale for wellness is usually to reduce employee turnover, improve employee retention, or lower absenteeism. That was fine, but our employees weren't just economic inputs, but good friends too.

We already had a core of employees who cared about wellness. Several times in past years, a few tried to start a lunchtime walking group. After a while, due to winter weather or waning interest (the pounds didn't just melt away), the group would eventually fizzle. There had been some weight loss pools where people put in $20, and the person who lost the most weight after three months kept the pot, but people cheated. One guy drank a couple of gallons of water just before the benchmark weigh-in. Another time we got cheap pedometers for everyone and had a contest to see who took the most steps in a week; one of the receptionists said she was putting it on her hyperactive dog when she got home from work. I talked to our core to see if they were interested in starting something more structured and educational. They were ready to go - they'd always been ready to go and wondered what took so long.

I approached some of the providers to see if any of them might be interested in heading up a wellness program, probably during lunch. Their responses were blunt: Wellness? I don't really know that much about it. Turns out their training is tilted more towards treating sickness than promoting health. Good idea, but I'm too busy. True, most of them were behind schedule all day and would scarf down lunch in their offices while they pecked away on their laptops updating patients' electronic medical records (they were still pecking away when most administrators went home in the evening). Wellness? You mean diet and exercise? Those mundane topics didn't seem as professionally interesting as ASCUS cells or the latest medications for depression.

I mulled the pros and cons of starting a wellness program for a month.

The cons? Discussions about food, diets, and exercise gain a religious ferocity that can break friendships, marriages, and work relationships. Too often these topics are no more resolvable than what Jesus looked like or who was the greatest quarterback in NFL history. We avoided discussing religion at work, for good reason. Unexpected dynamics could be set off between co-workers, like when you discover your co-worker, who always smells like garlic, is a vegan and won't go with you and the rest of the gang for lunch at Burger King.

Although my co-workers thought a wellness program was a good idea, it would fall to me to coordinate the effort. I knew a little about fitness and nutrition. I'd always exercised hard and been a student of exercise physiology. I'd spent a lot of money, too much, on books about exercise. Some staff knew it because they followed what I had learned on my tuffoldjock blog. Hard and consistent exercise, along with steadily improving food choices, are probably why I made it to full-retirement age in pretty good health, though decades of Extreme Weekend Warrior Gone Wild had left my musculoskeletal system worn and damaged. I'd be better than nothing.

The pros? The biggest was that my wife was willing to help. She was as informed and passionate about food and nutrition as I was exercise. We were free to do what we wanted because we weren't bound by any rules and regulations. Instead of the boring scripted approach you see in so many public health presentations that adhere to conventional diet and exercise dogmas, we could seek the truth in our own way, just as we did in our own lives. We could explore alternatives and encourage everyone to experiment and make up their own minds. Ideally, the group would be experiential (you do, not just listen), practical (take a walk, it doesn't need to be up Mt. Everest), and interactive (speak up, this isn't church where the preacher does all the talking).

A final con we turned into a pro: We had no idea how to run a wellness program, just an interest in wellness. I didn't want to think about what wellness is too much because I'd spent my share of time working with groups of people who'd gathered together to solve a problem, but failed to move forward because they were unable to define what, exactly, the problem is. We figured wellness would be what each person decides it is for her or him - for one it might be losing 5 pounds, for another being able to fall asleep at night, for another eating fresh fruit. We'd just get everyone together and go in search of wellness.

I was nearing the end of my employment at our health center. I'd soon be giving notice to our board of directors that I'd be moving along within a year. Although I loved the people and our mission, I was tired of government and insurance company expectations to do more with less, basically to turn water into wine. Besides, I relished unleashing creativity that was bounded for years by forms, reports, data, protocols, guidelines, and the medieval guild hierarchy of healthcare. Sure, we might stir up some controversy, but what were they going to do, fire me?

It was as if the wellness stars seemed magically aligned: our personal health, family health, organizational health, community health, and the health of the nation! If more people would get well, POW!, fewer people would access the healthcare system, and costs would come down, just like the alien spacecrafts falling out of the sky at the end of the movie Independence Day.

I couldn't think of any cons, other than it would make me busier in my off hours. Using the fingers on both hands, I tallied the final votes for and against. The pros won.

We needed a name for our wellness program, something catchy and inspiring, maybe a little edgy. Given the huge battles that lurked ahead because of so many anti-wellness forces in American life, it would have to resemble a crusade. I was thinking something along the lines of the Wellness Warriors or Wellness Platoon or Wellness Brigade or Special Wellness Operations. I ran these by my wife.

Why's everything always a war? she said.

I thought for a moment, my feelings a little hurt because she didn't jump at any of my ideas. With a hint of sarcasm, I asked, Think something duller would be better? Like, uh, the Wellness Club?

Why not? That's what it's going to be, isn't it?

I thought for another moment. She was right.

Thus was born the Wellness Club.

About this book:

Scientific jargon is limited, but when there's a term worth learning more about, it will be enclosed in asterisks, e.g., *cytokines*. Copy and paste into Google and find out more about it.

You will find all the books quoted in various chapters in the Resources.

Names of staff members have been changed to avoid inducing too much pride or embarrassment.

Important: This book is not intended to provide medical advice. If you have a medical problem, discuss any changes you contemplate making based on what you read in this book with your healthcare provider.

Chapter 1

If People Just...

Once I heard a doctor comment, If people just quit smoking, ate a little better, drank a little less, and exercised a little more, half our patients would disappear. But as they say down in Texas, If my aunt had balls, she'd be my uncle. Doctors don't anticipate working only halftime anytime soon.

However, the doctor's comment wasn't true only of our patients. You'd think healthcare workers, who witness firsthand the harsh consequences of failing to make simple lifestyle changes, would be exemplars of healthy living, but, strangely, healthcare workers are no healthier than the general population, and some studies show they are even worse.

We were no exception. Our staff was pretty representative of healthcare workers and the general population - lots of people overweight, about one in four obese (Colorado is the leanest state in America, but that's not saying much), maybe a little younger than average, and higher than average in percentage of Latinos and females.

Being typical, we had the typical excuses, too, for unhealthy lifestyles - long commutes to work, families to care for, and little time to exercise or prepare good food. Although there was a hospital cafeteria across the street that served healthful food at a reasonable price, many of our staff paraded the exact opposite direction to the fast food joints on the main drag a half a block away to get super-sized. Someone once joked that if you brought a 100 pounds of grass clippings and dumped them on the table in our lunch room, then poured on some salt, fat and sugar, every blade grass would be devoured within an hour.

Death by Candy

The window to my office was by a rear entrance to the clinical area. One sunny spring day I happened to look out just as the bus from a local nursing home pulled up. The driver parked close to the curb then jumped out to open a side door, where an automatic platform emerged from the side. On top of it was a wheel chair with a patient whom I recognized. Let's call him Ted. He was a person with a host of serious health problems - called co-morbidities by healthcare wonks - despite being only in his mid-50's. Many of us were on a first name basis with Ted because he visited so often.

While waiting for the driver, who had disappeared into the building with some paperwork, to return and lower him, Ted reached into his pocket for a pack of cigarettes and lit one up. It glowed brightly from the oxygen leaking from the plastic cannula attached to his nose.

An hour later, after Ted was hoisted back on the bus, I encountered his physician in the hallway and asked if he had mentioned to her that he's still smoking. She replied, No, but I could smell it. That's not the half of it. He ate a candy bar in the waiting room. Of course, with his advanced diabetes, that could be as harmful as his smoking.

Why would he do that? I asked.

I think he's trying to kill himself, she said matter-of-factly.

Are you serious? I responded.

She just shrugged and went to the next exam room. Without saying a word, the look on her face conveyed how frustrating it is for her to make the effort to treat a patient like Ted who is non-compliant, the healthcare wonk term for does not do what he or she is told.

The sad fact is Ted will probably die soon (if he hasn't already - his sister took him to another state where Medicaid is more generous). He did it to himself, as surely as if he held a gun to his head and pulled the trigger. His middle years have been miserable, and will get worse. On the way out, he'll cost his family, and the society at large, an unbelievable amount of money and grief.

Ted's emblematic of a big problem. Lots of people don't really understand the connection between the Ted's, the rest of us, and the worsening financial crisis in the U.S. healthcare system.

Ted's R Us

Ted's an extreme example, but not that extreme. A small percentage of disease is caused by genetic time bombs that can go off at any time. All of us have genetic vulnerabilities of one kind or another. But the major disabling and deadly diseases - diabetes, cardiovascular disease and several cancers - are largely avoidable with simple lifestyle changes, what healthcare wonks term modifiable risk behaviors. 7 of 10 deaths in the U.S. are due to these chronic illnesses.

In our hyper-informed civilization, we tend to think that if you educate people about something, then they'll internalize that knowledge and it will be expressed in their behavior. For instance, if you teach a person that driving on a two lane, two-way street you must stay in the right lane or you will cause a collision, most times that person will not drive in the wrong lane, not just to comply with the law, but to avoid injury and pain.

However, that's not necessarily true when it comes to their health. Many people are told to eat less sugar, drink less alcohol, or stop smoking or they will face serious health consequences, including death. Yet they completely ignore the warnings, whether delivered by somebody in a white coat, like their primary care provider or TV personalities like Dr. Oz and Sanjay Gupta.

A glaring weakness in the ACA, and upon which significant cost savings are dependent, is an assumption that patients will take more responsibility for their own health. Reflecting this hope, a study by the Robert Wood Johnson Foundation, written by a RN with PhD, concluded that In the 21st century people need - and want - to be actively involved in managing their health and health care. To take charge, they need access to a range of information and tools to help them understand and use it. Sounds good, but is this really true? Actually, a majority of people know much more about and are more interested in their cell phones than their bodies or healthcare.

Health illiteracy is the greatest killer of all.

- Walter M. Bortz, II, MD

A sizeable industry of highly-paid PhD's and MD's occupy lofty perches in government, academia, and foundations where they ponder what to do about our ignorant, self-destructive behaviors. They are a small part of what some call the Industrial Health Complex. Every now and then a contingent descends on Congress or state legislatures to issue a dire warning (and plea for more funding) about a health issue, which is then passed on to the population at large through various means. For example, as this book was being written, the Institute of Medicine released a heavily footnoted, 700 plus page report entitled Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation, which concluded, with great gravitas, that people need to exercise more