All right, good afternoon, everyone. Welcome to this session of the AOHC 2020 conference. We're actually going to start our session by hearing from our virtual presenter, Dr. Seema Saran. So we'll turn the time over to her to start us off for this session. Wonderful. Thank you, Nathan. Good afternoon, everyone. Can you hear me? Can everybody hear me? First for the mic check, I guess. I'll go ahead and begin. So welcome to the Lifestyle Medicine in the Workplace session. My name is Dr. Seema Saran, and it is a pleasure to be with you all today at the American Occupational Health Conference in Salt Lake City. My colleagues, Dr. Nathan Jones, Valerie Tivnen, and I will be discussing Lifestyle Medicine in the Workplace. But before we begin, we'd like to share our disclosures. I am the co-author of the book, The Practitioner's Guide to Lifestyle Medicine, and my co-presenters, Nathan and Val, have nothing to disclose. My distinguished colleagues and I have a great lecture planned for you, but I want to give a background to Nathan, Val, and myself to introduce ourselves. So Dr. Jones is a board-certified physician, both in Lifestyle Medicine and Occupational Environmental Medicine. He's authored numerous peer-reviewed articles, given multiple academic presentations on the implementation of Lifestyle Medicine principles in an occupational setting. Currently, he serves on the United States Air Force Lifestyle and Performance Medicine Working Group, where he co-leads the Culture of Health Initiative and is the specialty lead for Occupational Medicine. Dr. Jones completed his Occupational Medicine residency training at the Harvard T.H. Chan School of Public Health, where he also earned a master's degree of public health with a focus in occupational health and safety. I'll introduce Val next. So Valerie Tifnan is the Director of Population Health Strategy and Well-Being at Employee Benefit Solutions. Here, she creates the culture of health in the workplace and advises leaders on tactics to bring Lifestyle Medicine into the workplace to improve population health and decrease health care costs. Val has over 30 years of experience in the wellness, well-being, and Lifestyle Medicine fields. She's the chair of the Lifestyle Medicine in the Workplace Group at the American College of Lifestyle Medicine and has published papers and journals, such as the American Journal of Health Promotion. She has a master's in education from Boston University, an MPH from UCLA, and is an adjunct professor at Merrimack College and has even won Employee Benefit Advisors' Prestigious Wellness Director of the Year Award in 2017. My background is on the slide here. I'm a board-certified Lifestyle Medicine and Internal Medicine physician. I've obtained my MD and dual degrees in biology and psychology with honors at George Washington and completed my internship and residency at Johns Hopkins Bayview Medical Center in Baltimore, Maryland. And over the last 20 years, I've worked in primary care, internal medicine, urgent care, lifestyle medicine, and prevention, and my experience includes being a medical director at Anthem and at EHE Health, and that's a company, it's a nationwide preventive health company. I've created successful Lifestyle Medicine programs, practicing Lifestyle Medicine, of course, with my own patients, as well as clinical, virtual, and digital medical programs to optimize access and personalized care to employees of Fortune 500 companies across the United States. I'm also the co-chair of the Lifestyle Medicine in the Workplace group at the American College of Lifestyle Medicine and wrote a book on Lifestyle Medicine for practitioners. On behalf of Nathan, Val, and myself, it's our pleasure to bring you this session on Lifestyle Medicine in the Workplace. And as you may know, Lifestyle Medicine is one of the fastest-growing medical specialties in the U.S. and offers significant benefits to occupational health providers, our patients, and employers. Today, we'll discuss the six pillars of Lifestyle Medicine and how it's used to prevent, treat, and often reverse chronic disease, especially because in our workplaces, absenteeism, presenteeism, and direct healthcare spending due to chronic conditions like cardiovascular disease, diabetes, and the like represent an immense financial burden for employers. And there's an ever-growing body of research that supports the implementation of Lifestyle Medicine principles in the workplace to address those issues. So in this session, I will introduce you to the field of Lifestyle Medicine and its core tenets. I'll give you a background of this field and how you can implement a few things when you're seeing patients back in the clinics coming up this week. Nathan will discuss the impact that Lifestyle Medicine can have on the field of occupational medicine, and Val will discuss important resources that you can use today to incorporate Lifestyle Medicine in the workplace. At the end, we'll have a Q&A session, and as you go through the session, if you have any questions, please enter them in the Swapcard website or app. You can click the Live Discussion button to ask questions, to answer the polls, or chat with us using the Swapcard website. And for those of you joining us in the conference hall, you can also do it the old-fashioned way after we do the presentation, just by raising your hand. So I'd like to begin with a question. What percentage of chronic disease is due to lifestyle? And is it 20%, 30%, 50%, or 80%? And as you're thinking about this, we'll talk about the top 10 causes of death in the U.S. as of 2020, and this is according to the CDC. And as you can see listed, the top causes of death include heart disease as number one, cancer as number two, COVID-19 as number three, stroke, Alzheimer's disease, diabetes, and kidney disease. And when you look at all these diseases, we think about what the root cause is. You know, what percentage of your patients have these diseases, and what are the underlying causes? So it's atherosclerosis, hyperlipidemia, hypertension, obesity, inflammation. And what causes these underlying factors? There's one common denominator, and that's lifestyle. Maybe our patients are smoking, they're not exercising enough, they have a diet rich in processed meats or packaged foods, they have sugary beverages throughout the day. And this is a true pandemic. In fact, to answer the poll question, according to the World Health Organization, about 80% of chronic diseases, like these top 10, cardiovascular disease, cancer, and diabetes, are actually due to lifestyle. And it's a true epidemic. And as you know, we spend an inordinate amount of money in the U.S. on healthcare, about $3.3 trillion annually. And this infographic on the right is from the CDC. About six out of 10 people are sick with one or more chronic disease. And despite all of our spending, people are still sick. So we really need these interventions to treat the root cause. And that starts with the pillars of lifestyle medicine. And it's actually been shown, you know, what is better than any drug or prescription you can prescribe that can reduce your risk of developing disease by 80% and even keep working after you stop using that medication. And that's why lifestyle medicine is so powerful. So what is it? Well, this is the definition of lifestyle medicine, according to the American College of Lifestyle Medicine. So lifestyle medicine is an evidence-based approach at treating, reversing, and preventing chronic disease as a primary therapeutic modality. So first, before we go to drugs or procedure, it includes a whole food, plant-based lifestyle, dietary lifestyle with proper nutrition, regular physical activity, restorative sleep, stress management, positive social connection, and avoidance of risky substance use. And we'll go in depth into each of these pillars momentarily. But it really is the first line of defense. And we talked about the healthcare spending and its link to how we approach healthcare in the U.S., really focusing on sick care rather than on well care and keeping our patients free of these chronic diseases. And this is a field that is highly evidence-supported and reinforced by leading national and international organizations. And you don't need to look far here. You can see the American Heart Association, the World Health Organization, the Centers of Disease Control, the American College of Cardiology, the American College of Preventive Medicine, the American Cancer Society, all these institutions and organizations do find that lifestyle medicine, those underlying causes of chronic disease, is what's causing chronic disease states in the United States and worldwide. There's one study that comes to mind. It's Dean Ornish's seminal study. And it started in the 1990s. And it was a very clear study, because I love this picture here. On the left-hand side, you see two pictures of coronary angiograms, one on the left and one on the right. On the left side, you see a patient with atherosclerotic plaques in the left anterior descending artery. And what he did, he took about 48 patients, all of whom had atherosclerotic plaques that were clearly visible on angiograms, as evidenced by that one on the left-hand side. And he split the groups in two. There was an experimental group, where he fed them a low-fat vegetarian diet. They exercised for about 30 minutes a day. They avoided tobacco and did stress management exercises. That prescribed diet that he included excluded red meat, poultry, and fish, eliminating cholesterol and animal fat. It minimized vegetable oils as well, because of that source of saturated fats. And then patients after that had a second angiogram one year later. And this study was actually published in JAMA. And he found the control group had 100% disease progression and symptoms from their coronary artery disease. The experimental group, they found that their chest pain or angina symptoms diminished within weeks. Their cholesterol levels dropped dramatically without cholesterol-lowering drugs. 82% of them showed measurable reversal of their coronary artery blockage. And you can see the angiogram, the beautiful angiogram, without the use of stent or a lupus-lowering drug on the right here. It's beautiful. And then they also did a follow-up PET scan, a cardiac PET scan five years later. And they saw a 400% improvement in myocardial perfusion. And this is quite striking. And you don't need to look far back in the 1990s to see all the evidence behind lifestyle medicine. You can even go to the American Journal of Cardiology, and you can look at their guidelines on primary prevention of cardiovascular disease. And in the top 10 ways to prevent cardiovascular disease, you'll see lifestyle intertwined in each one of them, whether it be exercise, proper nutrition, controlling hypertension and the risk factors for cardiovascular disease. So here are the pillars of lifestyle medicine. We've got nutrition, sleep, exercise, substance use, stress management, and social connection. And I'll go into each one more in depth. Before we do this, I want to ask you all another question here. What percentage of adults currently implement healthy lifestyle habits? So I want you to think of yourselves. I want you to think of your patients, your family, your friends. How many of you feel that you're implementing healthy lifestyle habits according to what you've already learned about lifestyle medicine? Is it 43%, 33%, 23%, 13%, or 3%? And while you're thinking about this answer, I want you to think about a study that, another study, Truven did a study on a representative group of US citizens, about 5,000 of them, and asked them, are you making positive lifestyle changes, or are you instituting, do you live a healthy lifestyle? And 75% of the people who answered said, yes, I do live a healthy lifestyle. But the fact of the matter is that the answer is 3%, that 3% of Americans actually live a healthy lifestyle. And this is from a Mayo Clinic study of, again, about 5,000 people. And there were only four parameters that they used. It was whether or not they did moderate or vigorous exercise for at least 150 minutes per week. They just needed a diet score in the top 40%, so a little bit over 60. And what the health index, what the healthy eating index was, are you eating fruits and vegetables? Are you eliminating added sugars, eliminating saturated fats, limiting sodium intake in alcoholic beverages? They also had to have a body fat percentage under 20% for men or under 30% for women. And they couldn't be smoking to get that point. So we have our work cut out for us, don't we? So when you look at one of the main pillars, which is nutrition, you think about the correlation between nutrition and chronic disease. And according to JAMA back in 2017, nearly one half of all death is due to heart disease, stroke, and type 2 diabetes is actually linked to poor diet and poor nutrition. So going back even hundreds of years before with Hippocrates saying, let food be thy medicine and medicine be thy food, the poor diet caused a problem, but a healthy diet can also correct it. And so that's why it's so important to eat healthy. And that's a lot easier said when you've worked with patients for a number of years. What you want to focus on is when you're setting up your practice and talking about lifestyle medicine is making the connection between nutrition and chronic disease. You want to focus on more rather than less and making sure that they're incorporating at least once a week of a plant predominant meal with plenty of vegetables, fruits, legumes, whole grains, nuts, and seeds as much as possible. And going through a diet with them, a typical week of what they're eating, are they drinking sugary drinks like sodas or juices? Are they oftentimes getting processed meats like sausage or bacon, salami, processed snacks like crackers and chips, pastries? The other thing is dairy, unfortunately it has very high fat and saturated fat types. So maybe switching out the dairy that they normally use with some rice milk, for example, or almond milk, red meats and poultry and eggs are another source of saturated fats. So kind of talking about really focusing on the plenty rather than taking things away. The other big pillar is physical activity. And so, you know, as we know, movement can be medicine and the lack of movement can be a risk factor even more powerful than smoking, according to developing risk of coronary artery disease and heart disease, which of course is the number one killer in the US. So how much physical activity should you should do? It's about 150 minutes a week of moderate intensity activity. And that means when you're going for a brisk walk, for example, you'll be able to talk, but you won't be able to sing. And if they don't have 150 minutes per week, they can even do 75 minutes of vigorous exercise. Like that's when they're doing the exercise, they can barely say a few words. When you're talking about an exercise program with your patients, make sure you include strength training, flexibility, and a balance as well. And what I find is really helpful with patients is to develop SMART goals. So you want to develop goals that are specific, measurable, time sensitive, attainable, and realistic. And when you're talking about those types of goals, you can do very easy things like I will exercise twice a week for 10 minutes, I'll walk around my block for the next two weeks. And so it's very specific. It's what they're going to do. It's time sensitive. It's not going to be forever. And then they can see how they feel. Were they able to make the change or not? And then we can troubleshoot from there. Sleep is also really important. So we all recommend to get at least seven to nine hours of sleep per night, because especially if you're taking care of a population that may do shift work, have odd hours during the day, because we know it increases risk of abdominal adiposity, hypertension, irritability. If they do physical labor jobs where attention is in accidents are at risk, that's very important to make sure that our patients are getting enough sleep. It also causes poor job performance and decreased ability to focus when we're not getting enough sleep. And when you're discussing sleep with patients, it's not only important to talk about tips for better sleep and how sleep affects the development of chronic disease, but also talk to them about their other symptoms that could be disrupting their sleep and from the other pillars. Are they drinking alcohol? Are they exercising too close to bedtime? What's their nutrition look like? And do they have risk factors for things like obstructive sleep apnea, insomnia, or restless leg syndrome? Stress management is also a very important one. And there's good stress and bad stress. It's called e-stress and de-stress. And of course, stress can contribute to all cause mortality, heart disease, cancer, hypertension, obesity, migraines, and the like. But the infographic here on the left really shows the impact on the workforce. Approximately one in five workers have quit a job due to stress. Stress employees spend or cost organizations about 46% more in healthcare. And employee stress results in as much as $300 billion in lost productivity annually. So it's important to talk about stress with every patient. You know, making simple things like making connection with family and friends and even acquaintances are important, especially as you move through this conference. Positive reframing helps, spending time in nature. One of my favorites is practicing gratitude. So today, at some point, send a text to somebody that you just met, perhaps, or a family member or close friend, or even the person you got coffee from this morning, and express your gratitude towards them for whatever it is. That really helps change your outlook and also reduces stress levels. We go through exercises with my patients about finding signature strengths and ensure that they're taking care of their other health, making sure they're eating right, exercising regularly and doing activities they enjoy. Social connection is the last pillar. Actually, there's two more pillars, but social connection is linked to stress management as well. The CDC recently came out with a study that showed that social isolation and loneliness is actually linked to all-cause mortality in the tune of about 30%. So patients who feel like they're lonely or socially isolated have an increased risk of death by about 30% than the regular population. So it's important to ask about social connection, keeping, do your patients keep at least three close relationships, encouraging them to get to know their community, to find a greater sense of purpose. It's a great idea to do volunteer work, for example, trying to meet face-to-face as much as possible, either through Zoom or in person, joining a club, getting involved in a cause, all of those things can improve social connection, improve your overall health, and actually reduce your risk of developing chronic disease. And as physicians, we all know the importance of talking about substance use, you know, making sure you screen. All cause mortality, of course, is affected by tobacco use, alcohol use, cannabis use, and prescription drug use, as well as opiates. So we wanna make sure that we're screening every time and talking to patients about their risk factors and how it affects their overall health and their other markers of mental wellbeing and physical wellbeing. So it's important to screen those every day. And I'll conclude with a lifestyle change program that is actually nationally known, it's the Diabetes Prevention Program. And this is a major multicenter clinical research study that this is based on, and perhaps you are familiar with the Diabetes Prevention Program and have referred your patients to it. But basically, it's a study that was done focusing on eating healthy, on exercising at least 150 minutes per week. It teaches patients how to cope with stress, overcome challenges, and stick with a lifestyle change. And if it sounds familiar, it should, because a lot of the pillars of lifestyle medicine were incorporated in the study. What they achieved was patients lost about five to 7% of their body weight and reduced their risk of developing type 2 diabetes by a full 58%. And this was across ethnicities, races, genders, and the like. They even did a 10-year follow-up study and the participants in the study were still one-third less likely to develop type 2 diabetes. They also found it was even more effective in patients 60 years and older, lowering their chances for developing type 2 diabetes by 71%. So lifestyle change and lifestyle medicine really has a big part in our everyday practice and can have a big impact in your employee population that you care for every day. I'm looking forward to our discussion later on in our Q&A session. Next, I'll turn it over to Dr. Nathan Jones to talk to you about the specific benefits of lifestyle medicine on occupational medicine. All right, thank you, Dr. Serene. And I'll just get through these slides to the appropriate one. So as I get started, as an active duty physician in the Air Force, I am required to disclose that the content of this presentation does not represent the official views of the United States Air Force, Department of Defense, or the federal government. So as an occupational medicine physician, I recognize that there can be some perceived barriers, and some of them are real, and some of them are there for a good reason, to the implementation of lifestyle medicine into an occupational context. Many of us in occupational medicine recognize the importance of having a barrier between not only the personal health and the occupational health of an individual, but even the electronic health records that are there. And that is a very important part of life. And that is an important barrier. But what I want to draw your attention to is that lifestyle medicine in one form or another is being implemented into occupational medicine in various settings and ways, and a number of the organizations that you can see listed on the slide are contributing to that. Some to draw your attention to specifically, the American College of Lifestyle Medicine has a member interest group, Lifestyle Medicine in the Workplace. And Ms. Tivnan and Dr. Serene, my co-presenters, they are the co-chairs of that organization. Also within our own College of Occupational Environmental Medicine, there's the special interest section of human and health performance, or health and human performance. So anyone who has interest specifically within occupational medicine, I would encourage you to look at those two organizations and see what kind of interest that might have for you. You can see a quote from the ACOM Scope of Practice document from 2011. This is inside our wheelhouse as occupational health and medicine providers, something that we can and should be addressing. So beyond some of the, just overall health insurance claim data and absenteeism, presenteeism, many of you may be familiar with some of these medical standards that are required for the actual performance and clearance for different positions in various occupations. In my own context as an Air Force physician, there are medical standards that if a person has certain conditions, is on certain medications, has certain blood work with some of those conditions, they cannot deploy. And you can see some of the significant impact that some of these chronic lifestyle-related conditions have on the deployability of our United States Department of Defense civilian employees as well as military members. Many of you who deal with firefighters are aware of the NFPA 1582 standards, recently updated. It's a huge, huge problem among some of our public safety personnel who we count on to keep us safe, to protect us, to help us when we need it. And you all know many, I'm sure, DOT examinees who are coming in for different clearance that you simply cannot clear them based on some of these chronic lifestyle medicine-related conditions. This slide is more just kind of a humanistic approach to why we would want to implement lifestyle medicine in the workplace. Essentially, if you dive into some of the literature on lifestyle medicine, a lot of it comes down to dose, similar to the medications that we would prescribe for diabetes, blood pressure. Dose is important. And one of the portions of dose that goes into that concept of lifestyle medicine is how much time do you spend practicing it? How comprehensive is your approach to lifestyle medicine? Our workers spend a lot of time at work. And so if, as an environment that we're providing for them, their workplace environment, if we are providing an environment that is not conducive to lifestyle medicine principles, or even worse, is a barrier to some of those principles, not only are we kind of hindering their ability to apply some of these factors and helpful principles in their lives, but we may actually be contributing to the overall content of chronic disease in our working population. This is a nice graphic that's put out by the American College of Lifestyle Medicine and shows, by each of the pillars of lifestyle medicine, what are some of the occupationally relevant outcomes that can be measured and have been measured for addressing some of the lifestyle medicine pillars that Dr. Serene discussed. Don't have time to go into many of these in detail, but do just want to point out that there is evidence out there that not only does lifestyle medicine work, but it works within the context of an occupational application. So some of these papers will be, you can access the slides and can certainly look at them later on, but I like the one there at the bottom, very interesting, where it actually breaks down each of the six pillars of lifestyle medicine that Dr. Serene just told us about and analyzes the literature about worker productivity, however that's defined in your particular workplace, and addresses not only how the absence of positive lifestyle medicine principles will negatively impact worker productivity, but also demonstrating that when a lifestyle medicine initiative is put into place, it can positively impact worker productivity. This slide I included mostly to help out anyone who got in on the over-under bet for how many times we would see the hierarchy of controls graphic in this conference. So if you win your pool, you can thank me and cut me in a little bit. So included two copies of it here, just for you, but the one in the bottom is the NIOSH Total Worker Health approach to the hierarchy of controls, and it's an interesting graphic that I think does a lot of good to open our minds to how we can think about work as not just an opportunity to prevent illness, but also as a platform to promote health and well-being. And then the larger one on the right is one that I just kind of threw together in preparation for this conference, but I think is also a helpful idea, a helpful framework for us to think about some of the specific applications that we could consider in our own workplace. And Ms. Tivnan will talk about some of the more specific examples that she's come across in her own career and work in a few minutes. And then also just want to draw your attention to the implementation of lifestyle medicine in an occupational context is a spectrum. It can run on a spectrum, and this can run from the simple implementation of a very basic wellness initiative that just touches upon barely poking your toe into the water, one of the six pillars of lifestyle medicine, all the way to perhaps a contracted or even onsite lifestyle medicine physician, nurse, wellness coaches, all the way through to those certified providers who are actually dealing one-on-one with your workers and walking them through the path of disease reversal and improved health. Just one more slide before I turn the time over to Ms. Tivnan to talk about some of her experience. Thought you might find it interesting to hear about some of the initiatives that the United States Air Force, my current employer, is doing within this realm. There is an Air Force-wide lifestyle and performance medicine working group of which I'm a member, and they've really been doing some exciting work. They've come up with a clinical implementation guide that can be dispersed to different medical treatment facilities across the Air Force and can actually guide a medical treatment facility or a clinic from no lifestyle medicine to how are we now delivering lifestyle medicine in a clinical setting. There are now over 50 board-certified healthcare providers who are board-certified in lifestyle medicine, and in one form or another, lifestyle medicine is being clinically practiced at 19 different treatment facilities across the Air Force. We're also starting to bake this into the graduate medical education program where now physicians in training can have some of this didactic training in lifestyle medicine and hopefully some clinical hands-on training as well to where when they come out of residency, they can be eligible to sit for the board exam in lifestyle medicine and then continue on and grow this momentum of lifestyle medicine in the workplace. And with that, I'll turn it over to Ms. Tiffanin. I'm sorry. I was like, can you hear me? Yes, great. Thank you. So my role today is to provide to you some real-life examples of what companies are doing out there in terms of lifestyle medicine in the workplace. As Seema mentioned when she introduced me, I have about 30 years of, really, my passion is lifestyle medicine in the workplace. I've been doing this for a long time, and many of my clients are companies that are well-known like the Broad Institute, DraftKings, and everything in between. So I hope to enlighten you with some real-life examples of what they are bringing into their workplace. And I'd love to hear maybe in the Q&A, if you have your examples too, I would love to hear what you are implementing in the workplace. So let's start with the first pillar of lifestyle medicine, Eat Smarter. So there are many ways that you can bring healthy eating into the workplace, and the goal is really to make healthy eating a default. Unfortunately, we live in the US and where it's much easier to, and cheaper, to get a 99-cent burger from McDonald's, drive-through, so you don't have to move, than to actually buy a $12 salad, and maybe eat a whole food plant-based diet. So you have to really try to implement strategies in the workplace that eating healthy is a default. A couple of things that many companies are doing, creating policies, first and foremost, policies in the workplace that if your employees are organizing a meeting, and they have to purchase food for their meeting, that there are policies involved that those are the foods that you're allowed to purchase from these places. That makes it a little clearer, the message, that healthy eating in the workplace is important. Other things that they are doing involve bringing farm-to-table into the workplace, and I will pinpoint here, on the top left here, Gordon Sachs is a farmer from Nine Miles East Farm, which is a farm from New York State, and he has an amazing model, business model, and passion. His purpose is really to make healthy eating a default, and also to make healthy eating easy for busy people. So he has this text-to-order kind of model that your employees can actually receive a menu on a Sunday before the week start of everything that he will be delivering, including salads, soups. He has relationship with other farms in the region that he can get eggs, et cetera, and you pick what you want and purchase it in the app, and it's delivered to work or your home, depending on what you'd like to. So his business is in the Northeast, but I'm sure that there are models out there outside the Northeast in the US. Other things that companies are doing is revisiting their vending machine, right? I think it gets very confusing when an employer provides the message that eating healthy is important, that we should be having a whole food, plant-based diet most of the time, and then their vending machine, it still carries a lot of processed foods, high-sugar foods. So really revisiting that is smart. And also, if you are in a workplace that you still have that tradition of having bowls of candy all over the workplace, my suggestion is that you replace that with fruits so that, again, employees will be reaching to whole foods instead of candy, which, by the way, does not help their productivity and engagement at work at all. Other things that we have done that has been very successful is actually partnering with famous people to provide the message in the workplace of lifestyle medicine. Here's an example. We did a virtual cooking class with Alan Campbell. I'm not sure if you know him, but he used to be Tom Brady's personal chef, and he actually also wrote the TB12 book with him. And he is in the Northeast, and I had the pleasure to meet him, and he agreed to do a lot of the virtual cooking classes and if you're familiar with what Tom Brady eats, you probably will know that. It is very clean eating and more in the whole food plant-based area. So a couple of things here in terms of nutrition. Again, just to make sure I didn't forget anything. So coordinate farm-to-table deliveries, create nutrition policies, bringing also registered dietitians onsite or virtual. There are some registered dietitians that actually provide services to your employees, and it's actually charged to their insurance, which is very attractive to employers, right, this model. Bring healthier vending machines into your workplace, education and awareness on whole food plant-based diet, make healthy eating a default. Other things that some companies are doing is communicate to employees a list of physicians in their network who actually practice lifestyle medicine, you know, so to make them more aware that they have a choice to go to physicians that actually embrace this practice. In terms of increasing physical activity in the workplace, many companies are implementing amazing, fun and engaging programs. Right here is a program that we've created called Reach the Peak, it was last fall. So we were just kind of getting clear from the pandemic a little bit. So people were really excited about an activity challenge, and this one in particular involved employees had to climb a mountain a week. Actually, they were not literally climbing a mountain, it depended on the number of steps that they were doing. And each week the mountain became higher, so Everest was week seven. And the interesting thing is also that all participants would also receive every week information about their mountain, what people from that region eat, how they, their culture. So, and I think people really like the fact that they really wanted to virtually get out to beautiful places after we were, you know, enclosed, you know, with the pandemic for so long. Virtual exercise classes have become very famous during the pandemic and continue to be so because of the hybrid environment. And there are companies that you can partner with, but to be very honest, there are a lot of free stuff in the internet there. We, at EBS, we created actually a flyer that says those are free virtual classes that you can provide this information to your employees. Also, making employees and organize races, right? Making them aware of races that they can walk and run in the places that they live, work and play. That can also improve socialization. Turning the work lunch into a walking lunch. And also making sure that you have in your benefits fitness reimbursement program. So your employees, no matter how they like to improve their physical activity, and if there is a cost for that, that they can be reimbursed. Again, decreasing all the barriers to have a healthy lifestyle. Sleep more soundly. Sima had amazing insight about it, and I will be preaching to the choir here if I tell you the importance of sleep for our health. I'm sure you know very well that sleep is very important, not only for physical health, but mental health. And you can be a sleep-friendly organization. Here are just some examples, right? Providing sleep education. Encouraging role models, right? Leaders who work 24-7 may set a poor example. Support work and leisure boundaries. Urge disconnecting during vacations. and I'm not sure, raise your hand if you heard of this, I read, I think it was in The Economist, Portugal is a country that actually they implemented a law that it's illegal for companies or managers to contact employees after work hours. Raise your hand if you've seen this in the news, yes, a couple of people have. I'm not sure how they're gonna make people accountable for it, right, but I thought it was a very interesting insight and perspective. Encourage sleep at work, I know that sometimes when I talk about this, people cringe a little bit, and of course it depends on your industry, right, not all workplaces, that can probably be possible, but creating a mindfulness room or relaxation room that it's comfortable, that has a nice couch, that people, maybe if they're stressed, they can go in, meditate, take deep breaths, you know, rest, or if you are in a work setting like mine that many of our folks travel a lot, including myself, that can be positive, and that's probably what I'm gonna be doing on Thursday, because my airplane actually arrives in Boston at 11.50 at night, and then I have to go to work the next day, so I'll definitely take a 20 minute nap in the middle of the day, probably at two o'clock, and at my workplace it is not only acceptable, but, you know, encouraged. And accommodate schedules, consider allowing flexible hours, right, if possible. Allow employees to tell you, I prefer to work at this time, so they can have a positive work-life integration, which is positive not only for engagement at work, but their health and mental health also. And under managing stress better, I already mentioned the, you know, mindfulness room. Many companies are setting a space aside, right, and allowing employees to do that. Sometimes they bring a meditation instructor. Virtual yoga classes also can be positive for managing stress better. Yoga, as you probably know, is a mindfulness practice, and there's lots of studies showing how mindfulness practice can improve mental health, decrease anxiety, decrease depression. And one of the things that a lot of companies are doing is partnering with other mental health companies outside their EAP. EAPs have not been very effective during the pandemic, mainly because of, you know, the system really became, you know, overwhelmed with the demands. And many companies are going to other companies, and, you know, during the pandemic, many companies actually appeared to really feed this need. Companies like Lira Health, Modern Health, Talkspace, Ginger, you probably have seen and heard many of those. And it can be expensive, but definitely, the benefit of it is that employees can actually have a therapy in two days, right? I unfortunately, my practice had a company contact me because an employee's wife was told that her therapy would be in eight weeks from the appointment that she was able to, that she wanted to, and she actually committed suicide. And then we had to get the EAP involved to help that population and that employee. So this, it can be really effective for short-term help on mental health. So here's some examples. The problem that we try to solve for this company is they had actually really good mental health resources, but they were all over the place, and employees did not know about them. So we put them in one place, and we actually made QR codes. So as employees see this, they can very quickly engage in the tool that they're interested in, right? This company actually didn't just email this to employees. They actually printed and mailed it to their homes with the goal of exposing this to spouses and dependents also. I'm not sure about what you see in your practice, but as a population health practitioner, I see in my population health data that mental health claims are much higher in spouses and dependents compared to employees actually. So you want to reach that population also. And I want to enlighten you with a short video actually from Harvard. Harvard University in Cambridge. They have done some interesting work bringing lifestyle medicine in the university to help decrease stress of their students. So if you can play the video, that would be awesome. Thank you. The trash out. He's always leaving stuff around the house. He's mostly lazy. He's mostly just sleeping on the couch. She's more of an aesthetic contributor more than a functional contributor. She looks good. He doesn't like being cleaned. So yeah, he doesn't like showering now. He's a fabulous roommate. He's one of the best guys you could have. He's dependable. He's always there for me. And he's a dog. What we found is people who own dogs are more likely to reach the guidelines for physical activity. Lowering blood pressure and cholesterol. Reducing stress levels, reducing cortisol levels and increasing oxytocin. And then for your spirit, connection with the dog, connection with neighbors around you and giving you a sense of purpose. My dog's name is Charles River. People call him Charles. People call him Chuck, Charlie. I just like Charles. And he has lived at Harvard for now three years. I couldn't imagine being in Wigglesworth without Duke. I think he's the best part of our room, for sure. Just kidding. It's absolutely a daily occurrence that we have people coming up to us saying, oh my gosh, I miss my dog. And you know, you just see the smiles that he puts on people's faces. Students will come in sometimes kind of anxious. We know that they want to say something to us but we don't know what it is. And then they just start petting him and they start saying what it is we know that they wanted to say. I've had students come to study break and be like, oh, I'm just here for the dog. And I'm like, oh, thanks. No matter what happens over the course of a day, you take him for a walk and two minutes into the walk you don't even remember what you were upset about. Especially in the wintertime, it's easy to just put your head down and disappear. But we're outside so much now, five or six or seven miles a day maybe. It's something we can rally around and it's something that brings all of us joy. We're able to really connect in a level that's very different than connecting about social studies or biology. Because a laugh together is a real strong, powerful way of bonding. And dogs enable that laughter. Wait, you're stuck, you're stuck. Great. So again, being creative, promoting dogs in the workplace can be a good thing too, right? To decrease stress. I just have a few slides, cultivating relationships. You probably have seen the studies from Gallup that showed that having at least one best friend at work increases health, productivity, engagement. And sometimes creating environments in your workplace to really promote socialization is a good thing. This is an example. And the environment at your work tells your employees what to do without saying a word, right? So very important to think about that too. And then the power of partnerships. I have been very lucky to be able to partner with amazing people in the lifestyle medicine field. Dr. Beth Frey, which you saw in the video, she's a lifestyle medicine specialist and physician. She has an amazing program. We put this program together that we are offering to many companies. Gordon Sachs brings the food. Jessica Arbor, our personal trainer. I bring the mindfulness training. Dr. David Katz brings Diet ID, which is the company that he built. And Insight Tracker allows us to see the before and after results of what we've done, right? And the other thing I wanna bring to you is make sure that you are building a holistic total benefits rewards package to your employees. Not only promoting the traditional layer here, mental dental vision, but also other things that you can highlight. And this can be great, not only for retention of your talent, but also bringing new talent to your workplace. If you really wanna see a lot of the ROI and VOI of what we do, they are all at John Hopkins. Dr. Ron Getzo has amazing research done in this field and his website has amazing resources. And I would also finally recommend you to go to the ACLM website. There has lots of resources. We have a couple of people here from the American College of Lifestyle Medicine and in the Workplace Member Interest Group. Rosandra is actually also from our group and is presenting in another room. And Nathan and Seema also among others. But in this website, you can see lots of resources. Finally, my final message to you is everything that I said is all in the surface. None of this will impact your employees if you don't pay attention what is under the surface. Your diversity, equity and inclusion strategy, your social determinants of health, how you face that in your workplace. If you have open communication, your own written rules, how your managers treat your employees is also very important. Thank you very much. So it looks like we do have a few minutes for questions or comments if there are any. Yes, it looks like there's one question if you all can hear me. A question from the audience says, many companies have an HR benefits group which manages well-being. Where do occupational medicine providers fit in? And that is a wonderful question. Dr. Jones, would you like to start and we can add to your answer and answer this one together? Yeah, so again, as we talked about, I think it's very easy to see ourselves in our limited role of you are not my patient, I am not your doctor. I am here to evaluate you for your fitness to return to duty. Do you fit with this position that you're being hired for in a pre-placement exam? And I think that approach is valid, but I think also as many of us are leaders in terms of the occupational health and safety within our organizations, that's a powerful position to be in to advocate for some of these more holistic, comprehensive approaches that have been recommended, including the exploration of is it appropriate to try to bring in, like I said, even a contracted board-certified lifestyle medicine practitioner to see patients, to send them to their clinic. I think in my current role, one of the biggest things that I do as the occupational medicine provider is to essentially lend my credibility to some of the educational offerings that we already have on my Air Force Base in terms of promoting these positive lifestyle medicine practices, where I go to the lectures and I chime in and I'm giving input into those lectures, and then they turn around and see me in the clinic for their OSHA surveillance exam for whatever chemical they're working with, give a little plug here and a plug there, and I think that's at least a great place to start for occupational medicine providers. Yeah, so. That is excellent. You know, in addition to as physicians, as leaders in our company, as leaders within our patient population, you know, there's this concept of chief wellness officer. We oftentimes have direct contact with decision makers within our organizations, and discussing the impact that lifestyle medicine can make and making that thought of, you know, putting that bug in our CEO's ears of the importance of lifestyle medicine and how it can really increase productivity, reduce absenteeism, improve working culture, and improve productivity, and really improve the bottom line. There was even a study done saying that, you know, people who are well at work are not only well at work and well at home, but they actually drive the value of the company. So, you know, stock prices go up. So talking to the C-suite is really important as a leader in the company and as occupational health physicians. And as Val discussed during her part of the presentation as well, is that it really is an iceberg. Find out what your company's mission is and how lifestyle medicine can support that as well. So there's so many different ways that we as physicians, as occupational health specialists, can talk to our companies and really impact the health of the total population. Yeah, thanks, Seema. And we have a few in-person comments here as well that we'll take. Oh, wonderful. Yes, sir. And we have a couple more questions online as well. Hey, this is Ron Stout. Thanks for the great introduction. A couple other resources, if I may. One is my former colleagues at Procter & Gamble. I double-dogged Gary to ask him about the Vibrant Living Program. It's one of the best expressions, I think, of lifestyle medicine in the workplace that I've seen. And then secondly, if you haven't received the introduction to lifestyle medicine in the mail, I did bring some copies in the back. They're stacked up on a chair there. And it gives a little bit more about the evidence base. So thanks a lot. Thank you so much. Thank you. And I think, yeah, that does speak to, you know, I think a lot of times it's easy for us to kind of lump everything into a wellness program category, not that there's anything wrong with that, but that this is kind of a growing medical field that does have a board certification, not ABMS, but, and then Dr. Stout was instrumental into bringing this to the forefront of the, a special edition of the Journal of Family Practice. So, you know, this is a growing area to be involved in and definitely something that could provide benefit to your own organizations as well. Yeah, another in-person question here, Seema. Oh, wonderful. So my name's Dorian Kenley. I'm from the University of Washington. I'm a big fan of lifestyle medicine conceptually, but I think you guys touched on it a little bit. One of the chief problems we have is a cultural problem, right? It's a corporate culture sometimes with things like sleep and so forth. And sometimes there's an individual culture problem. And so, you know, all these great interventions, getting more sleep, eat better, exercise, so on and so forth. How do you propose to bridge that culture gap? Because in lifestyle medicine, it's not just an issue of take this inhaler, take this medicine. It's coming up with an intervention that a person themselves has to then implement in their life. And to me, that's the biggest obstacle with lifestyle medicine. And it's something that whenever we have lifestyle medicine conversations, I don't really hear readily addressed. I hear about how great all of our interventions can be statistically and we see great studies, but the patient still has to do it for themselves. That's a great point. So I'm going to talk from the corporate wellness approach. Right? It's a process and it's a journey, right? And some corporations take in a little easier than others. But I think we wanna take really the opportunity to implement the program ecologically. So in the ecological theory, you hope that the employee will learn something at work to do something at work and they will bring it to their homes, to their families, their communities. Right? So I always like to see the big picture. And I think I agree with you. And I think one frustration I have is that sometimes there is a CEO that is very gung-ho about lifestyle medicine and next year he's not there anymore. And then there's another one that doesn't care about it much. So, but it's a process. I think what we're talking about is not popping up here. It's a long-term, right? And behavior change is not easy. So we have to continue and get it with it. Do you wanna add anything? That's great. And just to add to Val what you were saying, you know, and the challenges that we face as practitioners, sometimes it can be very frustrating working with patients and, you know, they know, we all kind of know what we're supposed to do, but that behavioral component, that behavioral health component of really making the change, sustaining that change. There's several things that you can do in practice when talking with your patients. You can do a stage of change. If you're familiar with Kurchaska's model, we ask about how ready are you, how willing and ready are you to make lifestyle-minded changes in your life? We talk about goals. So not just their health goals, but their overarching goals. You know, we get a lot of, we wanna be there for our grandchildren. We wanna be able to be healthy and able to do the things that we wanna do and maybe go on vacation or retire. And what we use is different techniques like motivational interviewing, those SMART goals I talked about as well. And it's really all about empowering the patient and letting them know this is not a pill. This is something that we're gonna do together that can shape your trajectory of health and help you reach your goals. And it's something that you can not only have to do just yourself, is enlist your whole practice. So maybe your medical assistant has a special interest in this or they can follow up with patients. There's several different programs online and things that you can use, resources to help your patients kind of get into the way, get into the mood of making that change, preparing for the change, doing that actionable change and then sustaining it over time. So there's a whole field dedicated to that approach because it's not just about saying this is what you need to do and go ahead and do it. It's really being their partner and their mentor as they go through lifestyle change. That was a great question. Yeah, and I apologize. We are at time, but Will definitely can stay afterwards to answer any other questions. But again, very much appreciate everyone's participation in this session. Thank you. Thank you so much for listening. Thank you.

Lifestyle Medicine in the Workplace

Six pillars of Lifestyle Medicine

Employee health

Well-being

Productivity

Healthy eating policies

Physical activity initiatives

Better sleep in the workplace

Stress management strategies

Occupational medicine providers