ImageThere is an old saying –real men don’t wear pink.  On Saturday, October 26, the manly members of the Ohio State football team and over 90,000 other real men and women wore pink in honor of Breast Cancer Awareness Month, also raising awareness about programs at The Ohio State University Comprehensive Cancer Center and the Stefanie Spielman Comprehensive Breast Center.  It’s not often you see a football team, much less an entire stadium, drenched in pink.  It was a very visual reminder of breast cancer awareness.

Breast Cancer Awareness Month may be coming to a close, but breast cancer won’t stop at the end of the month. I would imagine you know someone who has been affected by breast cancer. You may wonder what can you do besides wear pink? You can start by taking steps to detect the disease in its early stages and encourage others to do the same.  Yes, men DO wear pink and CAN encourage the women they love to get breast cancer screenings.

The importance of finding breast cancer early

The goal of screening exams for early breast cancer detection is to find cancers before they start to cause symptoms. Most doctors feel that early detection tests for breast cancer save thousands of lives each year, and that many more lives could be saved if even more women and their health care providers took advantage of these tests.

Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health.

  • Despite their limitations, mammograms are still a very effective and valuable tool for decreasing suffering and death from breast cancer.

Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional preferably every 3 years. Starting at age 40, women should have a CBE by a health professional every year.

  • CBE is done along with mammograms and offers a chance for women and their doctor or nurse to discuss changes in their breasts, early detection testing, and factors in the woman’s history that might make her more likely to have breast cancer.

Breast self-exam (BSE) is an option for women starting in their 20s. Women should report any breast changes to their health professional right away.

  • Sometimes, women are so concerned about “doing it right” that they become stressed over the technique. Doing BSE regularly is one way for women to know how their breasts normally look and feel and to notice any changes. The goal, with or without BSE, is to report any breast changes to a doctor or nurse right away.

There are additional tests to be considered if you are at high risk.   Talk with your doctor to determine if you are at high risk and if an MRI makes sense for you.

Valorie Bender CWPM

Source:  American Cancer Society (last updated 09/17/2013). Breast Cancer, Early Detection. Retrieved October 16, 2013, from http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-importance-of-finding-early

 ImageDubai recently launched an initiative to pay chunky citizens real gold to lose weight, as part of the United Arab Emirates’ efforts to curb the obesity epidemic.  I would guess they will have some success in the short term, but I would be curious to see if contestants keep the weight off.

Various monetary incentives are becoming a larger and larger part of the wellness culture.  Wellness professionals would love employees to be motivated by a desire to not become sick.  However, for most people the possibility of maybe getting sick somewhere in the future causes their motivation to also move to “sometime in the future”. The prospect of an immediate reward is much more motivating.

I am not against incentives.  They can be used successfully. However, before going down that road it is important to understand the plusses and minuses of using incentives.

Plus side

  • Incentives have been shown to be powerful tools for short term, easy to accomplish behavior (flu shot, complete a health assessment).
  • Incentives often increase participation.  Participation can be a first step toward lasting behavior change.

But their usefulness may be limited in regard to more complex, deep-seated behaviors.


  • Paying incentives may become economically unsustainable over long periods of time.
  • Incentives are not shown to work for long-term maintenance of behavior change.
  • Incentives can encourage the potential for unintended negative consequences (cheating, short cuts and unethical behavior).
  • Incentives may be construed as an entitlement and potentially reduce motivation and appreciation for the wellness program.

Incentives should be one element, among many, in driving engagement, participation and sustained behavior change.  It should not be the primary mechanism to drive outcomes. 

If not incentives, then what?

  • Create a supportive culture.  Provide opportunities to give and receive social support (promote team challenges, buddy systems).
  • Provide an environment where the healthy choice is the easy choice (such as, healthy vending and cafeteria food, walking paths or exercise classes at the workplace).
  • Provide comprehensive communications: tell them, tell them, and tell them again.
  • Implement relevant programs.  Use a needs and interest survey to find out what is of interest to your employees.
  • Use recognition as a reward.
  • Make the wellness program part of the culture.  It should be part of recruitment, onboarding, safety, community affairs, productivity, etc.

The true cost of making something as deeply personal as health choices about money, is a culture where it’s more difficult for people to want to do something good for themselves (just tell me what I need to do to get the money).  According to positive psychology research, one of the key elements for true happiness or well being, is pursuing items for their own sake, not merely to get anything else.

Valorie Bender, CWPM


NY Daily News (last updated July 22, 2013). Dubai paying citizens gold to lose weight in fight against obesity.  Retrieved July 22, 2013, from http://www.nydailynews.com/life-style/health/dubai-gold-weight-loss-article-1.1402404#ixzz2ZnnHSGNv

Terry, P.E. PhD, Serxner, S.A., PhD, MPH, Moller, A. PhD, Spring, B.A. PhD. The Motivation Issue.  The Art of Health Promotion, March/April, 2013.

Witherspoon, Reese, How to Create an Environment Where Intrinsic Motivation Can Flourish. Last updated July 17, 2013. Health Enhancement Systems. Retrieved July 22, 2012 from http://www.hesonline.com/blog.

Seligman, Martin E. (2011).  Flourish A Visionary New Understanding of Happiness and Well Being. New York, N.Y.: Free Press.


Many companies have random and intermittent wellness activities, which are usually independent of each other and are short puzzle1term oriented. Far fewer companies have sustainable wellness programs resulting in changing behavior, lowering health risks and providing a positive economic return.

The key to having the later is making the effort to have an Administrative Infrastructure in place for the wellness program.  Administrative Infrastructure refers to the assortment of personnel, policies, procedures, and resources in place to support the wellness program.  This type of structure is required to bring about long-term cultural and organizational change.

Think of the infrastructure as the core pieces of your program. There are 16 key components, which make up a complete administrative infrastructure.

Program Design

–       A design team is established to help create the initial design of the program.

–       Budget planning

–       Proposals

–       Vendors

–       Wellness program work plan (what are the activities, who is responsible)

–       Program Brand (should include a logo and tag line)

–       Program Goals

–       Program Objectives

–       Ongoing evaluation

Program Operations


–       Wellness Program Coordinator or Manager

–       Wellness Advisory group (to make decisions, approve budgets)

–       Support Staff (admin, health coaches, educators etc.

–       Employees wellness network (the feet on the ground to help coordinate)

–       Ad hoc teams (as needed for special projects)

Internal System Support

–       Email support

–       Wellness Website

Not all organizations will have all components.  The larger the organization, the more complete the infrastructure will need to be.  Regardless of the size of your organization, if your wellness program is not achieving measurable results, take a hard look and ask the question – Do you have only wellness activities or do you have a solid plan and the pieces in place to implement that plan?  Then take a look at each of the 16 elements, and see what is missing and can be incorporated into your program. The good news is you don’t have to implement everything at once.  Infrastructure should be built in phases and should change over time.  As your wellness program matures the infrastructure should mature right along with it.

Source: Chapman, L. (2009). Building a Sustainable Administrative Infrastructure for Worksite Health Programs. The Art of Health Promotion, November/December 2009



Depression. The topic few like to discuss. However, this disease affects many lives and businesses. Depression as defined in the Merriam Webster dictionary:

(1) : a state of feeling sad : dejection (2) : a psychoneurotic or psychotic disorder marked especially by sadness, inactivity, difficulty in thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal tendencies

With a definition like this, is it any wonder few discuss this topic. However, opening discussion and creating awareness about depression is necessary for the health of employees and the business’ bottom line. The Journal of the American Medical Association draws the sobering conclusion, that depression costs employers $44 billion a year in lost productivity. Those are strictly indirect costs; and do not begin to reflect medical costs.

Work is a big part of our lives. Depression can affect employees’ abilities to perform their jobs efficiently. The inability to concentrate fully or make decisions can lead to safety risks, accidents or costly mistakes. Other problems can include absenteeism, alcohol and drug abuse, or morale issues.

If five or more of the following symptoms persist for more than two weeks, medical attention may be called for:

  • Sleeping too little, or too much, difficulty falling or staying asleep
  • A persistent sad, anxious, or empty feeling
  • Markedly diminished interest or pleasure in almost all activities
  • Reduced appetite or weight loss or increase appetite and weight gain
  • Fatigue or low energy
  • Difficulty concentrating or remembering things, indecisiveness
  • Feeling of worthlessness or excessive guilt
  • Restlessness, irritability

Fortunately, depression is not a life sentence. It is a very treatable condition.

If you suspect an employee is depressed, approach the employee and offer your support:

  • Confront the situation quickly in a caring and gentle way.  Express genuine concern.
  • Be empathetic and non-judgmental.
  • Listen.  Everyone has a story and wants to be heard. Do not try to solve the problem.
  • Provide a solution.  Refer the employee to the Employee Assistance Professional or have a referral to counselors available.
  • Follow up and provide a supportive environment.

In eighty percent of cases, successful treat is possible for people with clinical depression. With recognition, intervention and support, most employees can overcome their depression and push forward with renewed energy.

Vicki Prussak B.A., CWPM, ACE

Certified Wellness Coach


Sources:  Depression. 2013. In Merriam-Webster.com.  Retrieved April 2, 2013, from http://www.merriam-webster.com/dictionary/hacker

Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time among US workers with depression. JAMA. 2003 Jun 18;289(23):3135-3144.  Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=196767





When employers develop work-site health promotion programs they often begin with healthy eating or physical activity campaigns.  While exercise and eating right will always be standard programs, organizations forget to promote current benefits. These benefits can have an impact on their employee population’s health; specifically, dental benefits.  There is a proven connection between oral health and medical cost savings.

After analyzing five years of health claims, a 2008 study by the University of Michigan School of Dentistry and the Blue Cross Blue Shield Foundation of Michigan showed that for people with diabetes, getting regular periodontal services can lower overall medical and pharmacy costs by more than 10% and Diabetes-related medical costs could be lowered by as much as 19%.

Other studies have indicated a person with periodontal disease is up to four times more likely to develop heart disease and have twice the prevalence for diabetes than those without periodontal disease. Pregnant women with periodontal disease are at an increased risk for preterm births and low birth weight babies.

So in addition to starting new programs, consider promoting current benefits. Most dental problems do not become painful or visible until they are highly advanced.  At that point treatment can be time consuming and expensive. In comparison, the cost of basic oral hygiene is low.  It benefits all to encourage employees to have regular preventative visits to keep problems at bay.

Consider these options to encourage dental visits.

  • Advertise your dental benefits. 
  • Educate your employees about the link between oral health and other health issues.
  • Bring dentists on site.
  • Award a new electric toothbrush to employees who get their annual check up.
  • Promoting your existing dental benefits is a low cost, easy campaign, which can result in measurable results.




This story is based on a compilation of stories I have heard through my work  as a registered nurse in the Emergency Department and Hospice.  For the purposes of the story that I feel very passionate about telling, Jake is the character that will represent all the stories I have heard and the situations with which I have been involved.  Although this story is not based on any one person, it is never the less completely true and accurate.

This is about the man of my dreams, Jake. He is my best friend and husband of 35 years.  He is 56 years old and has never looked or acted older.  He struggles everyday and it kills me to see him suffer.  You see, he was diagnosed with Coronary Artery Disease 18 months ago and he has not been the same since the doctors told him the blockages in his arteries were too risky for any type of intervention.  He had been having this pain in his chest and arms at night and every time we tried to go for our treasured walks in the woods.

I miss the old him. We used to hike into the middle of the woods and go camping year-round.  We loved nature. Being in the woods together was like our little piece of heaven on earth.  Now, I am sure neither of us knows where our  “heaven on earth” is any longer.  Jake struggles every day just to muster the strength to get to work.  It is not uncommon for him to miss 4-5 days monthly because he had a bad night and could not sleep.  He is always going between the bed and the chair.  It is rare that he even sleeps for more than 2-3 hours uninterrupted.  He says he gets “the pain” at night and his arms ache.  He gets up to “pop a nitro, or two, or three”, as he says.  He wears oxygen more and more all the time to help deliver more oxygen to his ailing heart. That just worries me terribly. I am afraid I will wake up to find my husband gone. I know it will happen at some point, but I am not ready.

The same company has employed Jake since we were married all those years ago.  His boss has been so kind and understanding about his illness and the fact that there is no cure. The strain on his co-workers has been enormous, however, and that wears on Jake, a lot.  He often talks about how he “burdens them” and how “they should just can him for being so useless”.  Jake was their best salesman and he has numerous awards of recognition adorning his office, resting in memory of who he was and what he could accomplish with ease.  Jake was the money-earner for the company at one time, now he is costing his employer thousands of dollars in health care claims and sick time.  In addition, his absenteeism is placing his responsibilities on the backs of all his co-workers and long-time friends.  These are the things that drive him further into depression. Depression makes his chronic illness more pronounced and the symptoms take over.  Jake, from his perspective, is no longer living life.

Research on chronic illness and depression indicates that depression rates are high among patients with chronic conditions:

Heart Attack: 40% -65% experience depression

Coronary Heart Disease (without heart attack): 18% – 20% experience depression

Stroke: 10% – 27% experience depression

Diabetes: 25% experience depression

Chronic Pain Syndrome: 30% – 54% experience depression

Most disease processes can be controlled through preventative health actions such as yearly visits to the doctor, weight management through proper nutrition and exercise and stress management.

Maybe going for regular check-ups at the doctor and listening to our bodies really is the best way to ensure the best life possible, unfortunately, for Jake, it’s just too late.

For more information on the link between Chronic Illness and Depression:


By Melissa Naborowsky, RN

Many of the companies with which I met mention their aging workforce. These companies often have low turnover, with many employees with 10 or more years of service. The American workforce will be impacted over the next two decades by the cohort of individuals known as the ‘baby boomers’. Born between 1946 and 1964, baby boomers are now entering their 60’s. During the next 18 years, they will be joined by the remainder of their generation. By 2010, 39% of the US population will be over the age of 45.

With the recent economic crisis, many older workers may be staying in the workforce longer as they rebuild their retirement savings. As these workers continue in the workforce, the health and productivity picture of these employees warrants consideration.

There are many reasons to want to protect and encourage this group of workers. Your company may have invested heavily in their training and education. Long-term employees may be viewed as corporate assets based on their ‘institutional knowledge’. UNUM Provident reports that workers over the age of 40 have lower incidences of worker injuries, short-term disability and unscheduled absences than employees under the age of 40. However, older workers typically have more severe consequences and therefore slower recovery rates when ill or injured. [i]

Logic would suggest that health care costs rise as a person ages. Research shows that medical costs rise an estimated 25% from age 40 to 50 and 35% from 50 to 60. But more important than age, is the presence of risk factors such as smoking, weight, and the amount of physical activity an individual gets. This chart shows the annual medical costs associated with risk factors.

An approach to dealing with the prevalence of risk factors is to encourage workers, regardless of age, to minimize the impact of health risk factors. Understanding and controlling health risks is the first place to start.

Understanding risk factors is accomplished by administering a health risk assessment or employee needs or interest survey. AdvancingWellness clients have expressed both surprise and concern when assessments of this nature report the numbers of risk factors prevalent in their employee population. As an example, in one company 60% of their workforce is overweight or obese.

Controlling risk factors is addressed by implementing worksite wellness programs that provide education and awareness programs, encourage behavior change and create supportive environments in the workplace.

We are all aging, that part we can’t change. What we can change is how healthy we are as we age.

[i] “Health and productivity in the aging American workforce: realities and opportunities, UNUM Provident, Spring 2005.


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