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Expert Interview

David Katz

David Katz, M.D. M.P.H., F.A.C.P.M., F.A.C.P., is a board-certified specialist in Internal Medicine and Preventive Medicine/Public Health.   An Associate Professor in Public Health Practice at the Yale University School of Medicine, Dr. Katz formerly served as the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years.  In addition, Katz is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, CT; and founder and president of the non-profit Turn the Tide Foundation.  Katz has published over 100 scientific papers, numerous textbook chapters, nearly a thousand newspaper columns, and 12 books to date.  He and his wife, Dr. Catherine Katz, developed Nutrition DetectivesTM to teach children to make healthy choices.  Dr. Katz shared his insights and expertise with the CDC in November 2009 to inform employers about how they can promote health and wellness within their employee populations and communities.

Q:  Why is it important for employers to address obesity in the workplace?
Dr. Katz:   First, it is well established that obesity drives up costs— medical costs, absenteeism costs, and presenteeism costs.  So employers certainly need SOMEONE to address the problem!  Then the question simply is— if not them, who?  Workers spend much of their lives in the workplace, so that setting can have a significant impact,   for good or for bad, on their attitudes, behaviors, and weight.  Creating a workplace environment that makes eating well and being active the norm is potentially a very important part of the comprehensive solution to epidemic obesity.

Q:  How can employers work with other stakeholders in the community such as the healthcare providers, schools, retail outlets, and public health departments to develop effective interventions targeting obesity?
Dr. Katz:  There are many ways to answer this question, so let's just use one illustrative example:

An employer has a majority of workers whose children attend a particular school district, and whose families attend the same one or several churches.  The employer invites the superintendent, principals, and pastors to a health promotion meeting.  The employer is prepared to invest in wellness programming so the schools and churches can offer it, and the return on investment (ROI) being that such programming now reaches the household of the employee via multiple portals.  This takes ‘worksite wellness' outside the worksite, and increases the likelihood that it will influence behavior and, health at the family- household level, which is really where the action is.

Q:  Why is childhood obesity an issue for employers?   What can employers do to address childhood obesity?
Dr. Katz:  Employees who are parents leave the work place and go home to their family life.  They have food in the house based in part on what their kids eat.  If kids are not in on eating well and being active, it is harder- if not impossible for parents to make it work, vice versa as well.

So, for one thing, employers will not effectively promote the health of their workforce unless they acknowledge and address the fact that the family is the basic functional unit of our society. 

And, second, employers insuring their employees typically insure their families as well.  Those kids could prove costly if they succumb to type 2 diabetes, as more and more are doing because of childhood obesity. 

Q:  How can employers motivate employees to make better health choices?
Dr. Katz:  By combining efforts to cultivate will, with efforts to pave the way.  Deliver the message of how important lifestyle is to health.  Then implement programs and policies that make the pursuit of health lie along the path of least resistance.  Will is not way; both matter.

Q:  How can employers support overweight and obese employees who face barriers to change?
Dr. Katz:  It depends on the specifics, but in general help is needed to identify the barriers and build a route around them.  If the barrier is cost, consider workplace vouchers to offset the cost of gym membership or produce.  If it is knowledge, provide education.  If it is motivation, provide incentive.  Much like the answer to #4: cultivate the will to change, but then pave the way toward change as well.  To know where those paving blocks should be laid down may require consultation with the employees to find out where they feel they are bushwhacking.  We have developed and tested a behavior change concept called "impediment profiling,' which, essentially, helps identify personal barriers to change so they may be targeted and overcome in a customized manner. We've had great success with this in smoking cessation and promoting physical activity, and are now applying it to dietary change.  Every employer can apply the basic approach by getting feedback from employees about what makes healthful change hard, and then doing something about THAT obstacle, to make it easier.

References

Anderson LM, Quinn TA, Glanz K, Ramirez G, Kahwati LC, Johnson DB, Buchanan LR, Archer WR, Chattopadhyay S, Kalra GP, Katz DL; Task Force on Community Preventive Services. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review. Am J Prev Med. 2009 Oct;37(4):340-57. PubMed PMID: 19765507.

Katz DL. School-based interventions for health promotion and weight control: not just waiting on the world to change. Annu Rev Public Health. 2009 Apr 29;30:253-72. PubMed PMID: 19705560.

Katz DL. Life and death, knowledge and power: why knowing what matters is not what's the matter. Arch Intern Med. 2009 Aug 10;169(15):1362-3. PubMed PMID: 19667297.

Faridi Z, Shuval K, Yanchou Njike V, Katz JA, Jennings G, Williams M, Katz DL; The PREDICT Project Working Group. Partners reducing effects of diabetes (PREDICT): a diabetes prevention physical activity and dietary intervention through African-American churches. Health Educ Res. 2009 Mar 4. [Epub ahead of print] PubMed PMID: 19261690.

Katz DL. School-Based Interventions for Health Promotion and Weight Control: Not Just Waiting on the World to Change. Annu Rev Public Health. 2009 Jan 15. [Epub ahead of print] PubMed PMID: 19146397.

Katz DL, O'Connell M, Njike VY, Yeh MC, Nawaz H. Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis. Int J Obes (Lond). 2008 Dec;32(12):1780-9. Review. PubMed PMID: 19079319.

Katz DL, O'Connell M, Yeh MC, Nawaz H, Njike V, Anderson LM, Cory S, Dietz W;  Task Force on Community Preventive Services. Public health strategies for preventing and controlling overweight and obesity in school and worksite settings: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep. 2005 Oct 7;54(RR-10):1-12. Review. PubMed PMID: 16261131.

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The opinions expressed in these interviews are those of the interviewee and do not necessarily represent the official views of the Center for Disease Control and Prevention (CDC), the Department of Health and Human Services (DHHS), or the U.S. Government.  The placement of these interviews on the Center for Disease Control and Prevention's website does not imply the endorsement of one particular organization, author, product, or service over another. 


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