1. Reducing Health Care Costs Through Employee Health Improvement

2.  The United States spends twice as much on health care per capita ($7,129) than any other country... and costs are still rising.  In 2005, national health care expenditures totaled over $2 trillion.  From 2000 to 2006 health care premiums increased 87%.  The average family health insurance premium was $11,480 in 2006.  Employees paid an average co-pay of $2,973. www.whitehouse.gov Kaiser Health Foundation

3.  Hewitt Associates estimates that health care costs will increase to $28,530 per employee by 2019  85% of health care costs are spent on chronic degenerative conditions, including, diabetes, obesity, heart disease, lung disease, high blood pressure, and cancer, most of which are preventable and many of which are reversible!

4. But what are we getting for all of this money?

5.  The five-year cost of taking care of a patient who undergoes bypass surgery is $100,522.00; for patients undergoing angioplasty it is $81,790.00  Angioplasty and bypass surgery do not reduce the risk of heart attacks and strokes Stroupe KT, Morrison DA, Hlatky MA, et al. Investigators of Veterans Affairs Cooperative Studies Program #385 Circulation 2006 Sept 19;114(12):1251-7

6. The reason:  Cardiovascular disease is systemic.  Calcified plaques in the arteries close to the heart are not the cause of most heart attacks because they rarely rupture.  It is the thousands of soft, vulnerable plaques located in the blood vessels throughout the body that tend to rupture; bypass surgery and angioplasty do not address these plaques.

7. The AVERT study:  Patients were randomized to receive Lipitor or angioplasty  The patients who received only drugs experienced fewer heart attacks, less chest pain, and made fewer visits to the hospital than those who had angioplasty  This does not mean that statin drugs are a good alternative; they are the better of bad alternatives Waters, D. “Aggressive lipid-lowering therapy compared with angioplasty on stable coronary artery disease.” NEJM December 9, 1999 vol 341:1853-1855 no 24

8.  Annual costs for statin drugs (to lower cholesterol) range from $900 to $1800; this does not include the cost of physician visits or side effects from the drugs  Many studies show that cholesterol-lowering drugs do not reduce the risk of heart attack, stroke, or death The ACCORD Study Group. “Effects of combination lipid therapy in type 2 diabetes mellitus.” N Engl J Med. Mar 18 2010 Mora S, Ridker PM. “Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER).” Am J Cardiol. 2006;97(2A):33A-41A

9.  The annual cost of treating a patient with multiple sclerosis is $20,000 for drugs and $50,000 for total care  According to the Cochrane Collaboration, medications prescribed to treat multiple sclerosis are ineffective; within 10 years of diagnosis, over 50% of patients are walking with assistance, confined to a wheelchair, or dead, after receiving the best drug treatment medicine has to offer Kobelt, G “Costs and Quality of Life in Multiple Sclerosis: A Cross Sectional Study in the USA.” Munari, L, Lovati R, Boiko A “Therapy with glatiramer acetate for multiple sclerosis.” Cochrane Database Syst Rev. 2004; (1):CD004678

10.  The average annual cost for treating a diabetic patient is $11,744  Studies show that aggressive treatment to lower blood sugar levels does not improve health outcomes. American Diabetes Association “Economic Costs of Diabetes in the U.S. in 2007” Duckworth W, Abraira C, Moritz T, et al. the VADT Investigators. Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes. N Engl J Med. 2008 Dec 17 Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, et al. WT. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008 Jun 12;358(24):2545-59. ADVANCE Collaborative Group, Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008 Jun 12;358(24):2560-72.

11.  Taking drugs results in improvements in biomarkers like cholesterol and blood pressure  Improving biomarkers with drugs usually does not lead to better health outcomes  A new medical phenomenon: Many people die with great blood work

12.  Well-insured  Visited doctors regularly  Had all the right diagnostic tests  Took drugs for cholesterol, blood pressure and his pre-diabetic condition; also took a daily aspirin  Died at the age of 58 of a sudden heart attack

13. The reason:  The drugs he took did not address the miles of arteries lined with unstable plaques, one of which ruptured and caused his heart attack  How much money did NBC spend for health care that ultimately failed him?

15.  Research has shown that degenerative diseases can be prevented by making the right diet and lifestyle change  Research has also shown that the right diet can also stop and reverse these same diseases

16. 24 patients in 1985 who had collectively experienced 49 cardiovascular events:  15 cases of angina  13 cases of disease progression  7 bypass surgeries  4 heart attacks  3 strokes  2 angioplasties  2 worsening stress tests

17. After dietary intervention:  Cholesterol lowered from an average of 246 to below 150 mg/dl  Disease progression had been stopped and many patients had experienced reversal  Angina was improved or eliminated  Exercise capacity increased, sexual function restored  No further cardiovascular events, drugs, or procedures

18. 6 patients left the study:  4 cases of angina  4 bypass surgeries  1 angioplasty  1 case congestive heart failure  1 death 11 events in 6 patients who quit vs. NO events in 18 patients who were compliant!

19. Cost (estimated) prior to dietary intervention for bypass and angioplasty alone: $867,234 Cost for compliant patients after intervention: $0

20. Dr. Esselstyn has duplicated these results with over 250 patients during the last two decades!

21. DiabetesGall Bladder Disease Multiple SclerosisMigraines ArthritisAcne Autoimmune DiseasesOsteoporosis Gastrointestinal DisordersProstate Disease InfertilityPCOS DepressionPsoriasis Kidney StonesAlzheimer’s Disease

22.  Both type 1 and type 2 diabetics experience health improvement with the right diet  For type 1 diabetics the objective is to reduce the need for insulin and complications from diabetes  For type 2 diabetics, the objective is to stop its progression; often the condition can be reversed with diet

23.  Dr. James Anderson at the University of Kentucky placed 25 type 1 and 25 type 2 diabetics on a whole-foods, plant-based diet.  After just three weeks, the type 1 diabetics were able to lower their insulin requirements by 40% and their cholesterol dropped by 30%.  Twenty-four out of 25 type 2 diabetics were able to completely discontinue their insulin medication in only a few weeks Anderson JW. “Dietary fiber in nutrition management of diabetes.” In: G. Vahouny, V and D Kritchevsky (eds), Dietary Fiber: Basic and Clinical Aspects.” Pp.343-360. New York: Plenum Press,1986.

24. Dr. Neal Barnard’s studies:  Placed patients on a whole foods, plant-based diet and compared them to patients consuming a typical diabetes diet as recommended by the ADA  Patients lost more weight, were able to significantly reduce or even eliminate medications, and showed significant improvements in A1C levels (a marker for average blood sugar levels during the previous 2-3 months) after only a few weeks.

25.  Additionally, patients following the plant-based diet experienced rapid drops in blood cholesterol levels, which is significant since most diabetics die from cardiovascular disease Neal Barnard, M.D. et al, “A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type-2 Diabetes.” Diabetes Care 29:1777-1783 1006 DOI: 10.2357/dc06-0606 Neal Barnard, M.D. et al, “Changes in Nutrient Intake and Dietary Quality Among Participants With Type 2 Diabetes Following a Low-Fat Vegan Diet or a Conventional Diet for 22 Weeks.” J Am Dietetic Assoc. October 2008 vol 108 #10;1636-1645

26. Dr. Roy Swank’s Study:  144 MS patients were taught to consume a diet low in saturated fat.  Swank followed this group for 34 years, and tracked the progression of their disease Swank RL. “Effect of low saturated fat diet in early and late cases of multiple sclerosis.” Lancet 336 (1990):37-39

27.  For patients who consumed less than 20 grams of saturated fat per day, disease progression was halted  Eighty-percent of the patients who consumed more than 20 grams of saturated fat died of MS  Swank was able to duplicate these results in almost 5000 patients Swank RL. “Effect of low saturated fat diet in early and late cases of multiple sclerosis.” Lancet 336 (1990):37-39

28.  It’s more effective  It’s less expensive  All patients experience improvement  There are no negative side effects  The only situations for which diet is not a better choice are emergency and trauma

29. Plant-Based: ◦ 90% of calories from plant foods: major food groups are fruit, vegetables, whole grains, and legumes ◦ Low in fat, no oils ◦ High in fiber, 45+ grams ◦ Less processed food ◦ Differentiate between food and a treat

30. The Work of Dr. T. Colin Campbell at Cornell:  Experiments on lab rats showed that animal protein was a powerful cancer promoter  When rats were fed a diet with 5% animal protein, none of them developed pre- cancerous lesions  When they were fed a diet with 20% animal protein, 100% of them developed pre- cancerous lesions  When protein was reduced to 5%, the lesions started to regress  The same effect was not observed with soy and wheat protein

31.  The largest study ever conducted on the relationship between diet and disease  Showed that animal protein was a powerful predictor of the risk for cancer and heart disease  Elevated cholesterol was associated with increased risks of both heart disease and cancer  Differences in disease rates among family members were related to differences in diet

32.  Genes and family history are not the main causes of disease  Research has shown that only 2-3% of health outcomes are attributed to genes; diet and lifestyle habits are the biggest determinants of health outcomes

33.  Migration studies show that when people move from one area to another and start eating the typical diet of their new home, they soon have the disease risk of the area to which they moved  Identical twins have different risk factors for disease based on diet and lifestyle differences Haenszel W and Kurihara M. “Studies of Japanese migrants: mortality from cancer and other disease among Japanese and the United States.” J. Natl. Cancer Inst. 40 (1968):43-68 M Knip et al, “Environmental Triggers and Determinants of Type 1 Diabetes.” Diabetes 54, suppl 2 (December 2005):S125-36 Haas, C, Creighton, C, Pi, X, et al. “Identification of genes modulated in rheumatoid arthritis using complementary DNA microarray analysis of lymphoblastoid B cell lines from disease-discordant monozygotic twins”Arthritis and Rheumatism, Vol. 54, No. 7, July 2006, pp 2047-2060.

34. Informed consent: When people are given accurate information about the lack of efficacy and safety for traditional medications and procedures, and the scientific proof that diet can stop or reverse their disease, many of them will make changes in their diets

35.  Although it sounds counterintuitive, studies show that the bigger the dietary changes, the higher the rate of compliance  The reason is that big changes result in significant health improvement, while smaller changes do not  Health improvement is a powerful incentive for compliance Neal D. Barnard, M.D. et al “A Low-Fat Vegan Diet Elicits Greater Macronutrient Changes But is Comparable in Adherence and Acceptability Compared with a More Conventional Diabetes Diet Among Individuals With Type 2 Diabetes.” J Am Dietetic Assoc Feb 2009; vol 109 no 2:263-272 Barnard, Neal, et al, “Adherence and Acceptability of a Low-Fat Vegetarian Diet Among Patients With Cardiac Disease,” Jrnl of Cardiopulmonary Rehab. Vol 12, no 6; Nov-Dec 1992

36.  Conflicts of interest in developing federal dietary guidelines  Doctors receive little to no nutrition training in school  National organizations like the AMA and ADA are sponsored by food and drug companies  National health organizations like the AHA are sponsored by food and drug companies  Training for health care professionals does not focus on stopping or reversing disease

37.  Forks Over Knives  Bill Clinton’s very public conversion to a plant-based diet  Availability of information to the masses  General public is seeking alternatives to traditional medical care

38.  In business for 15 years  The world’s leader in programs designed to improve health through diet and lifestyle change.  We have worked with individuals, employers and schools throughout the U.S. and 33 foreign countries  Programs are scientifically proven to stop or reverse common health conditions and reduce the costs of medical care.  Studies show that results are predictable for most of the chronic conditions that are costing your company the most money.

39.  Most “wellness” programs offered in employment settings do produce some results; most are effective at managing disease, but for most people, the diseases can be STOPPED or REVERSED with the right strategies.  This means that: ◦ many type 2 diabetics, can become former diabetics; ◦ many people with coronary artery disease can get rid of their disease and avoid both medications and expensive procedures; and ◦ patients with common conditions like arthritis and autoimmune diseases can recover rather than managing them while their disease progresses

40. This reduces costs significantly: Osteoarthritis$5700/yr Autoimmune diseases (like rheumatoid arthritis)$15,500/yr Crohn’s Disease (Group I patients)$37,135/yr Multiple Sclerosis $50,000/yr Diabetes$11,744/yr Cardiovascular Disease: Annual Cost for Lipitor$700 Bypass surgery$61,800 Angioplasty$22,020

41.  Executive level buy-in and participation  Commitment to changing the corporate culture  Clear goals and objectives  Communication with employees  Ongoing support  Long-term strategies and plans

42.  Educational programs to help employees understand why and how to make changes  Programs to address emotional issues associated with food and change  Incentives designed to reward health outcomes and behavior change ◦ No incentivizing for “going through the motions”  Follow-up and reinforcement  Programs for family members

43.  Improve health and decrease health care costs by: ◦ Motivating employees to want to improve their health ◦ Showing employees how diet and lifestyle influence health ◦ Providing training that teaches skills for change ◦ Improving productivity, absenteeism, morale, recruitment and retention of employees ◦ Creating a culture that emphasizes health promotion ◦ Measuring results

44.  Health care costs can be reduced by taking an entirely different approach proven to reduce the cost of care by stopping disease progression or reversing it  Reducing costs is imperative in order for plans to remain viable  Employers are in a powerful position to help employees improve their health AND to reduce costs of health insurance

45. Corporate Headquarters 510 East Wilson Bridge Road, Ste. G Worthington, Ohio 43085 614 841-7700 Toll Free: 800-761-8210 Pamela A. Popper, Ph.D., N.D. President www.wellnessforum.com