By nature, engineers are skeptics, so when Massachusetts-based EMC Corp., an IT firm, signed on to implement an evidence-based nutritional program, it brought in Dr. Thomas J. Moore, the program's co-creator, to make his case personally to EMC employees.
The program — called DASH (Dietary Approach to Stop Hypertension Program) for Health — is an online tool promoting a scientifically proven diet that lowers weight, blood pressure and cholesterol levels. EMC introduced DASH for Health in 2002.
Whether employees were sold by the scientific nature of the program or Moore's personal appeal, DASH has been extremely successful. In the program's first year, 6,000 of EMC's workforce of 18,000 joined the Web-based program — without any company incentives to prod their enrollment.
"We offered no incentives for employees to participate in the DASH program," says Delia Vetter, senior director of benefits at EMC. "The important thing here is that our employees saw the program as credible and scientifically based," she adds.
The results are equally as impressive as the enrollment numbers. Comparing 2001 and 2002 claims data on 128 individuals with hypertension, diabetes and high cholesterol who recorded their health information as they followed the DASH program, the participants on average lost 3.5 pounds, lowered their systolic blood pressure by nine points and their diastolic pressure by five points, according to Vetter.
The program saved the company $1,000 in medical claims per individual with hypertension, diabetes and high cholesterol. The company offers a traditional HMO and PPO and last year introduced health savings accounts.
Health experts advocating evidence-based wellness approaches are not surprised by EMC's success with the DASH program. "Companies moving in the direction of evidence-based plan design will indeed overtime have lower-than-average market trends, will improve the health outcome of their population and have a more present and productive workforce," Jennifer Boehm, a principal at Hewitt Associates, believes.
The evidence behind the DASH program
Moore, co-creator of the DASH diet and director of clinical research at Boston University Medical Center, explains that the diet is rooted in findings from a four-year, randomized controlled trial conducted from 1992 to 1996.
Of the 459 individuals in the trial, one-third had true high blood pressure, while the rest had high-to-normal pressure. Study participants ate according to the DASH diet — recommended by the Department of Agriculture — which is rich in fruits, vegetables, whole grains and low-fat dairy foods, and recommends red meats and saturated fats in moderation. By comparison, the typical American diet is high in saturated fats and red meat, and sparse in fruits and vegetables.
In the study, those with high blood pressure lowered their systolic blood pressure by 11 points and their diastolic pressure by five-and-a-half points compared to those who ate the typical American diet, Moore explains, adding that the blood pressure reduction is the same one would get by taking a typical antihypertensive medication.
Further, he says, "Although DASH was originally developed to lower blood pressure, we now know that it lowers cholesterol, helps people lose weight, and even makes them feel better." As such, some health experts view the diet as an example of evidence-based medicine — programs based on medicine or scientific studies determined to be irrefutable and having a measurable effect on health outcomes.
To aid DASH users and to maintain data on the program's effectiveness, Dashforhealth.com acts as template for the DASH diet and teaches users how to eat and exercise in a healthy way. Users track their weight, blood pressure and how much they exercise, and can print the data to review with their doctor.
"We know from lots of studies that people are far more successful at changing and maintaining the changes if they keep track of what they are doing," Moore notes.
Twice a week, the DASH team publishes new information on the Web site, including articles about food preparation, eating out, losing weight and getting fit.
High reward for low cost
Although EMC does not charge its employees for the program, Moore says DASH can be offered for less than $10 per employee per year. In addition, the program can work with other health management tools within an organization.
For example, EMC has an online wellness page for each employee featuring information about the company's health benefits, and allows employees online access to the DASH program.
"Today we have about 4,000 employees participating in the program and each year it is offered during open enrollment," says Vetter, pointing out that 90% of the workforce has completed a health risk assessment. "We now have data to devote to programs to help our employees on a proactive basis," she adds.
Moore believes small employers might find the program attractive because of its low maintenance in terms of cost and management.
"You offer the program to your employee, and we do the rest, so it does not make a difference if you have 500 employees or 50,000," he says. —L.C.B.
