How can dietitians inspire people with diabetes to invest in their health? One way to do this is by getting involved in worksite wellness programs for diabetes. These programs can be powerful conduits through which RDs can foster healthful behavior change to improve diabetes management. They provide a way to meet people with diabetes right where they are on a daily or near-daily basis—as opposed to occasional counseling at a practitioner’s office. And the programs enable RDs to take advantage of workplace-related benefits, such as health insurance, to motivate employees with diabetes. The following are strategies for building a successful workplace wellness program for improved diabetes management.
1. Establish expectations. RDs and employers expect employees involved in these programs to improve their health by learning how to better manage blood sugar, lower hemoglobin A1c levels, eat more healthfully, and be more physically active. But it’s also essential for dietitians and employers to listen and learn what participants hope to gain from the program. Their goals may be different; some may wish to reduce the number of medications they take, be fit enough to play with their grandchildren, lose weight, or simply feel better. If employees feel their voices are heard, they’re more likely to buy in to the program and meet their goals.
2. Advocate for individual sessions. While group counseling sessions seem like the best choice in a workplace setting, one-on-one counseling is the way to go. I’ve taught group classes in the past, and I’ve found that, when you offer tips or constructive criticism more broadly, employees tend to think the advice doesn’t apply to them, causing them to stop paying attention. For instance, when you mention weight loss, the slender person in the room may feel none of your advice going forward will apply to them. When you discuss insulin, you likely will lose everyone in the room who doesn’t take insulin. With individual sessions, employees feel you’re addressing their specific needs.
Counseling sessions should be private so employees can open up without feeling judged, establishing trust between the practitioner and employee. These one-on-one sessions also can provide RDs the opportunity to discuss individual progress with employees through, for example, food and exercise journals, and make personalized recommendations.
An important caveat to individual sessions is that they require a full-time dietitian who’s committed to the diabetes worksite wellness program. Thankfully, employers are beginning to better understand the importance of having RDs on staff for their employees’ health and well-being.
3. Take small steps. Once employees and RDs determine what areas employees need to work on, RDs can help them develop a plan to make “baby-step” changes to their routines that will eventually affect their health. Dietitians also can help them establish a goal that’s realistic, specific, and measurable such as five to 10 minutes of activity every other day or reducing soda intake from two cans to one each day. These types of goals often lead to greater success and less disappointment, while expectations that are too high are less sustainable and can contribute to employees feeling overwhelmed and eventually giving up.
It also helps to ask employees what behavior (if they could list just one) creates the biggest obstacle to their success. Employees usually know the answer, but they need to identify it and say it out loud to recognize they want to do something about it. Partnering one employee with another with the same ambition may be helpful. People usually are more receptive to walking with a coworker or walking group during their lunch break to stay motivated.
4. Provide resources and support. RDs are aware of how unhelpful it is to tell clients they need to make behavior changes without providing them with specific tips and resources that will lead to success. If you simply suggest an employee increase his physical activity, he may interpret that as, “I need to work out in a gym for an hour each day.” Instead, provide this employee with a 10-minute workout he can do at home; he’s more likely to give it a shot.
Providing tools for stress management also is essential, especially since you’re counseling clients in the workplace, a potential source of significant stress. It’s difficult for employees to make behavior changes when they’re feeling overwhelmed or stressed about work and managing diabetes, which exacerbates everyday stress. In addition, unforeseen stressors or breaks in routine can send an employee’s attempts at behavior change spiraling. So help employees develop coping mechanisms that don’t involve excessive food or alcohol intake. Suggest they work with the employer’s employee assistance program if needed for psychological or addiction counseling.
5. Gather evidence of the program’s impact. Qualitative and quantitative feedback can help improve employees’ outcomes and justify employers’ program expenditures. Begin by evaluating the employee’s level of knowledge on diabetes management, healthful behaviors, etc, with a pre- and posttest. The pretest measures baseline knowledge and helps the RD decide what areas to focus on in individual counseling. The pretest also can demonstrate improvements in knowledge of diabetes management and behavior change when compared with the posttest.
Dietitians should work with the employee’s primary care physician or endocrinologist to measure the impact of the wellness program and improve buy-in from employers, practitioners, and employees. To do this, employees sign a form allowing the diabetes worksite wellness program to communicate with their primary doctor, endocrinologist, and insurance provider. Send a letter to the employee’s doctor educating them about the program and benefits, and what it requires of the provider. Most doctor’s offices are happy to participate when they realize the program benefits their patients and encourages physician follow-up. Let outside practitioners know to perform a lipid panel, measure hemoglobin A1c, and microalbumin levels, and conduct ophthalmology and foot exams annually. This ensures the employees are being closely followed by their physicians and are engaged in their own medical care, enabling the wellness program to measure outcomes.
6. Create financial incentives. Work with employers to offer financial incentives to employees who participate in the program, such as waiving copays on diabetes medications, insulin pumps, and continuous glucose monitors (CGMs).
Copay waivers on medications and supplies may improve medication compliance and diabetes management, and using CGMs provides employees with constant awareness of blood sugar levels. (CGMs can prevent nocturnal hypoglycemia resulting in emergency room visits. Newer monitors can wake up employees with an alarm or enable their insulin pumps to suspend insulin when blood sugar begins to drop.) One study showed that decreasing hemoglobin A1c reduces diabetes complications and lowers medical costs, and lifestyle changes that result in A1c reductions can decrease medication use, saving employees and insurers even more money.
When people can immediately see the results of how food, exercise, and stress affect blood glucose, they’re less likely to deny the consequences of their behavior, and this improves employee acceptance of the program.
To summarize, RDs should enable employees to determine their own goals and use the diabetes workplace wellness program to give them the tools to achieve them. Proper support and individual counseling create an atmosphere of trust and encourage employees to work toward improved diabetes management.
— Heidi-Jo Kaplan, MS, RD, LD, CDE, holds her master’s degree in clinical nutrition from New York University and her bachelor of arts from Sarah Lawrence College. Kaplan presently works at Sarasota County Government and clinically oversees the Diabetes Wellness Program (DELI – Diabetes Education & Lifestyle Improvement). She was the manager of the diabetes and bariatric programs at Sarasota Memorial Hospital. She has lectured and speaks on radio and television on a variety of subjects including nutrition, diabetes, weight loss, and behavior change.