The Compelling Case for Simplifying Workplace Nutrition Programs

Soaring healthcare costs powerfully motivate employers to promote workplace wellness, but finding programs that deliver clear and lasting results is a challenge. Most workers already know that a nutritious diet rich in vegetables and fruits is vital to good health. So why do so few of us eat well?

Traditional programs offer lengthy, complex nutrition data and strategies that can confuse and intimidate even those eager to make healthy changes. Evidence-based research suggests the most successful approach to workplace nutrition is also the simplest, such as emphasizing produce first.

This paper focuses on an uncomplicated, produce-based approach to workplace nutrition programs that boosts effectiveness and delivers impressive benefits — including higher productivity, increased adherence to healthy changes, cost-effective improvements, and a corresponding positive impact on the bottom line.

Produce Consumption: Why So Low? Public awareness campaigns and wellness programs routinely tout the benefits of consuming more fruits and vegetables, but current research reveals awareness rarely translates into action. The numbers speak for themselves:• Fewer than 25% of US adults consume the ideal 5+ daily

servings1

• No US state yet meets the Centers for Disease Control’s modest national objectives for consumption of fruit (75% of people eating 2+ servings/day) or vegetables (50% of people eating at least 3 servings/day)2

• Based on overall calorie intake, not even 1 in 10 Americans eats enough produce3

• In a 5-A-Day Study Center research trial, only 17% of participants ate 5+ daily servings of vegetables and fruits; the average person ate just 3.6 servings4

• From 2008-2009, the number of Americans eating 5+ servings/day of produce 4+ days/week declined from 56.4% to 55.6%.5

Despite the widely publicized health benefits of a greener diet, Americans’ produce consumption is actually falling. The sheer volume of dietary information and program options competing for consumer attention is overwhelming. It’s easier for workers to tune out healthy eating strategies than to sort through countless, often contradictory choices. Employers promoting healthy eating need a compelling message to cut through the noise and inspire results. Unscrambling the nutrition information with a clear point like produce first is the crucial link that transforms knowledge into action.

The Compelling Case for Simplifying Workplace Nutrition Programs

1

Current Daily Intake of Fruits and Vegetables in the US1

4.4%

24.5%36%

35.1%

1-2 Servings/Day

3-4 Servings/Day5+ Servings/Day

Never or <1 Serving/Day

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Why Eat More Produce?

Multiple studies confirm that eating a diet packed with vegetables and fruits is associated with better overall health and decreased risk of chronic disease. Produce-based diets result in substantially improved outcomes for a wide array of common and costly high-risk conditions: • Heart disease. People who eat 5+ servings/day of produce

have a nearly 15% lower risk of heart attack and 20% lower risk of heart disease than those who consume much less.6, 7 Each extra helping decreases heart disease rates by 4%, with the robust antioxidants found in green leafy vegetables and vitamin C-rich items most improving heart health. Vegetarians typically have higher levels of salicylic acid — a chemical that acts like aspirin to ease pain and reduce harmful heart inflammation — than nonvegetarians.8 Teens who eat more fruits and vegetables also show fewer signs of inflammation and oxidative stress, strongly suggesting that the earlier healthy produce habits are formed, the better.9

• Blood pressure. Eating more produce lowers blood pressure. In a large clinical trial, those who boosted vegetables and fruits reduced systolic blood pressure by 2.8 mm Hg and diastolic blood pressure by 1.1 mm Hg.10

• Stroke. People eating 5+ daily servings of produce are 30% less likely to suffer a stroke than those eating <3 servings. Each additional serving of fruits or vegetables further reduces stroke risk by 6%.11

• Diabetes. A review of 6 studies found that those eating just over 1 additional serving of green leafy vegetables are 14% less likely to develop type 2 diabetes.12

• Metabolic syndrome. Women who consume the most fruits are 34% less likely to develop metabolic syndrome.13

• Cancer. People who don’t smoke, maintain a healthy weight, exercise regularly, and eat a diet high in vegetables and fruits have a 36% lower risk of developing cancer than those who don’t adopt these healthy habits. Evidence also suggests that produce-heavy dietary patterns protect against cancer.14

• Obesity. A produce-rich diet can mean a 24% lower risk of becoming obese and a 28% lower risk of gaining weight over time.15 Those who eat the most fruit have the least body fat.16

• Osteoporosis. Choosing fruits and vegetables packed with vitamin C results in higher bone mineral density.17, 18

• Macular degeneration and cataracts. Better nutrition and more vitamin C results in clearer eye lenses.19 Women who eat more produce have a 10%-15% reduced risk of developing cataracts.20

According to the World Health Organization, over 2.6 million lives could be saved each year only by eating enough vegetables and fruits.21 Astonishingly, increasing produce consumption could reduce heart disease by 31%, stroke by 19%, stomach cancer by 19%, esophageal cancer by 20%, lung cancer by 12%, and colorectal cancer by 2%.

These facts are powerful incentives to eat well — and produce first is a strong but concrete message to help people make a lifelong healthy change.

People who don’t smoke, maintain a healthy weight, exercise regularly, and eat a diet high in vegetables and fruits have a 36% lower risk of developing cancer

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With minimal time and effort, employers can adopt produce first as an overarching foundation for effective workplace nutrition programs.

This approach involves no calorie-counting, no portion size calculations, and no charts or manuals to consult. Instead, it’s an easy-to-remember message: Think of and

eat produce first, other foods next; give fruits and vegetables — foods that are nutrient-dense, low in calories, and packed with vitamins, minerals,

antioxidants, and fiber — top priority.

Increased adherence to healthy change is the most significant benefit of produce first. Research finds that general, succinct

concepts are easier for people to learn, retain, and act on than ideas with multiple rules and examples.22 The

most sophisticated and well-intentioned nutrition programs fail if participants think they’re too

complicated. A study examining weight loss programs found that complex rules — rather

than self-motivation or discipline — was by far the strongest predictor of whether

participants made lasting positive changes.23

Simplicity is the essential

ingredient for promoting long-term diet change.

Simplicity Is the Key

Simplifying Workplace Nutrition Programs Can:• Promote healthy eating habits

• Maximize compliance with dietary guidelines

• Decrease cognitive confusion caused by information overload

• Streamline program planning

• Improve participation with easy-to-remember, easy-to-follow guidelines

• Inspire long-term disease prevention

• Reduce average healthcare costs/participant.

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Cost Benefits

Removing the complexity from workplace healthcare and wellness initiatives results in immediate bottom-line benefits with reduced absenteeism and increased employee retention — employees who participate in these programs are absent less often and like their jobs more.24 The physically better that employees feel, the greater job satisfaction and overall happiness they report.25

A simple nutrition message such as produce first also produces long-term financial gain by lowering average healthcare costs/participant:

• Researchers examining a simple employer-sponsored, Internet-based nutrition program noted an average healthcare cost reduction of $827 for participants with cardiovascular risks.26

• A study of Virginia’s simple nutrition program concluded that each $1 spent yielded $10.64 in healthcare savings, either by delaying disease onset or preventing it altogether.27

Employers who invest in workplace wellness reap immediate benefits as well as future savings — and transform employees’ lives with positive change.

What You Can Do

1. Underscore education. Provide workers with plentiful tips (such as knowing what makes up a serving, putting produce at the top of the grocery list, and bagging it first) as well as recipes featuring produce.

2. Make convenience count. Keep “grab-and-go” snacks like apples and bananas easily accessible in cafeterias and vending areas.

3. Concentrate on color over calories. Encourage employees to focus on produce color, variety, and freshness instead of counting calories or weighing portions.28 Brighter, deeper hues not only look and taste better, they’re signs of higher concentrations of vitamins, antioxidants, and minerals.

4. Manage the message. Prominently posting the produce first message throughout work spaces — break rooms, cafeterias, even stairwells — inspires workers to keep making healthy food choices.

5. Support and encourage. Social support from coworkers and team leaders creates a positive atmosphere and helps make wellness-promoting nutrition habits permanent.

6. Remember happiness matters. Accentuate the emotional and psychological benefits of a simplified nutrition approach. The enhanced sense of well-being and satisfaction from a healthier diet matters as much as with physical fitness.

7. Call for action. Emphasize that physical activity in conjunction with a healthy, produce-based diet yields the best results. Good nutrition and an active lifestyle go hand in hand.

8. Unify your approach. Reach out to all levels of staff and leadership to be part of produce first to enhance unity and create a positive culture for change.

The most sophisticated and well intentioned nutrition programs fail if participants think they’re too complicated.

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Resources• American Journal of Clinical Nutrition (www.ajcn.org)

• American Journal of Health Behavior (www.ajhb.org)

• American Journal of Health Promotion (www.healthpromotionjournal.com)

• Annals of Internal Medicine (www.annals.org)

• British Medical Journal (www.bmj.com)

• Centers for Disease Control and Prevention (www.cdc.gov)

• Current Directions in Psychological Science (http://journals.sagepub.com/home/cdp)

• Fruits & Veggies Matter (https://www.fruitsandveggiesmorematters.org)

• Health Education & Behavior (http://journals.sagepub.com/home/heb)

• Health Psychology (www.apa.org/journals/hea)

• Journal of Medical Internet Research (www.jmir.org)

• Journal of Nutrition Education and Behavior (www.jneb.org)

• Journal of Occupational and Environmental Medicine (www.joem.org)

• Journal of Occupational Health Psychology (www.apa.org/journals/ocp)

• Journal of the American Dietetic Association (www.adajournal.org)

• Journal of the American Medical Association (www.jama.ama-assn.org)

• National Institute for Occupational Safety and Health (www.cdc.gov/niosh)

• The New England Journal of Medicine (http://www.nejm.org)

• Occupational and Environmental Medicine (http://oem.bmj.com)

• Partnership For Prevention (www.prevent.org)

• Social Science & Medicine (www.elsevier.com/locate/socscimed)

• Society of Human Resource Management (www.shrm.org)

Conclusions• Although the consumer healthcare market is saturated

with nutrition information and wellness strategies, already low levels of US produce consumption continue to decline. Employers promoting workplace wellness need a powerful message to reverse these trends. Studies show that people learn, retain, and act on simple guidelines like produce first more successfully than nutrition plans with complex rules.

• Plentiful evidence-based research supports the effectiveness of high produce levels in delaying or preventing the development of numerous common life-threatening illnesses.

• Employers who implement and enthusiastically support workplace nutrition initiatives like produce first see immediate gains — reduced absenteeism, higher productivity, and increased retention — in addition to long-term reductions in healthcare costs.

C H O I C E S

Eating great can be as simple as making Colorful Choices. No calorie counting, no fat gram tabulating, no weighing or measuring. By choosing a daily rainbow — red, orange, yellow/white, green, and blue/violet — of fabulous fruits and vivid vegetables, healthy nutrition can be enjoyable, filling, and fun.

Learn more: www.colorfulchoices.com

Another Keeping Healthy People Healthy™ solution from HES

Simple Effective Fun

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Endnotes1 Adults Meeting Fruit and Vegetable Intake Recommendations — United

States, 2013 July 10, 2015 / 64(26);709-713 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6426a1.htm.

2 Centers for Disease Control and Prevention. State Indicator Report on Fruits and Vegetables, 2013: https://www.cdc.gov/nutrition/downloads/state-indicator-report-fruits-vegetables-2013.pdf

3 Kimmons J, Gillespie C, Seymour J, Serdula M, Blanck HM. Fruit and Vegetable Intake Among Adolescents and Adults in the United States: Percentage Meeting Individualized Recommendations. The Medscape Journal of Medicine 2009;11(1):26.

4 Thompson B, Demark-Wahnefried W, Taylor G, McClelland JW, Stables G, Havas S, Feng Z, Topor M, Heimendinger J, Reynolds KD, Cohen N. Baseline Fruit and Vegetable Intake Among Adults in Seven 5 A Day Study Centers Located In Diverse Geographic Areas. Journal of the American Dietetic Association 1999;99(10):1241-1248.

5 Witters, D. In U.S., Uptick in Healthy Eating, Access to Affordable Produce, But Fewer Report Eating At Least Five Servings of Fruits and Vegetables Four Days Per Week. Available online: www.gallup.com/poll/125336/Uptick-Healthy-Eating-Access-Affordable-Produce.aspx.

6 Law MR, Morris JK. By How Much Does Fruit and Vegetable Consumption Reduce the Risk of Ischaemic Heart Disease? European Journal of Clinical Nutrition 1998;52(8):549-556.

7 Joshipura KJ, Hu FB, Manson JE, Stampfer MJ, Rimm EB, Speizer FE, Colditz G, Asherio A, Rosner B, Spiegelman D, Willett WC. The Effect of Fruit and Vegetable Intake on Risk for Coronary Heart Disease. Annals of Internal Medicine 2001;134(12):1106-1114.

8 Blacklock CJ, Lawrence JR, Wiles D, Malcolm EA, Gibson IH, Kelly CJ, Paterson JR. Salicylic Acid in the Serum of Subjects Not Taking Aspirin. Comparison of Salicylic Acid Concentrations in the Serum of Vegetarians, Non-Vegetarians, and Patients Taking Low Dose Aspirin. Journal of Clinical Pathology 2001;54(7):553-555.

9 Holt EM, Steffen LM, Moran A, Basu S, Steinberger J, Ross JA, Hong C, Sinaiko AR. Fruit and Vegetable Consumption and Its Relation to Markers of Inflammation and Oxidative Stress in Adolescents. Journal of the American Dietetic Association 2009;109(3):414-421.

10 Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin P, Karanja N. A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure. The New England Journal of Medicine 1997;336(16):1117-1124.

11 Joshipura KJ, Ascherio A, Manson JE, Stampfer MJ, Rimm EB, Speizer FE, Hennekens CH, Spiegelman D, Willett WC. Fruit and Vegetable Intake in Relation to Risk of Ischemic Stroke. Journal of the American Medical Association 1999;282(13):1233-1239.

12 Carter P, Gray LJ, Troughton J, Khunti K, Davies MJ. Fruit and Vegetable Intake and Incidence of Type 2 Diabetes Mellitus: Systematic Review and Meta-Analysis. British Medical Journal 2010;341(184):c4229.

13 Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC. Fruit and Vegetable Intakes, C-Reactive Protein, and the Metabolic Syndrome. American Journal of Clinical Nutrition 2006;84(6):1489-1497.

14 World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007.

15 He K, Hu FB, Colditz GA, Manson JE, Willett WC, Liu S. Changes in Intake of Fruits and Vegetables in Relation to Risk of Obesity and Weight Gain Among Middle-Aged Women. International Journal of Obesity and Related Metabolic Disorders 2004;28(12):1569-1574.

16 Davis JN, Hodges VA, Gillham MB. Normal-Weight Adults Consume More Fiber and Fruit Than Their Age- and Height-Matched Overweight/Obese Counterparts. Journal of the American Dietetic Association 2006;106(6):833-840.

17 Prynne CJ, Mishra GD, O’Connell MA, Muniz G, Laskey MA, Yan L, Prentice A, Ginty F. Fruit and Vegetable Intakes and Bone Mineral Status: A Cross-Sectional Study in 5 Age and Sex Cohorts. American Journal of Clinical Nutrition 2006;83(6):1420-1428.

18 New SA, Robins SP, Campbell MK, Martin JC, Garton MJ, Bolton-Smith C, Grubb DA, Lee SJ, Reid DM. Dietary Influences on Bone Mass and Bone Metabolism: Further Evidence of a Positive Link Between Fruit and Vegetable Consumption and Bone Health? American Journal of Clinical Nutrition 2000;71(1):142-151.

19 Jacques PF, Chylack LT, Hankinson SE, Khu PM, Rogers G, Friend J, Tung W, Wolfe JK, Padhye N, Willett WC, Taylor A. Long-Term Nutrient Intake and Early Age-Related Nuclear Lens Opacities. Archives of Ophthalmology 2001;119(7):1009-1019.

20 Christen WG, Liu S, Schaumberg DA, Buring JE. Fruit and Vegetable Intake and the Risk of Cataract in Women. American Journal of Clinical Nutrition 2005;81(6):1417-1422.

21 Lock K, Pomerleau J, Causer L, Altmann DR, McKee M. The Global Burden of Disease Attributable to Low Consumption of Fruit and Vegetables: Implications for the Global Strategy on Diet. Bulletin of the World Health Organization 2005;83(2):100-108.

22 Feldman J. The Simplicity Principle in Human Concept Learning. Current Directions in Psychological Science 2003:12(6):227-232.

23 Mata J, Todd PM, Lippke S. When Weight Management Lasts. Lower Perceived Rule Complexity Increases Adherence. Appetite 2010:54(1):37-43.

24 Parks KM, Steelman LA. Organizational Wellness Programs: A Meta-Analysis. Journal of Occupational Health Psychology 2008;13(1):58-68.

25 Parks KM, Steelman LA. Organizational Wellness Programs: A Meta-Analysis. Journal of Occupational Health Psychology 2008; 13(1):58-68.

26 Sacks N, Cabral H, Kazis LE, Jarrett KM, Vetter D, Richmond R, Moore TJ. A Web-Based Nutrition Program Reduces Health Care Costs in Employees with Cardiac Risk Factors: Before and After Cost Analysis. Journal of Medical Internet Research 2009; 11(4):e43.

27 Rajgopal R, Cox RH, Lambur M, Lewis EC. Cost-Benefit Analysis Indicates the Positive Economic Benefits of the Expanded Food and Nutrition Education Program Related to Chronic Disease Prevention. Journal of Nutrition Education and Behavior 2002; 34(1):26-37.

28 Kemp G, Paul MW, Segal R. Healthy Eating: Easy Tips for Planning a Healthy Diet and Sticking to It. February 2010. Available online: www.helpguide.org/life/healthy_eating_diet.htm.

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