Because of the way it's structured, the nation's health care system may be more accurately labeled a "disease care system." But wellness advocates point to growing recognition that health promotion and wellness play an important part in preventing disease and reducing medical costs.

"If you think about our whole medical care system, it evolved as a 'disease-treatment model,' " said Dr. Donald Hensrud, medical director of the Healthy Living Program at Mayo Clinic in Rochester, Minn.

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"A hundred years ago, there was not the recognition of how physical activity and diet impact health," said Hensrud, a Grand Forks native. "It was more, the medical system evolved as a need. If you get sick, you go to the doctor, you get a pill, and you get better-that's an oversimplification, but for many years that's the way it evolved."

But "starting probably with smoking in the '60s-and in the late '70s is when weight started to go up-the impact of lifestyle, and therefore health promotion, on our overall health, has become more and more apparent as time has gone on. And it doesn't fit well into our current medical system which is still largely a disease-treatment model, again, in spite of overwhelming evidence that health promotion is important," he said.

"Wellness is not well-reimbursed" by the federal reimbursement system, Hensrud said.

Nonetheless, health care organizations, such as Mayo and others, are teaming up with other organizations and businesses to encourage wellness and improve the health of their employees. And individuals, on their own or at their doctors' urging, are seeking out programs designed to inspire healthy lifestyle changes-sometimes at their own expense.

More employers are acknowledging the value of health promotion and its impact on their employees' well-being, which affects productivity and absenteeism and therefore the company's bottom line.

"Corporations have become very active (in employee health promotion)," said Hensrud. "They want their costs to go down."

And some research has confirmed that workplace wellness programs are cost effective.

A study published in the Journal of Occupational and Environmental Medicine reveals that return-on-investment was estimated to be $2.53 for every dollar spent on a long-standing health promotion program at Duke University.

Targeting costlier conditions

Such health promotion programs are aimed at preventing or reducing the impact of chronic conditions that end up costing individuals and their employers the most-for example, obesity-related conditions such as Type 2 diabetes, high blood pressure and heart disease.

"Obese adults are also anywhere from 20 to 40 percent at greater risk of depression," said Katie Nermoe, corporate wellness director with Sanford Health Plan.

"There's more research linking obesity to cancer," she said.

"So, rather than continuing to treat these conditions in the form of office visits, pharmaceuticals and hospital stays, at the health plan we've started treating them through diet and exercise," Nermoe said.

Obesity is not only unhealthy, it's expensive.

"Obese adults will spend 42 percent more on their health care costs compared to adults who are healthy," Nermoe said.

"If you are morbidly obese-which means having a BMI (body mass index) greater than 40-research shows your health care costs can be as much as 81 percent higher."

For Sanford Health Plan members with obesity-related conditions, "we've started a couple new disease management programs that are designed to reduce utilization of health care and pharmaceuticals by helping (them) lose weight and become healthier," she said. "Some of them are exercise-based, some of them are diet-based, and some of them are both."

One such program, "Profile by Sanford," launched five years ago, has grown to 30 locations, including Grand Forks, and more than 10 states.

"It's a division of Sanford that's grown very quickly, and it's because of the amount of success people have had on that program," Nermoe said.

In June, 12 Fargo residents participated in the 30-program that included exercise sessions three times a week.

"With that group, on average, participants' cholesterol decreased by 45 points. As a group, they lost 6 percent of their body weight and had a 3 percent decrease in blood pressure," Nermoe said.

"(The Profile by Sanford program) has seen hundreds of patients go off of medications and either reduce or reverse chronic disease," she said.

"If you can help patients get to a healthy weight, then they don't have that susceptibility to obesity-related illness."

At Altru Health System, health promotion and disease prevention efforts have shown similar success.

For patients who may be struggling with obesity, Altru offers several outpatient programs to the general public, including a weight management program and an integrated health coaching program that offers patients a customized solution to address their health concerns, said Jennifer Estad, manager of employer health solutions and integrative medicine.

In the integrated health coaching program, "our ultimate goal is keep them out of the hospital and at home, and as healthy as they can be," Estad said.

"We track our successes through different biometric measurements in those programs," she said.

Participants in the weight management program have had, on average, a reduction of BMI of 13.2 percent upon completion of the program, she said.

Integrated health coaching program participants "have had a reduction of 8 percent in BMI after six months of participation," Estad said. This program offers people who may not be able to commit to a weekly class and need more flexibility.

"In both those programs, we've seen a reduction in the need for prescription medications, so that will help them save dollars over the course of their lifetime," she said.

Estad, too, has seen evidence of the higher medical costs that are associated with poor health status.

"Data from the CDC show that medical costs for people with obesity-related conditions are $1,500 higher per year than those who fall in a normal weight category," she said.

Community health

The priorities that guide Altru's health promotion and disease prevention efforts are driven by results of a community-wide health assessment that's conducted every three years, Estad said.

The assessment serves as a tool to determine "what our community needs are," she said. "(It helps us) to align our program to better meet the community's health needs."

The most pressing issues that have emerged from the assessment, Estad said, include the rate of obesity among children, adolescents and adults; access to behavioral health services; illegal and prescription drug abuse; health care coordination and access to health care services; and alcohol abuse.

Estad is optimistic that the health care system will change, and that wellness and health promotion will be an important priority in the future.

"Health care is in a state of transition right now we don't know what those reimbursement structures will look like in the future," she said. "We have a commitment to our community, and to look after the health of our community.

"In these changing times with health care, and with the changing landscape of health care delivery, those structures will change in the future and we need to be ready to meet those challenges."

"Prevention, I believe, is going to be key moving forward," Estad said. "And keeping people healthy will be better for the individual, the community and the health care system."