The employer as health coach.

n engl j med 357;15 www.nejm.org october 11, 2007 1465 problems. The women, both in their 30s and mothers of young children, were obese and had diabetes. Gardiner weighed over 200 lb, smoked heavily, and avoided physical activity. Matovich weighed 230 lb, took insulin several times a day, had had episodes of severe hypoglycemia, and could not lift her babies because of pain from herniated lumbar disks. Both wanted to feel better and to reduce their risk of future illness. Their employer had a stake in their health, too: studies correlating medical claims data with individual risk factors show that obese, physically inactive employees with diabetes are likely to get sicker and rack up high medical bills. Through determination and company-sponsored health-promotion programs, both women have transformed themselves — doing so largely at work. They attend Weight Watchers meetings at the office and exercise at the company’s well-equipped gym, where Matovich has been treated by a physical therapist and Gardiner works with a personal trainer. They eat lunch at a corporate cafeteria that offers many nutritious, low-calorie choices, including a subsidized salad bar. Gardiner was motivated to quit smoking in part by the promise of a substantial reduction in her health insurance premium, and coworkers helped her get through the difficult early weeks of tobacco withdrawal. She has lost 27 lb to date and has run two half-marathons during the past year; Matovich has dropped 72 lb so far. Both have been able to cease taking diabetes medications. They told me that without the health services available at their workplace, they would not have had the time and opportunity to make these changes. Gardiner says not only does she feel better, but “I think they probably get more out of me, because I’m a healthier person.” With 28,500 employees worldwide and more than 18,000 in North America, General Mills is one of a growing number of big U.S. companies that are tackling high medical costs by promoting wellness in their workforce. Corporate health executives, once mainly concerned with workplace safety and health insurance benefits, have begun tracking emThe Employer as Health Coach