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(gentle music) (upbeat music) - Welcome to Business Forward.

I'm your host, Matt George.

Joining me tonight, Dr. David Tennant.

Dr. Tennant is a primary care physician with Unitypoint Proctor.

Welcome.

- Thanks for having me.

- Well, I'm glad you're here.

This is gonna be a fun talk topic.

We're gonna talk about workplace wellness and we're gonna talk about some other things but let's start with you.

Are you from around here?

- Not originally, no.

So I grew up in the Chicago suburbs.

I went to Illinois, Chicago for undergrad Ross.

And then I did my residency at University Hospitals which is in Cleveland affiliated with Case Western.

And then I moved to Peoria about four years ago.

- Okay, so I love that you moved to a town like Peoria.

Love middle Illinois.

So what made you say, okay, I'm in Cleveland, grew up in Chicago, I'm coming to middle Illinois.

- Well, there were a handful of factors.

For one, my dad was actually working here at the time.

He was an ophthalmologist working for Bond.

He's since retired and bought a place in Florida.

But then when you're in residency, you know, you really do get a lot of job offers like every day.

And on paper, this really was the most attractive one.

When I left residency as a primary care doctor, I really wanted to do outpatient and inpatient.

And there's only a handful of primary care doctors who still do hospital rounds when their patients get admitted.

I don't know how many primary doctors there are in all of Peoria but there's probably less than 10 of us that still do hospital rounds.

It's not so easy to find a hospital willing to hire you to do that and I found one and I took the job.

- Why is that (clears throat)?

- It's another skillset that you have to maintain.

You'd have to ask someone who runs hospitals, I wonder if it's maybe a little bit more expensive for them.

I could be wrong about that but it's kind of a lot of fun.

- Primary care's a broad term.

What exactly does that mean when someone says primary care doctor?

- Yeah, if you ask 10 different primary care doctors, you might get 10 slight variations on the theme but I'll tell you what my practice is like.

So, I mean, in residency, we did everything.

Like I was involved in delivering babies, seeing babies, the prenatal care, young adults, adults.

Much that I don't do anymore like I don't really see babies.

I certainly don't deliver children in Peoria locally.

But my practice is primarily adults and senior citizens and then of course the hospital rounds too.

And one of the things I'm expanding into is just talking to people specifically about obesity.

Like, what is their diet like?

What kind of exercise regimen and they're going through?

And some of the underlying health factors that come from their weight issues.

- So what makes someone like you find a niche or a specialty like obesity as an example?

I mean, is it because you have so many patients that come in and you see the underlying factors or what is it?

- It is a hugely underserved thing.

And I think in the next 10 years, you're gonna see a lot more doctors who specialize or at least spend a lot more time into it.

It's something like 70% of adult Americans are either overweight or obese and those numbers are going up fast.

The number of people who are, oh, I'm sorry, the percent of the population that's overweight has been maybe consistent since like the '60s about like 30 to 35%.

But when you look at the number of people who are properly obese, that's like tripled.

It went from like 12% of the population closer to 40.

And if you look at people who are severely obese, meaning a BMI above 40, it's gone up from one in a hundred to seven.

That means it went up seven fold in the last 50 years.

It's really been a dramatic change.

And it affects all kinds of things.

It increases your risk of heart disease.

It increases your risk of high blood pressure.

It increases even the risk of certain types of cancer.

I mean, it's really kind of devastating stuff.

- So you said BMI of 40, what is a normal or what should a normal body mass index be?

- Yeah, that's a good question.

So it's 18 and a half to 25 and that sort of serves as a baseline of like where you are now.

And it has to do with weight versus height to take sort of a generic example.

If you have say someone that's 200 pounds, it's like, well, are they five feet tall or they six feet six?

I mean, this is not the same thing.

So it factors that in and it's not the most perfect indicator of being overweight.

Like for example, if you were to test the starting line backing core of the Chicago Bears, a lot of these guys are gonna come back obese.

They're not, they're just really very muscular.

But as a quick and dirty, get a number pretty fast, It's a pretty effective screening tool.

- So let's talk about how, man I've got a hundred questions for you, let's talk about how this affects employee health.

- So what employers have learned is that the insurance is it's very, very expensive for them.

Nationally, it costs hundreds of billions of dollars just in direct healthcare costs for obesity and some of these downstream things that I was talking about.

And if you start looking into indirect costs, things like employees either taking sick leave or workers' comp claims or just something called presenteeism which is I think a relatively new term.

It means when someone's physically at work but their productivity is let's say sub-par.

It's costing employers a ton of money and for better or worse, they're kind of stuck with it.

I mean, insurance has been linked to employment.

This goes back to the '30s.

You can't just uproot it.

And what they found is that if people were to lose like 5% of their weight, it could save them hundreds or even thousands of dollars per year per employee plus maybe even their family members if that's through the insurance too.

And they've come up with interesting and creative ways to try to address that.

- This is probably a dumb question, but is it mainly just because of bad habits?

- Yes, it really is.

That's like the number one factor that employers have identified as just poor employee health habits.

There are certainly other things that could play into it.

I mean, some people have a genetic predisposition, some people may have like hypothyroidism or something.

But the number one factor does seem to be poor health habits.

And just from my clinical practice, I think the employers probably have a point.

You know, I spent a lot of time with my patients at least over the last few months, like when they come in with a complaint and I wonder if it's like, is it just like the food that they're eating?

Is that like the underlying thing?

And people get almost no fiber.

You know, normal amount of fiber in our diet is supposed to be like 30 to 40 grams a day.

I think we're getting less.

I think we're getting like 15.

And if you find some of the people who are like, sort of have like chronic medical condition, it's gonna be probably even less than that.

- So you said 70% people are obese.

You know, sometimes I'll look at those charts.

I know you said they're not necessarily the most accurate, the BMI charts or whatever.

But sometimes it'll say like 180 pounds at this height and I'll go, wait a minute, am I obese?

Or, you know what I mean?

You start putting yourself in that thing.

And I don't feel like I am but then at the same time, the charts saying I'm pretty darn close.

- Yeah, overweight or obese is the 70%.

So includes people who are just a handful of pounds overweight.

There are a couple of factors.

The first is, I mean, if you're, if you're working out a lot and if you have a lot of muscle bulk then that doesn't mean you're unhealthy, of course.

But also it's a screening tool.

It serves as kind of like a population study thing.

I will tell you though, like in my practice, I don't do a lot of population studies.

I have like, I'm one doctor with one patient at a time.

And I tell people, like don't get too obsessed about like the exact number on the scale.

Don't get too obsessed with your exact BMI.

It might be useful as sort of like a starting point, like, okay, this is where I am when I reached that point in my life when I need to start taking care of myself, like I had my wake-up call for whatever reason.

It's useful there.

But, you know, a lot of people come in to see me and they're like, I want to lose 80 pounds or it's like something like really hyper aggressive stuff.

And, you know, you'll like once in a while find someone who succeeds in that.

But we don't have a lot of control exactly over the weight that we are.

Like literally the fat cells in our body have their own, they have ways of becoming more efficient.

If you start losing weight, if all you're worried about is literally the pounds on the scale, you want inefficient use of energy, like you want to literally burn the fat, our body has ways of preventing that.

So I tell people like, you know, you really want to focus on the things that you definitely have control over.

Like, what are you eating for breakfast?

What are you eating for lunch?

What are you eating for dinner?

When you snack, what are you snacking on?

How much exercise are you getting?

And it's a part-time job.

I mean, if you're gonna get serious about what, maybe my patients are watching, they're laughing 'cause they've heard this speech before, but it's a part-time job.

It could be like 20 hours a week.

You know, I mean like half an hour a day for exercise, probably half an hour, breakfast, lunch, dinner, if you average it out to actually like buy the groceries, to cook it, to eat it.

I mean, maybe it's not all your time, maybe your spouse is going through it too and you can take turns cooking but I mean, it's a time commitment for sure.

- And it's expensive.

It can be expensive to buy healthy.

I've heard that.

- Yeah, that's true.

I mean-- - True or not true, shoot me down, I'm good.

- At times it can be expensive.

But I think a bigger factor is there are so many inexpensive unhealthy options and it just sort of gums up the works.

- I think I agree with you.

That I totally agree with you and it's fast and accessible.

- Yes.

- And then people, what I noticed too is so many different places, everybody, it's portion size.

I'm telling a doctor everything that he already knows.

(both laugh) So let's take food off the table for a minute.

What about smoking an alcohol or drug use?

I mean those affect employers too.

- Yes and yeah.

So in terms of smoking, a lot of times, you know, they ask you like, when you're going in, like, do you smoke?

They might even do like a nicotine test, I've seen that before 'cause it affects their insurance premiums absolutely.

It all comes from the same factor that employers are recognizing these costs of keeping their employees insured.

They understand that like when people are looking for new jobs, other than literally like the function of making the widgets in the first place, like one of the related factors they might ask is like what are the insurance premiums?

Like what am I covered?

It's one of the top questions that employees ask.

So employers are very, very acutely aware of it and I would say even becoming more aware of it as time goes on and that all plays into that 'cause if people are unhealthy, the premiums go up.

I mean, their care has to be paid for somehow.

- I think about what you said earlier, if 70% are overweight and obese, you, you know, relate that to just insurance policies in general.

That's why policy dollars are not going down.

All of the costs are shooting up up.

- Higher than inflation.

- A lot higher than inflation.

- Yep, it's something like 18% of the entire American gross domestic product just goes towards healthcare.

I've seen studies that just obesity itself and all the downstream factors from it, the high blood pressure, the heart disease, some of the cancers, osteoarthritis.

10% of GDP, I had to like double check that 'cause that's like an absurd number.

- Crazy, say that again.

- I've read studies where it says 10% of the American gross domestic product just goes to treating like-- - It's not funny but it's an amazing stat.

- Yes, I mean, it's really, you wouldn't guess it.

- No, so what can we do?

- There is an extent to which, I mean, there were some obvious things.

You know, when I talked to my patients, the first, like before I break down their diet like I was telling before, I ask them like a simple question.

In your opinion, is your diet good or bad?

Multiple choice, two options, good, bad.

The most common answer I get and I mean by far is some version of even worse than that.

It's like horrible, terrible, worse than bad, something like that.

So there's an extent to like, we know, like we're not eating the right foods.

Now, there are some questions out there about what are the right foods.

Like there's a lot of like, I dunno, I hear some weird things like paleo.

And like I heard someone going on like this, like blood type diet, whatever that is.

You know, like you really wanna stick on like fruits, vegetables, lean meats.

One of the more common ones that I recommend is something called the dash diet.

It's not the only one I recommend.

But it was written by a room full of cardiologists.

And what I assume was an exotic resort somewhere.

But it's like a low salt diet.

It was designed for people with high blood pressure but they found everyone who goes on it tends to like lose weight, live longer and it's because it's kind of like the obvious stuff, like that your, you know, your mother and your grandmother told you, like stay away from the processed foods, eat your fruits and vegetables, eat lean meats occasionally, that kind of thing.

- Yeah, interesting.

Do employee wellness program, I mean, you know, I've seen wellness programs come and go and it's hard to sustain something like that.

Do employee wellness programs work?

- They're trying, you know, there there's a handful of things that they've been trying.

The first thing is they clean up the environment in their office space.

And what I mean by that is like the stairwells are well lit and clean.

The hallways are well-lit and clean and accessible so that people are getting in their steps throughout the day.

They, sometimes, I've seen this or read about it rather, maybe I've seen it too, where they take that a little bit more aggressively and they intentionally slow down the elevator or they intentionally slow down the escalator or something.

The logic behind it being, you want people like you want a lie to develop, ah, forget it, I'll just take the steps like that sort of things so that people get their steps in throughout the day.

- That's interesting.

- You know, some like where I work at Unitypoint, for example, and I think this is within the last six months that they did this and just to be clear like I work there, I don't speak for them.

I'm not involved in any of the administrative decisions or anything but they gave everyone this app with all like these exercise programs on there and I've played with it.

You know, there's a handful of that requires no equipment in your house at all.

There's some that require like some very cheap equipment.

So if you're willing to put in the time, there it is for you.

And this is, you know, you need points of big employer.

I don't know, probably one of the top five in Peoria, I would assume.

For smaller employers, it gets a little tricky.

- That's where I was going at next.

So go ahead.

- If you were, like hypothetically, to just pay for your employees gym membership or something, that's income.

So it affects their...

There's a tax burden associated with that.

Whereas if you just have like gym in the basement of your building, that's not income so that's like sort of like a built-in advantage for the big employer, disadvantage for the smaller one.

- That's interesting.

I was just gonna say, is it harder for small business to do it and I think it is because, I mean, let's say you're an employer of 10 or better yet let's say you're a fast food restaurant.

You're around at all day, right?

- Yes.

- You're around it all day.

Did the 10,000 step challenge that started probably a decade ago, did that help with any of this?

It doesn't look like it number wise.

It did for me personally.

- Did it?

- Yeah.

- Yeah, it's hard to tease out 'cause the numbers population wise have gotten worse and continue to get worse.

Maybe someone knows but it's tough to tease out.

If like one specific intervention stopped the worsening numbers from getting even worse.

- What are some of the exercise interventions employers are experimenting with?

You said Unitypoint and there was an app.

I mean, is there more of that out there that's happening where you can opt in for it or you can have more opportunities to get involved to try to get in shape?

- I think the answer is yes.

You know, one of the things that employers will sometimes try is they will directly pay their employees, like a few hundred bucks every quarter or something like that if they can prove or at least like claim that they did some exercise on a daily basis for months or a year on end.

I watched this YouTube video once of like some, I'm gonna get some of the facts of this wrong, but there's like some of the lumber company in Arkansas and they had just this huge number, like way above the national average of overweight, obese employees.

And they were having all these like sick days and presenteeism and all that kind of stuff.

And what they did is they hired some nutritionists.

They hired some of these, I guess it must've been physical therapists.

They were coming out there and they were, harassing is the wrong word, pressuring and keeping an eye on their employees like, are you dieting?

Are you exercising every day?

And I'm sure there were some reticence upfront on both sides.

You know, like the employer's like shouldn't we be focusing on lumber or something and they have a point.

And the employer's like, you know, I'm busy right now but once you get over that initial reticence and everyone realizes like there are some long-term benefits to this, everyone ended up pretty happy with it.

They saved some money down the road.

It really kind of, it was a success.

- That's pretty cool.

So let's take the hot topic for the past couple of years and I think it's gonna stay the hot topic, mental health.

Because if you take the obesity piece, there is a mental health piece to it too because there's lack of self-worth.

There's lack of energy.

There's all of those different things.

I'm guessing you see that as a doc.

- Oh, no question for the reasons you just said.

And then also obesity is a really high risk factor for obstructive sleep apnea which is to say, people are not sleeping very well at night.

And some of them get their CPAP machines and then they're feeling better afterwards and it affects their mood too.

But show me the most well-adjusted person in the world and then take away their sleep for weeks, months, years, like they're gonna get anxious.

They're gonna have some mental health issues down the road.

So absolutely, I would say there's a correlation there.

- You know, everything that you're saying, whether it's smoking or overeating, everything affects everything, doesn't it?

- Yes.

- I just sometimes wonder if it ever is gonna get better.

- It's a good question.

- Yeah, going back to the mental health piece, what can we do as employers to help more with the mental health piece or maybe the wellness piece tied to it but the mental health piece at work?

- I think there's a handful of options.

I mean, first of all, the insurance, they provide good mental health options but then I think focusing on wellness is fair enough.

Like we talked about some of the exercise options.

You really wanna present some good nutrition options while you're at work.

People spend a big chunk of their lives there and you're hungry.

Like you're busy and you kind of get back to work and if all you have is this really kind of like unhealthy food options, you're asking for poor wellness down the road.

- That's true actually if you think about it because people are stressed right now, there's a lot going on.

You know, COVID is ramping back up again so there's that mental health piece to it.

And then that's interesting.

So is what you're talking about with the employer piece is that why smoking policies now are getting sometimes a little tighter and people are putting in smoking policies at some business and a vaccine policies and all of these different things?

I mean, you're almost saying the health of our people, and I'm not advocating for them, just making a statement, the health of our people is the most important thing.

You may not like it so you can go work somewhere else but we're having no smoking as an example.

- Yeah, I mean, again, I'm not involved in a lot of the administrative decisions.

- Well, I'm just talking in general.

I mean, I'm seeing more of this throughout the country.

People making decisions that have to do with the health.

- Yes, yeah, I would say that's right.

- So we talked about it earlier, you could go anywhere and be a doctor, right?

Why do you pick here?

- I think it's a great place to live.

- I'm glad you said that.

- No, I mean, you know, I grew up in the Chicago suburbs, not terribly far from the Wisconsin border up in Lake County.

And growing up, I visited most of the big cities in Illinois.

Like I'd been to Rockford, you know, Moline.

I'd been to Bloomington Champagne.

I'd never been to Peoria growing up, zero times.

And it's maybe not the most interesting city as a tourist but as a place to work and live, there's no question.

I think this is the best place I've worked and lived, It's relatively low cost of living, plenty of space.

I can't believe how much space I have living here as opposed to Chicago or Cleveland where I lived before which is also a great city.

I'm happy with the school choice for my kids, you know, the daycare.

Like we're just really happy working and the plus I get to do the job I wanted to do.

- And you can be there at your work in five minutes.

- Well, I live out in the country but yes, you could, I could have if I chose to.

- You could, if you chose to and traffic's like...

I say this about middle Illinois all the time 'cause I grew up in middle of Illinois and I think to myself, I love being here.

And when you look at people that come in from other cities, I don't care where it's at.

But you know that that migration from Chicago or St. Louis or wherever it is.

Peoria, Bloomington, Galesburg, these are great places to raise a family.

- I agree.

- Cool, so I know patients always come first and I hate to bring COVID back into it but I said it earlier so I'm just gonna ask you.

How has this affected a business like yours even though you're a doctor, just the processes and flows, is it annoying?

- At times.

- Yeah.

I mean, I tell you, it's changed some things for good but other things I just didn't know from a doctor's point of view how you look at it, what your take on it is from a business flow.

- It's very up and down.

I mean, healthcare can always be a little up and down.

You know, I remember in November when the hospitals were just bursting at the seams, we just had every bed full and it was incredibly busy.

And a lot of the other things don't go away.

You know, there's still patients coming in with all the non COVID issues that they might have and just 'cause I'm spending, you know, an extra whatever it was a couple hours a day dealing with people, managing coronavirus in the hospital, it was just very, very busy.

And, you know, this was before Thanksgiving and is before the vaccine too.

So I remember like there was a train of thought out there, it was like, well, this is before Thanksgiving, families are gonna get together in Thanksgiving and probably again at Christmas.

And you could imagine like these numbers are gonna get worse.

Like what are we going to do?

And fortunately as locally, it didn't happen.

- Yeah, and that rumor was floating everywhere.

I mean, it almost felt like big brother is watching you saying, do not go talk to your family (laughs).

- Yeah, yeah.

- Well, this is fun.

You know, I did my homework on you and I appreciate you reaching out and talking to you because I think you could be the resident doc here for Business Forward because I think there's a lot of different topics that not only relate to business but also to community and to just our health in general and we need to do a better job across the board of taking care of ourselves.

Like you said, we have to do it.

It's gonna hurt our business, our kids, our families and so on.

So, well, I appreciate you coming on.

You're welcome back anytime.

You do some great things in this community and I hear a lot of great things about you so I appreciate it.

Well, this is another episode of Business Forward and I'm Matt George.

We'll see you next time.

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