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Summary & Comment

What does stress management have to do with successful weight loss? A lot. as it turns out. Stress is pervasive in our society today and levels are rising, not getting better. A person’s state of mind and psychological well being directly impacts their decisions about food choices. People may eat more when stressed, or eat "comfort" foods that hamper their weight loss efforts. If their spouse or family or work situation causes them ongoing stress, this is another obstacle to be overcome before successful weight loss and weight maintenance can take place.

The psychological component of the weight loss formula is just as important as the nutrition and exercise components. That’s the whole basis behind Dr. Phil’s best-selling diet book and weight loss program (Ultimate Weight Solution). Tackle your inner self before beginning a weight loss diet.

The vast majority of American workers say they are stressed, more than a third say that their job is harming their physical or emotional well-being, 42% say job pressures are interfering with their family or personal lives, and half report more demanding workloads than they had a year ago.

Those are among the main conclusions of "Attitudes in the American Workplace VII," the seventh annual Labor Day poll by the Marlin Company, a North Haven, CT, workplace communications firm.

The telephone survey, conducted by Harris Interactive, also showed that roughly half of workers (48%) say that they at least sometimes have too many unreasonable deadlines and/or too much work to do and that 42% feel they sometimes, rarely or never have adequate control or input over their work duties.

What causes the majority of stress in your life? 28% said workplace demands; 21% family or personal demands; 42% said both equally; 8% said neither, and 2 % said they don’t feel stressed. Those who said that workplace demands cause the bulk of their stress are much more likely to have high (i.e., negative) scores on the Workplace Stress Scale™ than those who say more of their stress comes from family or personal demands.

Close to two-thirds of adults (64%) say they take steps to control stress in their lives. The largest number of Americans try to cope with stress by taking their mind off their problems through passive leisure activities such as watching TV, reading, or listening to music. Eight in ten adults (82%) at least sometimes participate in these kinds of activities to cope with stress.

Men and women clearly differ in the way they cope with stress. The biggest differences are women’s greater tendency to talk with someone when they feel stressed (83% vs. 68%) and to go out shopping (47% vs. 24%). Women are also more inclined than men to say they watch TV, read, or listen to music to reduce stress (88% vs. 77%). Men, however, are more likely than women to drink alcohol (23% vs. 13%).

Insurers typically do not pay or reimburse for stress management services (other than psychiatrists or psychologists), and experts interviewed do not see any change in this policy resulting from future health care reform. Public and private health insurance currently provide minimal or no coverage for anxiety disorders-- or for mental healthcare in general--especially outpatient services.

Insurers will pay for specific stress related conditions or complaints such as migraine headaches, depression, etc. if the diagnosis is directly related. For example, insurers will reimburse for things like post-traumatic stress, physician-based programs, and hypertension. They will not reimburse for things like yoga, rolfing, or massage.

Approximately 22.7 million Americans--8% of the population--will suffer from an anxiety disorder at some point in their lives. Anxiety disorders are among the most treatable of all psychiatric disorders. However, only about one-third of those people suffering from an anxiety disorder actually receive any treatment.

The list is long and includes the following…

• biofeedback centers

• stress reduction clinics

• licensed psychologists and psychiatrists

• physical therapists

• wellness programs offered by companies to their employees

• EAPs (employee assistance programs)

• hospitals

• health risk appraisal companies

• health clubs

• massage services

• books, tapes, cassettes (self-help programs)

• computer interactive services (software programs)

• physicians - via the prescribing of anti-anxiety drugs

• acupuncturists

• hypnotists and hypnotherapists

• social workers

• health educators.

In the opinion of stress medicine experts, stress management programs open and close every day, and many of the techniques used by them have little or no scientific basis at all.

Stress management experts or vendors use a variety of methods to relieve patients’ stress levels. These methods may be used in one-hour or three-hour sessions, "brown bag" sessions during lunchtime at the work site, intensive weekend retreats provided for companies, or lectures to large groups or at the professional’s office through one-on-one weekly counseling sessions spanning 6-20 weeks. Specific tools used may include:

• A stress level assessment using scored questionnaires and computer software that produces individual or overall company reports to use as a baseline measure for an employer

• Breathing techniques

• Muscle relaxation

• Biofeedback via monitors/machines, or low-cost stress dot cards or other heat-sensitive devices

• Counseling in coping mechanisms and problem-solving techniques

• Focus group therapy

• At-home materials: books, audio cassettes, newsletters and workbooks

Just how many hospitals in the United States offer stress management programs is difficult to determine. Many programs are inexpensive educational workshops or seminars that span one or two sessions, rather than in-depth 8-week programs typical of weight loss plans. Generally, stress management is included with a smorgasbord of health promotion topics, including: weight loss, nutrition, CPR, back care, health risk appraisals, and cholesterol screening--via health fairs and lunchtime sessions.

In BestDietForMe.com/Marketdata’s October 2002 report: The U.S. Weight Loss & Diet Control Market, we estimated that 2,300 hospitals nationwide offered a low-cost (average cost: $145) nutritional counseling program developed in-house by hospital staff. Marketdata estimates that 50% of this number are taking advantage of free or low-cost stress management programs that are hospital-based, or 1.1 million people. Stress management programs are more likely to be shorter in duration, perhaps an evening or weekend workshop, usually no more than one or two sessions. Contrast this with a six- to 14-week weight loss program. Consequently, the cost is much lower, $50 or less. This is true for most, but not all hospital-based programs.

A health club should be a natural setting for educating people about stress management. At a club, one usually finds a collection of people with a positive attitude toward self-improvement. These persons are already motivated to change their lifestyles or habits. However, it appears from speaking to both clubs and vendors/consultants serving them, that most health clubs are really behind the times when it comes to offering stress management programs.

One of the fitness industry’s main trade groups, IHRSA (International Health, Racquet & Sportsclub Assn.) reported to BestDietForMe.com/Marketdata that, based on its survey of its more than 6,000 member clubs, a total of 24% did provide a wellness/stress management program to their members. Currently, there are 18,203 fitness clubs operating in the United States.

Typically, a club will bring in an outside stress "expert" to give a talk or presentation, and this will be packaged along with weight loss, smoking cessation, and other healthcare services, into a course spanning several weeks. Programs and prices will vary widely, depending on the club and the affluence of their members. The high-end clubs will usually combine a stress reduction workshop into a total membership package.

Based on BestDietForMe.com/Marketdata’s research and in-depth phone interviews, it seems as if the typical one-day workshop, class or seminar attracts only 30-70 people per year, at an average cost of about $40. Most clubs we spoke to said that they only offered the classes once or twice a year.

Today, there is nothing generic about corporate stress reduction programs. A stress audit is performed first to find out what the nature of the problems are, and then a program is tailored to resolve those problems based on resources available. Then a decision is made whether to provide services in-house or go to the outside "vendor" or expert.

Stress reduction techniques vary greatly among companies, and stress reduction is usually included as part of an EAP or other broader program. Stress reduction has become the leading priority for many EAPs, especially in California and other western states. Some employers feel that exercise programs work best, while others use meditation, muscle relaxation, and still others provide counseling for work- and family-related problems (such as parenting, legal and financial advice, and alcoholism). Most employers prefer group sessions rather than individual counseling for cost-effectiveness reasons.

HMOs are playing a major role in health promotion programs of various types, including stress management. An HMO may, for example, offer an employer’s workers a lunch-time workshop, but for stress management, weight loss, and smoking cessation, it’s more apt to provide a multi-session behavior modification course.

The American Institute of Stress

124 Park Ave.

Yonkers, NY 10703

Contact: Paul J. Rosch, M.D., Pres.

Phone: 914-963-1200

FAX: 914-965-6267

www.stress.org

Essi Systems, Inc.

70 Otis St.

San Francisco, CA 94103

Contact: Martha Evans

Phone: 415-252-8224

www.essisystems.com (workshops)

Institute of Stress Medicine

3020 Brock St. North

Whitby, Ontario

Canada L1N 5R5

Contact: Dr. Naresh Kumar

Phone: 905-666-8747

The Midwest Center For Stress And Anxiety

106 N. Church St.

Oak Harbor, Ohio 43449

Contacts: Lucinda Bassett, David Bassett (has an infomercial, runs radio ads)

Phone:  800-944-9460

Mind/Body Medical Institute

824 Boylston St.

Chestnut Hill, MA 02467

Contacts: Dr. Herbert Benson

Phone:  617-991-0102

New York University

Stress Disorders Medical Services

c/o Reed Moskowitz, MD

17 East 96th St., Suite 1B

New York, NY 10128

Phone:  212-348-9187

Self-Programmed Control Center

11949 Jefferson Blvd., Suite 104

Culver City, CA 90230

Contact: Alfred A. Berrios, PhD.

Phone:  800-STA-CALM

The SPC Center’s main product is the ever-present credit card-sized biofeedback card that changes color based on your skin temperature. More than one billion have been sold since 1982.

Stress Reduction Program at the University of Massachusetts Medical Center

55 Lake Avenue North

Worcester, MA 01655

Contact: Jon Kabat-Zinn, Ph.D.,Assoc. Professor of Medicine, Clinic Director

Phone: 508-856-2656