Are our Wellness Associations Well? 3 Questions to Ask When Joining a Wellness Professional Association

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As a wellness professional, you may choose to join a professional association for many reasons. It may be because you want to stay up to date on current information, stay engaged in the profession, and perhaps earn some continuing education credit. As the wellness profession matures, it is important that our professional associations also mature as they continue advancing their mission to educate, mentor, and elevate the field. After working for a professional association with a long history of promoting wellness worldwide, there are a few questions I suggest wellness professionals consider asking when deciding which association will deliver the professional development experience they need and maintain the credibility of the wellness industry as a whole:

  1. How does your association set quality standards for their education, certification, and content marketing programs? Or, what best-practices does your association follow in these areas?
  2. How does your association demonstrate accountability to stakeholders?
  3. How does your association’s organizational and leadership practices foster a culture of wellness?

Professional associations serve as thought leaders in the profession and are often key stakeholders in developing industry-wide standards that guide higher education, certification and continuing education programs. When joining a wellness association, it is important that its leaders are either involved with setting standards or following established national standards and best-practices. For instance, if your association offers certification programs, you may want to ask if they are accredited by the National Commission for Certifying Agencies (NCCA) to ensure the program meets the highest standards in the certification industry. Or, if you plan to attend their conferences or training programs, you may want to ask if they use a peer-review process for training content, blind reviews for conference session selection, and have visible conflict of interest disclosures for presenters. Finally, does your wellness association have quality standards for the information they post on social media? The internet is full of spurious claims and dubious research, which is why many of us turn to our professional association to help us sort out the “click bait” and find credible resources. Therefore, it is important that wellness associations have quality standards and avoid sharing questionable media stories or research articles as part of their content marketing strategy under the guise of providing you up to date and credible information.

We may assume that if our wellness association is teaching us about worksite wellness, that they are probably the epitome of a well organization. But what if that is not the case and your wellness association is organizationally unwell? Since many wellness associations are in the business of educating professionals about standards, practices and ethics in worksite wellness, the wellness association has an obligation to act as a role model in this area. Does the Executive Director consume fast food for lunch everyday, ignoring personal, community, and environmental health? Do board members routinely serve their entire term or resign early because of internal incivility? Do staff feel their work is meaningful and valued by the organization or do they just show up for the paycheck? You may not be able to find answers to questions like these, but inquiring more about the organization’s leadership practices and wellness programming, or gauging their response to a suggestion that they include employee wellness metrics in their annual report might provide some insight on the extent to which they “walk the walk.” The culture of an organization has ripple effects on the quality of products, services, and support it is ultimately able to provide for its members or customers.

As professionals, we need to ensure that our professionals associations are transparent and accountable to stakeholders. Many wellness associations are not-for-profit entities and enjoy a public appearance of honesty and integrity. However, without access to their annual reports and outcome evaluations, how can we know for certain that they are being fiscally responsible and actually meeting their stated mission and objectives? Professional associations, especially those with non-profit status, should have items such as their bylaws, board minutes, and annual reports that include financials publicly available on their website. If you cannot find these items on their website, your wellness association may not be able to demonstrate that it is serving your needs or making a meaningful impact on your career development. Asking questions about your wellness organization’s evaluation processes and transparency protocols ensure that you can be confident your organization is providing value and achieving its goals with donor and tax-exempt monies rather than spending thousands dollars on golf outings and family trips for the Executive Director.

Wellness associations offer many valuable resources and programs to support professionals in making a difference each day. However, if our wellness associations are not being held accountable, how can we ensure the wellness profession and industry as a whole are operating at the highest standard? This begins by ensuring that our wellness associations truly walk the walk of wellness by following best-practices in educational programming, being transparent and accountable to members and consumers, and creating thriving organizational cultures within their own organization. We can nudge our profession in this direction by asking these type of questions before joining a wellness organization or attending their educational programs.

What Health Professionals Need to Know about Sugar Taxes

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Calls for taxes on sugar-sweetened beverages (SSB) by health professionals and advocates continue to occupy news headlines. Many of these commentaries rely extensively on emotional justifications for implementing these taxes as a public health measure to prevent weight gain, diabetes and cavities.

Taxes on sugar sweetened beverages are not new and have been implemented in many areas in many different ways. In theory, this sounds like a great idea, but what is the actual evidence that they meaningfully impact public health?

Theoretically, given a large enough excise tax on SSB, consumption levels decrease, leading to significant improvements in weight and obesity rates. In Mexico for example, one analysis estimates that a SSB excise tax may have resulted in a 7.5% average reduction in SSB consumption, with the greatest decrease among households at the lowest socio-economic level, while an analysis of 15 cities in the United States that have implemented an excise tax on SSB estimates that the incidence of diabetes could potentially decrease by 6% within a year of the tax reaching its full effect. However, the estimates from these economic models only predict a decrease of less than one pound of body weight, with no real improvement in health. Furthermore, empirical evidence of self-reported soda consumption did not significantly change after Berkeley, CA, implemented its tax on SSB as people shifted their purchases to neighboring counties or online vendors. This may be because demand for sugar-sweetened beverages tends to be slightly inelastic among the general population when prices increase, meaning that price does not significantly influence a consumers decision to purchase them.

But at what cost? Are the actual changes in consumption or health outcomes substantial enough to be considered worthwhile? How sustainable or long-lasting are these improvements? And are there other programs or policies that would lead to more significant health outcomes and have a societal or individual cost that is equivalent to or lower than a sugar tax?

It is important to remember that while sugar taxes may be associated with improved weight status at the population level, there is no evidence that they cause improvements in actual health status. One reason may be because lifestyle choices contribute to less than a quarter of one’s of current health status and sugar-sweetened beverage consumption is just one of many lifestyle variables. A greater proportion of an individual’s health risk is due to social determinants of health such as one’s social environment, physical environment/total ecology, and health services/medical care.

Focusing the health conversation on taxing sugar-sweetened beverages may actually be distracting efforts to take action in addressing more substantial causes of poor health like low wages, poor housing conditions, access to affordable healthy food, violence and trauma, systemic oppression, and quality healthcare. Increasing the price of SSB may deter consumption of these products, but it does nothing to increase access to affordable healthy food or healthcare services in the communities that are affected most by food insecurity and diet-related health issues. Policy alternatives, like subsidizing the cost of fruits and vegetables, and investing in community-based food systems would do more to improve access to healthy choices–without the need to penalize people for taking pleasure in a sugary beverage now and then.

While the case of Mexico shows that a SSB tax may reduce consumption of the taxed beverages, they also estimated a 2.1% increase in purchases of un-taxed beverages due to the substitution of SSB with other products like juice, milk, diet soda, and even alcohol. While certain substitutions may be beneficial, a focus on decreased consumption of SSB and changes in BMI are too narrow to be meaningful. Without empirical evaluations of the SSB tax impacts on actual health outcomes, it is difficult to determine if the tax is actually worthwhile in achieving anything more than imposing administrative costs on society and placing an unnecessary burden on the individual autonomy of both healthy and unhealthy individuals.

Unfortunately, few studies have empirically evaluated the effects of taxes on sugar-sweetened beverages and the evidence that they improve public health measures is limited. Many studies in this area rely on econometric modeling rather than measuring peoples’ actual behavioral response to the tax. Before getting on the SSB tax band-wagon, health professionals should advocate for more extensive empirical research in this area as a way to promote evidence-based policy decisions in public health.

Related: Junk-food Taxes: Do They Work?

Self-determination and Resiliency: The Case for Community-based Food Systems

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There are no unicorns, and there are no unicorn foods. This was the analogy given by an agricultural economist speaking on a panel about the future of our food system in reference to the fact that we as humans have multiple, and sometimes conflicting, values and needs that cannot be met by one perfect food. Since no one food, or one food system, is likely to live up to meet all of our needs, we ultimately need to make decisions and prioritize what is most important to us. Personally, I have oscillated through periods of shopping at farmers’ markets and supporting local food systems, and also periods of relying on grocery store chains to deliver the most convenient and economical source of daily sustenance. After the book Dark Money, by Jane Mayer, landed on my reading list this past summer, my commitment to community-based food systems once again strengthened as I reflected on the themes of self-determination and economic diversity.

Dark money is a detailed history that tells the story of a wealthy network of capitalists who have organized and funded a strategy to promote a neoliberal policy agenda aiming to capture the state and impose a new order around corporate interests. This strategy is designed by powerful business leaders to influence public opinion in support of policies that seek to privatize public goods, erode environmental and safety regulations, and suppress wages and labor rights, ultimately boosting corporate wealth and power at the expense of the public. Organizations, like the Koch Foundation, use their tax-exempt foundations to channel money to tax-exempt non-profits that champion their cause through research, advocacy, and public education. Or, as Kari Polanyi Levitt and Mario Seccareccia put it in their erudite commentary on the subject, these foundations foster the “proliferation of neoliberal think-tanks and other such lobby groups, often masquerading as research institutes that can hijack government policies at the local and national levels and end up almost as in camera advisors to elected representatives.”

This brings me back to our food system. Our predominate, commodity-based, food system has contributed to a dietary pattern disproportionately skewed toward a handful of artificially low-priced foods, namely wheat, corn, and processed meat products. Even within types of foods, variety has decreased. The varieties of cabbage grown, for instance, have decreased from 544 in 1903 to just 28 in 1983. In part, this has to do with innovation in seed production that provides farmers greater certainty in the quality of their product. But it is also the effect of a more highly consolidated food system that demands homogeneity in appearance and transport hardiness. All of this is associated with negative impacts on public health. While this system is arguably highly efficient in delivering calories, it is limited and fragile in its ability to provide workers with a living wage and ensure access to a diverse range of appropriate foods for large segments of the population. Further, its resilience over the long-term is questionable.

Resiliency in the food system consists of three key dimensions: (1) the diversity of the food system’s components, (2) the degree to which the components are connected, and (3) the degree of decision-making autonomy within the food system. Significant consolidation of the food system decreases the diversity of its components, including the varieties of foods grown, production methods, distribution channels, employment options for workers. Alternatively, community-based food systems support a wider base of farmers and value-added producers. These smaller, more diverse, networks increase farmer autonomy while building sustained relationships and shared responsibility for investing in the health and prosperity of the community. For example, the New South Produce Cooperative and Grassroots Farmer’s Cooperative in Arkansas connect members to distribution networks, provide technical assistance, and help small farmers raise capital as a collective. This wider base of producers also leads to more diversity in crop varieties, production methods, and employment options that are adapted to local conditions and cultures.

If degree of decision-making autonomy among a broad base of producers is a key component of a resilient food system, this brings us back to reflecting on the systematic erosion of public voice resulting from the extreme neoliberal agenda described in Dark Money. Because of the substantial wealth large food companies have accumulated in relation to workers and consumers, they now have a more influential political voice than the majority of citizens. Eroding the impact of citizens’ political voice creates a more controlled environment in which farmers and other food producers may find themselves with limited autonomy over their production and distribution decisions. With limited competition in the industry and few places to look for more favorable contracts, more and more decisions are instead dictated by corporate interests (whether or not it is beneficial for the farmer or local community). Operating under such conditions leaves the base of our food system vulnerable to shocks, disincentivizes innovation, and makes it difficult to adopt beneficial practices critical for adaptation.

When an industry becomes too concentrated and competition is diminished, politically powerful companies tend to rely on “special political privileges” rather than invest in the human, social and financial capital creation to build the adaptive capacity required for innovation, ultimately hindering their resiliency and ability to consistently provide stable levels of appropriate foods to the public. Farmers’ markets and locally-owned shops may not prove to be the most efficient way to produce and distribute food. But it can be an efficient way to produce and distribute a portion of our food if we re-define efficiency to account for alternative values like autonomy, civic participation, fairness, and long-term resiliency. So, at least for now, I’ve once again circled back to grocery shopping at farmers’ markets and local shops like my right to self-determination and democracy depend on it.

10 Ways to Connect your Worksite with Local and Regional Foods

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10 Ways to Connect your Worksite with Local and Regional Foods

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Creating a worksite environments that support healthy eating habits by linking employees to their local and regional food cultures is an important multi-level wellness strategy. By making it convenient for employees to choose foods that are both healthy and enhance the economic diversification of their community, your employees and your organization contribute to the overall well-being of your community. Many strategies for encouraging local and regional foods can be easily implemented in worksites of all sizes.

  1. Local Food Atlas: Many regions have created local food atlases to help people identify the farmers in their area. This can be a great resource to hand out at the worksite to help employees learn where they can purchase local foods. For example, check out the Central WI FarmFresh Atlas here.
  2. Cooking workshops and tasting events: Cooking events and workshops that feature local foods are great ways to introduce people to new cooking skills and new foods. If space is limited, try connecting with local farm vendors or organizations to have an off-site lunch and learn.
  3. Volunteer days: Provide employees with volunteer hours that they can use to support local food events in your community
  4. Host Community-Supported Agriculture (CSA) open house: Each spring you could host a farmer meet and greet so employees can meet local farmers, learn about their products, and sign up for a CSA.
  5. List of CSA drop points: Distribute information about CSAs in your area and nearby drop points each spring to encourage employees to sign up.
  6. Become a CSA drop point: Having a CSA drop point within your organization is a great way to make CSAs more convenient for your employees by eliminating “one more stop” from their after-work to-do list.
  7. Farmers’ market walks: If your workplace is within walking distance of a weekday farmers’ market, schedule a break-time or lunch-time walking routine to pick up fresh fruits, vegetables and flowers.
  8. CSA subsidies: Check with your health insurance about offering a rebate for CSA participation, or provide employees with a subsidy to help cover their CSA and increase their fresh fruit and vegetable consumption.
  9. Compost bins, food residuals: Local foods do not end at the plate. Food residuals (often referred to as food waste) are an important part of the local food cycle. There are many great ways to collect food residuals in the office and compost them for use in the organization’s landscaping or returning it to the CSA vendors in your community.
  10. Set up a farmers’ market onsite: Consider if there is a need for a farmers’ market vendor or two in your area during the day. Easy access to a farmers’ market is a convenient way for employees to access local foods and great way to boost morale.

 

 

Junk Food Taxes: Do They Work?

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The Navajo nation recently became the first place in the United States to impose a tax on junk food in an effort to address concerns about obesity in their communities. A “sin tax” to disincentivize the consumption of foods associated with health risks is not new, but it is gaining momentum as communities recognize the need to create food environments that are health promoting. So far, soda and sugar-sweetened beverages have been the primary targets.

Soda and sugar-sweetened beverages have been implicated as a major source of excess calories, leading to weight gain.  Nationally, Americans consume an average of 1 gallon of soda each week, or about 1000 calories completely void of nutrients.  Sugar-sweetened beverages account for roughly half of the 250-300 additional calories American are consuming compared to 60 years ago.  In response, taxes have been proposed in many states to discourage the purchase and consumption of sugar-sweetened beverages.  Thirty-four states currently have a sales tax imposed on soda sold in grocery stores, and 39 states tax vending machine sales.

The most prevalent argument in support of a sugar-sweetened beverage tax (SSB) is the effect on public health.  Health care costs for Americans with obesity are 36% higher than for Americans with a normal weight and prescription drug costs are 77 % higher.  Current estimates suggest a loss of $30 billion in productivity on the job each year due to lifestyle related health issues. Taxes are currently imposed on cigarettes and alcohol in an attempt limit their consumption and encourage healthy behavior.  Many public health advocates believe that a SSB tax would be reasonable and effective as well because consumers generally respond to higher prices by decreasing consumption.  The funds from taxes would ideally be used in nutrition and health education programs, and this is exactly what the Navajo nation plans to do.

The theory that increased price of SSB would reduce obesity rates is not currently well supported by the research.  Most taxes on soda are a sales tax that consumers do not see when they are making the purchase decision.  Current sales tax rates of 3-4% in participating states has not significantly affect the weight status of adolescents.  In addition, one study found only a 0.16% reduction in BMI in states with a sales tax on soda. Due to consumers’ propensity to substitute consumption choices, other studies show that any reduced soda consumption increases consumption of not only water, but milk, alcohol and juice.  Therefore, it is not clear that a tax on SSB would reduce BMI for overweight and obese individuals.

Current academic research fails however to present a holistic picture of the SSB tax, focusing specifically on weight loss.  While substitution of milk and juice for soda may not reduce weight, it will contribute necessary micronutrients that are typically inadequate to the diet of Americans like potassium, magnesium and calcium. We also know that BMI is not a strong indicator of health, as people with BMI scores in the overweight and obese categories can achieve positive health outcomes through health-promoting lifestyles, while people in the normal BMI category are at risk of poor health outcomes if they pursue health-detracting lifestyles (HAES cite). Viewing the tax through a health-based evaluation paradigm, rather than a weight-based paradigm may show more desirable outcomes.

As suggested in the research studies, current sales tax rates are too low and not visible enough to significantly impact consumer choices.  A higher rate in the form of an excise tax is another way to influence SSB consumption.  One study suggests it would take a 10% increase in price to produce an 8% reduction in soda purchases.  An excise tax (included in shelf price vs. at the register) of this magnitude, might be a more effective strategy for directing consumers away from soda.  This is more than double the tax rate imposed in participating states, and 5 times that of the Navajo nation. Furthermore, the increased price would be visible at the point of selection (when purchasing decisions are made) rather than at the point of payment.

While taxes are not the comprehensive solution to changing health-detracting behaviors, they can help shape the food environment to be more health promoting. If the Navajo nation looks beyond weight-based measures of success to health-based measures, their policy for shaping the food environment may ultimately become a model for other places in the United States to emulate.

 

1. http://time.com/3762922/junk-food-tax-obesity-navajo-nation/

2. Pratt, Katherine. A Constructive Critique of Public Health Arguments for Antiobesity Soda Taxes and Food Taxes. Tulane Law Review [online]. 2012; 87 (1): 73-140. Available from: LexisNexis Academic.

3. Kiviat, Barbara. Tax and Sip. Time [online]. 2010;176 (2): 51-52. Available from: EBSCOhost.

4. Powell, LM. Associations between state-level soda taxes and adolescent BMI. Journal of Adolescent Health.

5. Bacon, L. (2010). Health at every size: The surprising truth about your weight. BenBella Books.

6. Wansink, B., Hanks, A. S., Cawley, J., & Just, D. R. (2014). From coke to coors: a field study of a fat tax and its unintended consequences. Wansink, Brian, et al.” From Coke to Coors: a field study of a sugar-sweetened beverage tax and its unintended consequences.

7. Andreyeva, T., Long, M. W., & Brownell, K. D. (2010). The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food. American journal of public health, 100(2), 216.

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What to do When you Hate Beets?

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I don’t like beets.  When we hear this from children, we encourage them to try again, hoping they might like them once they get older.  Curiously though, once we become adults, encouragement to try disliked foods ceases and we develop the belief that our food preferences are fixed.  We might even justify this belief by claiming a genetic predisposition to dislike certain flavors or foods.  I don’t like beets, and at this point, I never will.  However, even a genetic predisposition to a certain trait does not necessarily equate to predetermination of behavior.  Our mental beliefs play a substantial role in our preferences for food.  And the good news is, our mental beliefs change.
As living beings, we are constantly changing.  At the conscious level, new experiences shape our ideas.  And at the unconscious level, all of our cells are reproducing and dying, our atomic energy arises, then passes away instantaneously.   We are literally changing both at an emotional level and physical level in every moment.  Consequently, we are not the same person we were yesterday, or last year, so how can we expect that our food preferences also do not change?
I certainly did not grow up eating fruits and vegetables.  Nor did I have parents who ate them. Typical childhood meals consisted of frozen pizza, Ramen noodles, and macaroni & cheese until I was 24 years old.  I doubt I even heard the word nutrition until my early 20’s, although I had certainly heard the word “diet” and been on several of them by that time.  All of that changed when I moved to Burma.  I was astonished by what real, fresh food looked like on the table in front of me when sharing meals with Burmese friends.  Needless to say, the dearth of fast food restaurants and Western packaged food meant that I had to learn how to eat vegetables.  Funny thing is, I now wonder why nobody ever told me how delicious they are!
It is well documented that it can take children 15-20 exposures to develop a taste for a new food. Trust, independence-seeking behaviors, and taste bud development all play a role.  However, more fundamentally, at each exposure we are an entirely new person, and this doesn’t stop when one reaches adulthood.  Therefore, even as adults, we can learn to like previously disliked foods if we keep these two facts in mind.  We can choose just one or two vegetables for our “let me learn to like this” bucket list, and make a strong determination to try them in various forms over the next few months or even years.
Practicing mindful eating can help enhance our expectation of liking a food (2). Prepare smaller quantities and taste the food slowly.  Notice the flavor and texture without labeling it as good or bad.  Be aware of how you feel about the flavor or texture, without judging the feeling.  Just notice.  If you still don’t like the food, accept the reality of that moment with kindness, and be determined to try again another day-knowing the person who tries this food again in the future will be new and different.
I now like beets.  It happened recently with a roasted beet and brie salad, and then again with a beet and coconut curry over rice.  With a strong determination to taste them, without consideration of past preferences, after 2 years of trying, at the age of 32, I finally like beets.
1. Ellyn Satter’s Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook, Kelcy Press, 2008.
2. Hong, P. Y., Lishner, D. A., Han, K. H., & Huss, E. A. (2011). The positive impact of mindful eating on expectations of food liking. Mindfulness, 2(2), 103-113.

The Multiple Dimensions of Food

I recently had the opportunity to attend the National Wellness Conference 40th Anniversary Legacy & Vision Dinner, during which several pioneers of the Wellness movement discussed their involvement in shaping the dialogue and structures inherited by younger generations.  One particularly grounding message for me was a reminder by John Travis, MD, MPH, that above all, the currency of wellness is connection.  We understand that what we eat is important for maintaining our physical wellness, and foodies have long advocated that being connected to our food helps us make healthy food choices.  However, as many of us intuitively know, food is about more than just healthy or unhealthy choices.  Food is a medium through which we connect to multiple dimensions of wellness.
Social connection is crucial to our well-being.  Quality social connections can reduce mortality by 50% (1) and observations from Blue Zones indicate that social connection contributes to the long, healthy lives enjoyed by the centenarians living in these communities (2).  However, many Americans have developed the habit of eating alone- at our workstations, in restaurants, and in our cars.  Food is a natural facilitator of social bonding.  Everyone eats, and everyone can talk about food.  While food is not the only way to facilitate social bonds, sharing cake at a friend’s wedding, enjoying a tomato salad with colleagues, or tasting mango-chicken curry on a family night out builds shared experiences and enhances opportunity for meaningful social connection.

Our intellectual well-being, the degree of engagement in creative and stimulating activities to expand ones knowledge and share this knowledge with others, is an essential element in our lifelong journey toward wellness (3).  Intellectual wellness can positively impact resiliency in the face of mental health difficulties and the ability to cope with stressful situations (4).  The connection with food, by gardening, photography, cooking, and even genetic engineering, is a way through which to exercise our intellectual and creative nature.

Food and eating behaviors also serve as symbols through which individuals connect with their faith and spirituality.  Special foods are prepared to celebrate important religious events and donated as a way to show respect and selflessness.  Avoidance of certain foods and fasting are a means of obtaining spiritual purification and heightened awareness.  Even though more people are transitioning away from organized religion, food is often still a symbol of values and morality in their lives.  Avoiding harm to animals through a vegan diet or eating organic vegetables may enhance spiritual connections and a sense of oneness with the world.

Emotional wellness can be promoted through a balanced and positive approach to food.  Emotions and food influence each other bi-directionally in ways that can both support or diminish our emotional wellbeing.  Stress may cause us to reach for comfort foods, while the over consumption of unhealthy foods may be a risk factor for depression and low energy (6). Excessive worry about health is associated with a decline in quality of life as inner guilt and self-hate are not the seeds of self-care and wellness as (5).  A connection with food, absent of guilt and worry, can improve our emotional well-being.  We feel rewarded when we cook a delicious meal, or believe we improved our community by purchasing local foods.

More than 15 million people depend on food production, manufacturing or service in the United States (7).  Chefs, nutritionists, plant breeders, farmers and truck drivers connect with food through the pursuit of a meaningful livelihood.  However, many of the employment opportunities available in the food and agricultural industry still place workers in unhealthy and stressful situations that are not conducive to occupational or overall wellness. Unmanageable work-family interfaces increase the likelihood of choosing unwanted foods and eating behaviors as a coping mechanism (8). The rise in worksite wellness programs can help more individuals positively manage the work-family interface, enabling food choices they find acceptable, increasing job satisfaction and occupational wellness.

Given that food influences so many aspects of our well-being, let’s ensure, as wellness champions, that our advice and wellness programming consider the full spectrum of the human experience with food. Our promotion of healthy diets need not detract from overall wellness, but rather it should enhance balance and connection with food in all of its dimensions of wellness to support people in realizing their full potential for health and happiness.

References:

1. Holt-Lunstad J, Smith TB, Layton JB (2010) Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med 7(7): e1000316.
2. Buettner, D. (2012).The Blue Zones: 9 Lessons for Living Longer from the People Who’ve Lived the Longest. National Geographic Books.
3. Roscoe, L. J. (2009). Wellness: A review of theory and measurement for counselors.Journal of Counseling & Development, 87(2), 216-226. http://www.stuaff.niu.edu/stuaff/grad_resources/pdfs/Wellness%20Article_Counseling.pdf
4. Hammond*, C. (2004). Impacts of lifelong learning upon emotional resilience, psychological and mental health: fieldwork evidence. Oxford Review of Education, 30(4), 551-568.
5. Sanhueza, C., Ryan, L., & Foxcroft, D. R. (2013). Diet and the risk of unipolar depression in adults: systematic review of cohort studies. Journal of Human Nutrition and Dietetics, 26(1), 56-70.
6. Rief, W., Glaesmer, H., Baehr, V., Broadbent, E., Brähler, E., & Petrie, K. J. (2012). The relationship of modern health worries to depression, symptom reporting and quality of life in a general population survey. Journal of psychosomatic research, 72(4), 318-320.
7. http://ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/ag-and-food-sectors-and-the-economy.aspx
8. Allen, T. D., & Armstrong, J. (2006). Further examination of the link between work-family conflict and physical health the role of health-related behaviors.American Behavioral Scientist,49(9), 1204-1221.