The last time Kim Hamburger bought scrubs for work, she didn’t know what size to order.

She’s lost 91 pounds since she started her employer’s workplace wellness program at the beginning of the year. She hopes to lose 4 more pounds by Christmas to reach her goal weight.

Hamburger, who is a nurse for a Medcenter One clinic in Dickinson, received a free membership to the Dickinson Community Center for participating in the program. She started out going there two to three times a week to exercise. Eventually she worked up to swimming 20 laps twice a week and riding her bike between Richardton, where she lives, and Gladstone, which is about 15 miles away.

She primarily likes to walk, ride her bike or swim.

“Once I started, I realized I liked it,” she said.

Now, she’s able to keep up with her 6-year-old son.

Medcenter One offers a comprehensive workplace wellness program that can be tailored to the needs of the individual employees. The concept of employers encouraging employees to adopt health habits has been around nearly 30 years, said Pete Seljevold, the worksite wellness director for Healthy North Dakota.

“There is much more attention recently with health care reform debate,” he said. It’s becoming a talking point in the debate, he said.

Healthy North Dakota is a statewide initiative to link different healthcare resources together so that people can collaborate on programs and services. The worksite wellness program is funded by Blue Cross Blue Shield and Dakota Medical Foundation.

In a study completed in 2001, 80 percent of employers who returned surveys had said they were interested in workplace wellness programs. The survey did not address how many businesses actually offered programs. The survey was weighted for businesses by human services regions and then by organization size. There was a 45 percent response rate to the 2,447 surveys sent out.

A survey completed last summer showed 30 percent of employees had access at their worksite to a wellness program. That survey did not look at what type of program was offered, whether a single event or a comprehensive program.

“We’re glad to see an increase in awareness,” Seljevold said. “We know, and research bears this out, that it really is effective and does work.”

For Hamburger, a free gym membership enticed her to sign up for the wellness program. When she got the results of her health risk assessment, she “realized a lot of things needed to change,” she said.

In conjunction with the gym, Hamburger also joined Weight Watchers. That program helped her modify her eating habits by helping her get a handle on portion control and what makes good food choices.

Incentives like the membership and monetary rewards for successfully completing components of the health risk assessment work to get employees involved. This year, participation in Medcenter’s wellness program doubled, said Kyle Darras, one of four employees who organize workplace wellness at Medcenter One.

The health assessment asks questions about physical activity,

eating habits and other health habits. This information is combined with measurements such as weight, blood pressure and cholesterol. It gives employees a snapshot of their relative health.

A business can take many approaches to a wellness program, from providing educational materials, to sponsoring health challenges. The most effective wellness programs are comprehensive, which include the educational materials and challenges in addition to the personalized services, such as the health assessment, health coaching and classes.

“We’ve had trouble not just preaching to the choir,” said Melanie Carvell, another workplace wellness organizer at Medcenter One, about gearing wellness messages to people who are already healthy. For this reason, the Medcenter program has changed from a challenge-based program to the more comprehensive programs that include health assessments.

A program is more successful if it focuses on reward and reinforcement of new habits. A program does not do so well when it tries to force employees to make changes, uses facts to promote change and uses fear to promote change, Carvell said.

It can take a year or two for employees to see significant results from lifestyle changes, Seljevold said. For a business, it can take three to five years before there are financial gains from a wellness program.

Among the primary benefits for employers to offer wellness programs is that it could lead to fewer healthcare claims, reduced absenteeism and increased productivity while at work, Seljevold said. It also can reduce workers compensation premiums and result in smaller increases in healthcare premiums, he said.

Employees in Medcenter’s program are already seeing benefits after participating for the last year. Nurse Joanne Allen has lost 52 pounds since starting the program in January.

“For years, my New Year’s resolution is to lose weight, you know, so I said I gotta do this,” Allen said.

She took the health assessment and passed three of the five components. Then she filled out an online questionnaire. Once these two steps were completed, she received a free one-year membership to the Dickinson Recreation Center. Medcenter One employees in the Bismarck area get a membership to Medcenter One Women’s Health Center or the Bone, Spine and Sports Clinic.

Without the free gym membership, she’s not sure she would have made the effort, “even though I was telling myself I was going to do it.”

She lost the weight through increasing her physical activity and watching what she eats. At first, motivation to go to the gym was difficult.

“When I left work, I would not want to exercise, but once I was there I was fine,” she said.

When the weather is nicer, she likes to take her exercise outdoors and go for walks.

St. Alexius Medical Center has had an employee wellness program for the past seven years, said Randy George, the human resource director at St. Alexius. The program has changed over time depending on the needs and the employees, and a committee evaluates the program about every two years.

In April, they offer screenings at a health fair. An outside company does the screenings, then the hospital gets a summary that tells them the percentage of employees that are affected by a particular health risk. Then, the hospital schedules monthly education programs based on the areas that the assessment shows needs work, said Melissa Jorgenson, a benefit analyst at St. Alexius. The education programs are open to all employees regardless of participation in the workplace wellness program.

Employees are rated on seven criteria, including nutrition, physical

health and spiritual health. Employees are given a bonus if they meet at least five of the seven criteria. The bonuses, however, are only given out when the hospital also makes its benchmarks for the year. These benchmarks let the hospital evaluate whether the program is successful.

Out of 900 employees eligible for the program, about 60 percent participate. Employees must be eligible for benefits to participate, which means they must work 20 or more hours a week.

Healthy North Dakota plans to do another survey in the next year to gauge the interest of businesses in providing workplace wellness programs.

The organization is working with the Fargo-Moorhead Chamber of Commerce to put together a survey to go out statewide that would gauge where businesses are at with offering workplace wellness.

The survey will be done online. He hopes to have results from the survey by this time next year.

“One piece of information we hope to learn is how many are doing comprehensive and how many are intermittent,” said Melissa Olson, director of Healthy North Dakota. Eventually, they want the Healthy North Dakota Web site to be a resource for businesses wanting to start a program.

In January, employees at Medcenter One will take the health risk assessment again. Allen said she’s looking forward to seeing her results compared to the one she took earlier this year.

Hamburger participated in a triathlon earlier this year at the Dickinson Recreation Center.

“I really enjoyed it,” she said. “I finished second to last, but I finished.”

Reach reporter Sara Kincaid at 250-8251 or sara.kincaid@bismarcktribune.com