TIPS FOR A HEALTHIER YOU
2019 MANATEE YOURCHOICE TOBACCO CESSATION PROGRAM
WHAT WE WILL COVER
Special Topic for 2019: How to improve and maintain Health First lab values
E‐Cigarettes
Physiological changes when you quit
What to expect when you quit
Resources available to you when you are ready to quit
Early upgrade
HEALTH FIRST
What is Health First?New incentive program that focuses on Metabolic Syndrome risk factors
How do I participate?You are automatically enrolled in Health Firstwhen you complete your QE Lab Work at Quest
How can I find my lab results?Quest onlineBlueprint for Wellness booklet that is mailed to your address on file.
These values will determine if you earn Health Bucks.
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WHAT IS METABOLIC SYNDROME?
Metabolic is defined as biochemical processes that keep the body functioning normally
Syndrome is defined as a condition characterized by a set related symptoms.
Metabolic Syndrome is a group of risk factors that increases the risk of developing significant impairments in the way the body functions such as diabetes, heart disease and stroke.
HEALTH FIRSTSTATISTICS
36.2% of known‐nicotine users are at risk for Metabolic Syndrome
You a have 37% greater risk than the non‐smoking population.
Smoking and using tobacco greatly increases one’s risk for atherosclerosis and cardiovascular disease, more so than ones that do not use tobacco.
Metabolic Syndrome affects 1 in 4 Americans
Increases the risk of developing heart disease, diabetes, heart attack or stroke.
Risk increases when more risk factors are present.
WHAT FACTORS INFLUENCE YOUR RISK FOR METABOLIC SYNDROME?
Things we can modify
Overweight/Obesity
Insulin Resistance
Get Moving
Reduce Stress
Eat Quality Calories
Nicotine/Tobacco Use
Know Your Numbers
Things we can’t modify
Genetics We have a lot more impact on our genetics than we think.
Race
Age Risk increases with age.
History of heart disease or gestational diabetes
Family History
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FINDING YOUR RESULTS
QUEST ONLINE
Follow the instructions to log in to Quest ‐ just as you did to complete the EREQ. If you need assistance logging in (can't remember password, etc.), please call Quest at 1‐855‐623‐9355.
Once you are logged in, select "Health Conditions", then "Metabolic Syndrome".Your lab values for each of the risk factors will be listed and a circle in the center will be either green or red.
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FINDING YOUR RESULTS
BLUEPRINT FOR WELLNESS BOOKLET
Turn to page 3 where you will see your lab values and a circle in the top right corner will be either green or red.
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INTERPRETING YOUR RESULTS
Healthy Range (green)If you have 3 or more green checkmarks, you do not have Metabolic Syndrome and will automatically earn $400 in Health Bucks. Keep engaging in a healthy lifestyle to prevent metabolic syndrome. If you have any areas of concern or other goals you wish to work on, we are here to help!
Metabolic Syndrome (red)If you have 3 or more red exclamation points, you have Metabolic Syndrome.You have the option to put yourHealth First by engaging in an alternative, personalized plan to improve your risk factors and earn $400 in Health Bucks. Call Christina Edenfield by August 31, 2019 to get started.
METABOLIC SYNDROME RISK FACTORS
Do you have healthy numbers?
Metabolic Syndrome is considered diagnosed when 3 or more risk factors are out of range.
HDL Cholesterol Triglycerides Blood Pressure
BMI Fasting Blood Glucose
Men Women> 40 > 50mg/dL mg/dL
< 150 mg/dL < 130/85 mmHg
< 30 < 100 mg/dL
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HDL CHOLESTEROLWhat is it?A waxy and fat‐like substance that is produced by the liver. High‐density lipoproteins (HDL) = good cholesterol
Why does it matter?Helps remove cholesterol from the arteries by taking the excess cholesterol back to the liver for removal.
What do abnormal results indicate?Excess cholesterol can lead to coronary artery disease.
Normal RangeMen ‐ > 40 mg/dLWomen ‐ > 50 mg/dL
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TRIGLYCERIDESWhat are they?
A type of fat found in the blood.
Why do they matter?
Any excess calories our bodies do not use are converted into triglycerides and later stored in our fat cells. Hormones release triglycerides to be used as energy between meals. If we consume more food and drinks than we need, triglycerides levels increase in the blood.
What do abnormal results indicate?
Excess fat in the blood has been shown to lead to atherosclerosis.
Normal Range
< 150 mg/dL
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BLOOD PRESSUREWhat is it?
A measure to determine the force of your blood against the arterial walls as your heart pumps (systolic‐top number) and while at rest (diastolic‐bottom number).
Why does it matter?
The higher the force needed to pump blood, the harder the heart has to work.
What do abnormal results indicate?
Damage to the walls of arteries.
Increased risk for arterial and cardiac diseases such as atherosclerosis, heart disease and stroke.
Normal Range
< 130/85 mmHg
*Both the systolic and diastolic values should be less than 130/85
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BMI/ABDOMINAL OBESITYWhat is it?
A predictive measure of body fat based on height and weight.
Why does it matter?
Two types of abdominal fat: subcutaneous and visceral.
Increased visceral fat (around organs) is thought to lead to:
Lipotoxicity, where excess triglycerides and fatty acids are released into the blood to organs such as the liver, pancreas and heart.
Increase the body’s stress response which can raise blood pressure, cardiac risk and blood sugar levels.
What do abnormal results indicate?
Increased risk of developing cardiovascular disease.
Normal Range
BMI
< 30
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FASTING BLOOD GLUCOSEWhat is it?
A measure of the amount of glucose that is circulating in your blood at the time of the lab test.
Why does it matter?
Elevated levels can damage the walls of the vessels throughout the entire body.
If glucose is unable to enter the cells, cells will not get the energy that they need to function the body.
What do abnormal results indicate?
Elevated blood sugar levels can be a predictor of insulin resistance and can be diagnosing criteria of prediabetes and diabetes.
Normal Range
< 100 mg/dL
What is hemoglobin A1c?Hemoglobin A1c is a measure of the amount of glucose found in the blood over the past 2‐3 months.Normal Range ‐ < 5.6 %Prediabetes – 5.7‐6.4%Diabetes ‐ > 6.4%
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WHAT IS INSULIN RESISTANCE?In normal metabolism, the pancreas is triggered to release insulin allowing glucose to be absorbed from our blood to our cells for energy.
With insulin resistance, the pancreas releases insulin but it cannot do its job of bringing glucose into the cells.
The pancreas is then triggered to release more insulin.
As long as the pancreas is able to produce enough insulin, blood sugar levels will be within the normal range.
The pancreas eventually tires out and cannot produce enough insulin, so glucose stays in the blood, leading to prediabetes and type‐2 diabetes.
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KNOW YOUR NUMBERS
First, let’s look at your most recent labs to see where you are.
Assess whether your lab values are in range of the healthy target listed, or out of the healthy range.
Tally your total in range and out of range risk factors and write in the bottom right corner.
SO WHAT CAN WE DO?
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HOW TO BUILD INTO MY ROUTINEACTIVITY
30‐60 min of moderate aerobic exercise 3 days/week
Resistance exercise 2‐3 days/week
Find ways to be active
Use the stairs Take an exercise class
Get up every hour and walk around the office/building
Check out an online exercise service or free YouTube videos
Park further away and walk Schedule time for yourself to be active
Meet with one of our personal trainers to create a personalized activity plan.
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HOW TO BUILD INTO MY ROUTINENUTRITION
Consume an antioxidant‐rich diet high in vegetables, nuts, seeds, fruits (esp. berries)
Increase omega‐3 fatty acids by adding fatty fish (salmon, mackerel, herring), flaxseed, chia seeds, walnuts
Limit processed foods, simple carbs and sugar intake
Limit alcohol to <1 drink/day (females) and <2 drinks/day (males)
Plan foods and beverages as much as possible
Sub out a portion of red meat for fatty fish
Add more vegetables to your meals Try roasting vegetables for a sweeter and crunchier texture
Sneak antioxidant foods into you meals such as nuts, seeds, fruits, and vegetables
Meet with one of our registered dietitians to address your specific goals.
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HOW TO BUILD INTO MY ROUTINEBEHAVIORAL HEALTH/STRESS
Get a behavioral screening to identify issues that may be having a negative impact on your health
Cope with stress by practicing resiliency and/or by taking 5‐10 slow deep breaths when feeling stressed
Practice meditation, mindfulness, and relaxation techniques
Set a reminder to take 3 deep breathes every hour
Practice setting boundaries with family, friends and coworkers
Try a yoga or Tai Chi class Practice pausing before responding
Speak with one of our LAMP advocates to address your specific goals and concerns.
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HOW TO BUILD INTO MY ROUTINESLEEP
Aim for at least 7 hours of sleep per night
Rule out Obstructive Sleep Apnea
Set an alarm to go off 30 minutes prior to when you want to go to bed
Stop caffeine by the afternoon
Remove noise, light or pets from bedroom
Limit phone and tv use before bed
Keep a regular sleep schedule Try separate blankets in a shared bed
Check out Better Sleep with Aetna for personalized education and tips to get better sleep.
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HOW TO BUILD INTO MY ROUTINEPHARMACY/PCP
Take medications consistently as prescribed
Work together with your doctor
Talk to your doctor about your questions and concerns
If you forget to take medications, set a reminder
Advocate for yourself Try using a pill box
Speak with our Clinical Pharmacist, Ibrahim Fadeyi for a review of your current medications.
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HOW TO BUILD INTO MY ROUTINEOTHER
Utilize your many resources for weight loss and maintenance
Stop or cut back smoking
Maintain a healthy weight or aim for 5‐7% weight loss
Contact your Tobacco Advocate, Christina Edenfield for cessation aids,
resources and support.
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HOW DO I SET MYSELF UP FOR SUCCESS?GOAL SETTING
1. If you have more than 1 elevated risk factor, Identify where you want to focus your attention. The good news is working on one area can positively affect other labs values as well.
2. Start small. What are some daily habits you can start with first that will help you achieve your larger goal of ______?
Long‐Term Goal
Lose 20 lbs.Reduce A1C by
2 points
ShortTerm Goal
Begin exercising 2‐3 days/ week
Daily Habits:
• Begin drinking a cup of water in the morning
• Pack gym bag• Start day w/ simple
movement OR Walk 15 mins on lunch break
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PERSONALIZED GOALS AND ACTION PLAN
Life happens and roadblocks will pop up. Let’s try to plan for some of those here.
What are some distractions that could hinder me reaching this goal?
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Roadblocks that might come up
I will do what to handle them:
Ex: It is raining on the day I was going to walk outside after work.
Ex. I will go the gym after work and walk on the treadmill. I will do my kid’s dance game at home. I will do body weight or weight exercises at home.
POTENTIAL ROADBLOCKS
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RECENT RESEARCH ON E‐CIGARETTES AND QUITTING
Method
Randomly assigned 886 adults attending U.K. National Health Service cessation services to either of two groups, 1) nicotine replacement therapy (NRT) product(s) of their choice (gum, patch) or 2) e‐cigarette starter pack, for 3 months. Both groups received weekly behavioral support for 4 weeks.
Results
1 year abstinence (quit smoking) rate 18.0% ‐ e‐cigarette group 9.9% ‐NRT group
Discussion
Even though e‐cigarette use was more effective than NRTs for quitting smoking cigarettes, 80% continued vaping after 1 year, compared to only 9% who continued to use NRTs.
Throat or mouth irritation was reported more in the e‐cigarette group (65.3%) compared to the NRT group (51.2%).
E‐cigarette use can be effective for quitting cigarettes, but one runs a high risk of continuing to use e‐cigarettes compared to using NRTs to quit.
A Randomized Trial of E‐Cigarettes versus Nicotine‐Replacement TherapyHajek, P. et al.
New England Journal of Medicine, 2019
Hajek, P. et al. (2019). A Randomized Trial of E‐Cigarettes versus Nicotine‐Replacement Therapy. New England Journal of Medicine, 380, 629‐637. DOI: 10.1056/NEJMoa1808779
E‐CIGARETTES
Be an informed consumer and check to make sure you know the risks for all of the ingredients and chemicals with your e‐cigarette and e‐liquid.
Bottom line e‐cigarettes have been shown to be less harmful than traditional cigarettes, but e‐cigarettes still come with their own health risks from added chemicals and nicotine.
For more information, check out the following resources
CDC. About Electronic Cigarettes. Retrieved from https://www.cdc.gov/tobacco/basic_information/e‐cigarettes/about‐e‐cigarettes.html
FDA. Vaporizers, E‐Cigarettes, and Other Electronic Delivery Systems (ENDS). Retrieved from https://www.fda.gov/TobaccoProducts/Labeling/ProductsIngredientsComponents/ucm456610.htm
PHYSIOLOGICAL CHANGES WHEN YOU QUIT
20‐30 minutes after quitting, blood pressure and pulse decrease
48 hours after quitting, taste and smell improve
2 weeks ‐ 3 months after quitting, circulation, lung function, and stamina improve
1 year after quitting, risk of heart disease reduces by half compared to that of smokers
5 years after quitting, risk of cancers of the mouth, throat, etc. are reduced by half.
WHAT TO EXPECT WHEN YOU QUIT
COMMON WITHDRAWAL SYMPTOMS
Irritability Increased appetite Anxiety Depression Difficulty thinking Constipation
Decreased heart rate Lightheadedness Headache Sleep problems Nausea
don’t be scared of withdrawal symptoms…they will pass
WHAT TO EXPECT WHEN YOU QUIT
WAYS TO LESSEN OR MANAGE CRAVINGS Acknowledge that these withdrawal symptoms are normal and just a part of quitting and they will pass
Break the routine: Find other things to hold in your hands Bring a beverage in your car or on a walk Use toothpicks, gum, hard candy Engage in activities in smoke‐free environments
Take some well‐deserved time for yourself…what have you wanted to do, but have kept putting off?
Take care of yourself – eat well, drink water, get some exercise, get enough sleep
For more additional tips, check out the American Cancer Society at https://www.cancer.org/healthy/stay‐away‐from‐tobacco/guide‐quitting‐smoking/quitting‐smoking‐help‐for‐cravings‐and‐tough‐situations.html
RESOURCES AVAILABLE TO YOU WHEN YOU ARE READY TO QUIT
Tobacco cessation aids at no cost
PrescriptionContact your doctor or use our Tobacco Clinic
Chantix (Requires pre-authorization) Wellbutrin
Nicotine Replacement Therapies (NRT’s)
Patch Lozenge gum
CALL CHRISTINA FOR NRT’S AND THE TOBACCO CLINIC AT X6464
ALL REQUIRE A PRESCRIPTION OR ORDER
RESOURCES AVAILABLE TO YOU WHEN YOU ARE READY TO QUIT
One‐on‐one coaching
Receive 5 sessions of individualized coaching with a licensed mental health counselor (LMHC).
Tobacco cessation clinic
A personalized coaching program that includes medication assessment and prescriptions.
Contact Christina at x6464 to get started
EARLY UPGRADE
You can upgrade to the ultimate plan anytime throughout the year once you quit smoking.
Contact Christina at x6464 to get started 2 negative lab draws at least 90 days apart
You will be upgraded to ULTIMATE on the 1st of the month following your second negative lab draw.
1 negative lab draw will be required to stay in ULTIMATE the following year
EARLY UPGRADE
Early upgrade started in 2016. So far, 102members have quit and upgraded to the ultimate plan.
So far in 2019, as of February 1, 31 members have quit and upgraded to ultimate!
This year it could be you!
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2016 2017 2018
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Early UpgradeNumber of Members That Quit and Upgraded to Ultimate
QUESTIONS?NEED SUPPORT?
Contact Your Tobacco advocate
Christina Edenfield
941‐748‐4501 x6464