1. City of San Angelo
Wellness Report
February 2013

2. San Angelo, Texas

3. Wellness Report
• 2012 shows improvement from 2011 in
the overall health of employees.
• Weight and nutrition continue to be the
most crucial and costly modifiable risk
factors.
• There is opportunity to improve, however,
the employees are to be commended.

4. Overall Wellness Rating
2011 2012
Doing Well
Doing Well
(60-79)
(60-79)
60%
60%
Excellent Excellent
(80-100) (80-100)
14% 16%
Needs Needs
Improving Improving
(20-59) (20-59)
26% 24%
• Average wellness score for City of San Angelo
employees is 69, compared to 67 last year. (out of 100)
• 47% have a “health age” younger than actual age, compared to 42%
last year
• 53% have a “health age” greater than or equal to age, 58% last year

5. 80/20 Rule
• Generally, 80% of health care costs come
from 20% of the people.
• As the number of health risks go up, so do
the health care costs.
• City employees with 5 or more risk
factors decreased by 9%.
(Health claims are generally 3-4 times higher in people with
5+ risk factors)

6. Chronic Diseases
39% 40.8% 2012
Diabetes
36% 45% 2011
20.9% 31.2% 2012
Heart Disease
21% 35% 2011
26.8% 23.4% 2012
Cancer
27% 23% 2011
38.6% 2012
Metabolic Syndrome
37%
at risk
2011
15.8%
Osteoporosis
18%
high risk
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

7. Diabetes
Diabetes is increasing rapidly in the U.S.
• One third of people do not know they are diabetic.
• Type 2 diabetes is largely preventable.
Major risks: Obesity (BMI 30+ - 326 people); Nutrition (517 people);
Low HDL (<39.9 – 299 people)
City of San Angelo employees
• 19.9% compared to 19% last year have 0 - 1 risks – excellent, doing well
• 39.4% compared to 36% of employees have 3 - 4 risks – needs improving
• 40.8% compared to 45% of employees have 5+ risks – caution, high risk

8. Heart Disease
70 – 80% of heart disease is linked to modifiable risks.
• Actively eliminate any known risk factors.
Major risks: Obesity (BMI 30+ - 326 people); Low HDL (<39.9 – 299
people); Metabolic syndrome ( 3+ indicators – 298 people)
City of San Angelo employees
• 47.9% compared to 43% last year have 0 - 1 risks – excellent, doing well
• 20.9% compared to 21% last year have 2 risks – needs improving
• 31.2% compared to 35% last year have 3+ risk factors – caution, high risk

9. Cancer
Cancer is 2nd leading cause for death in US and is the leading
cause for persons of working age.
• 2/3 of all cancer deaths can be prevented.
• Get proper cancer checkups for age and gender.
Major risks: Smoker (96 people); Obesity (BMI 30+ - 326 people);
No or low physical activity (<5 days.wk – 553 people)
City of San Angelo employees
• 49.8% compared to 50% last year have 0 - 2 risks – excellent; doing well
• 26.8% compared to 27% last year have 3 risks – needs improving
• 23.4% compared to 23% last year have 4+ risks – caution, high risk

10. Cancer Screenings
COMPLIANT NON COMPLIANT
Mammograms
73.2% 21.6% 2012
74.3% 21.7% 2011
PAP test
84.5% 9.9%
83% 17%
51.6% 40.4%
Prostate Check
59.5% 40.5%
47.2% 46.3%
Colon Screening
51% 49%
In 2012, the City began paying all cancer screenings at
100% without a deductible. (Formerly at 80% after deductible had
been satisfied.)
However, pro-active screenings did not increase overall.

11. Modifiable Risks
of Chronic Diseases

12. Modifiable Risks
Top Six Priority Health Recommendations
• Weight management (323 people overweight; 326 obese)
• Good nutrition (599 people have 6+ risk factors; 325 have 10+)
• High blood pressure (420 pre-hypertension; 160 high bp)
• Physical activity (553 less than 5 days/wk; 66 have no PA)
• Sleep (430 people get inadequate sleep - less than 7-8 hrs/night)
• Osteoporosis (380 have 2+ risk factors; 1 has 4+ risk factors)

13. City of San Angelo
Chronic Disease Risk Factors
43.4% 42.1% 2012
Nutrition 2011
38%
41.8% 42.2%
Weight 2012
40.2% 44.3% 44.3% 2011
54.4% 20.7% 2012
Blood Pressure
19.7% 2011
54.7% at risk
22.4% 8.5% 2012
Fitness high risk
21.5% 8.6% 2011
Sleep 55.7% 2012
Osteoporisis 49.2% 1% 2012
0 20 40 60 80 100
(Smoking drops off list of being in the top 6)

14. Employee Weights
2011 2012
Obese Obese
45% 42%
Under Under
Weight Weight
0% 0%
Healthy Healthy
Weight Overweight Weight Overweight
15% 40% 16% 42%
BMI
Healthy weight 18.5 - 24.9
Overweight 25 - 29.9
Obese 30 - 34.9
Very Obese 35+
17.9% of emp (138 people) are very
obese, above the national norm of 12%.

15. Nutritional Statistics
Choosing unrefined, plant-based, low-calorie, low
saturated-fat foods can greatly decrease risk of heart
disease, diabetes, and many cancers.
In the City of San Angelo:
•599 (77.6%) people compared to 675 (82.9%) last
year are at increased risk with 6+ nutritional risk
factors.
•325 (42.1%) people compared to 422 (51.8%) last
year are at high risk with 10+ nutritional risk factors.

16. Employee Perception of
Personal Health
2011 2012
42.9%
40.2%
8.7%
8.3%
0.9% 0.5%
47.6%
49.1%
Very good to excellent
Good
Fair
89.3% think they are in
Poor good to excellent health
(compared to 90.5% last year)

17. Economic Impact
Estimated Excess Health Claims Cost
cost per
# of
employees employee
2011 2012
no risks 77 67 $0
1 risk 137 168 $861
2 risks 214 166 $1,764
3 risks 159 164 $2,690
4 risks 105 96 $3,788
5 risks 61 61 $4,821
6 risks 34 29 $5,919
7+ risks 28 22 $6,995
14.5% of employees (112 people) have 5 + risk factors,
influencing personal health for the individual, as well as
health care costs for the city. (15% last year)

18. Examples of Estimated Excess Cost
per Risk Factor (5 of 15 risks reported)
EMPLOYEES
2011 2012 Excess Cost
• Overweight (BMI >27.5) 515 502 $746,034
• High BP* (140/90+) 309 282 $499,198
• Low HDL (<40mg/dL) 326 300 $297,135
• Smoking* (14 signed up for class) 100 96 $172,006
• Seat Belt Use (<100%) 130 115 $149,438
Overall Estimated Excess Health Claims:
Estimated excess cost for 2011 $1,993,176
Estimated excess cost for 2012 $1,862,103
Potential savings from 2011 $ 131,073
(goal of $199,317)
• Most expensive risk factor pp for excess health cost
Source: University of Michigan. Study of 205,000 employees showing relationship
between risk factors and healthcare costs.

19. ACCOMPLISHMENTS in 2012
• Improved average wellness score from 67 to 69
• Reduced obesity percentage by 3% (334 lbs lost)
– 281 people lost 2+ lbs
– 73 people lost 10–19 lbs
– 29 people lost 20+ lbs
• Reduced employees with 5 or more risk factors by 9% (123 to 112)
• Reduced risk factors for diabetes, heart disease and osteoporosis
• Improved the nutrition of 249 people

20. Programs Implemented
• Biggest Loser Contest
• Diabetes Education Classes
• Smoking Cessation Classes
• Wednesday Walking Group
• Label Reading Class with Dietitian
• 30 Day “My Plate” Challenge (food pyramid)
• Fruit and Vegetable Challenge
• Pedometer Challenge
• Flu Shots

21. Suggested Programs for 2013
• Wellness Incentive Program – initiate a point system
• Biggest Loser Contest Quarterly for Employees
• Programs
– Diabetes Education Classes
– Smoking Cessation Class
– Wednesday Walking Group
• Group Class Opportunities
– Label Reading Class with dietitian
– Eat This, Not That
– Lifestyle changes to lower cholesterol
– The DASH diet (help lower BP)
• Exercise
– “Couch to 5K”
– “Move for Life”
– Pedometer Challenge
– Wellness Challenge – 12 wk program
• Private fitness program for those at high risk
• Weekly monitoring including exercise and nutrition tracking

22. Solutions: Health Management
• Utilize the city clinic, primary care providers and
the wellness program to manage health of City
of San Angelo employees.
– Monitor employees with 5+ risk factors (112 employees)
– Develop clinical protocols/pathways for diseases.
Referral to specialist if necessary.
– Encourage employees to get recommended
cancer checkups (mammograms, prostate, PAP, colon)