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Employee Wellness: 
Two Parts Perspiration, 
One Part Persistence 
With employee health affecting bottom lines, organizations 
need to support preemptive initiatives that encourage 
both personal wellness and quantifiable results. Here’s how 
we are addressing this major challenge.
Executive Summary 
Between January and June this year, 127 Cognizant employees could 
have walked halfway to the moon. Their cumulative footsteps covered 
half of the 238,000-mile distance — and they’re still walking. 
This group has taken nearly 200 million steps as part of iCommit2Fit, 
an innovative wellness improvement program that we designed and 
piloted for our associates in five U.S. locations. The voluntary program 
combines personal commitment, technology, incentives and coaching. 
At the close of the six-month pilot, virtually all of our participants have 
substantially increased and sustained their physical activity levels while 
losing weight and seeing significant improvements in their Body Mass 
Index (BMI) ratios. 
What sets iCommit2Fit apart is the personalized, one-to-one coaching 
deployed to help associates outfitted with Fitbit® wearable smart 
bands to monitor their physical activity, with the goal of improving 
their wellness. While wearable smart bands like Fitbit are all the rage, 
they are no wellness elixir.1 The reason? While great at automating data 
collection without any human intervention, the current generation of 
devices can’t instruct users on ways to increase their physical activity 
today or tomorrow, much less next week or month. The bottom line: to 
KEEP CHALLENGING October 2014
improve their wellness, humans need the counsel and encouragement of 
fellow carbon-based beings to increase their physical activity, improve 
their nutrition and adopt healthier lifestyles. 
In fact, our findings show that participants who attended the coaching 
sessions without fail recorded activity levels and weight loss that were 
almost 75% higher than the levels for participants who missed coaching 
sessions. Equipped with the knowledge gained from this pilot, we are set 
to expand the program to 1,400 more employees across the U.S. 
This whitepaper shares the lessons we learned from the pilot program 
and our ideas for improving the wellness of our associates so that other 
enterprises can improve their wellness initiatives. Doing so is a matter 
of health for both employees and employers, alike. Consider that the 
medical costs associated with obesity are estimated at $190.2 billion 
per year, or 20.6% of national health expenditures.2 Employers offering 
health insurance bear a portion of these costs and have a stake in 
helping employees lead more active, healthier lifestyles. 
EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 3
4 KEEP CHALLENGING October 2014 
iCommit2Fit in Action 
When designing iCommit2Fit, we hypothesized that proactive, personalized and 
technologically savvy support was necessary to help individuals embrace and 
sustain behaviors that improve health and prevent or alleviate chronic health 
conditions. The healthcare industry is already measuring “patient activation” rates 
as a way of predicting which individuals will consume more healthcare services and/ 
or succeed in managing their existing health conditions.3 
We solicited voluntary applications for iCommit2Fit from five Cognizant facilities 
across the U.S., located in the South, Southwest, Midwest and Southeast. Applicants 
were reviewed for any pre-existing health conditions that could preclude their par-ticipation; 
those selected were equipped with a Fitbit activity tracker. 
From an iCommit2Fit participant’s perspective, the requirements were simple: wear 
the activity tracker to capture daily steps walked; log food intake in a daily digital 
diary; upload data on a weekly basis; and participate in weekly coaching sessions 
via telephone (see Figure 1). On the back-end, we used the data capture and person-alized 
coaching capabilities of our HealthActivate patient engagement platform to 
administer the program (see sidebar, page 7). 
iCommit2Fit Data Flows 
Figure 1 
Daily food 
logging 
Periodic 
webinars 
Weekly nutrition 
e-mails 
Daily step goals 
Weekly step 
count upload 
via activity monitor 
Portal/ 
Personal Coach 
Weekly virtual 
meeting with coach 
All participants reported their pre-program daily “step” baseline. Based on 
that measure, each participant’s coach set a daily step goal for the first 
month of the program. If a participant easily met or exceeded that goal, the coach 
would increase it. 
Devices were synchronized with participants’ smartphones or laptop dongles, then 
uploaded directly from Fitbit to the Cognizant HealthActivate portal. Laptops 
equipped with the Fitbit software were available at several office locations for use
by participants without smartphones or with data synchronization issues. To ensure 
consistent and accurate results across all participants, we disabled the manual data 
entry feature. Thus, all step counts came from the devices; none were estimated by 
participants. 
In addition to weekly phone-based coaching sessions, participants received per-sonalized 
e-mails with observations and advice from coaches. If a participant was 
meeting step goals but not losing the desired weight, a coach might examine the 
food log and note an abundance of fried or fatty foods and suggest alternatives. 
Four Times around the Earth 
During the pilot — which ran from January 2014 to June 2014 — the 127 participants 
cumulatively took almost 200 million steps, or approximately 100,000 miles. To put 
this into perspective, the circumference of the earth is almost 25,000 miles. The 
participants also cumulatively lost three-quarters of a ton of weight. 
The iCommit2Fit participants started out at a higher weekly step average than the 
Cognizant corporate benchmark, the U.S. average and the Fitbit user average (see 
Figure 2). From January to June, participants increased their weekly step counts 
from an average baseline of 36,500 across all groups to 75,000, an improvement of 
105% and more than twice the American daily step average. Participants doubled 
their own baseline steps as well as the average American baseline steps, while 
consistently attaining 10,000 steps per day, 
as recommended by the American Heart 
Association, and reaching 30 minutes of 
moderate physical activity per day as recom-mended 
by the U.S. Surgeon General. 
All participants improved their step counts, 
with the largest percentage increases achieved 
in the Overweight and Obese 1 and 2 BMI 
categories, indicating much greater activity 
by those participants (see Figure 3, next page). 
BMI reduction is a critically important metric; 
for example, the risk rate of acquiring chronic 
diseases increases substantially as people go 
from Overweight to Obese 1, and from Obese 1 
to Obese 2. Members of the Obese 1 and Obese 
2 categories in the 41 to 50 age range posted 
the greatest weight loss by percentage (see 
Figure 4, next page). 
iCommit2Fit 
Average 
Average Daily Steps Comparison 
EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 5 
80K 
70K 
60K 
50K 
40K 
30K 
Fitbit Average 
U.S. Average 
Cognizant Baseline 
JAN. FEB. MARCH APRIL MAY JUNE 
Figure 2 
From January to June, participants increased their weekly 
step counts from an average baseline of 36,500 across 
all groups to 75,000, an improvement of 105% and more than 
twice the American daily step average.
250 
(lbs.) 
200 
150 
100 
50 
0 
80K 
70K 
60K 
50K 
40K 
30K 
20K 
10K 
OVERWEIGHT OBESE 1 OBESE 2 
Average Weight Loss 
by BMI Category 
NORMAL 
Average Step Gain 
by BMI Category 
OVERWEIGHT OBESE 1 OBESE 2 
= STARTING WEIGHT = WEIGHT AFTER 6 MONTHS 
6 KEEP CHALLENGING October 2014 
The weight loss significantly reduced BMI 
measures in all of our participants, with the 
greatest reductions coming in the Obese 1 and 2 
categories (see Figure 5, next page). These indi-viduals 
recorded the lowest baseline step counts 
of all program participants. 
The BMI reductions enabled nearly 27% of our 
participants to move to new BMI categories. 
Thirteen participants who began the program 
in the “Obese 2” category lost enough weight 
to improve to the Obese 1 category (see Figure 
6, page 8). Nineteen people reduced their BMI 
enough to move from the Obese 1 category to 
Overweight. 
The BMI improvements among participants in the 
Overweight and Obese categories, coupled with 
their increased step counts, suggest that these 
individuals made significant lifestyle changes. 
Further, our data indicates that the support structure underlying 
iCommit2Fit was a significant influence on those results. 
The Coaching Difference 
Not surprisingly, the participants who followed all the program 
requirements — weekly step goals, daily food logging and weekly 
coach meetings — saw the greatest average weight loss, or 20 
pounds. Conversely, those with the lowest compliance rates lost 
about five pounds on average. 
Personalized weekly coaching had a strong impact on participant 
results. 
Roughly 15% of participants who had 100% coaching compliance — 
that is, they did not miss a single coaching session — took 54% more 
steps and lost twice as much weight as those who had 95% coaching 
compliance rates. They took 70% more steps than those with the 
lowest compliance rate and lost three times as much weight (see 
Figures 7 and 8, pages 9 and 10, respectively). 
In other words, participants with 95% compliance rates missed only two of 23 
meetings, yet lost only half the weight and took slightly more than half the steps 
of those who made it to all their coaching sessions. Similarly, the group with the 
lowest compliance rates missed about three meetings, lost only about a quarter of 
the weight and took only about 30% of the steps of those in the 100% group (see 
Figure 9, page 10). 
44 
72 
36 
76 
34 
72 
31 
70 
0 
NORMAL 
= BASE STEPS = STEPS AFTER 6 MONTHS 
Figure 3 
Figure 4 
The BMI reductions enabled nearly 27% of our 
participants to move to new BMI categories.
Roughly 15% of participants who had 100% coaching 
compliance took 54% more steps and lost twice as much 
weight as those who had 95% coaching compliance rates. 
These results signal to us the value and impact of the personalized and 
consistent expert coaching underlying iCommit2Fit. They also complement 
studies showing that workplace health programs tailored to an individual’s 
personal goals can lead to increases of up to 35% in the amount of time a 
person will spend in physical activity.4 
Healthy Optimism 
Our initial pilot program was not long enough in duration or large enough 
in participant numbers to draw conclusions about the impact of increased 
activity and weight loss on employee productivity or health claim costs. 
However, we are optimistic about achieving positive results. For instance, 
greater activity and improved BMI should contribute to reduced healthcare 
costs. It is estimated that obesity-related productivity losses cost employers 
$225.9 billion per year, with an obese employee costing employers an 
additional $460 to $2,500 in medical care and sick days over the average 
annual individual healthcare cost of $3,000 per person.5 
Improvement by BMI 
Weight Category 
NORMAL OVERWEIGHT OBESE 1 OBESE 2 
23.5 22.8 
= BASE BMI = BMI June 2014 
Figure 5 
28.2 27.2 
32.4 
30.5 
41 
38.3 
50 
40 
30 
20 
10 
0 
Quick Take 
Cognizant’s Connected Health Solution 
The HealthActivate platform combines “bring your own health device” (BYOhD) data 
collection capabilities with analytics and virtual and live coaching to offer a next-generation 
care management platform. The platform accepts data from virtually 
any BYOhD that an individual might use, from an activity tracker to an in-home 
blood sugar testing device to a wireless scale. 
Our analytics engine reviews this data and alerts coaches to any anomalies 
requiring intervention. Some interventions are automatic and virtual, such as an 
instant message or e-mail; at other times, coaches (who are trained nurses) will 
call the individual to find out why a medicine dosage was missed or to determine 
whether a sudden weight gain indicates a serious problem. The platform helps indi-viduals 
on the cusp of chronic conditions to become healthier and enables partici-pants 
who are managing diabetes, heart conditions, etc. to do so more effectively 
and avoid acute care episodes. 
EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 7
JAN. JUNE 
BMI Category Changes 
Obese 1 
13 
Obese 2 30 
Remained 
Obese 2 
JAN. JUNE 
1 
Moved to 
Obese 2 
23 
19 
Remained 
Obese 1 
43 43 
Moved to 
Obese 1 
Moved to 
Overweight 
8 KEEP CHALLENGING October 2014 
But as noted by the American Heart Association, regular exercise, such 
as 10,000 daily steps, reduces coronary heart disease in women by 30% 
to 40%, while moderately active people see their stroke risk reduced by 
20% and highly active people by 27%.6 We are hopeful that participants 
will see improved health as they continue their steps, while we closely monitor the 
impact of greater employee wellness on health costs as we expand the program. 
Lessons Learned 
While we are very pleased with the results of the first phase of iCommit2Fit, the 
pilot participants taught us a variety of lessons and raised issues that we hope to 
address in the expanded program. 
• Device details. It is critical to use a reliable activity tracker that also largely 
automates the data upload process. We selected the Fitbit, both for these capa-bilities 
and its name recognition. It is important to have extra devices on hand: 
When a tracker was lost or stopped working for any reason, participant activity 
quickly dropped. 
As iCommit2Fit grows, we will watch for more advanced devices that can track 
a wider range of physical activities and convert them to a meaningful measure. 
Potential exercise movement to capture includes swimming, weight-lifting, yoga, 
etc. As participants become more fit, they might be more likely to participate in 
activities that our activity tracker cannot capture. 
Figure 6 
Nineteen people reduced their BMI enough to 
move from the Obese 1 category to Overweight, while 
two participants went to Normal from Obese 1.
Quick Take 
The Criticality of BMI-based Weight Categories 
The Body Mass Index (BMI) is a mathematical formula that uses an individual’s height and 
weight to evaluate whether he or she is at a healthy weight. A BMI of 18.5 to 24.9 is 
considered healthy, while a reading of 25 to 29.9 is considered overweight. Research-ers 
and clinicians divide obesity into three categories: Class I (30–34.9), Class 
II (35–39.9) and Class III (40). Class III is further divided into super-obesity 
(BMI 50–59) and super-super obesity (BMI 60+).10 
What we found in our pilot program is that as participants lose weight 
and begin to transfer from one BMI category to the next, it is crucial 
for them to realize that meeting their goal is not enough; they must 
sustain it. One way that we work to ensure goal maintenance is through 
high-intensity interval training. We believe that when coaches encourage 
individuals to increase the intensity of their workouts, it poses a new and 
different challenge to the participants and results in a sustainable loss. 
Research has found that people on diets typically lose 5% to 10% of their starting weight 
in the first six months. However, at least one- to two-thirds of people on diets regain more 
weight than they lost within four or five years, and the true number may well be significantly 
higher.11 This is why we extended our pilot from three to six months and hope to extend the 
program indefinitely in the future. 
• Going beyond step counts. We will also explore whether and 
how to incorporate other wellness activities into the pro-gram 
to help participants maintain their weight loss. To ac-complish 
this, we will actively track the wearable industry 
as devices become more mature and are able to capture 
activities beyond steps. Many smaller companies are be-ginning 
to engineer devices that capture body-weight ex-ercises 
(i.e., push-ups, squats and crunches), swimming, 
strength-training and other activities. As devices become more 
mature and able to track additional activities beyond walking 
and running, our coaches will be further trained in exercise 
therapy to offer a wider array of services. 
• Limits of the BMI. While the BMI is widely used as a measure, 
it is only a mathematical estimate of a person’s weight catego-ry 
and cannot take into account body fat percentage or bone 
25 
20 
15 
10 
5 
Impact of Weekly Coach 
Meetings on Weight Loss 
iCommit2Fit 
Performance Rankings 
Average Weight Loss (lbs.) 
structure. A person weighing 145 lbs and measuring 5’8” in 
0 
height could be very fit — or they could be carrying more body 
fat than muscle mass (see above sidebar). 
Changes in body fat percentage would be a more accurate 
Figure 7 
measure of wellness, but obtaining this reading is more intrusive 
and resource-intensive. Home health devices that offer body fat measurement 
could be evaluated. 
• The incentive effect. We experimented with three types of incentives: individual, 
worksite-based and team-based. Individuals could earn congratulatory e-mails, 
color bands for their trackers, hoodies and custom t-shirts, all of which were 
designed to appeal to goal-oriented but noncompetitive participants. 
= TOP 15% 
= MIDDLE 70% 
= BOTTOM 15% 
5.4 
10.8 
MISSED  3 MISSED 2 
20.2 
MISSED NONE 
Number of Coaching Meetings Missed 
EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 9
As iCommit2Fit grows, we will watch for more advanced 
devices that can track a wider range of physical activities 
and convert them to a meaningful measure. 
Impact of Weekly Coach 
Meetings on Steps Taken 
MISSED  3 MISSED 2 
Number of Coaching Meetings Missed 
Impact of Coach Meetings 
on Weight Loss 
87% 
Meeting 
participation 
25 
20 
15 
10 
5 
150K 
120K 
90K 
60K 
30K 
10 KEEP CHALLENGING October 2014 
Worksite challenges involved seeing which site teams recorded the highest 
compliance rates in terms of step counts, food logging and coaching. Winners 
were treated to a lunch during program-related webinars. 
Finally, several weeks into the program, we randomly selected participants 
to form teams across the five pilot locations. To score points for their teams, 
members had to complete their daily food log, meet their weekly step goals and 
complete their weekly coach meeting. Missing even one of these activities would 
reduce the team’s overall score. 
Certain teams proved especially competitive, so members would drop out rather 
than hurt the team by leaving an activity incomplete. We will examine our scoring 
procedures and communication to ensure that the formation of teams enhances 
the iCommit2Fit support system. 
• Data sharing. Participants, especially in the various challenges, want 
to know how their performance compared with others. Due to priva-cy 
restrictions of HIPAA and PHI, the data that can be shared with par-ticipants 
is highly restricted. When members of the five-member teams 
witnessed a dip in their cumulative score, some wanted to know which team 
member caused the average to be lowered. However, because protecting 
privacy is of utmost importance, we have utilized safeguards to ensure par-ticipants’ 
data is only reviewed by Cognizant health 
coaches and those administering incentives. To help 
Figure 9 
95% 
Meeting 
participation 
100% 
Meeting 
participation 
BOTTOM 15% MIDDLE 70% 
Percentage Weight Loss 
TOP 15% 
0 
5.4% 
10.8% 
20.2% 
Figure 8 
Average Monthly Step Count 
MISSED NONE 
0 
38.4K 
68.1K 
125.2K 
= TOP 15% 
= MIDDLE 70% 
iCommit2Fit 
Performance 
Rankings 
= BOTTOM 15% 
the cause while remaining compliant with regula-tory 
restrictions, we created a Fitbit Community in 
the Fitbit portal, where users could opt-in to share as much 
information as they were comfortable sharing. 
• Attrition happens. Our program attrition rate was about 
18% (or 25% if we include the 11 participants who never 
synched their devices with the portal), which is lower than 
the typical 30% annual attrition rate that health clubs 
experience.7 We enrolled 150 participants (18 individuals 
joined after a few early participants bowed out), of whom 
127 were still active six months later. While some partici-pants 
dropped out due to medical conditions or injury, oth-ers 
left the program after changing jobs. 
• Climate matters. The onset of very hot summer weather 
in some of the locations had a definite impact on results. In 
one location, weather advisories recommended not walk-ing 
outside until after 10:00 p.m. On the flip side, locations 
in the Midwest and North experienced a harsher than nor-mal 
winter in early 2014, with the polar vortex impacting 
outdoor activities. It is important for coaches and par-ticipants 
to identify alternate walking venues and tactics 
ahead of time, such as in malls or other indoor sites.
Empowering Employees for Personal Wellness 
“Five little lights changed my life,” says Jacqui 
Bennion, one of the 150 participants in our iCom-mit2Fit 
wellness pilot program. After six months 
of watching her Fitbit wristband display the 
signal that she had reached her daily goal of 
12,000 steps, Bennion feels more fit, has gained 
better control over her diabetes and has made “a 
complete change” in her lifestyle. “The program 
is about so much more than weight loss; it’s about 
getting healthy,” she said. 
“Getting healthy” similarly was the driver behind 
Kathy Martin’s participation in the program. “I 
have six grandkids and two more on the way,” 
Martin said. “I want to be there for them — but 
I have a tendency to give up in an instant. With 
iCommit2Fit, I had a support team, goals to make 
and motivation.” 
“The accountability the program offered was most 
important to me,” says Scott Seeliger. “Seeing 
that information — the activity and food log — on 
a daily basis was a big motivator to reaching 
my goals.” 
Motivation with a Personal Touch 
The personalized support provided by iCommit2Fit 
coaches was especially important for Bennion and 
Martin. Bennion’s coach worked with her to set 
up appropriate calorie counts and eating styles to 
maintain steady blood sugar levels. Martin gained 
so much energy that she tried running a portion 
of her daily 1.5-mile walk — and promptly hurt her 
knee. She and her coach found alternative ways 
to remain active, such as doing upper-body work. 
“My coach was my motivator,” Martin says. “It’s 
easy to start when someone’s watching, and my 
coach was huge in that role.” 
Bennion enjoyed competing against friends 
during the iCommit2Fit team challenges, an 
aspect of the program that Seeliger also cited as 
a big motivator. “I am a competitive person and 
definitely liked the challenge of being able to win 
prizes,” he said. 
Whether through coaching or competition, the 
motivation worked: Seeliger used a local skywalk 
system as well as nighttime walks in 10° F weather 
to log his 12,000 daily steps. Bennion turned to 
an indoor trampoline rebounder and a local air-conditioned 
Walmart to beat the 113° F heat, and 
Martin walked around her kitchen island to avoid 
subzero wind chills. 
Committed to Wellness 
All three report much improved health and 
energy. Martin is no longer winded by walking 
up a short flight of steps in her house; Bennion 
has improved blood sugar numbers; and Seeliger 
dropped 45 pounds. Each said they expect their 
education about healthier food choices to have 
a lasting effect on their wellness. “Logging the 
value of everything you put in your mouth makes 
a big difference,” Bennion said. “I was not going 
to log French fries.” 
Family members of participants also saw side 
benefits. Martin’s husband lost 20 pounds 
because of the changes to her cooking style, and 
Seeliger’s family’s diet has also changed. “I have 
8-year-old twins, and it was just so important 
for them to be exposed to healthier behavior,” 
Seeliger said. 
Although the pilot ended in June, Bennion, Martin 
and Seeliger have all continued their daily steps 
and more. “I have so much more energy than I 
did eight months ago,” Bennion said. With her 
improved endurance, she is starting to move 
into more intense interval training and planking 
exercises. Seeliger has started the Couch-to-5K™ 
running program. 
“We don’t just sit on the couch anymore: 
we find other things to do,” said Martin, 
who estimates her family’s tele-vision- 
viewing went from as 
much as eight hours a day to 
just two hours a week. The 
“other things” include yard 
chores, fixing old cars and 
remodeling a property. 
“It’s been fabulous,” she said. “I 
know I’m in a better place because 
of iCommit2Fit.” 
Quick Take 
EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 11
Spreading the Success of iCommit2Fit 
The basic principles behind the success of iCommit2Fit are transferable to other 
settings. Voluntary participation and a good activity-tracking device are the basic 
prerequisites. Our results indicate that personalized expert coaching to constantly 
challenge participants is the mandatory component that enables participants to 
achieve significant activity gains and weight loss. 
We were fortunate to have access to our HealthActivate platform and its coaching 
resources (see sidebar, page 11). Other companies could turn to third-parties for 
similar services. Health insurers and large healthcare systems are increasing-ly 
investing in wellness and patient care programs that could offer some of the 
features we built into iCommit2Fit. 
Factors to consider in program selection include the ability of the service 
provider to: 
• Offer high-quality, clinically trained coaches who can tailor advice and recom-mendations 
to participants. 
• Manage administrative aspects, from enrollment through technical support, 
through tabulating results for incentives or internal use. 
• Support data transmissions from potentially a variety of personal health devices, 
which currently do not adhere to a data standard. 
• Protect participant privacy. 
Studies show that employees increasingly will pay for larger shares of their health 
costs, whether as co-pays in employer-sponsored coverage or when selecting their 
own health plans through employer-defined benefits contributions.8 Programs such 
as iCommit2Fit potentially can help employees reduce their need for expensive 
healthcare services. This development could benefit employers, too. 
One way to determine whether to invest in a program like iCommit2Fit is to look at 
aggregate, non-personal employee health data and calculate what percentage of 
health claims are arising from “lifestyle” conditions, from diabetes to heart disease. 
It is also worth noting that one review of more than a dozen employer wellness 
programs indicated average savings of $358 through reduced health costs per 
employee per year, while costing the employer $144 per employee per year. For 
every dollar an employer spent on its program, it saved $3.37.9 
Our expansion of iCommit2Fit this coming fall is not just about good health for our 
employees; it is also about ensuring that our business is fit and productive, too. We 
are proud of our iCommit2Fit participants and their hard work and look forward to 
logging many more steps from them. 
Footnotes 
1 Matt Clinch, “Wearable Smart Bands Set for 350% Growth in 2014,” CNBC, Feb. 12, 
2014, http://www.cnbc.com/id/101410507#. 
2 “Obesity Accounts for 21 percent of U.S. Health Care Costs, Study Finds,” Science- 
Daily, April 9, 2012, http://www.sciencedaily.com/releases/2012/04/120409103247. 
htm. 
3 Julia James, “Patient Engagement,” Health Affairs, Feb. 14, 2013, http://www. 
healthaffairs.org/healthpolicybriefs/brief.php?brief_id=86. 
4 “Workplace Health Promotion,” Centers for Disease Control and Prevention, http:// 
www.cdc.gov/workplacehealthpromotion/implementation/topics/physical-activity. 
html. 
12 KEEP CHALLENGING October 2014
5 “The Price of Inactivity,” American Heart Association, http://www.heart.org/ 
HEARTORG/GettingHealthy/PhysicalActivity/FitnessBasics/The-Price-of-Inactivity_ 
UCM_307974_Article.jsp. 
6 “Physical Activity Improves Quality of Life,” American Heart Association, http://www. 
heart.org/HEARTORG/GettingHealthy/PhysicalActivity/FitnessBasics/Physical-activity- 
improves-quality-of-life_UCM_307977_Article.jsp. 
7 Heather Rascher, “Battling Attrition: A Study in Improving Member Retention at 
Health Club Facilities,” Sports Economics Perspectives, Issue 3, http://www.sportsec-onomics. 
EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 13 
com/Images/PDF/SE_Perspectivevol3.pdf. 
8 “Aon Hewitt 2013 HealthCare Survey,” Aon, 2013, page 7, http://www.aon.com/ 
attachments/human-capital-consulting/2013_Health_Care_Survey.pdf. 
9 Katherine Baicker, David Cutler, Zirui Song, “Workplace Wellness Programs Can 
Generate Savings,” Health Affairs, February 2010, Vol. 29, No. 2, pp 304-311, http:// 
content.healthaffairs.org/content/29/2/304.full#ref-22. 
10 “Why Use BMI?” Harvard School of Public Health, http://www.hsph.harvard.edu/obe-sity- 
prevention-source/obesity-definition/obesity-definition-full-story/#references. 
11 Stuart Wolpert, “Dieting Does Not Work, UCLA Researchers Report,” UCLA, April 3, 
2007, http://newsroom.ucla.edu/releases/Dieting-Does-Not-Work-UCLA-Research-ers- 
7832. 
About the Authors 
Niresh Terence Sivathasan is a Manager within Cognizant’s Business Process 
Services (BPS) Strategic Operations’ group. During his four-year tenure, he has 
engaged in various due diligences and contracting initiatives, and was a part of 
the program team of one of Cognizant’s largest BPS clients. Niresh is the program 
manager for iCommit2Fit and oversees all aspects of the program. He earned his 
B.A. from the University of Texas and a Juris doctorate from the University of 
Oklahoma College of Law. Additionally, he is licensed to practice law in Texas. Niresh 
has a passion for wellness after overcoming his own weight struggles. He altered 
his lifestyle to become more physically active and competes in local charity races, 
soccer and ice hockey. He can be reached at Niresh.Sivathasan@cognizant.com | 
LinkedIn: www.linkedin.com/pub/niresh-sivathasan/3/27/592 | Google+: plus.google. 
com/s/niresh%20sivathasan 
Dr. Anthony Nguyen is Cognizant’s Chief Medical Officer. He led the development of 
the coaching protocols and oversaw all clinical aspects of the pilot. Anthony is part 
of the Global Clinical Services teams and is responsible for furthering Cognizant’s 
role in helping our clinical partners run better and run different. Anthony graduated 
magna cum laude from University of CA, Irvine, and received his M.D. at Tufts School 
of Medicine. He is board-certified in internal medicine. Anthony’s passion in wellness 
stems from his medical education, as well as his dedication to surfing at a high 
level. Anthony can be reached at Anthony.Nguyen@cognizant.com | LinkedIn: www. 
linkedin.com/in/anguyenmd 
Acknowledgments 
The authors would like to acknowledge Gajen Kandiah, Executive Vice-President of 
Cognizant’s Business Process Services Business Unit, for his vision and contribu-tions 
to this white paper.
World Headquarters 
500 Frank W. Burr Blvd. 
Teaneck, NJ 07666 USA 
Phone: +1 201 801 0233 
Fax: +1 201 801 0243 
Toll Free: +1 888 937 3277 
inquiry@cognizant.com 
European Headquarters 
1 Kingdom Street 
Paddington Central 
London W2 6BD 
Phone: +44 (0) 207 297 7600 
Fax: +44 (0) 207 121 0102 
infouk@cognizant.com 
India Operations Headquarters 
#5/535, Old Mahabalipuram Road 
Okkiyam Pettai, Thoraipakkam 
Chennai, 600 096 India 
Phone: +91 (0) 44 4209 6000 
Fax: +91 (0) 44 4209 6060 
inquiryindia@cognizant.com 
About Cognizant 
Cognizant (NASDAQ: CTSH) is a leading provider of informa-tion 
technology, consulting, and business process outsourcing 
services, dedicated to helping the world’s leading companies 
build stronger businesses. Headquartered in Teaneck, New Jer-sey 
(U.S.), Cognizant combines a passion for client satisfaction, 
technology innovation, deep industry and business process 
expertise, and a global, collaborative workforce that embod-ies 
the future of work. With over 75 development and delivery 
centers worldwide and approximately 187,400 employees as 
of June 30, 2014, Cognizant is a member of the NASDAQ-100, 
the SP 500, the Forbes Global 2000, and the Fortune 500 
and is ranked among the top performing and fastest growing 
companies in the world. Visit us online at www.cognizant.com 
or follow us on Twitter: Cognizant. 
© Copyright 2014, Cognizant. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any means, 
electronic, mechanical, photocopying, recording, or otherwise, without the express written permission from Cognizant. The information contained herein is subject to 
change without notice. All other trademarks mentioned herein are the property of their respective owners.

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Employee Wellness: Two Parts Perspiration, One Part Persistence

  • 1. Employee Wellness: Two Parts Perspiration, One Part Persistence With employee health affecting bottom lines, organizations need to support preemptive initiatives that encourage both personal wellness and quantifiable results. Here’s how we are addressing this major challenge.
  • 2. Executive Summary Between January and June this year, 127 Cognizant employees could have walked halfway to the moon. Their cumulative footsteps covered half of the 238,000-mile distance — and they’re still walking. This group has taken nearly 200 million steps as part of iCommit2Fit, an innovative wellness improvement program that we designed and piloted for our associates in five U.S. locations. The voluntary program combines personal commitment, technology, incentives and coaching. At the close of the six-month pilot, virtually all of our participants have substantially increased and sustained their physical activity levels while losing weight and seeing significant improvements in their Body Mass Index (BMI) ratios. What sets iCommit2Fit apart is the personalized, one-to-one coaching deployed to help associates outfitted with Fitbit® wearable smart bands to monitor their physical activity, with the goal of improving their wellness. While wearable smart bands like Fitbit are all the rage, they are no wellness elixir.1 The reason? While great at automating data collection without any human intervention, the current generation of devices can’t instruct users on ways to increase their physical activity today or tomorrow, much less next week or month. The bottom line: to KEEP CHALLENGING October 2014
  • 3. improve their wellness, humans need the counsel and encouragement of fellow carbon-based beings to increase their physical activity, improve their nutrition and adopt healthier lifestyles. In fact, our findings show that participants who attended the coaching sessions without fail recorded activity levels and weight loss that were almost 75% higher than the levels for participants who missed coaching sessions. Equipped with the knowledge gained from this pilot, we are set to expand the program to 1,400 more employees across the U.S. This whitepaper shares the lessons we learned from the pilot program and our ideas for improving the wellness of our associates so that other enterprises can improve their wellness initiatives. Doing so is a matter of health for both employees and employers, alike. Consider that the medical costs associated with obesity are estimated at $190.2 billion per year, or 20.6% of national health expenditures.2 Employers offering health insurance bear a portion of these costs and have a stake in helping employees lead more active, healthier lifestyles. EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 3
  • 4. 4 KEEP CHALLENGING October 2014 iCommit2Fit in Action When designing iCommit2Fit, we hypothesized that proactive, personalized and technologically savvy support was necessary to help individuals embrace and sustain behaviors that improve health and prevent or alleviate chronic health conditions. The healthcare industry is already measuring “patient activation” rates as a way of predicting which individuals will consume more healthcare services and/ or succeed in managing their existing health conditions.3 We solicited voluntary applications for iCommit2Fit from five Cognizant facilities across the U.S., located in the South, Southwest, Midwest and Southeast. Applicants were reviewed for any pre-existing health conditions that could preclude their par-ticipation; those selected were equipped with a Fitbit activity tracker. From an iCommit2Fit participant’s perspective, the requirements were simple: wear the activity tracker to capture daily steps walked; log food intake in a daily digital diary; upload data on a weekly basis; and participate in weekly coaching sessions via telephone (see Figure 1). On the back-end, we used the data capture and person-alized coaching capabilities of our HealthActivate patient engagement platform to administer the program (see sidebar, page 7). iCommit2Fit Data Flows Figure 1 Daily food logging Periodic webinars Weekly nutrition e-mails Daily step goals Weekly step count upload via activity monitor Portal/ Personal Coach Weekly virtual meeting with coach All participants reported their pre-program daily “step” baseline. Based on that measure, each participant’s coach set a daily step goal for the first month of the program. If a participant easily met or exceeded that goal, the coach would increase it. Devices were synchronized with participants’ smartphones or laptop dongles, then uploaded directly from Fitbit to the Cognizant HealthActivate portal. Laptops equipped with the Fitbit software were available at several office locations for use
  • 5. by participants without smartphones or with data synchronization issues. To ensure consistent and accurate results across all participants, we disabled the manual data entry feature. Thus, all step counts came from the devices; none were estimated by participants. In addition to weekly phone-based coaching sessions, participants received per-sonalized e-mails with observations and advice from coaches. If a participant was meeting step goals but not losing the desired weight, a coach might examine the food log and note an abundance of fried or fatty foods and suggest alternatives. Four Times around the Earth During the pilot — which ran from January 2014 to June 2014 — the 127 participants cumulatively took almost 200 million steps, or approximately 100,000 miles. To put this into perspective, the circumference of the earth is almost 25,000 miles. The participants also cumulatively lost three-quarters of a ton of weight. The iCommit2Fit participants started out at a higher weekly step average than the Cognizant corporate benchmark, the U.S. average and the Fitbit user average (see Figure 2). From January to June, participants increased their weekly step counts from an average baseline of 36,500 across all groups to 75,000, an improvement of 105% and more than twice the American daily step average. Participants doubled their own baseline steps as well as the average American baseline steps, while consistently attaining 10,000 steps per day, as recommended by the American Heart Association, and reaching 30 minutes of moderate physical activity per day as recom-mended by the U.S. Surgeon General. All participants improved their step counts, with the largest percentage increases achieved in the Overweight and Obese 1 and 2 BMI categories, indicating much greater activity by those participants (see Figure 3, next page). BMI reduction is a critically important metric; for example, the risk rate of acquiring chronic diseases increases substantially as people go from Overweight to Obese 1, and from Obese 1 to Obese 2. Members of the Obese 1 and Obese 2 categories in the 41 to 50 age range posted the greatest weight loss by percentage (see Figure 4, next page). iCommit2Fit Average Average Daily Steps Comparison EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 5 80K 70K 60K 50K 40K 30K Fitbit Average U.S. Average Cognizant Baseline JAN. FEB. MARCH APRIL MAY JUNE Figure 2 From January to June, participants increased their weekly step counts from an average baseline of 36,500 across all groups to 75,000, an improvement of 105% and more than twice the American daily step average.
  • 6. 250 (lbs.) 200 150 100 50 0 80K 70K 60K 50K 40K 30K 20K 10K OVERWEIGHT OBESE 1 OBESE 2 Average Weight Loss by BMI Category NORMAL Average Step Gain by BMI Category OVERWEIGHT OBESE 1 OBESE 2 = STARTING WEIGHT = WEIGHT AFTER 6 MONTHS 6 KEEP CHALLENGING October 2014 The weight loss significantly reduced BMI measures in all of our participants, with the greatest reductions coming in the Obese 1 and 2 categories (see Figure 5, next page). These indi-viduals recorded the lowest baseline step counts of all program participants. The BMI reductions enabled nearly 27% of our participants to move to new BMI categories. Thirteen participants who began the program in the “Obese 2” category lost enough weight to improve to the Obese 1 category (see Figure 6, page 8). Nineteen people reduced their BMI enough to move from the Obese 1 category to Overweight. The BMI improvements among participants in the Overweight and Obese categories, coupled with their increased step counts, suggest that these individuals made significant lifestyle changes. Further, our data indicates that the support structure underlying iCommit2Fit was a significant influence on those results. The Coaching Difference Not surprisingly, the participants who followed all the program requirements — weekly step goals, daily food logging and weekly coach meetings — saw the greatest average weight loss, or 20 pounds. Conversely, those with the lowest compliance rates lost about five pounds on average. Personalized weekly coaching had a strong impact on participant results. Roughly 15% of participants who had 100% coaching compliance — that is, they did not miss a single coaching session — took 54% more steps and lost twice as much weight as those who had 95% coaching compliance rates. They took 70% more steps than those with the lowest compliance rate and lost three times as much weight (see Figures 7 and 8, pages 9 and 10, respectively). In other words, participants with 95% compliance rates missed only two of 23 meetings, yet lost only half the weight and took slightly more than half the steps of those who made it to all their coaching sessions. Similarly, the group with the lowest compliance rates missed about three meetings, lost only about a quarter of the weight and took only about 30% of the steps of those in the 100% group (see Figure 9, page 10). 44 72 36 76 34 72 31 70 0 NORMAL = BASE STEPS = STEPS AFTER 6 MONTHS Figure 3 Figure 4 The BMI reductions enabled nearly 27% of our participants to move to new BMI categories.
  • 7. Roughly 15% of participants who had 100% coaching compliance took 54% more steps and lost twice as much weight as those who had 95% coaching compliance rates. These results signal to us the value and impact of the personalized and consistent expert coaching underlying iCommit2Fit. They also complement studies showing that workplace health programs tailored to an individual’s personal goals can lead to increases of up to 35% in the amount of time a person will spend in physical activity.4 Healthy Optimism Our initial pilot program was not long enough in duration or large enough in participant numbers to draw conclusions about the impact of increased activity and weight loss on employee productivity or health claim costs. However, we are optimistic about achieving positive results. For instance, greater activity and improved BMI should contribute to reduced healthcare costs. It is estimated that obesity-related productivity losses cost employers $225.9 billion per year, with an obese employee costing employers an additional $460 to $2,500 in medical care and sick days over the average annual individual healthcare cost of $3,000 per person.5 Improvement by BMI Weight Category NORMAL OVERWEIGHT OBESE 1 OBESE 2 23.5 22.8 = BASE BMI = BMI June 2014 Figure 5 28.2 27.2 32.4 30.5 41 38.3 50 40 30 20 10 0 Quick Take Cognizant’s Connected Health Solution The HealthActivate platform combines “bring your own health device” (BYOhD) data collection capabilities with analytics and virtual and live coaching to offer a next-generation care management platform. The platform accepts data from virtually any BYOhD that an individual might use, from an activity tracker to an in-home blood sugar testing device to a wireless scale. Our analytics engine reviews this data and alerts coaches to any anomalies requiring intervention. Some interventions are automatic and virtual, such as an instant message or e-mail; at other times, coaches (who are trained nurses) will call the individual to find out why a medicine dosage was missed or to determine whether a sudden weight gain indicates a serious problem. The platform helps indi-viduals on the cusp of chronic conditions to become healthier and enables partici-pants who are managing diabetes, heart conditions, etc. to do so more effectively and avoid acute care episodes. EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 7
  • 8. JAN. JUNE BMI Category Changes Obese 1 13 Obese 2 30 Remained Obese 2 JAN. JUNE 1 Moved to Obese 2 23 19 Remained Obese 1 43 43 Moved to Obese 1 Moved to Overweight 8 KEEP CHALLENGING October 2014 But as noted by the American Heart Association, regular exercise, such as 10,000 daily steps, reduces coronary heart disease in women by 30% to 40%, while moderately active people see their stroke risk reduced by 20% and highly active people by 27%.6 We are hopeful that participants will see improved health as they continue their steps, while we closely monitor the impact of greater employee wellness on health costs as we expand the program. Lessons Learned While we are very pleased with the results of the first phase of iCommit2Fit, the pilot participants taught us a variety of lessons and raised issues that we hope to address in the expanded program. • Device details. It is critical to use a reliable activity tracker that also largely automates the data upload process. We selected the Fitbit, both for these capa-bilities and its name recognition. It is important to have extra devices on hand: When a tracker was lost or stopped working for any reason, participant activity quickly dropped. As iCommit2Fit grows, we will watch for more advanced devices that can track a wider range of physical activities and convert them to a meaningful measure. Potential exercise movement to capture includes swimming, weight-lifting, yoga, etc. As participants become more fit, they might be more likely to participate in activities that our activity tracker cannot capture. Figure 6 Nineteen people reduced their BMI enough to move from the Obese 1 category to Overweight, while two participants went to Normal from Obese 1.
  • 9. Quick Take The Criticality of BMI-based Weight Categories The Body Mass Index (BMI) is a mathematical formula that uses an individual’s height and weight to evaluate whether he or she is at a healthy weight. A BMI of 18.5 to 24.9 is considered healthy, while a reading of 25 to 29.9 is considered overweight. Research-ers and clinicians divide obesity into three categories: Class I (30–34.9), Class II (35–39.9) and Class III (40). Class III is further divided into super-obesity (BMI 50–59) and super-super obesity (BMI 60+).10 What we found in our pilot program is that as participants lose weight and begin to transfer from one BMI category to the next, it is crucial for them to realize that meeting their goal is not enough; they must sustain it. One way that we work to ensure goal maintenance is through high-intensity interval training. We believe that when coaches encourage individuals to increase the intensity of their workouts, it poses a new and different challenge to the participants and results in a sustainable loss. Research has found that people on diets typically lose 5% to 10% of their starting weight in the first six months. However, at least one- to two-thirds of people on diets regain more weight than they lost within four or five years, and the true number may well be significantly higher.11 This is why we extended our pilot from three to six months and hope to extend the program indefinitely in the future. • Going beyond step counts. We will also explore whether and how to incorporate other wellness activities into the pro-gram to help participants maintain their weight loss. To ac-complish this, we will actively track the wearable industry as devices become more mature and are able to capture activities beyond steps. Many smaller companies are be-ginning to engineer devices that capture body-weight ex-ercises (i.e., push-ups, squats and crunches), swimming, strength-training and other activities. As devices become more mature and able to track additional activities beyond walking and running, our coaches will be further trained in exercise therapy to offer a wider array of services. • Limits of the BMI. While the BMI is widely used as a measure, it is only a mathematical estimate of a person’s weight catego-ry and cannot take into account body fat percentage or bone 25 20 15 10 5 Impact of Weekly Coach Meetings on Weight Loss iCommit2Fit Performance Rankings Average Weight Loss (lbs.) structure. A person weighing 145 lbs and measuring 5’8” in 0 height could be very fit — or they could be carrying more body fat than muscle mass (see above sidebar). Changes in body fat percentage would be a more accurate Figure 7 measure of wellness, but obtaining this reading is more intrusive and resource-intensive. Home health devices that offer body fat measurement could be evaluated. • The incentive effect. We experimented with three types of incentives: individual, worksite-based and team-based. Individuals could earn congratulatory e-mails, color bands for their trackers, hoodies and custom t-shirts, all of which were designed to appeal to goal-oriented but noncompetitive participants. = TOP 15% = MIDDLE 70% = BOTTOM 15% 5.4 10.8 MISSED 3 MISSED 2 20.2 MISSED NONE Number of Coaching Meetings Missed EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 9
  • 10. As iCommit2Fit grows, we will watch for more advanced devices that can track a wider range of physical activities and convert them to a meaningful measure. Impact of Weekly Coach Meetings on Steps Taken MISSED 3 MISSED 2 Number of Coaching Meetings Missed Impact of Coach Meetings on Weight Loss 87% Meeting participation 25 20 15 10 5 150K 120K 90K 60K 30K 10 KEEP CHALLENGING October 2014 Worksite challenges involved seeing which site teams recorded the highest compliance rates in terms of step counts, food logging and coaching. Winners were treated to a lunch during program-related webinars. Finally, several weeks into the program, we randomly selected participants to form teams across the five pilot locations. To score points for their teams, members had to complete their daily food log, meet their weekly step goals and complete their weekly coach meeting. Missing even one of these activities would reduce the team’s overall score. Certain teams proved especially competitive, so members would drop out rather than hurt the team by leaving an activity incomplete. We will examine our scoring procedures and communication to ensure that the formation of teams enhances the iCommit2Fit support system. • Data sharing. Participants, especially in the various challenges, want to know how their performance compared with others. Due to priva-cy restrictions of HIPAA and PHI, the data that can be shared with par-ticipants is highly restricted. When members of the five-member teams witnessed a dip in their cumulative score, some wanted to know which team member caused the average to be lowered. However, because protecting privacy is of utmost importance, we have utilized safeguards to ensure par-ticipants’ data is only reviewed by Cognizant health coaches and those administering incentives. To help Figure 9 95% Meeting participation 100% Meeting participation BOTTOM 15% MIDDLE 70% Percentage Weight Loss TOP 15% 0 5.4% 10.8% 20.2% Figure 8 Average Monthly Step Count MISSED NONE 0 38.4K 68.1K 125.2K = TOP 15% = MIDDLE 70% iCommit2Fit Performance Rankings = BOTTOM 15% the cause while remaining compliant with regula-tory restrictions, we created a Fitbit Community in the Fitbit portal, where users could opt-in to share as much information as they were comfortable sharing. • Attrition happens. Our program attrition rate was about 18% (or 25% if we include the 11 participants who never synched their devices with the portal), which is lower than the typical 30% annual attrition rate that health clubs experience.7 We enrolled 150 participants (18 individuals joined after a few early participants bowed out), of whom 127 were still active six months later. While some partici-pants dropped out due to medical conditions or injury, oth-ers left the program after changing jobs. • Climate matters. The onset of very hot summer weather in some of the locations had a definite impact on results. In one location, weather advisories recommended not walk-ing outside until after 10:00 p.m. On the flip side, locations in the Midwest and North experienced a harsher than nor-mal winter in early 2014, with the polar vortex impacting outdoor activities. It is important for coaches and par-ticipants to identify alternate walking venues and tactics ahead of time, such as in malls or other indoor sites.
  • 11. Empowering Employees for Personal Wellness “Five little lights changed my life,” says Jacqui Bennion, one of the 150 participants in our iCom-mit2Fit wellness pilot program. After six months of watching her Fitbit wristband display the signal that she had reached her daily goal of 12,000 steps, Bennion feels more fit, has gained better control over her diabetes and has made “a complete change” in her lifestyle. “The program is about so much more than weight loss; it’s about getting healthy,” she said. “Getting healthy” similarly was the driver behind Kathy Martin’s participation in the program. “I have six grandkids and two more on the way,” Martin said. “I want to be there for them — but I have a tendency to give up in an instant. With iCommit2Fit, I had a support team, goals to make and motivation.” “The accountability the program offered was most important to me,” says Scott Seeliger. “Seeing that information — the activity and food log — on a daily basis was a big motivator to reaching my goals.” Motivation with a Personal Touch The personalized support provided by iCommit2Fit coaches was especially important for Bennion and Martin. Bennion’s coach worked with her to set up appropriate calorie counts and eating styles to maintain steady blood sugar levels. Martin gained so much energy that she tried running a portion of her daily 1.5-mile walk — and promptly hurt her knee. She and her coach found alternative ways to remain active, such as doing upper-body work. “My coach was my motivator,” Martin says. “It’s easy to start when someone’s watching, and my coach was huge in that role.” Bennion enjoyed competing against friends during the iCommit2Fit team challenges, an aspect of the program that Seeliger also cited as a big motivator. “I am a competitive person and definitely liked the challenge of being able to win prizes,” he said. Whether through coaching or competition, the motivation worked: Seeliger used a local skywalk system as well as nighttime walks in 10° F weather to log his 12,000 daily steps. Bennion turned to an indoor trampoline rebounder and a local air-conditioned Walmart to beat the 113° F heat, and Martin walked around her kitchen island to avoid subzero wind chills. Committed to Wellness All three report much improved health and energy. Martin is no longer winded by walking up a short flight of steps in her house; Bennion has improved blood sugar numbers; and Seeliger dropped 45 pounds. Each said they expect their education about healthier food choices to have a lasting effect on their wellness. “Logging the value of everything you put in your mouth makes a big difference,” Bennion said. “I was not going to log French fries.” Family members of participants also saw side benefits. Martin’s husband lost 20 pounds because of the changes to her cooking style, and Seeliger’s family’s diet has also changed. “I have 8-year-old twins, and it was just so important for them to be exposed to healthier behavior,” Seeliger said. Although the pilot ended in June, Bennion, Martin and Seeliger have all continued their daily steps and more. “I have so much more energy than I did eight months ago,” Bennion said. With her improved endurance, she is starting to move into more intense interval training and planking exercises. Seeliger has started the Couch-to-5K™ running program. “We don’t just sit on the couch anymore: we find other things to do,” said Martin, who estimates her family’s tele-vision- viewing went from as much as eight hours a day to just two hours a week. The “other things” include yard chores, fixing old cars and remodeling a property. “It’s been fabulous,” she said. “I know I’m in a better place because of iCommit2Fit.” Quick Take EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 11
  • 12. Spreading the Success of iCommit2Fit The basic principles behind the success of iCommit2Fit are transferable to other settings. Voluntary participation and a good activity-tracking device are the basic prerequisites. Our results indicate that personalized expert coaching to constantly challenge participants is the mandatory component that enables participants to achieve significant activity gains and weight loss. We were fortunate to have access to our HealthActivate platform and its coaching resources (see sidebar, page 11). Other companies could turn to third-parties for similar services. Health insurers and large healthcare systems are increasing-ly investing in wellness and patient care programs that could offer some of the features we built into iCommit2Fit. Factors to consider in program selection include the ability of the service provider to: • Offer high-quality, clinically trained coaches who can tailor advice and recom-mendations to participants. • Manage administrative aspects, from enrollment through technical support, through tabulating results for incentives or internal use. • Support data transmissions from potentially a variety of personal health devices, which currently do not adhere to a data standard. • Protect participant privacy. Studies show that employees increasingly will pay for larger shares of their health costs, whether as co-pays in employer-sponsored coverage or when selecting their own health plans through employer-defined benefits contributions.8 Programs such as iCommit2Fit potentially can help employees reduce their need for expensive healthcare services. This development could benefit employers, too. One way to determine whether to invest in a program like iCommit2Fit is to look at aggregate, non-personal employee health data and calculate what percentage of health claims are arising from “lifestyle” conditions, from diabetes to heart disease. It is also worth noting that one review of more than a dozen employer wellness programs indicated average savings of $358 through reduced health costs per employee per year, while costing the employer $144 per employee per year. For every dollar an employer spent on its program, it saved $3.37.9 Our expansion of iCommit2Fit this coming fall is not just about good health for our employees; it is also about ensuring that our business is fit and productive, too. We are proud of our iCommit2Fit participants and their hard work and look forward to logging many more steps from them. Footnotes 1 Matt Clinch, “Wearable Smart Bands Set for 350% Growth in 2014,” CNBC, Feb. 12, 2014, http://www.cnbc.com/id/101410507#. 2 “Obesity Accounts for 21 percent of U.S. Health Care Costs, Study Finds,” Science- Daily, April 9, 2012, http://www.sciencedaily.com/releases/2012/04/120409103247. htm. 3 Julia James, “Patient Engagement,” Health Affairs, Feb. 14, 2013, http://www. healthaffairs.org/healthpolicybriefs/brief.php?brief_id=86. 4 “Workplace Health Promotion,” Centers for Disease Control and Prevention, http:// www.cdc.gov/workplacehealthpromotion/implementation/topics/physical-activity. html. 12 KEEP CHALLENGING October 2014
  • 13. 5 “The Price of Inactivity,” American Heart Association, http://www.heart.org/ HEARTORG/GettingHealthy/PhysicalActivity/FitnessBasics/The-Price-of-Inactivity_ UCM_307974_Article.jsp. 6 “Physical Activity Improves Quality of Life,” American Heart Association, http://www. heart.org/HEARTORG/GettingHealthy/PhysicalActivity/FitnessBasics/Physical-activity- improves-quality-of-life_UCM_307977_Article.jsp. 7 Heather Rascher, “Battling Attrition: A Study in Improving Member Retention at Health Club Facilities,” Sports Economics Perspectives, Issue 3, http://www.sportsec-onomics. EMPLOYEE WELLNESS: TWO PARTS PERSPIRATION, ONE PART PERSISTENCE 13 com/Images/PDF/SE_Perspectivevol3.pdf. 8 “Aon Hewitt 2013 HealthCare Survey,” Aon, 2013, page 7, http://www.aon.com/ attachments/human-capital-consulting/2013_Health_Care_Survey.pdf. 9 Katherine Baicker, David Cutler, Zirui Song, “Workplace Wellness Programs Can Generate Savings,” Health Affairs, February 2010, Vol. 29, No. 2, pp 304-311, http:// content.healthaffairs.org/content/29/2/304.full#ref-22. 10 “Why Use BMI?” Harvard School of Public Health, http://www.hsph.harvard.edu/obe-sity- prevention-source/obesity-definition/obesity-definition-full-story/#references. 11 Stuart Wolpert, “Dieting Does Not Work, UCLA Researchers Report,” UCLA, April 3, 2007, http://newsroom.ucla.edu/releases/Dieting-Does-Not-Work-UCLA-Research-ers- 7832. About the Authors Niresh Terence Sivathasan is a Manager within Cognizant’s Business Process Services (BPS) Strategic Operations’ group. During his four-year tenure, he has engaged in various due diligences and contracting initiatives, and was a part of the program team of one of Cognizant’s largest BPS clients. Niresh is the program manager for iCommit2Fit and oversees all aspects of the program. He earned his B.A. from the University of Texas and a Juris doctorate from the University of Oklahoma College of Law. Additionally, he is licensed to practice law in Texas. Niresh has a passion for wellness after overcoming his own weight struggles. He altered his lifestyle to become more physically active and competes in local charity races, soccer and ice hockey. He can be reached at Niresh.Sivathasan@cognizant.com | LinkedIn: www.linkedin.com/pub/niresh-sivathasan/3/27/592 | Google+: plus.google. com/s/niresh%20sivathasan Dr. Anthony Nguyen is Cognizant’s Chief Medical Officer. He led the development of the coaching protocols and oversaw all clinical aspects of the pilot. Anthony is part of the Global Clinical Services teams and is responsible for furthering Cognizant’s role in helping our clinical partners run better and run different. Anthony graduated magna cum laude from University of CA, Irvine, and received his M.D. at Tufts School of Medicine. He is board-certified in internal medicine. Anthony’s passion in wellness stems from his medical education, as well as his dedication to surfing at a high level. Anthony can be reached at Anthony.Nguyen@cognizant.com | LinkedIn: www. linkedin.com/in/anguyenmd Acknowledgments The authors would like to acknowledge Gajen Kandiah, Executive Vice-President of Cognizant’s Business Process Services Business Unit, for his vision and contribu-tions to this white paper.
  • 14. World Headquarters 500 Frank W. Burr Blvd. Teaneck, NJ 07666 USA Phone: +1 201 801 0233 Fax: +1 201 801 0243 Toll Free: +1 888 937 3277 inquiry@cognizant.com European Headquarters 1 Kingdom Street Paddington Central London W2 6BD Phone: +44 (0) 207 297 7600 Fax: +44 (0) 207 121 0102 infouk@cognizant.com India Operations Headquarters #5/535, Old Mahabalipuram Road Okkiyam Pettai, Thoraipakkam Chennai, 600 096 India Phone: +91 (0) 44 4209 6000 Fax: +91 (0) 44 4209 6060 inquiryindia@cognizant.com About Cognizant Cognizant (NASDAQ: CTSH) is a leading provider of informa-tion technology, consulting, and business process outsourcing services, dedicated to helping the world’s leading companies build stronger businesses. Headquartered in Teaneck, New Jer-sey (U.S.), Cognizant combines a passion for client satisfaction, technology innovation, deep industry and business process expertise, and a global, collaborative workforce that embod-ies the future of work. With over 75 development and delivery centers worldwide and approximately 187,400 employees as of June 30, 2014, Cognizant is a member of the NASDAQ-100, the SP 500, the Forbes Global 2000, and the Fortune 500 and is ranked among the top performing and fastest growing companies in the world. Visit us online at www.cognizant.com or follow us on Twitter: Cognizant. © Copyright 2014, Cognizant. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the express written permission from Cognizant. The information contained herein is subject to change without notice. All other trademarks mentioned herein are the property of their respective owners.