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LAS VEGAS — As more and more Americans grapple with health issues, many related to spiralling rates of obesity, an opportunity has emerged for supermarkets to become the first resource for consumers who wish to take charge of their health and wellness.
As more and more Americans grapple with health issues, many related to spiralling rates of obesity, an opportunity has emerged for supermarkets to become the first resource for consumers who wish to take charge of their health and wellness.
Last October the Food Marketing Institute (FMI), in partnership with MMR, assembled a panel of leading retailers and suppliers to discuss the challenges facing the industry as it develops strategies to seize the opportunity.
In May FMI and MMR revisited the subject with another panel during the FMI 2010 conference in Las Vegas. This time the discussion centered on how retailers and manufacturers can respond to consumers’ health and wellness concerns and needs. Of particular interest to participants were questions related to how such resources as in-store pharmacists, dietitians and clinics can best be utilized to engage customers in the quest for healthier lifestyles.
The latest research sponsored or published by FMI underlines the importance of these questions. For example, a recent report by SymphonyIRI Group Inc. in partnership with FMI reveals that the factors and behaviors associated with childhood obesity are far more complex and subtle than previously thought.
Most recently, the 18th annual edition of Shopping for Health, released by FMI and Prevention magazine, shows that nearly half of consumers are paying more attention to calorie counts than they were two years ago and are buying more low-calorie products — but they have little grasp of how many calories they are consuming. Worse, more than 40% do not watch calorie intake at all.
Rountable participants included Thom Blischok, global president of innovation and strategy at SymphonyIRI Group; Karen Buch, director of lifestyle initiatives at Weis Markets Inc.; Helen Eddy, vice president of health and wellness at Hy-Vee Inc.; Cathy Polley, vice president of pharmacy services at FMI; Patrick Quinn; senior director of trade at Novo Nordisk AS; Bob Richardson, director of sales and customer development at Clorox Co.; Michael Roberts, vice president of pharmacy operations at Adheris Inc.; Steve Roden, president and chief executive officer of LearnSomething; Rebecca Snead, executive vice president and chief executive officer of the National Alliance of State Pharmacy Associations; Craig Stacey, director of health strategies at Supervalu Inc.; and Lisa Walker is vice president of marketing at Campbell Co. The discussion was moderated by David Pinto, editor of MMR and president of Racher Press Inc., the publisher of MMR.
Here is an excerpt of the discussion at the FMI conference:
PINTO: What does health and wellness mean to each of you? It’s still somewhat undefined, isn’t it? Becky, let’s start with you.
SNEAD: I come from a very pharmacy-focused perspective. When we talk about health and wellness from the pharmacy perspective, it’s the whole patient experience. One of the big challenges, as you all know, is adherence — what is going to motivate people to want to engage in and manage their own health care. For pharmacy, it means to assure adherence to medicines. Pharmacists must be responsible for providing patient care that ensures optimal medication therapy outcomes. So I look at it from a more holistic perspective.
RICHARDSON: In the broader health and wellness arena it now becomes a matter of behavior change, not just adherence or compliance.
SNEAD: That’s right, but a critical building block is medication adherence.
ROBERTS: For me, it’s getting away from reactive medicine and moving toward prevention. So much of the model now involves reacting to sickness.
RICHARDSON: This is Clorox’s interpretation, and it’s pretty broad. Generally, we focus on prevention through cleaning surfaces. But we are encouraging FMI and GMA to look at it in terms of five pillars: food and nutrition, personal care, environment, wellness, and health care. This definition can address issues like obesity, diet and environment. It can be about lifestyle change. We’re looking at the total geography of the grocery store, bringing together the center store, the perimeter departments, and pharmacy. This is the broader definition that Clorox is encouraging others to adopt.
PINTO: Lisa?
WALKER: At Campbell’s, our mission is nourishing people’s lives everywhere, every day. And nourishing means giving them life in their years, not just years in their life. We provide healthy food choices, because when people eat better they can prevent disease.
So it’s very important to us at Campbell’s to provide healthy food choices, particularly in the center store, because people believe that you have to shop the perimeter in order to eat healthy. And we make really healthy, affordable, tasty choices for consumers in the center store.
EDDY: I’m a pharmacist by training as well. When we first started getting involved in health and wellness and brought our first dietitians on staff, I thought this was what we needed. Because we cannot help customers achieve their health goals by just what we dispense in the pharmacy. It’s really how do we bring together that holistic picture of the entire customer, the entire patient, using every resource we have to get them to a healthy state?
Sometimes we focus on nutrition, but it’s also about stress management and emotional health. It’s all those things coming together. And that’s where I think supermarkets are really well positioned to address these things.
We always talk about the pharmacist being the most accessible health care professional. The in-store dietitian is another pillar of that. They both provide access to information and access to solutions for our customers.
PINTO: And you’re delivering on that. Thom?
BLISCHOK: I’m not going to give you my opinion on what health and wellness is, but I’m going to give you the opinion of 1,400 shoppers to whom I talked for this conference. Their No. 1 definition of health and wellness is looking good and feeling good. They look at health and wellness from a 360-degree perspective. They look at it as nutritional — more so than I would have imagined when I started this research. They also look at it as preventative.
It also involves living a better life for my family and myself. There’s a holistic approach to stress management, a spiritual perspective — basically living in a better state than they do today.
There has been a change in the American dream. Ten years ago, 90% of Americans wanted to get rich. Today, 20% of Americans want to get rich. Ninety-four percent of Americans just want to live a simpler, better life.
But most importantly, and it amazed me more than any other fact I’ve learned over the past two months, it’s about education. I would never have imagined the degree of knowledge the shopper wants about how to live better and how to eat better. We are at the cusp of a change.
PINTO: If what you say is true, why is obesity such a problem in this country?
RICHARDSON: Well, for young kids, it’s because they’re eating a lot of fried foods. Obesity’s a problem because America, over the past 50 years, has become sedentary. Obesity is our first pandemic, it is a true pandemic, and it will continue to be a pandemic for the foreseeable future.
Metabolic syndrome will become the largest single disease in America in the next five years. And we don’t have a solution. That’s where FMI comes in, because if we don’t change the education, if we don’t convince Americans to shop differently and to eat differently, we’re in trouble.
So the next 10 years are really going to be about a whole shape shift in how America deals with this.
PINTO: Mike?
ROBERTS: I’ve been involved in the patient-messaging, patient-education, behavior-change business for the last 10 years in a couple of different organizations.
We’re going to start entering what I call medication adherence 2.0: It gets tougher. Behavior change is extremely difficult. We’re going to be bringing new adherence strategies, new behavior-change strategies to market. And I think we’ve got to become more holistic: It’s not just about medication or fitness. It’s food, and it’s supplementation.
And it needs to be a complete picture to really understand what people’s triggers are for behavior change.
PINTO: Craig?
STACEY: For the last year I’ve helped Supervalu get started in helping our company think more broadly about the health and wellness area and how we can help our shoppers.
As we talk about it within our company and our health and wellness team, we like to think of health and wellness as simple, small solutions that help people live a healthier life. And I think the key there is simple and small. People are willing to make some small changes. If we try to overwhelm them with large changes, especially for some of the health conditions they’re dealing with, we won’t get very far.
A lot of people have different needs when it comes to health and wellness, and that’s why it’s hard.
BUCH: From a nutritionist’s perspective, I think about health and wellness in terms of the behaviors that people need to address to achieve better health. It starts with getting enough physical activity and choosing nutrient-dense foods in a balanced proportion. It sounds real simple. It’s the basic eat-right-and-exercise formula, which people know they should do.
But often there’s a disconnect between having the knowledge of what we should do and actually doing it. It may come down to a time-management issue: When people don’t have a good work-life balance, stress factors in and it becomes difficult to devote enough time to exercising, shopping for the right foods and cooking for their families.
Registered dietitians working for retailers are uniquely positioned to help people find solutions right at the point of purchase. Having registered dietitians available to help shoppers manage their individual nutritional concerns is a growing trend that I think will continue to expand in the grocery industry.
QUINN: Diabetes is very much a self-managed disease, and when I think of health and wellness, it too is a self-managed thing. There has to be some individual awareness and responsibility for your own health and wellness, but I think people, as we talked about, just aren’t sure where to start. And there’s more information out there now than there ever has been before, so I think it’s a perfect time for some of this to begin getting aligned, because it’s an individual decision.
PINTO: Steve?
RODEN: From some of the research that I’ve seen from GMDC [Global Market Development Center], the shopper is defining it as feeling good about oneself and avoiding illness. And it’s interesting that the data suggests there’s a relatively small core of shoppers, 13% or so, that are primarily making their purchase decisions based on health and wellness.
We think Thom’s right: It’s an education problem. And we’re trying to come up with vehicles to educate the shopper.
Some of our recent experimentation involves using shopper education opportunities like blood pressure machines, where we have 45 seconds of the customer’s undivided attention. A great place to educate them on diabetes or healthy eating or whatever the topic might be.
PINTO: John Agwunobi, who runs health care for Walmart, recently gave a speech in which he said he can’t understand why healthy food costs more than unhealthy food. And I can’t understand that either.
EDDY: I think our goal as a retailer is not to dictate the choices to our consumers, but give them a range of choices and the information they need to make the appropriate choice for their family.
Craig made a point about small changes. It doesn’t have to be a dramatic change. And I think what we try to get across to consumers is that small changes can bring you big health results.
STACEY: I think Helen said it very well. We have to provide the information. We can’t dictate. And that’s what we did with our nutrition iQ program. We took FDA criteria and worked with the Joslin Clinic, part of an academic medical center affiliated with the Harvard Medical School, to establish better screening of sodium and sugar, lower amounts of sugar and saturated fat when it came to food in our stores.
Without regard to brand or price, we help consumers determine which products they want based on the information.
WALKER: We’re finding that, even with nutritional labeling, people don’t know what’s good and what’s bad for them. Is 1,000 milligrams of sodium per meal a lot or a little? People really don’t know. Partnering with some of the retailers, we’ve been able to educate shoppers about what’s right for them to be eating.
SNEAD: When I used to practice pharmacy, it seems I focused on what not to eat with the medication: We were trained in what foods not to eat that would interact with patients’ medications. And what we ultimately need to do is switch that, and start engaging consumers, for example, in what to eat, based upon their disease state. That, along with a continuous quality improvement process and techniques to motivate them to stay on their medication, will make a huge difference.
EDDY: We’re doing some of that in our stores with our dietitians and pharmacists. We identify the customer’s medical condition by the prescriptions they are taking, and then provide them with information on superfoods that may help them with that medical condition. We also provide, on that same handout that identifies the superfoods, an easy recipe using those foods.
PINTO: Thom?
BLISCHOK: I’m a contrarian on this. I’m not sure that healthier food costs more. I would say that you can eat healthy on a budget, but you have to be willing to spend some time cooking.
BUCH: There was a recent study that found junk foods do cost less than healthy foods like fruits and vegetables, calorie for calorie. But when we consider how expensive it is to be ill, it makes sense to spend a little more money up front on better food choices that can help prevent illness.
ROBERTS: There’s an opportunity there, too. We’ve got the nutritionists, we’ve got the pharmacists, and we now have clinics in most of the stores.
And the Internet’s a great way to centralize the communication platform. Why don’t the nutritionist and the pharmacist and the nurse practitioner work together to educate that patient over the Web, and in a very efficient manner?
PINTO: How many of you are working with physicians in any way?
RODEN: We are, from an educational point of view. We’re running learning sites for medical associations. We have about 20 or 30 national health care associations that educate doctors on everything from HIPAA to Medicare-fraud prevention, but we’re not yet exploiting the link between retail and these associations with health and wellness issues.
PINTO: Has it been a positive experience?
RODEN: Yes.
PINTO: Thom, do you work with them?
BLISCHOK: We work with specialists who focus on diabetes, pain management and allergies. We work with physicians and dietitians and pharmacists to begin to understand the interactions between what people eat and the medications they take as a way to build a holistic view of their shopping and spending.
BUCH: Before working in the grocery industry, I provided nutrition therapy in an outpatient setting and doctors were my referral source. Some physicians do recognize the connection between nutrition and health, and they’re evolving toward taking a more holistic approach by integrating nutritional therapies along with other methods of treatment.
STACEY: You said an interesting thing about physicians being an excellent referral source for a dietitian. I think that’s the case, and we have to figure out how to make that a standard situation that we can take advantage of, not only from a business point of view but also in just helping the patient manage a disease state by melding food and pharmacy together and making it easier for them.
BUCH: I think there are a couple of opportunities. Offering immunizations can help connect the pharmacy with the customer in an effort to help people stay healthy. Offering screenings to detect chronic diseases like diabetes is another.
STACEY: We’re really trying to focus on our clinical services. It’s very easy to do with immunizations, because they have become a commodity.
I think clinical services are a great entry point for a dialogue with the shopper on health and wellness and some of the other services that we can provide.
SNEAD: Yes, and I think we need to capitalize on the public’s awareness, because of H1N1 this last year, of pharmacists’ availability and visibility.
The states are going to have challenges and opportunities with the implementation of health care reform, and they are going to have to find partners to work on screenings and on prevention and wellness messages. We need to look at how we can continue to be strong community partners.
BLISCHOK: What if some retailer stepped out and said, “We’re going to introduce a health and wellness card, but you’re not going to get rewards for cigarettes; you’re not going to get rewards for fried chicken. You’re going to get rewards for health-and-wellness-related products.”
PINTO: Has anybody done this?
EDDY: We’re seeing a lot of interest in reward cards on the part of those employers that are actually paying the health care bills for their employees. They are looking for ways to incent their employees into making healthier choices.
SNEAD: Another thing that I thought of was the idea of coupons that shoppers could get that would give them half an hour’s consultation with a dietitian or pharmacist services instead of $2 off of some item.
EDDY: We’ve done some of those, and it was a terrific way to introduce those shoppers to our in-store dietitians and the services that we offer. They’re very aware that Hy-Vee has dietitians in our stores, but they do not always know what an in-store dietitian can do for them and the impact they can make on their health.
And back to the point about physicians, we’ve been giving physicians information about the services that we offer in-store, in our pharmacies and with our dietitians. And the referrals have started to come.
WALKER: One of the things that we’ve heard from consumers is that a doctor can spend 10 minutes with them and diagnose them with a disease the first time. They’re scared because they don’t know much about the condition and they now have a list of things that they can’t do. That might be the opportunity for the retailer, particularly through pharmacy.
BLISCHOK: How do we address the issue of wellness, not the issue of managing disease states? Because I think the bigger opportunity in our collective industry is to show people the road map to wellness by promoting wellness in the stores.
RODEN: About 1.1 million people a day take their blood pressure in retail stores; 400 million a year. Those are Web MD-like numbers. And that is an education moment, where we’ve got somebody sitting there for 45 seconds. We’ve been researching it, and the most popular topic based on shopper selection is how do they lose weight.
WALKER: Weight management is a great place to start because it’s the most visible. We don’t realize we have most of the other conditions until we’ve been diagnosed, but people know they are overweight before somebody has to tell them they’re overweight.
PINTO: But how do you do that? How do you tell someone who’s overweight how not to be overweight?
RODEN: It’s little steps. You don’t do it in one big, “Here’s Your 25-step Weight-Loss Program.” It’s a series of smaller steps that you encourage them to take.
BUCH: It’s a series of linked behaviors that form a chain that keeps people stuck in their old habits. And the key is to start making the small changes necessary to break the behavior chain.
PINTO: How do you all handle vitamins? Do you just have them for sale, or do you advocate for them? And do you advocate for some more than for others? Helen?
EDDY: We like to position them fairly close to the pharmacy, because we think it’s important to have a pharmacy interaction there. Dietitians also do a fair amount of recommendations. I think positioning them in the store to enable some kind of professional consultation is important.
RODEN: We’re doing a lot of vitamin education right now. We’re taking direction from the manufacturers on what can be said and what can’t be said, but it is one of the fastest-growing categories. And it is one of those major gateways that we were talking about in terms of starting the journey to be a health-and-wellness-focused shopper.
STACEY: At Supervalu we typically position supplements by the pharmacy for that interaction. But we also believe that we have to provide education on how to use them within a diet. And explain how supplements can be part of a healthy lifestyle. It’s important for us to figure out the right balance in that discussion, and it’s not an easy thing to do.
BUCH: I think staying on top of the science is very important. Vitamin D comes to mind because it is related to so much more than just bone health. In fact, suboptimal vitamin D is related to myriad disease states including hypertension, cancer and more.
BLISCHOK: There is no easy solution. About 75% of Americans believe their first step toward health and wellness is taking vitamin supplements. But the biggest problem we have is the general American public, which really is not educated on how to eat well. So I think education, relevant education, plays a huge role here.
BUCH: I agree that education is necessary. And the consistent, broad-based access to dietitians and the information they can share is just not there. When I do a store tour in one of our Weis Markets stores and actually take people around and shop with them, and answer their questions and show them how to read food labels, and help them understand what the best choices are for their meals, people love it. But it’s a matter of access.
WALKER: One of the things that we’ve found is that having a third-party endorser has really helped consumers think differently about our products. For example, we partner with the American Heart Association and then with other retailers, like Supervalu or Safeway, that get behind the Go Red for Women Program. And we merchandise all of our products that are heart healthy, together with other manufacturers’ products, so there’s sort of a one-stop shop.
STACEY: I think the third-party comment is very fair. It’s not Supervalu, it’s not General Mills and it’s not Campbell’s saying that this is a good source of fiber. It’s dietitians. It’s scientists and it’s the FDA; it’s not marketing.
ROBERTS: Two years ago Bruce Berger had demonstrable results of motivational interviewing, a technique of behavioral psychology. And whether it’s the nutritionist, whether it’s a pharmacist, whether it’s a nurse practitioner, the reality is none of us have those skills. We’re pretty good at talking at people, but not necessarily at changing behavior or finding ways to motivate change. I think that’s another discipline that we can bring to the setting. Or teach the people we have the additional skills.
EDDY: We’ve started down that path, partnering with a local college, Des Moines University. We’ve put most of our dietitians through health-coach training, and motivational interviewing is part of that process. And we’ve had a few pharmacists who were interested and they’re going through it now. We’re looking at developing a module for motivational interviewing and health coaching that our pharmacists can take as well.
BLISCHOK: I believe that in the next five years people will either select or deselect a retailer based on that retailer’s attentiveness and consistency and on truly helping change our lives. I think that’s a big issue, a really big issue.
PINTO: Are you all optimistic about what you’re doing, about making progress, even if you get discouraged?
STACEY: Both. I’m optimistic because Supervalu has made a commitment to it. We’ve put programs in place trying to solve this. It’s something that our CEO recognizes as a growth engine for the company. But I’m also frustrated because solving this isn’t easy, and it requires a lot of patience and persistence, and we can’t go as fast as we need to.
BUCH: We have the unique opportunity to address health and wellness right at the point of purchase. The retailers who are making it simple and making the shopping experience more enjoyable, adding theater, demonstrating household solutions — I think those are the retailers that are going to succeed overall.
One thing that we’re doing at Weis Markets to have a real impact is educating children about health and wellness. We’re accomplishing it through educational field trips in our stores. We’re also able to send some education information home to be shared with parents. If we can help educate and inspire the youngest generations about how to live a healthier lifestyle, I think that’s how we’re going to have a positive impact over time.
WALKER: I was going to mention our Labels for Education program that has been active for over 30 years. Kids are the major focus of the program. Campbell’s is providing physical education equipment for schools, and providing information on healthy food choices to the schools as part of that program, because we know that today’s kids are going to be the adults of tomorrow. Also, many of the Hispanic moms are getting their information from their kids via the schools.
QUINN: I think there’s a big challenge in the area of time. I think that we’re talking business models where it takes time to do this right, even to get these baby steps. So that’s still a challenge.
WALKER: As part of our Campbellkitchen.com web site, which I’m responsible for, we now have nutrition information provided with nearly all of the recipes. They also come with a shopping list. The consumer knows that this recipe has these nutritional facts, and here are the things that she has to buy in order to get there. So at least it’ll reduce the shopping time for that one meal.
SNEAD: As a customer, I can’t tell you the number of times I’ve gone into a store with a recipe, and I get so frustrated by the time I get to the eighth item because I can’t find it that I give up. It’s really got to be individualized.
POLLEY: We actually have many members who have in-store kiosks that not only tell you what aisle your choices are in but can give you recommendations on what to do with foods you have at home in the refrigerator.
RODEN: I’m optimistic, and my optimism lies in the fact we’re identifying a narrow set of gateway categories by which the shopper values you as a health and wellness resource. And by focusing a little more narrowly in picking that handful of six or eight categories, including cleaning, baby care, nutritional supplements, healthy drinks and food, there’s a smaller number that we could attack right now and get a real result in terms of the shopper rewarding us as a health and wellness destination.
RICHARDSON: For Clorox, it’s a corporate commitment. If you look at innovation, where we’re going to commit our time is going to be health and wellness and sustainability. You’ll definitely see this corporation committed to those two megatrends.
SNEAD: I’m very optimistic. I think that we can’t lose sight of the fact that there’s got to be individualization. We’re going to develop strategies, but those strategies have to be implemented on a patient-by-patient basis. There’s no real quick win.
And as I think about pharmacy, and where pharmacy’s going to go in the next three to five years, there’s going to be a tremendous increase in the volume of patients with access to health care. State Medicaid programs are going to surpass Medicare in terms of the number of covered lives.
I think pharmacy has a tremendous opportunity, if we can send a strong enough message to our state officials to look at health care a little differently. Let’s focus on prevention and wellness and healthy lifestyles, encouraging patients to engage in their own health care.
WALKER: I’m very optimistic, because 10 years ago we weren’t having these conversations and now we are. But it’s going to be a long road, because it’s taken us a long time to get into the habits that we’re in as a country, and it’s going to take a long time to get out of them. I do think these baby steps are already starting to make a difference for some individuals. I also believe if we as an industry continue to work together, we can make progress.
EDDY: I don’t think the words for us are optimistic or pessimistic — it’s that we are committed. And we are determined. My chairman and CEO has pretty much told us what our goal is — that we are going to be in the healthiest company in America, and we’re going to help the states in which we operate become the healthiest states in the country. And we’re committed to getting our employees and our customers healthier, and helping them achieve their health goals.
PINTO: Thom, any final comments?
BLISCHOK: I’m not optimistic or pessimistic, either. I’m frenetic, a different word. I would say there are three fundamental things that I would recommend.
One is, I think we have to start with very simple and clear education. I think this education will be about the benefits of simply eating right and taking medicines. I think labeling is going to be the difference between the winners and losers: clear labeling that helps people select products.
And, I think simple preventative care. I think people can understand that there are some things they can buy — such as vitamins, nutrients, supplements, neti pots, hand creams and hand sanitizers — that will help. I would challenge every retailer in this room, and I will give you the data. I’ll give you the top 50 wellness items bought in the last quarter in America. And I challenge you to put them on the front page of a flier and say, “We are committed to health and wellness.”
This is what America’s buying. To tell Americans that you can help them stay healthier, I think, would be marvelous.
ROBERTS: I have another word, too. It’s pragmatic. Really looking for things that work, interventions that work. And prove them. Measure them. Document them.
PINTO: Cathy, how would you like to sum up?
POLLEY: The diverse group of experts gathered around this table today is representative of the supermarket industry’s desire to help our customers lead healthier lives through the choices they make at the supermarket and in their homes. The supermarket provides the unique asset of food, pharmacy and knowledgeable nutrition experts in one location to help America’s grocery shoppers better manage diseases, lower stress, improve nutrition and enhance their quality of life through healthy eating. Our members’ commitment is evidenced by the leadership role grocery stores and their vendor partners undertake to provide appropriate information and opportunities for all consumers to create and maintain healthy and active lifestyles. What we heard in our discussion today is strong evidence
of that commitment.
