LIES, DAMNED LIES, & WORKPLACE WELLNESS

Which of the following statements is true?

1. The earth is flat.
2. Global warming is a hoax perpetrated by the Chinese.
3. The research supports drinking 8 glasses of water a day.
4.  Workplace Wellness saves money on health care costs.

Answers:

1. Not this one - though that doesn’t stop this organization from claiming that it is.
2. Not this one - although certain people have suggested so. (hint: rhymes with grump).
3. Not this one - no such research exists.
4. Not this one - no properly conducted study in the past 10 years supports this.

So why do we keep hearing that "workplace wellness works"?

Now that’s a question that will take a little digging into. Let’s start with a Randomized controlled trial that was just published in April in the prestigious Journal of The American Medical Association (JAMA).

Briefly, researchers from the University of Chicago and Harvard randomly assigned 20 BJ's Wholesale Club stores to participate in a wellness program offered to all employees, and compared the results to their other 140 stores where the program was not offered (33,000 workers in all).

The wellness program consisted of lots of the usual; asking participating workers to fill out a health risk questionnaire, have some medical tests such as blood pressure and blood glucose, and take up to eight classes on topics such as nutrition and exercise. Participants were incentivized to a total on average of 250 dollars.

After 18 months - wait for it – here are the all too common results:

• No differences in any health measures - blood sugar, cholesterol, BMI, etc.
• No changes in how much employers spent on health care
• No differences in how often they missed work 
• No impact on job performance 
• No differences in employee tenure

To Summarize: The program had no significant effects on 27 self-reported health outcomes and behaviors, 10 clinical markers of health 38 medical and pharmaceutical spending and utilization measures, and 3 employment outcomes.

Desperate for something positive to report, the authors claimed that those participating in the wellness programs self-reported “significantly greater rates of some positive health behaviors”- specifically engaging in regular exercise and managing their weight.

It is possible that participants were exercising more as a result of the intervention, however the self-reported nature of those findings makes that conclusion questionable at best. After all, what would you be likely to report after participating in such a program for a year and a half?

 As for the conclusion that participants were “managing their weight better” which is how it was reported in the lay press, a bit of closer examination is required. The original article in JAMA stated that participants self-reported increases in “actively managing” (not better managing) their weight. It is perhaps not surprising that the researchers chose to see this as positive health behavior given our culture’s obsession with dieting and thinness. However, acknowledging the consistent, conclusive, dismal results of hundreds of studies over the past 4 decades involving people who are “actively managing their weight,” this is at best a questionable assumption.

It is hard to imagine anyone taking away anything positive from this study, but as always there was the inevitable spin from the industry. One wellness vendor said that the incentives simply weren’t large enough. Unfortunately, there is absolutely no evidence (and there never has been any) that these kinds of incentives would “generate better results” as this person claimed.

And then of course there were the usual complaints that the program was not targeted properly and/or lacked the intensity, duration or focus to produce positive outcomes. These are the same complaints we have heard almost verbatim after each failed study – of which there are now at least 11 others, most of which were designed specifically to prove that wellness works but accidentally showed the opposite.

Following each study and with only slight variations, the spin inevitably goes something like this:

1. Yes, this study, like the others before it does not show that these programs save money (or even pay for themselves) or have much of an impact on health.
2. But… this study, like every study involving humans is messy and therefore is simply not definitive.
3. Since the study was not perfect, we need another study, in which we will mess with one or another of the variables – and eventually come up with the same conclusions.

The authors desperate attempt to salvage something from the ruins was almost humorous, as they concluded:

  “Although limited by incomplete data on some outcomes, these findings may temper expectations about the financial return on investment that wellness programs can deliver in the short term."

Ya think?

Full Circle

This pattern has been repeated over and over and over again, approaching ad nauseam since the 2010 passage of the now discredited Safeway Amendment. The situation has reached the point where an appropriate analogy can now be made to weight loss research of the past four decades, certainly scores if not hundreds of studies. Regardless of the population, the length and intensity of the program, the type of intervention, the credentials of the people running the program, and every other variable imaginable, the results of weight-focused interventions are remarkably similar and frightfully dismal.

And yet, somehow, someone always finds a little something or other they can claim they need to alter to qualify for another research paper which will ultimately reach the same conclusions – and do damage to untold numbers of people who will see themselves as failures and may have their health compromised as a result of the weight cycling that occurs for the overwhelming majority.

A Code Of Conduct for "Ethical" Workplace Wellness

It is for this reason that Salveo Partners – along with Al Lewis, The National Wellness Institute, WELCOA, and many other individuals and organizations has adopted an amendment to the Employee Health and Wellness Program Code of Conduct that states that, ethically, weight loss programs must provide this upfront transparent information to potential participants about the most likely outcomes and potential iatrogenesis of their offerings:

“Research shows that the vast majority of people who participate in weight loss programs will eventually gain their weight back after the program ends. Many will also gain back more than they lose. The weight cycling that occurs with repeated participation in weight loss programs may have negative effects on their health.”

Similarly, I would propose that it is no longer ethical to subject employees to incentivized clinical wellness programs (including for research purposes) at the workplace without at least providing similar upfront, transparent information about the most likely outcomes and potential for iatrogenesis as consistently and conclusively demonstrated in the research over the past decade. These approaches were from the get-go opposed by most major health and prevention organizations in the U.S. They do not save on health care costs, don’t pay for themselves and have minimal positive impact on health. It is simply time to put a stop to this nonsense.

What Can We Do Instead?

We use the Thriving Organization Pyramid (free download available here) to demonstrate what it takes to create and nurture organizational and employee wellbeing. There is no question that the two are inextricably interconnected. And for sure, nothing is more important to organizational effectiveness than the wellbeing of its employees. As Simon Sinek so poignantly points out:

“Happy employees ensure happy customers. And happy customers ensure happy shareholders – in that order.”

The critical underlying issue is that the wellbeing of employees does not start at the top of the pyramid in the space labelled wellness programs and resources because:

• Without addressing the bottom parts of the pyramid – culture, leadership, physical and psychological safety, wellness programs do not (and are not going to) make much of a difference.
• If those issues are adequately addressed, properly implemented wellness programs - no incentives, screening according to USPSTF guidelines, proper research methodologies, etc. and done for and not to employees - (thanks to Al Lewis for that terminology) can add significant benefit.
• Regardless of how appropriate and/or comprehensive wellness programs are, they are not healthcare cost savings strategies.
• The key is to shift from offering wellness programs to installing employee wellbeing as part of your cultural brand – an overarching umbrella that encompasses everything you do to support employees in bringing their best selves to work and home each day (i.e. the entire pyramid).
• For example, consider embedding wellness/wellbeing within your leadership and people development strategies instead.

Here We Go Again

As I was writing this piece, another randomized controlled trial popped up on LinkedIn. This one is included in the eleven mentioned previously. Reported in The Los Angeles Times, the study was originally concluded about a year ago. You will never guess what they found.

Some 3,300 employees of the University of Illinois at Urbana-Champaign were given a year of access to a workplace wellness program similar to what many companies offer their workers. A control group of 1,534 didn’t get access to it. I have left off the name of the vendor because given the consistent and conclusive findings of the past ten years, does it really matter?

Without going into all the details, the researchers found participation in the wellness program:

• Did not result in better health outcomes 
• Did not lower healthcare costs.
• Did not alter medical spending habits of participating employees which were almost identical to those of non-participants.

Actually, the control group had slightly lower health insurance claims than those with access to the program. In the researchers own words:

  “We don’t see anything trending toward savings.”

For those who will be tempted to slap the usual spin about why this study also wasn’t the final word because, blah, blah, blah, blah, blah and so we need more studies – I entreat you – PLEASE DON’T. Please allow the incentivized wellness experiment to die the peaceful death it so eminently deserves.

OMG! - Seriously?

My sincerest apologies. I was just getting ready to wrap this up and post it on Pulse, when an email popped up on my computer. It is a marketing piece for a state Workplace Wellness Conference that I had actually keynoted a number of years ago (apparently didn't have much of a sustained impact at least on the marketing team). Without going into a lot of detail, I wanted to point out two issues relevant to this conversation.

The first issue has to do with the pictures on the brochure. Posting them would give away what State it is, and as I said before, that really doesn't matter. The four pictures are populated by seven young, thin, white employees; one in a tie curling a small weight with his right arm, one eating an apple in front of her computer, one on his bike in his office leaning on his desk, and four standing in a conference room all in various stretch poses (one with his foot on the table) with stacks of papers in front of each.

This is actually pretty much the same brochure pictures from when I keynoted the conference. During my presentation I went out of my way to kindly suggest to them that workplace wellness was so much more than this - clearly that fell on deaf ears. I also stressed the importance of diversity - well...

The second issue relates more directly to the essence of this piece. I actually considered writing a separate post on the text in the brochure, but will here just summarize the most egregious part. Here is what they said to market their conference:

"Properly designed health promotion programs can positively impact an employer’s bottom line. The American Journal of Health Promotion analysis found that for every dollar invested in workplace wellness, employers could expect a return on investment (ROI) of $5.81 due to improved employee health & reduced medical claims - that is almost six dollars returned for every dollar invested. When more advanced prevention strategies & technologies are offered in health and productivity management, experts agree that employers could expect a ROI perhaps even as high as 15:1. Employers are well aware that neglecting the health of employees carry a high price in healthcare costs."

The good news is there is one sentence fragment here that is accurate. An ROI of 5.81 "is almost six dollars returned for every dollar invested." That is undeniably true! Every other statement is misleading or blatantly false. Let's break it down:

1. "Properly designed health promotion programs can positively impact an employer’s bottom line." We have already discussed this. No properly conducted study in the past decade has demonstrated anything even nearing this reality.
2. "The American Journal of Health Promotion analysis found that for every dollar invested in workplace wellness, employers could expect a return on investment (ROI) of $5.81 due to improved employee health & reduced medical claims." This was actually reported in that Journal but it was more than a decade ago, included studies that were even older and many that were not properly conducted or evaluated.
3. "When more advanced prevention strategies & technologies are offered in health and productivity management, experts agree that employers could expect an ROI perhaps even as high as 15:1." That is just plain nuts. There was no such comment in the cited Journal article. There was a comment that another almost 15 year-old-study claimed an ROI of that size as a result of supposed decreases in absenteeism, but that conclusion was based on comparing participants to non-participants, a study design that has been repeatedly invalidated as described here and here. And even if some "experts" back then thought that, they sure as hell don't think it now, as Rand's Dr. Soeren Mattke concluded almost a decade after that piece was published :

“The industry went in with promises of 3 to 1 and 6 to 1 based on health care savings alone – then research came out that said that’s not true – then they said ok we are cost neutral – and now as research says maybe not even cost neutral they say but is really about productivity which we can’t really measure but its an enormous return.”

4. "Employers are well aware that neglecting the health of employees carry a high price in healthcare costs." Aside from the questionable use of the English language, and with the possible exception of some very stuck wellness vendors, almost no one believes that wellness programs can lower healthcare costs - and even if they did think that almost 15 years ago - this conference is upcoming this year - 2019. Again, Dr. Mattke, five years ago:

We keep positioning wellness programs as a healthcare cost-savings strategy even though the non-vendor research does not support these claims.

Just to add insult to injury, the individual who wrote this outdated, misleading piece in the American Journal of Health Promotion is also on record as saying that: 1) HRA's can cut the average health care cost in half after three years and that 2) wellness can reduce costs by 327% (hint: you cannot reduce a number by more than 100%).

There is really no excuse for this organization to be relying on terribly outdated data and misleading conclusions (not to mention a lack of editing) to market their conference. It gives all of us and our industry a bad name! OK - so back to the wrap up before something else pops up!

More Than “Just a Wellness Person”

Let’s stop subjecting employees to these ineffective and often iatrogenic initiatives and focus our attention and often scarce resources on the things that we know make the difference between organizations that are just surviving and those that are thriving. We will be doing everyone a favor because:

1. Employees hate these programs anyway – they have the lowest Net Promoter Scores of any industry.
2. Organizations will have saved substantial sums of money they can now spend on things that really matter – culture work, leadership development, health care literacy, etc.
3.  In terms of healthcare costs, both organizations and individuals can turn their attention to the only way of lowering them – by addressing them directly, a process that can begin right here.

Workplace wellness professionals often know quite a bit about wellness but very little about the workplace. This is highly problematic, particularly now when the business landscape in the so-called VUCA world is changing so dramatically and so rapidly. If you are reading this as a workplace wellness practitioner, not to worry. There are lots of ways for you to get intimately involved in helping to create thriving organizations besides teaching lunch and learns, facilitating weight loss programs and implementing HRAs and bio-metric screens. At Salveo Partners we teach professionals how to do this. You can read about this in more detail here.

The bottom line is that wellness professionals can be uniquely positioned to bring the understanding of the multiple dimensions of the human experience (think mind, body, spirit for the organization) to the corporate world. From nurturing relationships and coordinating cooperation across important organizational disciplines, to carefully crafting and training culture and wellbeing teams and ambassadors, to helping view data holistically, wellness professionals can greatly increase their contributions to creating thriving workplace cultures far beyond the possibilities made possible by just running programs.

And with some additional training they can also bring this holistic, humanistic approach to the most critical aspects of organizations, leadership development and vision and mission work, where updated understandings of human behavior, intrinsic motivation, emotional intelligence and resilience are highly valued. Lots of great work to be done when you understand that you can be so much more than “just a wellness person.”

If that sounds exciting to you and you want to greatly broaden what you bring to the table, you might want to check out our next intensive online training coming up in September.

Let’s end the “wellness or else" era once and for all, stop treating employees like rodents running through a maze, and join the amazing business revolution already in progress. Take care – Dr. Jon