Corporate wellness skeptics are out early this year, arguing that the data is squarely on their side and that simpler, laissez faire approaches could be more effective.
Healthcare consultants and wellness critics Vik Khanna and Al Lewis are at it again, chipping away at the hopes and dreams for employer wellness programs.
In the American Journal of Managed Care, Khanna, Lewis and researcher Shana Montrose have combed through all of the most recent wellness evidence and concluded that wellness and weight loss programs specifically aren't saving money, reducing disease burden or helping people slim down.
"It is time to end coercive or financially based wellness programs focused on weight issues," write Khanna, Lewis and Montrose. "There is no evidence that these programs work, but ample evidence exists that they are a morale-reducing and expensive distraction from the business of business."
For starters, Khanna and colleagues challenge the idea that America's weight and obesity program is actually a drag on productivity and economic growth. There is no correlation between obesity and manufacturing productivity or economic growth among the group of twenty nations, nor in the U.S. States, they note. Texas, the 15th most obese state, also has the country's second-highest per capita gross domestic product.
Putting that economic question aside, the country's obesity and diabetes are still imposing real costs to society. If the trends continue in tandem with the wave of aging baby boomers, the national budget and healthcare system will face real challenges -- from an increasing burden of diabetes-related cardiovascular disease and disability to senior living needs for 350-pound individuals with limited mobility.
To those ends, employer-based wellness and weight loss programs do not seem to be making much, if any headway.
"It is reasonable to assume that wellness savings and obesity reduction savings should correlate closely, but corporations have not found savings in wellness programs," Khanna, Lewis and Montrose argue.
They cite a litany of Health Affairs and RAND studies that have generally found no savings for employers and only in a few cases modest healthcare utilization improvements. The longest wellness study, probing PepsiCo's Health Living program, covered a period of seven years and although it found evidence of long-term return on investment, it's not clear that the weight loss interventions were the drivers of success.
Launched in 2003, the program included both lifestyle and disease management components. The study in 2010 concluded that the program reduced costs by $360 per participant annually, but from the management of diseases like asthma, heart disease, stroke, diabetes, low back pain and chronic obstructive pulmonary disease. No savings could be attributed to the lifestyle management components, the study found.
Other studies have found wellness program's associated with higher healthcare spending, likely due to the stream of tests, overtreatment and overdiagnosis following health risk assessments, many of which aren't recommended by the U.S. Preventive Services Task Force. A 2011 study of Blue Cross Blue Shield of Kansas City's wellness program, for instance, found that costs increased $600 per person.
Waiting for weight loss
Like the ROI of wellness programs, weight loss among individuals and groups can seem elusive "On the micro level, no corporation has ever followed large numbers of employees over a long enough period to track recidivism," Khanna, Lewis and Montrose write.
On a larger scale, Khanna and colleagues argue, studies can have dubious methodology and even then show only limited benefit.
A report on Highmark Blue Cross' ShapeUp program for its 19,000 employees in Delaware, Pennsylvania and West Virginia only included results for active participants who succeeded in short-term weight loss -- not counting changes for nonparticipants, dropouts or anyone who gained weight -- and touted that 0.86 percent of the total workforce dropped into a lower weight category. According to Khanna, Lewis and Montrose, that is "perhaps even a lower percentage than random weight variation or regression to the mean would account for on its own."
Wellness Coaches USA, they noted, previously boasted that participants lost at least 12 pounds without disclosing participation rates or long-term healthy weight maintenance. The company recently started disclosing that data, too. Khanna and colleagues also criticize Cigna for guaranteeing weight loss and risk reduction for some employees but not accounting for those who gain weight.
"On the macro level, obesity and obesity-related medical events should be declining in the employer-insured population, if these programs are working as advertised given the number of employees with access to them."
So far, the only major population cohort that has seen a reduction in obesity over the last decade in is young children (following a steep rise, however, since the 1980s). And in total hospital admissions, wellness-related medical events have declined fast for Medicaid and Medicare patients than commercially insured populations, according to Khanna and colleagues.
All of which also leaves them wondering if there are perverse incentives in wellness programs generally. Are people likely to crash diet in workplace "biggest loser" contests or pay-per-pound weight loss reward programs? Are they honestly answering questions about eating habits, alcohol consumption or smoking?
These kinds of approaches can be "humiliating" and foment a sort of "surveillance-state mentality that encourages cheating," Khanna, Lewis and Montrose argue.
If employers want to help workers live healthy and productive lives, they should think both more broadly and more simply about the strategies, with the goal of first doing no harm, according to Khanna and colleagues.
Instead of health risk assessments and weight loss initiatives, "employers could subsidize healthy food options in workplace cafeterias, give employees an extra break designated for taking a walk, or reimburse fitness memberships."
Employers can also work with local governments to improve mass transit and active transportation options like bike and walking paths, and adopt flexible working arrangements like telecommuting, which some insurance leaders themselves use to good effect. As LuAnn Heinen, a vice president at the National Business Group on Health, argues, the end goal could be better called "wellbeing."