What’s Science Got to Do With It?

Penn State University is now embroiled in a national controversy over the ham-handed launch of its coercive and intrusive wellness program, which can cost recalcitrant employees as much as $1,200 per year for not joining.  That ignominy of being the most distasteful and coercive program, however, belongs to Blue Care Network of Michigan, which recently published results from their “voluntary” walking program designed exclusively for their obese enrollees.  The invitation to join was extended to enrollees with a body mass index (BMI, which is an unscientific, mathematically bereft proxy for health – see Keith Devlin’s excellent article ) of 30 or greater.  The program was “voluntary” as long as you were okay with paying $2,000 in added insurance premiums if you did not volunteer.

Avoiding the $2,000 price tag came with its own cost in dignity and privacy.  Enrollees agreed to either: 1) wear an electronic pedometer and connect it to their computer daily to document completion of at least 5,000 steps or, 2) join Weight Watchers or some other approved “weight cycling” program.  This princely sum is not irrelevant to most families.  In fact, it is almost exactly equal to per capita spending on food eaten at home in the US and about four percent of median US household income in 2011.  So, in a household occupied by a single adult, this will almost buy your groceries for a year, meaning that is hard to refuse, and the less money you make the more likely that resistance will prove futile.

The BCN strategy legitimizes telling people who look a certain way that they should submit to online, electronic monitoring or pay more for their insurance than people who don’t look that way.  Why would an obese person submit to this when it is entirely possible that he or she is fitter and more metabolically healthy than an normal weight unfit person who would never be condescended to this way?

More disturbing is the prospect that this is only the leading edge of life-invading monitoring by the wellness industry.  It is easy to envision sleep monitoring because you have bags under your eyes.  Or, what about wrist-worn breathalyzers to make sure you don’t go over the one or two drink limit, or sneak cigarettes after lying on your health risk appraisal that you don’t smoke?  How much electronic surveillance would you be willing to undergo on the pure guesswork that it might save someone (i.e., your employer or your health plan) money?

Almost a third of the people who “volunteered” for the BCN walk-a-thon were angry and felt coerced into joining the program. (Actually, this was about a third of the only 12% of participants who bothered to answer the satisfaction survey.)  Their outrage is understandable considering that the criterion for participation was their appearance (because we know that thin people all get the recommended amounts of daily physical activity, right?), as opposed to objective measures, such as cardiorespiratory fitness, cardiometabolic markers, or how many steps they already walked in a day .  Even more amazingly, because these risk managing master minds collected absolutely zero pre-program data, there is no way to know whether the intervention increased anyone’s fitness, improved their cardiometabolic markers, or saved any money.

Finally, there is this nugget: , 47% of participants surveyed initially said they disliked being strong armed into the program.  At the end, more than 30% still felt that way. It’s possible that people who lost weight changed their minds, although it will be interesting to see how they feel when they gain the weight back, which according to the last 25 years of published research most of them certainly will.  Maybe then, BCN can give everyone two monitoring devices and entice them with $4,000.  In any case here is the compassionate response about this from the authors (at page 8 of 13).

“…nearly a third of them did not like the program…. Nevertheless, given mounting costs associated with sedentary behavior, approaches to financially incentivize healthy behaviors are likely to expand and gain political support…”

So, in this “seminal work” we are left with this: people didn’t like it, we have no idea of its impact on any meaningful health measure or financial outcome, but despite nearly total ignorance of value, we should do it anyway. Why?   Because both the government and large corporations have staked a claim to beating back the “obesity epidemic” using the cudgel of differential insurance premiums to drive health behaviors.  This stems from the falsehoods trotted out by the C-suite at Safeway during debate over the Affordable Care Act, which gave politicians the cover to claim that this was a good idea for everyone.

The BCN program shows that we have sunk to a new low in the US.  It is the most coercive, penalty-laden weight loss program that either of us has ever seen which, at the end of the day, measured almost nothing except a highly leveraged participation rate.  There is not a single word in the entire paper about the importance of organizational culture change as a foundation for helping individuals change behaviors.  This exclusion perpetuates the idea that wellness is something you do to people, instead of something you do with and for them.

Jon Robison, Ph.D., MS, has been teaching at Michigan State University for almost 20 years. He presents at health-related conferences throughout North America and is the co-author of The Spirit and Science of Holistic Health: More than Broccoli, Jogging and Bottled Water, More than Yoga, Herbs and Meditation.

Vik Khanna is a St. Louis-based independent health consultant with extensive experience in managed care and wellness.  An iconoclast to the core, he is the author of the Khanna On Health Blog.  He is also the Wellness Editor-At-Large for THCB.