One year ago in these pages, Harvard Medical School’s Stephen Soumerai wrote a scathing essay arguing that employer fines on overweight employees were ineffective. We’re here to tell you that Professor Soumerai is a cockeyed optimist. A new review in the American Journal of Managed Care shows that these fines transcend ineffectiveness. They are counterproductive.
To begin with, forced corporate weight loss programs don’t work. Of roughly 1000 wellness vendors promising weight loss, only one, the iDiet, has received validation. Literally no other corporate weight loss program can check three simple boxes that are standard in medical research:
- The study was controlled the way grownups would define “controlled,” not using unmotivated non-participants as a control for motivated participants, which Health Fitness Corporation inadvertently invalidated
- the program was sustained for 18 months, rather than eight weeks, which seems to be the new standard for get-thin-quick programs; and
- The results showed both high persistence and significant weight loss.
Even that study had significant limitations: One could argue that the sample was small and even 18 months was not a long enough period to determine if weight maintenance was likely to be permanent.
As compared to the 1-in-1000 vendors with legitimate study designs and results, we’ve outed thirty programs, like ShapeUp’s, that simply make up weight-loss outcomes. Usually (as in ShapeUp’s case), data manipulation takes the form of reporting “last man standing” outcomes ignoring dropouts and non-participants, which in ShapeUp’s case comprised the vast majority of all eligible employees. Shape-Up went a step farther, and failed to report on people who had gained weight over the period. (Their report, on their “success” at Highmark, has disappeared from their website.)
Let us assume, for a minute, that these programs could help people lose weight and sustain the weight loss. What would the impact be of that weight loss on healthcare costs and productivity? Looking at healthcare costs two totally different ways yields the same results. Government data attributes 3% of healthcare spending to increased obesity. A company that succeeds in reducing that by 10% would save 0.3% of all health spending.
As an alternative methodology, use wellness-sensitive medical events. They account for about 4% of spending. Reducing that by 10% would save 0.4% of all healthcare spending. Even if these numbers are off by a factor of 10, the net impact would still be a trivial reduction in total corporate expenses.
Nor is there any savings in productivity. Fatter people don’t type, talk, present, drive, teach, write, add, cross-examine, subtract, paint, prescribe, assemble, or do anything else (except maybe deliver packages or steal bases) more slowly than thin people—which is why fatter states and countries enjoy economic growth equal to or greater than their thinner counterparts.
Once again, even if we’re wrong and there is a trivial positive impact on productivity, it couldn’t approach the program expense and especially the morale impact of shaming, demoralizing and invading the privacy of employees. Employees hate these programs, which is why fines are needed to force participation. Even so, occasionally they revolt (like Penn State and CVS) or sue (Honeywell).
So far, our conclusions agree with Professor Soumerai’s. But as mentioned above, we go a step farther and put these programs in the realm of “counterproductive,” not just ineffective.
Attaching money to weight loss would naturally lead to bingeing before the first weigh-in, followed by crash-dieting before the last one. Perhaps even more importantly, a growing body of literature supports that repeatedly losing and gaining weight is not benign. (see footnote below) In fact, it may actually worsen many of the conditions that losing weight is supposed to cure. Even companies that make their money off weight cycling don’t endorse it.
Beyond that, some programs, notably Aetna’s, can specifically harm employees in the name of wellness. Aetna has partnered with a couple of unsuccessful drug companies to pitch obesity drugs to obese employees, drugs whose hazards prompted an editorial in JAMA Internal Medicine arguing that they never should have been approved. (One of these drugs is Belviq, which has the 3rd highest ratio of physician payments to sales of any drug.) Aetna has failed to disclose this editorial, and declined to answer questions about their program, including how can they position these drugs as “increasing productivity” when the drug’s disclosed side effects include impaired memory, attention, and language.
A great question is, why? Why would employers undertake programs that demonstrably fail, damage morale, and even sometimes harm employees? While stupidity and dishonesty can never be ruled out in situations in which benefits consultants are the major source of advice, there appears to be another more insidious motive: these fines themselves are now major sources of savings, as Bravo Wellness says on its website.
There is some good news. Companies that don’t obsess with their employees’ weights enjoy a significant competitive advantage in recruitment and retention simply by spending time maximizing the value of their endeavors rather than humiliating employees with weight concerns. So speaking as three people who all run small enterprises, we encourage our competitors to interfere as much as possible with their employees’ personal lives. Since it’s bad for their businesses, it’s really good for ours.
Ref – D.M. Bhammer and G.A. Gaesser. “Health Risks Associated with Weight Cycling.” In Wellness, Not Weight: Health at Eery Size and Motivational Interviewing. Ed. Ellen R. Glovsky. San Diego: Cognella, 2014.
Al Lewis and Vik Khanna are co-authors of Surviving Workplace Wellness with Your Dignity, Finances, and Major Organs Intact. Their website, They Said What, regales readers with stories of wellness innumeracy and deception.
Dr. Jon Robison is co-founder of Salveo Partners and co-author of the newly released, How To Build A Thriving Culture at Work: Featuring The 7 Points of Transformation.