Employee Health Codes Of Conduct: What Would They Look Like and Who Would Accept Them?

You start a new job, you sign a contract, and then the division hands you the employee code of conduct. Now, in addition to the “no wearing a speedo” to the office, dress code clause, there is a section on health. Imagine, just as important as your job description or dress code, is your health. From the first day you join the company, you are offered resources, motivation, and encouragement to also maintain health during the duration of your employment? This is the idea behind Health Codes of Conduct.

Most workplace health programs achieve modest gains in health behavior. In a study with 147 employees we collected reactions to a novel approach to workplace wellness that suggests promising directions for future programs. Specifically, the idea is to engage and motivate employees to assume responsibility for their health through a Health Code of Conduct from the first day they are hired.

Results of this study found all employees offered modest to high support for the idea of Health Codes of Conduct, including overweight employees. Additionally, employees in the current study provided responses to various components of a health code of conduct. Our study found participants most likely to select Health Code of Conduct components that were easy to implement, but also low cost, such as asking employees to take an annual physical or work to achieve a certain BMI during employment.

Interestingly, while support was observed on average across various employee segments, there was one group that did not support the idea of a Health Code of Conduct. While overweight employees even provided support, it was obese employees (with a BMI over 30) that provided the lowest responses and reactions to the program.  Why did overweight but not obese employees on board for Health Codes of Conduct? We believe that a mechanism like Health Codes of Conduct might serve as a precaution whereby overweight employees who sign these materials are more motivated to stay on track with a diet or other health plan, whereas obese employees may need extra motivation, such as fitness or nutrition education in addition to this Health Code of Conduct.

Using the specific features of Health Codes identified here, visionary companies can tailor their own company’s Health Code of Conduct with the appropriate monetary and non monetary incentives and disincentives to engage a diverse employee base. However, overweight employees appear to view such programs as an extra motivation and incentive to lose weight and get healthy, whereas obese employees see the program as a penalty.


Rebecca is a fellow at NYU Langone Medical Center in the Department of Population Health. 

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7 replies »

  1. Sorry to prattle on, but I just did a bit more reading about the study. I see that you and Dr. Wansink wrote, “One flaw of such many workplace wellness programs is that the burden for employee health is often shouldered by the employer, instead of the employee.” Obviously, I disagree. Employers have borne the burden of the cost of behavioral change programs, gyms, screenings, etc.. But that still leaves the burden of health to the employee. Don’t get me wrong: Employees should be responsible for their health behaviors. And it is, indeed, nice when employers support this responsibility. But many employers have by no means acknowledged or fulfilled their fair share of responsibility to employee health.

  2. Hi, Dr. Robbins. I appreciate your out-of-the-box thinking about employee health. But I don’t think it’s far enough out-of-the-box. If American workplace wellness programs have only achieved modest gains in employee health, part of the reason is because employers have been convinced that their primary role in health is to provide resources, motivation, and encouragement. The real levers of employee health are…

    — Job demands and job control…
    — Rewards, and how they sync with perceived worker effort…
    — Long work hours and overtime…
    — Work-life conflict…
    — Organizational justice…
    — Shift work…
    — Job security…

    Employers committed to an evidence-based approach to employee health should focus on these factors. Upon request, I’d be happy to provide a link to my website in which some of this evidence is summarized. This is also the approach embraced by other economically advanced countries and, to a large extent, the US National Institute on Occupational Safety and Health (NIOSH) Total Worker Health program.

    Perhaps there is a place of compromise: A “Health Code of Conduct” strikes me, personally, as demeaning. Personally, I might be more willing to accept a “Health Agreement,” in which I do what I can to achieve optimal health and the employer does what it can to evoke optimal employee health. And what the employer can do does not stop at providing resources, motivation and encouragement (which are important, but ultimately icing on the cake). The employer must be committed to changing itself — with participatory management, secure jobs, reasonable schedules, fair rewards, work-life policies like paid parental leave and paid sick time, and encouraging alternative work arrangements, like work-from-home. Employers that assume, despite the paucity of evidence, that accountability for the health of an employee population falls exclusively on the shoulders of employees, are not likely to surpass their modest gains in wellness.

  3. Hi all,

    Thank you for this great discussion! If you would like to see the paper, just email me for a copy at robbins.reb@gmail.com We can get into the methods, certainly, and explain a bit more about who we sampled and what we found.

    One of our biggest take aways is that this is a tool that will allow corporations to guide culture in a healthful direction. Scores of evidence suggests that social factors matter. What if from the first day it is made clear that your health as an employee is a priority for your company?

    We tested a range of potential incentives and disincentives employers might include in their Health Code of Conduct, ranging form capping BMI (aggressive) to simply taking a health risk assessment (conservative). These were intentionally diverse recognizing that all corporations are different. Certainly, this is envelope pushing, and we argue that solutions like this are needed to advance the wellness field beyond null (or negative; your article below, @whynobodybeliev, suggests.

    Yes, there is bound to be pushback. Our study found that to come predominantly from obese – not overweight – groups predominantly, suggesting the program and policy might be rolled out with particular care among these groups.

    Be well!


  4. As the sun rises in the east and sets in the west, so too does Al Lewis criticize employee wellness posts.

  5. For the sake of accuracy, I should probably mention at this point that the “no wearing a speedo” rule is actually in place here at THCB following “the Matthew incident”

    We consider this both health and dress code related

  6. John has an excellent point. Not every employee in our company is thin, but they as of now are all motivated high-performers. Why would I care about their weight? Wouldn’t that just annoy them and make them self-conscious. There is one other slight problem too: these weight loss programs not only don’t work, period, but they can encourage bingeing before the first weigh-in and crash-dieting before the last. http://www.ajmc.com/journals/issue/2015/2015-vol21-n2/employers-should-disband-employee-weight-control-programs

    Have you ever run a company? There is a reason HR puts these programs in rather than line managers. Line managers need to hit targets and something as foolish as pestering employees about their weight will just make their job harder.

    Finally, if you think these programs work, why not claim the million-dollar reward we are offering to show that wellness at least breaks even? http://theysaidwhat.net/2015/08/06/show-wellness-isnt-an-epic-fail-and-collect-a-1-million-reward/

  7. I get the point here Rebecca.

    BUT I think there will be employees who argue back –

    Hey, it’s none of your freaking business what I do !

    I should be able to eat a cheeseburger every day.

    Jog / Not Jog / Sleep Not Sleep /

    Lie in bed watching Netflix all weekend

    Your code of conduct implies that there is something wrong with me

    What would you say to them?