Life inside company “wellness” programs — see those frowny faces

While glowing reports of company “wellness” programs fill business and healthcare management publications, many employees have very different perspectives.

Marketed by health plans and “wellness” companies, employer wellness programs begin with a Health Risk Assessment. Employees, like those at Dow Chemical Company, complete a detailed questionnaire which asks about their smoking, eating and exercise habits, lifestyles down to seat belt use, and personal and family medical histories. As Human Resources Executive reported this week: “Dow’s health-services staff checks each participant’s height, weight and blood pressure, and draws blood to measure cholesterol and blood-sugar levels. The numbers are then entered on the assessment.”

Most of these “health risk appraisals,” assign employees a “ health age” or “risk age.” According to Don Hall, president of a company selling wellness program and health risk assessments: “The average person can add 5 or 6 years to their life expectancy if they’ve lived a really healthy lifestyle.”

The “best” plans refer employees to doctors or company-sponsored wellness programs. “An overweight employee is told about Weight Watchers and other programs to aid weight loss, for instance.”

Employees get the results of their health risk assessments in different ways. While many get an electronic or written report; others are met with by a nurse or other health professional. At Dow Chemical Company, for instance, every employee’s HRA is reviewed in a face to face meeting with someone from the company’s health services department where “future action” is discussed.

Companies marketing these employer wellness programs unfailingly tell employers that the keys to the success of any program are to make it a priority from the top management down, put a team together to administer it and create a corporate culture of health. Employers embodying their programs are recognized in annual awards, such as the 2007 Well Workplace Award Winners just announced by one wellness company, Wellness Councils of America. And the lobbying organization for wellness program interests, National Business Group on Health, will give out its Best Employers for Healthy Lifestyles Award on May 9th. One of last year’s Platinum award recipients, Medical Mutual of Ohio in Cleveland, has a team of three and a half full-time-equivalent employees that’s dedicated exclusively to their company program. As Occupational Hazards reported, Medical Mutual also funds up to 70% of the cost of Weight Watchers (a founding Board member of NBGH). The other parts of their program include mandatory health screenings, health education seminars and, of course, the annual health risk assessment “to track employee health, measure the program's success, determine program priorities and provide an incentive for participating.”

The company uses the information from the employee’s HRA, combined with the employee’s health claims data, to place each employee in one of three risk categories: low, medium or high risk. As reported, “Medical Mutual determines each employee’s risk category by using the 12 risk factors – such as blood pressure, cholesterol levels, [weight] and smoking status.”

“It’s all about reducing risk.”

As the coordinator for a wellness program in New York told the Worcester Telegram & Gazette last week:

I do wellness coaching....Once I get an HRA in, I will contact the person and go through an entire assessment, much in the same way you would if you went to your medical office. I...also do an assessment to determine the patient’s readiness to change. Typically, it’s weight, but it can be heart health, high blood pressure, high cholesterol, and usually there’s a fitness piece.

I want to know everyone in your household, your pets, the things that will get in the way of you making these changes. I want to know everything I can about you. Then there’s some accountability. You want to report back to me and tell me how you’re doing.

Dieting and thinness are equated with "health" and "fitness" in almost every company wellness program. The San Antonio Express ran a story this week about the employer wellness program at a local insurance company, where a company executive said that thinking about “wellness” has quickly become part of the company culture. They started their own Biggest Loser style competition and employees are gathered for exercise “to the strains of Survivor's ‘Eye of the Tiger’ over the office PA system. Many company programs host weight-loss competitions. Another company rolled out is “Commit 2B Fit” program which includes “constant health education in the office.” The company, according to the Express, also “no longer hires smokers.”

According to a corporate wellness program company report:

Making wellness part of the prehiring and welcoming of new employees sets the stage for workers to self-manage their health. It “sets the tone for a culture of individual accountability in health, and reinforces that employees are expected to be knowledgeable and active in managing their personal health.”

And companies use incentives to compel compliance. “We use every sneaky, devious trick we can to get people to do things that are good for them,” said one company president. For example, they price sodas at higher prices than the diet versions. But increasingly, as the Express noted, it’s hitting employees’ pocketbooks in far more substantial ways. Employers, for instance, will raise the amount of health insurance premiums workers pay by $500, then “waive” the price increase if employees agree to a health risk assessment and the inherent obedience it entails.

Creating cultures of health includes using the “peer approach.” In other words, the pressures and environment can get so intense and intolerant of those who aren't complying, it becomes a matter of ‘go along to get along.’

This can and is making the workplace not only a foreboding place to work, but for some, actually life-threatening. It goes beyond concerns over the lack of efficacy behind employer wellness programs, but brings up questions about if employers can compel people to do things for which there is evidence it could be harmful for them. Plenty of employees are not appreciative of these initiatives, but their perspectives never make the news.

Employees who have educated themselves on their bodies and health, or learned from years of dieting, know that dieting and weight loss programs are not only ineffective, but have been shown to jeopardize their health in the long-run.

Employees who understand that risk factors are not measures of health, lifestyle behaviors, or future risk; know that the mildly-raised numbers for most are largely reflections of age, social stresses or size; and that the evidence demonstrates that a life-time of medications to keep their indices at “ideal” ranges may not be best for them and may actually put them at greater risk. [See upcoming post: The greatest myth of health risk factors]

Employees who have come to understand and appreciate the natural diversity of shapes and sizes, know that weight is not a sound measure of health, good behavior or well-being, and object to weight discrimination.

Employees who value work-home balance; and may prefer to get their activity doing things they enjoy away from work, such as go home and play ball with the kids, walk with their family after dinner, go for a swim, work in their garden or go dancing with their spouse; or those who would prefer to engage in physical activities that are more appropriate for them, rather than participate in work-sponsored kickboxing or runs.

Employees who simply believe their private lives are of no business of their employer to micro-manage.

But some of the most overlooked oppositions come from what these programs are like for those recovering from eating disorders. Insightful and painful stories have been written recently on this aspect and are well worth our time to consider. They chronicle how these employer wellness programs are making the workplace so unbearable, that some have found it essential for their health and wellbeing to quit their jobs.

When a company “Fitness Challenge” was instituted at his company, Patrick wrote an incredibly powerful, and well-written essay explaining how dysfunctional the messages and behaviors being encouraged in this program were. It’s must reading. His fiance is a recovering anorectic who’d spent years in recovery to get to the more healthy place she is today and this program made him angry. He wrote:

I know I’m healthy. I can run for thirty minutes on an elliptical machine at the gym or go through a 45-minute Pilates class without falling over afterward. I can go for half-day hikes in the mountains and feel as good at the end as I did at the beginning.... I’m satisfied with my health. My employer is not.

My employer wants me to lose weight, to exercise more, to eat better, because, damn it, I can’t do it on my own...Of course, I didn’t sign up. One, I have this huge anti-authority streak in me, and that alone makes me resist such groupthink corporate solutions to social problems. Two, I’m healthy, and I tend to get indignant when someone – or some corporation – 1,000 miles away and never in eyesight tells me I’m not. My fiancée is a recovering anorexic, and perhaps it is this, even more than my antiauthority side, that has me angry about this new program.

Employees who sign up for the Challenge were given a calendar with patronizing little smiley faces for meeting the goals and frowny faces for not. The “health” prescriptions include suggestions like:

“Eat half your lunch today. If you eat out, take half in a doggy bag.” This is an exact trigger for disordered behavior. You’re aware how that process works....You know, if eating half my lunch is healthy, eating NO lunch must be even healthier. And no breakfast, too....So it begins. This story does not have a happy ending. See my frowny face.

“The Challenge” is also big on counting. It’s right there on the poster I see every time I come in to work, every time I leave, and every time I use the bathroom – “Whether you’re counting calories, steps, minutes, inches or pounds: Your health counts!”

No. Don’t tell me – or, maybe even more important, don’t tell my fiancée – that we need to start counting calories, counting inches, counting pounds. She did that for half a decade and all it did was get her sick. See my frowny face.

The calendar also mandates weekly weigh-ins and random daily calorie counts. I’m sorry, but that’s the last thing I want my eating-disordered fiancée doing. No, no, no. For her, and for any other person with a tendency to eating disorders, this is the first step to ritualized behavior. See the process? … You know, if I weigh myself EVERY DAY, and if I count my calories at EVERY MEAL….No. I won’t subject her, or myself, to that. See my frowny face.

Last month, Charlynn at Disordered Times wrote:

The company I work for (which will remain nameless) recently started a “fitness challenge” that encourages employees to eat nutritious foods, exercise, and develop a healthier lifestyle....Sounds like a great way to encourage health, right? ...What’s not to love? Well, for one thing, this. This is the poster that currently decorates the walls of my workplace at a frequency of every two feet. Well, almost. It seems like there are that many. I have a couple of problems with this poster.

Exhibit A: the scale. 100?! No healthy adult above 5' tall should consider that a healthy or ideal weight! That’s a horrible message to send to anybody, much less someone who is interested in losing weight...

Exhibit B: fork and tape measurer. Here we go again. Food and weight. Food and weight. Repeat ad nauseam....

Exhibit C: the specified goals....This is a screen shot of the online sign-up form. It’s very clear what they are promoting. For those vulnerable to eating disordered behavior, this is very dangerous ground. For those not prone to it, it still reinforces the dysfunctional relationship with food and weight, whether it’s realized or not. That isn’t healthy for anybody…It just so happens that it keeps the disordered mentality of this culture alive instead of promoting what it claims it is promoting: health.

After a few weeks of this program, her online diary became increasingly more upset that everything about a “healthier lifestyle” being promoted revolved around calorie counting. It’s worth reading her next post in its entirety, as it shares the same concerns of eating disorder clinicians, but here are a few excerpts.

For the eating disordered, [calorie counting] is a way of life...Basically, I see this “goal of the day” as an exercise in eating-disordered behavior in otherwise normal, non-calorie-counting people, regardless of total intake.

But why stop there? Why not feed peoples’ obsession with weight as well? If they don’t already have one, let’s create it by making them weigh in every Sunday (see calendar). Yeah, that should reel them in. The more weight they lose, the more interested they’ll be in watching the number drop. Not only will they weigh in on Sunday, but eventually Monday, Tuesday, Wednesday…*grumbleSCREAM!grumble* Don’t fuck these people up!

To win a smiley face for the one of posted goals, employees are told to only eat half their lunch, and she wrote about that, saying:

I really have a bone to pick with this one. What if you brought a bagged lunch consisting of a sandwich, a piece of fruit, and a small dessert and saw that as your daily goal? It’s a perfectly sensible lunch, but for the sake of putting that damn smiley face on the calendar...THIS IS NOT A HEALTHY GOAL. This is what people with eating disorders do. This also, incidentally, leads to the binge/purge/starve cycle that so many eating-disordered people fall into....

What ultimately pisses me off, if you didn’t guess, is that I don’t see this program as a pursuit of real health. It’s about dieting, and dieting does not equate health....No one knows what might trigger the properly predisposed person into taking a diet too far. No one knows who those vulnerable people are. The company I work for certainly doesn’t, and yet, their corporate offices are telling all of my co-workers that they should improve themselves by eating less and working out more.

They’re telling me the same thing, and you know what? I’m angry. I spent nearly five years in eating disordered hell, and just when I’m reaching some semblance of normalcy in my life, you assholes are telling me that I should jump on the bandwagon for the sake of lower insurance premiums?...

It’s been a long, agonizing progression, but my world no longer revolves around what I eat, when I eat it, and whether I’m losing weight or not....That’s a far cry from the person I was two years ago, who had resigned herself to dying from her eating disorder and wished for as much. It’s been a lot of work reaching this point, so it’s very disappointing when something like my workplace’s “fitness challenge” presents itself as a quick way to tear it all down. It makes my own challenge of living that much harder.

Carrie, a recovering anorectic, has been chronicling her job and its diet-obsessive culture. Last Monday she wrote:

After every Big Fat Loser episode, I keep thinking “This can't get any worse." And yet, every time, I am proven wrong. It can and does get worse....The reporter from the local paper is here to do a feature on the Big Fat Loser contest and how it was so beneficial, and how the health department is setting such a good example...I see the display poster they made for the interview. There were all of these little gold stars scattered around saying how many pounds each person had lost, how great they feel, that they had to buy new clothes because they lost so much weight. Blah blah blah. I actually feel offended not only because of the obvious reasons, but because I couldn't add my own little gold stars....

Her emotional article explains what she lost when she lost weight and the toll it took on her life. The employee “wellness” program proved so unhealthy for her, she turned in her resignation Friday.

How much of the “success” ROIs quoted for these programs are reflections of the numbers of fat, older, smoking and other employees such as her, who have simply been run off? If employers only hear the marketing spins, and they never hear employees' perspectives, and they never hear from medical professionals about the poor science behind these wellness programs, and they never hear from eating disorder experts about the harmful messages saturating these programs, how many more may be harmed?

© 2007 Sandy Szwarc