Older and heavier need not apply

“Think your weight is nobody's business? Try telling that to employers,” wrote Julie Forster in the Pioneer Press in the Twin Cities.

It’s that time of the year again. The National Business Group on Health, a lobbying organization of large employers, health insurers, pharmaceutical companies and other stakeholders, has been stepping up its marketing of employer “wellness” programs.

The obliging media has been publishing articles profiling various member companies and writing about the professed “promising results” of their wellness programs in reducing health insurance costs. We can expect more such promotional articles as member employers vie to win the “2008 Best Employers for Healthy Lifestyles award” to be announced at the NBGH’s upcoming Leadership Summit on Obesity, May 12-13^th and as NBGH promotes this year’s program entitled: “Health at Work: Changing culture, behavior, environment.”

One poll that’s been quoted in the news and human resource publications, might seem to support the popularity of employer wellness programs. On February 21^st, the consulting firm, Watson Wyatt Worldwide, released a survey that reported half (53%) of the 117 large U.S. employers it had surveyed said they will use financial incentives to encourage employees to participate in wellness programs, including completing health risk assessments, by 2009. They reported that another 32% surveyed said they would consider it for the future.

Polls are, of course, a tried-and-true marketing technique to shape public opinion by creating the bandwagon effect. How the questions are phrased and interpreted, and who is selected to be polled, enable the pollster to “find” virtually anything he/she sets out to. Watson Wyatt has conducted a number of polls for NBGH. This poll would appear to be trying to convince nonmember employers that all successful companies are getting on the wellness bandwagon, while hoping consumers will believe that it’s so pervasive and accepted it’s futile to protest.

Earlier this week, the Pioneer Press wrote about General Mills, Inc., and other companies following its wellness program. Readers weren’t told General Mills is a founding Board member of the NBGH Institute on the Costs and Health Effects of Obesity. [Click on image to enlarge.]

Watching your figure? So's the boss

Think your weight is nobody's business? Try telling that to employers. Faced with ever-soaring health insurance costs, more employers are putting wellness programs into overdrive. They're no longer hinting that it might be time to think about getting healthier. They're making it part of the culture.

General Mills has made "healthy weight" a cornerstone of a wellness mission statement, launching dozens of fitness programs for workers at its Golden Valley headquarters and in its manufacturing plants. A Minneapolis marketing firm launched a "Biggest Loser"-style weight-loss contest, which morphed into workouts five hours a day for the most zealous participants. A commercial insurance agency in Minneapolis hired a chef to teach workers how to cook healthier meals. In Indianapolis, one employer proposed $30 fines for overweight workers.

Perhaps the most dramatic move here can be found at Treasure Island Resort & Casino, where employees and their spouses are now required to take a medical exam at work to qualify for employer-sponsored insurance. Included in the screening: a body mass index reading used to determine the cardiovascular disease risk created by excess body weight. If that number is too high, workers at the Red Wing casino will be encouraged to hit the exercise mat...

The article went on to quote the NBGH’s familiar talking points about the obesity epidemic and fat people driving up health care costs, etc. The human resources consulting firm, Hewitt Associates was also sourced. Hewitt will be familiar to JFS readers. It’s another founding board member of NBGH’s Institute on the Costs and Health Effects of Obesity. The Institute was launched in 2003 to promote health risk assessments and employer wellness interventions for healthier, more productive employees and, most importantly, as promising to lower healthcare costs for companies.

This time last year, Hewitt had released a press release announcing a nearly identical survey.

According to Pioneer Press, the latest Hewitt survey said 88% of the employers surveyed plan to “make significant investments in wellness programs in the next three to five years.” It was used to assert that “growing numbers” of employers are “alarmed” and taking steps to enact employer wellness programs. Sounds an awfully lot like a bandwagon pitch.

The Twin Cities’ article made a brief mention that only 12% of employees think their employers should be telling them how to stay healthy. While we didn’t hear much more about that vast majority of workers who don’t want their employers telling them what to do, Ms Forster provided sufficient information to reveal troubling problems and concerns surfacing with these programs.

When an employer, Treasure Island, issued new mandates for full blood tests required for employer-provided health insurance, employee concerns about the privacy of their genetic information were dismissed with assurances “there’s no truth to the concern over genetic screening.” In order to enroll in employer insurance plans, these casino workers must now:

... file into a private room at the casino to give two vials of their blood; have their blood pressure checked; and fill out a questionnaire about their lifestyle, medical history, and height and weight. Spouses must do the same.

Following the screenings, workers will receive reports that not only include results but also come with recommendations for improving their health. Weight is key. For those who have a body mass index greater than national standards, a health coach is available to devise and monitor a weight-loss plan. This part of the program is optional. Treasure Island will also use the aggregate information to determine what diseases and health conditions are driving up costs and devise wellness programs to get at the root causes.

While anonymous surveys might detect reluctance among workers, don't expect many to balk at an employer's elevated interest in what they eat or how far they walk in a week. "As a practical matter, unless the labor market is very tight, there's no pushback from employees about anything," said Peter Cappelli, director of the Center for Human Resources at the University of Pennsylvania's Wharton School. Cappelli studies changes in the work force. "Employers can ask their employees to stand on their heads and they'll do it."

General Mills has a model employer wellness program, according to the article. It issued a wellness mission statement that was distributed to all employees, saying: “We would like every General Mills employee to have an active lifestyle, a healthy weight, a normal cholesterol level, normal blood pressure and to be a nonsmoker.”

These are mostly euphemisms for thin and young. Evidence-based research to date has shown these health indices are primarily measures of genetics, aging and social stresses, and “normal” levels have been redefined so low as to exclude most older, heavier or genetically predisposed people. The only way for most of these workers to meet these arbitrary benchmarks are to take controversial prescription drugs or engage in equally controversial and ineffective weight loss measures. It is exactly these discriminatory aspects of employer wellness programs, which reward and penalize workers based on arbitrary health indices, that caught the attention of the Department of Labor and lawyers earlier this year.

The Final Rules of the Nondiscrimination and Wellness Programs in Health Coverage in the Group Market, Health Insurance Portability and Accountability Act (HIPAA), regulations issued last July specifically state these programs cannot be “a subterfuge for discriminating based on a health factor.” Briefly, the ruling also states that wellness programs must be “designed to promote health or prevent disease,” which none of these programs have sound evidence to support effectiveness in preventing disease. Under the HIPAA federal law, all workers covered under the same employer-sponsored plan must pay the same premiums regardless of their health, and wellness programs under group-health insurance coverage “must not differentiate among individuals in eligibility, benefits or premiums based on any health factor of an individual."

When Clarian Health Partners in Indianapolis tried to launch a program that fined employees up to $30 per pay period if they didn't meet certain health standards, including weight targets, the backlash was so vigorous it toned down its program. Now, instead of penalties, it “rewards” employees with $10 per paycheck for meeting the standard for body mass index, the Pioneer Press reported. But even this is a “really, really slippery slope,” cautioned Jim Winkler, leader of Hewitt's Health Management Consulting practice. As the article noted, the efforts of these employer wellness programs to skirt the law are exceedingly questionable:

"If the reward was irresistibly tempting, from a practical sense, you would lose the 'voluntary' aspect," said David Jordan-Huffman, an employment attorney at Oppenheimer Wolff & Donnelly in Minneapolis. "Does this reward, this bounty you are offering, rip it out of the realm of voluntariness?"

The Americans with Disabilities Act prohibits an employer from requiring medical exams or inquiries that aren't job related. Requiring firefighters to prove they can lift and carry heavy weight is OK. An accountant? No. But the employer can go beyond these limits as long as the inquiry is voluntary and the information is confidential.

But, according to Pioneer Press, some companies aren’t waiting for the legal issues to be resolved. One insurance company, Cobb Strecker Dunphy & Zimmermann, “put in place a full-blown fitness and nutrition plan with an aim to get its 70 Minneapolis-based employees to take off some weight and get fit.” According to Ms Forster, a few companies have made health and fitness such a strong expectation and part of the company culture that, sure, it’s “voluntary” and employers can choose to not take part, but “it’s a little like not being invited to the party.”

Here is where she reveals how coercive the work environment can become for workers to participate in weight loss programs, as well as how these programs are promoting unhealthy behaviors:

While employers aren't forcing workers to run around the block or skip the half-and-half in their morning dark roast, in some workplaces the health movement comes with a swagger. Employees at Periscope, a marketing and advertising firm in Minneapolis, are a case in point. They put on their own version of the "Biggest Loser" contest late last year.

Sixty-five of the firm's 200 workers joined in. Some showed particular zeal, working out five hours a day, attending workplace yoga classes and keeping track of their workouts with sensors embedded in their shoes synched with their iPods. Weekly weigh-ins at the company's gym took place on Fridays. People could go to a Web site to check results and size up their co-workers. In a few cases, employees lost 20 pounds in 10 weeks...

Rollins, 27, found herself caught up in the competition, working out 10 hours the day before the final weigh-in. She nabbed the top prize for number of hours of exercise. Last weekend, she went on a 14-mile run as part of her training for Grandma's Marathon in June.

In contrast, an older employee opted out of the contest, finding the intensity too much for his older body and saying it was easier to bow out than try to compete with younger employees. A recent inside look at what it is like to work in a company with a wellness program, what happens when an employee completes a health risk assessment and the resulting requisite interventions and wellness coaching, found plenty of employees who didn’t appreciate them. And concerns went beyond discrimination and making insurance more costly, to jeopardizing health and jobs. Corporate cultures of health can take especially tragic tolls on those trying to recover from or escape from the disordered eating and anorectic behaviors they encourage.

Believe it or not, employers and human resource/benefit administrators are being urged by weight interests to sponsor “Biggest Loser”-style competitions to jump start their wellness programs. Not only is there no science to support the effectiveness or health benefits in these contests or any weight loss method, these have serious health consequences for most participants. And, as has been consistently shown in the medical literature, a BMI<25 is not the healthiest weight for everyone, either.

The NBGH’s guide to employer wellness program, funded by a grant from the Robert Wood Johnson Foundation, promised employers that preventive health measures were proven to prevent illness and premature death in their employers and reduce healthcare costs. In actuality, wellness programs, screenings and preventive health initiatives raise healthcare costs for companies and employees, yet are being incentivized by healthcare management companies (insurance companies). [Information on PBMs here.]

From a health perspective, examinations of the scientific evidence behind the 494 pages of wellness program recommendations, screenings, and diet and exercise behavioral change strategies in the NBGH’s guide found no evidence for effectiveness, as well as numerous inconsistencies with U.S. Preventive Services Task Force recommendations, from which they were said to be following. Worse, there was no mention of the findings of the National Institutes of Health’s pivotal review of nearly half a century of evidence on weight loss or other recent reviews, which have concluded that most studies, and the strongest evidence, show that not only are weight loss programs ineffective for long-term weight loss, but that they can actually increase risks of premature deaths, heart disease, stroke, type 2 diabetes and cancers — by as much as several hundred percent. In fact, there is almost never a mention or consideration of any of the risks and safety concerns of weight loss initiatives and wellness programs. This review questioned if employers can coerce employees to comply with intrusive tests with no demonstrated validity and interventions that have no sound evidence of being effective or beneficial, but do have evidence they could jeopardize their health.

Efforts to trim the fat from employees and promote “wellness” may sound good to a company HR administrator or alternative practitioner, but you and your doctor may not agree that they’re in your best interests.