Employer Wellness: Carrots, Sticks, and Elevator Speeches

At yesterday’s Obesity Week 2013 Advocacy Forum, an engaged panel explored the potential benefits and pitfalls of employer wellness programs. Obesity Society advocacy advisor Ted Kyle chaired and organized the panel.

Joe Nadglowski, president and CEO of the Obesity Action Coalition, kicked off the debate, declaring himself “a skeptic” when it comes to the value of current programs. He shared study data illustrating the prejudice workers with obesity already face from employers, co-workers, and even healthcare providers.

A growing number of employers are using wellness program participation as a gateway to healthcare for employees with obesity, and the proportion of employers imposing penalties for employees who don’t meet wellness goals, many of which relate to obesity or weight, are estimated to double in 2014 and again in 2015. Yet many employers do not cover any treatments for obesity. Nadglowski urged employers interested in wellness to reward healthy behavior and begin with a work environment that encourages activity and healthy eating.

Jennifer Lovejoy, PhD, Alere Wellbeing and the University of Washington School of Public Health, agreed with Nadglowski that wellness must begin with well-designed workplaces. She also found benefits from work weight-loss interventions.

According to Lovejoy, weight-loss intervention programs of about an hour per week have been shown to have moderate impact among about 30-50% of the participants. Activity-only programs, while improving activity levels, do not produce significant changes in weight, and, therefore, do not reduce employer healthcare costs. She also looked at financial incentives, which some employers use.

Financial incentives were found to work well for incenting a one-time behavior like filling out a survey, but not for complex or longer-term behaviors. Of note, Lovejoy says employers who have demonstrated a real commitment to healthcare can offer a lower incentive and get the same impact as less committed employers do with a higher incentive. Anecdotally, she said employers are in a “very confused place right now” with a lot of emphasis on personal responsibility when it comes to obesity.

Mark G. Wilson, Workplace Health Group at the College of Public Health at the University of Georgia, gave an overview of current trends in employer wellness programs. In an environment of rising healthcare costs and premiums, Wilson says employers have become experts in understanding the obesity-related costs of healthcare, turnover, absenteeism, and loss of productivity. According to Wilson, obesity can cost an organization of 10,000 people approximately $6 million per year.

Deborah Horn, DO, MPH, FASBP, Vice President of the American Society of Bariatric Physicians, challenged the audience to create an elevator pitch for an employer who covers all treatments with no co-pays or required patient outcome metrics for a employee with diabetes but who covers no treatments for an employee with obesity, who in fact is not even aware treatments for obesity exist, and who requires that employees with obesity meet outcome metrics. The most compelling impromptu pitches urged the employer to focus on future vs. present costs and to consider value, not cost, when it comes to obesity treatment.

All panelists agreed that since employers will continue to search for ways to improve the health of their employees (and reap the rewards that come with that), obesity advocates need to continue to push for wellness programs that are evidence-based, bias-free, provide coverage for the widest range of treatments, and are part of a larger wellness-centric workplace initiatives.

Click here, here, here, here, and here for the presentations from the Obesity Week 2013 Advocacy Forum.

Carrot, photograph © Kandor / Wikimedia

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