Hoping for the Magic of Wellness to Kick In

The data are stubbornly refusing to cooperate with the wizards of workplace wellness. A new study in the Journal of the American Medical Association finds no effect on health or economic outcomes. Professor Eric Topol aptly sums it up in a tweet:

The folly of “workplace wellness” programs: no clinical outcome improvements despite billions of industry-wide expenditures. Results of a randomized trial.

And yet, true believers are still waiting for the magic to kick in. JAMA published an editorial alongside this study report. In it, Jean Marie Abraham calls workplace wellness programs “a work in progress.” She says they can be a “valuable complement” to health systems and communities for reducing chronic diseases. If they would only start working.

Bribes and Threats for Health

In the same issue of JAMA, three health policy experts describe the disappointing results of efforts to “incent” people to behave more healthfully. They describe a very mixed picture:

These discouraging results could seem like evidence that patient financial incentives do not generally work, were it not for many other studies demonstrating that incentives do work and empirical support that people respond to incentives in everyday life.

In other words, what’s wrong with this data? Why doesn’t it show what we know to be true? This stuff oughta work.

Choices and Human Diversity

The wizards of wellness are still waiting for the magic to appear.

But how we live our lives is the product of many choices, as well as many circumstances beyond individual control. So thinking that you can choose for other people requires a great deal of hubris. Instead of bribes and threats, providing care and support for people who want to improve their health might pay better dividends.

That would mean removing all the barriers to evidence-based obesity care that employers so routinely tolerate in their health plans. Helping people overcome obesity is a much smarter strategy than hitting them with coercive “incentives.”

Click here for the study in JAMA, here for the Abraham editorial, and here for the health policy viewpoint.

Magician, painting by Nicholas Roerich / WikiArt

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April 18, 2019