Wellness Programs are Missing the Mark
Many companies have introduced workplace wellness programs to improve their employees’ health and simultaneously reduce both direct and indirect employee health care expenses. In fact, according to the Kaiser Family Foundation, fifty-three percent of small firms and 82% of large firms offer some form of wellness programs. Despite collectively investing more than $8 billion in such programs, the return for companies has been extremely disappointing, with little in the way of cost savings or overall improvement in employee health and wellbeing.
That’s the sobering conclusion of a Harvard Medical School study published this year in the Journal of the American Medical Association (JAMA). The study, described as the “first peer-reviewed, large-scale, multisite, randomized controlled trial of a workplace wellness program,” found no significant effects on health outcomes blood pressure, cholesterol or body mass index. Moreover, there was no decrease in absenteeism, no improvement in job performance, and no reduction in healthcare use or spending.
None of this, of course, means that the programs have no value. Many organizations cite success stories of employees enhancing their lives by participating in a company-sponsored wellness program. The challenge is scaling the results so that more people can look and feel better, think clearer and be more productive. Otherwise, the associated costs of employee health will continue to spiral out of control.
According to the Department of Health and Human Services, the United States spends more than $3.5 trillion annually on healthcare. The bulk of this expenditure is earmarked to treat chronic health conditions like diabetes, heart disease, and cancer. By and large, diet and lifestyle changes can greatly improve these chronic health conditions. Obesity, which is a significant risk factor for all three diseases, is a prime example. The rate of obesity in America—nearly 40 percent—is alarming and heartbreaking. Moreover, 10 percent of women and five percent of men are severely or “morbidly” obese, more than 100 pounds overweight.
At the other end of the weight scale are societal notions of “appropriate” weight. Advertisers and Hollywood celebrities have historically glamourized unhealthy and unnatural thinness, triggering a range of issues, from low self-esteem to eating disorders, among many women and especially young girls. Fortunately, the negative impact of these unrealistic expectations is now well-understood, inducing advertisers to feature more “realistic” looking models in print ads and television commercials. And, in an effort to reveal themselves as real people, many celebrities are publishing authentic, unedited photos.
The shifting perspective on body image is important, but we must be careful not to trade one problem for another: unhealthy expectations of thinness for unhealthy acceptance of thickness. While beauty and attractiveness come in all shapes and sizes, there are serious risks to accepting obesity as normal and inevitable. The truth is that obesity is often deadly. We cannot ignore its impact on quality of life, life span, and overall cost to the health system—not to mention employers. Consider this: companies, on average, spend 42 percent more on health care costs for obese employees compared to employees at a healthy weight. Would you rather spend those resources elsewhere?
Why do Wellness at Work Programs Fail?
One of the most significant challenges is the mixed messages that companies send to their employees. Many organizations communicate to their employees that they’re investing in workplace wellness programs as an investment in their health, yet their actions can, at times, undermine the program’s intent. Examples include the boss who brings in donuts for employees to enjoy with their morning beverage, and the usual range of unhealthy foods provided at every office celebration, such as birthdays, anniversaries, and upbeat quarterly earnings. In some cases, just making it to Friday is a reason to feast the team on sugary processed foods. For lunch, an enticing array of “comfort” foods fill the cafeteria. Ten minutes on the treadmill can’t mitigate the unhealthy outcomes of chronic inflammatory consumption.
Another roadblock to behavior change is the fact that wellness programs are designed to tell people what they should do, instead of helping them understand why they have not done these things in the first place. Nobody grows up aspiring to weigh 400 pounds. People do not want or even expect to someday suffer from heart disease, high blood pressure or diabetes. Yet through certain lifestyle choices, many people increase their probability of suffering from these medical conditions.
Misinformation is part of the problem, as is willing ignorance. There are many competing “ideal diets” and a menagerie of studies claiming different best practices. Many people claim they’re confused about what is or is not healthy and, therefore, give up.
However, most everybody understands that exercise is important. Nobody doubts that fruits and vegetables are good for us, and that processed and toxin-laden food should be minimized or avoided. For the most part, people are educated about the right things to do. Why would they do the opposite?
The real problem is motivation and ability to change. For instance, most addicts can explain why addiction is harmful, but they still struggle to break the cycle. Without understanding this dynamic, wellness programs have little hope of influencing major change. They will continue to respond to symptoms as opposed to dealing with root causes.
Wellness Programs Can’t Do It Alone
All behavioral change hinges on the ability to manage 3 pounds. You read that right: 3 pounds. This is the weight of the average human brain.
Today’s wellness programs primarily address physical health concerns, but these are often just symptoms of underlying problems. The secret to unlocking our enormous human potential involves a deep understanding of our psychological fitness and what is needed to move forward. Wellness programs alone will not change our health; only we can do that. And employers can help, as working environments profoundly affects employees’ psychological states.
Unfortunately, employee overload is becoming the norm. Most employees say they are at or nearing capacity to handle work responsibilities and expect that they may be asked to take on work beyond their capacity over the next 5 years. We are clearly at the point of diminishing returns when it comes to stress. Certainly, a little stress can help people accomplish extraordinary things, but too much stress exacerbates existing health issues and creates new health challenges.
There are costly consequences. Employers are paying an estimated $300 billion per year on their employees’ job-related stress issues.4 In an apparent attempt to raise the awareness of the impact of workplace stress, the World Health Organization (WHO) changed their definition of “burnout” to give it some more heft, recognizing that it is a severe issue that profoundly affects people’s lives.
According to the WHO, workplace burnout is characterized by:
- feelings of energy depletion or exhaustion;
- increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
- reduced professional efficacy.
Stress is so debilitating that it sometimes crosses into diagnosable mental health challenges. More than 84 percent of employees have experienced symptoms of poor mental health where work was a factor.8 According to the National Alliance on Mental Health, 1 in 25 adults experiences a serious mental illness each year that substantially interferes with or limits one or more major life activities. Between six to eight percent of full-time US workers experienced major depression in the past year, contributing to the total overall economic burden of major depression, estimated to be $210 billion. And, because two-thirds of people dealing with depression do not seek help due to shame or fear of discriminatory actions, these figures represent just a fraction of the whole picture.
Given the psychological stressors on so many employees, is it fair to expect they will dutifully exercise and eat more fruits and vegetables—the advice they receive from the company’s wellness program? Many people instead try to control their chronic health condition through prescription medication. For the 55 percent of Americans who take prescription drugs, they take four medications on average. Unfortunately, many people are taking matters into their own hands and self-medicating. More than 70 percent of those abusing illicit drugs in America are employees, as are most binge drinkers.
As much as wellness is an individual endeavor, employees can’t do it alone. And yet, it’s increasingly clear that a company-sponsored, “one size fits all” approach will not generate substantive behavioral change. In part II of my Why Wellness Programs Fail series, I will introduce a new approach: Understanding Employee Needs.
