Looks like a lot of you employees should be getting your employers to refund your penalties for not losing weight…or retroactively award you your incentives…read on. One way or the other, it’s time to end corporate fat-shaming.
Here is yet another in the unending stream of reasons to be certain all those Koop-award-winning savings claims and just about every other announced wellness savings figure are fabricated: they are all based partially or totally on Body Mass Index (BMI) reductions among active motivated participants — but BMI turns out to be a worthless indicator of health status. (We’ve already pointed out that the whole concept of measuring anything on “active motivated participants” is garbage anyway, as Aetna recently proved by accidentally telling the truth.)
How worthless? A study due out in the International Journal of Obesity says 75-million Americans are misclassified, meaning their BMI doesn’t match their true underlying health status. (As an aside, this scoop comes from this morning’s STAT News, the new must-read healthcare daily.) Many people with high BMIs are healthy, while many people with low BMIs are high-risk. Shocking! Who knew?
Naturally (cue the smirk on our faces), we did. As recently as in last month’s expose of The Vitality Group‘s squirrely outcomes claims, we pointed out that BMI is a 200-year-old construct based on faulty reasoning to begin with — and noted it has been challenged on multiple bases for years. We were also the first to observe that BMIs don’t correlate with a company’s financial success. And our series: “The Belly of the Beast” chronicled one vendor’s misunderstanding of BMIs as well, though I understand they are improving quite a bit now and we wish them the best and look forward to telling you about their improvements.
The implications of this new research are staggering:
- Companies need to refund penalties, and also award incentives retroactively, to people who were unfairly denied their money because wellness vendors don’t know how to measure outcomes;
- The “subject matter experts” who wrote the HERO Report need to retract basically their whole ball of wax, since it obsesses with BMI — and they need to apologize to me for inaccurately calling my claims “inaccurate” when they are specifically and relentlessly urging readers to do the wrong thing;
- Wellness vendors need to learn a thing or two about wellness, for a change.
- And guess who’s 3.27-to-1 ROI was based on studies obsessing with BMI? Kate Baicker, that’s who. Despite multiple hedges and walk-backs, she has yet to issue a formal retraction of her puff-piece on wellness economics. This gives her a good excuse.
Of course, in wellness, “the implications are staggering” means: “business as usual,” and they won’t do a thing to address these new findings.
The EEOC can’t ignore this. How can they give employers more leeway — as they now intend to do — to fine employees based on a variable they now know to be wrong?
Quizzify 1, Wellness Vendors 0
Those of you who use Quizzify don’t have to fret, by the way. The correct answers to the Quizzify question: “What is a BMI?” already include:
- “A crude measure comparing your height and weight,”
- “Can be very misleading if you in otherwise good condition,” and
- “Is good to know but not to obsess with.”
(For those of you keeping score at home, Quizzify’s incorrect answer is: “It stands for ‘Bowel Movement Intensity,’ and indicates how much effort you required in order to stay regular.”)
Even so, we will be adjusting the answers going forward to take into account this new research, starting next week. We expect the wellness ignorati will follow suit in a few years — once they stop advocating lowfat diets, PSA tests, and annual mammograms. The good news is that they generally no longer recommend bloodletting.
They Said What? 
Al: Thanks for this great info…have shared with my 7,200 connections most in health care, insurance, benefits…and trust others with share with their connections. This is like a correction to a commonly held belief that is wrong…people will deny it, challenge the facts, stick their head in the sand. As a reminder Jim Fix, one of the greatest marathon runners, with 0 body fat died of a massive heart attack…at 49. (n of one individual, but happens all the time). Another interesting fact people may not realize is that of the hundreds of thousands that die each year in the US from sudden death heart attacks, more than 50% have normal or below normal cholesterol…most cardiologists (maybe all) will tell you the typical screening for total cholesterol with an calculated LDL (not directly measured which is most common) is a poor measure for heart attack risk.
LikeLike
Great comment, Chris. Agreed on all points except the one about Jim Fix — it’s “Jim Fixx.” (Bada-bing!) Keep up the great work and we’re looking forward to your exciting launch.
LikeLike
You buried the lead here — it’s the EEOC that’s got a lot of ‘splaining to do.
LikeLike
Guys
Another bombastic title. The BMI is not worthless. Did you read the discussion? For wellness and carrots and sticks, yes, but for a population with a high prevalence of disease (metabolic syndrome (+) with type II/III obesity) AND an inability to use waist to hip or other measures, it’s the best we have.
I get how and why we have the BMI. It’s a population-based metric and far from ideal. However, warts and all, it’s an OK screening tool when used by the right folks in targeted populations. Nonetheless, not for wellness–100%. You should make that clearer in your blog title.
Brad
LikeLike
What you are saying makes a lot of sense (we would post your comment even if we disagreed) but that’s not how the wellness industry uses it. They use it on all comers. So it is possible to agree with you (we do, to some extent) but also maintain our position that wellness vendors shouldn’t be carpet-bombing employees with BMIs.
LikeLike
Oh, by the way, as they say in philosophy, synthesis! Ours is a blog read by the wellness industry — and therein lies the reason for the title and why it WOULD be bombastic if indeed we were applying it more broadly. You are referring to it as a diagnostic tool and you run a hospital blog, it appears. So had I written this title on your blog, you’d have a great point. In any case, thanks for making me think — that’s how I know you’re not a wellness vendor.
LikeLike
A bit of a stretch. The measure is what the measure is–it doesn’t play favorites.
LikeLike
I did change it on your request — narrowed it down to employee wellness.
LikeLike
I hope you did it for you and not for me. That’s wellness 🙂
LikeLike
Its really hard to get through much of what you write Al because you have so much of your sarcastic wit thrown in.
LikeLike
(blushing) thank you. Sometimes we tone it down and put things on “real” websites. We might make a version of this for one of those.
LikeLike
[…] with the BMI, which of course is a dubious measure to begin with. No variances are given, so we will use the average figures. Six hundred and eighty-three people […]
LikeLike