Weight Loss “Challenges” Produce a Culture of Deceit, Not a Culture of Health
It turns out that HealthyWage’s “dieting for dollars” scheme, that I posted on yesterday, isn’t as bad as I thought. Apparently not all employees binge before the initial weigh-in, though many do. The good news is, some employees merely cheat! Here is how ConscienHealth describes it:
Mixed in with [HealthyWage’s] sales pitch is the smallest germ of truth. If you ignore the people that these programs harm and alienate, you can find employees who have fun with weight loss competitions. They form a team, pack on pounds before the competition starts, and revel in extreme dieting for the short-term results that these programs reward. We’ve seen people wear heavy clothes and carry rolls of coins for their initial weigh-in. Drink a two liter diet soda before you weigh in and you have a 4.4-pound advantage.
Sounds like rather than a “culture of health,” HealthyWage is proposing a “culture of deceit.” And HealthyWage isn’t alone. ShapeUp (now part of VirginPulse) and Wellness Corporate Solutions are also major promoters of get-thin-quick schemes.
Score another harm for the wellness industry. In future days I’ll be posting a comprehensive list of all the harms, direct and indirect, that “pry, poke and prod” programs, plus “dieting for dollars” have created in the corporate world. Hopefully there will be enough space on the internet.
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For Its Get-Thin-Quick Programs, HealthyWage Proposes Unhealthy Wagers
Just when you thought wellness vendors have all finally connected to the internet, HealthyWage comes along.
They write: “Given the financial upside and the fact that they’re just plain fun, it’s no wonder that diet competitions and weight-loss betting programs are exploding across America and beyond.” Crash-dieting is “just plain fun” ? That recalls the line from Surviving Workplace Wellness: “Wellness programs are designed to make employees happy whether they like it or not.” More importantly and to elaborate on the opening sentence, HealthyWage has managed to overlook all the research, easily accessible online, that says:
- Short-term weight loss is meaningless;
- Weight cycling — exactly the type of thing crash-dieting causes — is harmful;
- Employers can’t get employees to lose weight, and even if they could, weight loss doesn’t generate savings;
- In the commercially insured population, no avoidable admissions can be avoided by weight loss betting, making HealthyWage’s “financial upside” claim about as likely as its claim that these crash diets are “just plain fun.”
HealthyWage is resuscitating the old “Biggest Loser Contests,” under two new names: “Diet for Dollars” and “Pay for Pounds.” After I read this, I checked my calendar. It assures me that we have not reached the end of March yet, which means these names are intended to be serious, as is the program. They really want you, as a wellness manager in an HR department, to institute crash-diet programs.
But not so fast. They urge you to first undertake “a touch of due diligence before you pay to play.”
Further, they thoughtfully provided the “due diligence” questions they advise HR departments to ask before retaining a vendor to weigh their employees. Let’s play a little game here. I’ll excerpt four real questions that HeathyWage wants you to ask, but then sneak in a fifth phony one. See if you can guess which question that should not be part of due diligence, according to HealthyWage. (By the way, you may find this hard to believe after you read them, but I am not making up any of the other four.)
- Where does your prize money for our employees come from?
- How do you verify the weigh-in and prevent “fraudulent participants” ?
- Will you show us the body of research highlighting the effectiveness of paying employees to lose weight (um, like this article)?
- Does your get-thin-quick scheme come with a warning label, and will you indemnify us if any of our employees harm themselves while bingeing before the initial weigh-in or crash-dieting before the last one?
- How do we get media attention when you weigh our employees?
Since the fourth question addresses the harms of the ironically named company’s program, and is the most important question of all, it is no surprise that this is the question they don’t want asked, the phony one I inserted.
While the fourth is the most important, the second the most inscrutable, the third the most impossible, and the first the most naive, the fifth is the biggest head-scratcher.
For the fifth, I have a follow-up question for HealthyWage: Why would you want people like me writing columns like this about programs like yours?
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RAND’s Soeren Mattke Piles on Aetna’s Fabricated DNA Wellness Program Savings
Us. Bestselling author Nortin Hadler MD. And now RAND’s wellness uberguru, Soeren Mattke PhD.
What do we all have in common? Calling Aetna out on its phony savings from collecting its employees’ DNA to predict their future health. (Curiously, insured members who want a DNA consultation with a real doctor will find that it is not a covered benefit.)
Let’s make one thing clear: Aetna’s DNA program savings are invalid, period. It is not possible to save $1400/person (or any amount) in the first year (or any year) of a wellness program. And especially not if the people in the program were healthy to begin with, as these employees were. The cohort had a couple of risk factors for metabolic syndrome, which itself is a grouping of risk factors that might lead to a cardiometabolic disease. In other words, they were at risk for being at risk. You and I should be so healthy.
I suspect the reason Aetna picked $1400 as the fabricated first-year savings figure is that the program costs $500, and when HR people ask: “What’s your ROI?” you want to be able to respond: “Between 2-to-1 and 3-to-1” — and hope you are dealing with people who will actually believe whatever they are told. Where are these people? Trump rallies? I can’t find any. When we market Quizzify, even though our savings are 100% guaranteed, our prospects still make us demonstrate exactly where the savings will come from and how they will be measured. And the only thing guaranteed about this Aetna program is that it will lose money.
If you read the article carefully, as we did (unlike the peer reviewers), it actually self-invalidates, just like most other wellness vendor studies. There is no meaningful difference in health indicators between the control and study groups at the end of the period. Hence there can be no savings attributable to the program.
The logic is also rather twisted. Literally, they claim that if they tell you that you’ve got a gene for obesity, you’ll try harder to lose weight. Come again? When I was a kid, I saw a horserace on TV and told my mother I wanted to be a jockey. But my mother pointed out that at my growth trajectory I was likely to reach 6’5″. (I did.) So I immediately gave up that dream. Had I applied Aetna’s logic instead, I would have doubled down on riding, and maybe put a brick on my head.
Highlights of Dr. Mattke’s Criticism
Along the same themes as myself and Dr. Hadler, Dr. Mattke wrote a Letter to the Editor of the Journal of Occupational and Environmental Medicine (JOEM). Keeping in mind that because Dr. Mattke is employed by a nonprofit whose entire credibility depends on its reputation for neutrality and objectivity, it’s fair to infer that, however critical his comments, he is being very muted in his critique.
Also–though fairly discredited due to this and other obviously invalid articles — the JOEM is an “academic” journal, with standards for decorum that preclude calling people “losers” or accusing them of having small hands. So Dr. Mattke is doubly constrained in this letter. One can only imagine what he really thinks.
Four key points:
(1) He “congratulates” Aetna on designing a rigorous randomized control trial (RCT) to begin with (they did), but “wishes they actually applied that rigor to the analysis”;
(2) He points out that instead of following through on that design, they compared participants to non-participants. He says they need to look at “the eligible population, not the cohort of the eligible population that volunteered to join.”
(3) Only 11% of the invited employees joined (would you give your DNA to your employer?). “This highly selected group may differ in important observable and unobservable characteristics from the population, posing a substantial threat to validity.”
(4) “The study didn’t report the cost of the intervention.” Hey, if my wellness program cost $500 per participant, I wouldn’t either. ( I know it’s not always about us, but Quizzify costs $38 or less.)
He has other points as well, but with my 60-year-old eyes, they are hard to discern from the free online version of the letter, and I’m sure as heck not going to pay for it. Now that I’ve seen enough examples of what they use it for, the idea of sending money to these JOEM people is about as appealing to me as donating to Trump’s campaign.
Time for Aetna to Fess Up
Aetna is a fine organization in other ways. They do a lot of good things and have other excellent initiatives, in other divisions of the company. They should just call this DNA fiasco a mistake and move on. Instead they’ve been insisting that the figures are real. At some point a “mistake” becomes a lie, and Aetna is rapidly reaching that point.
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Major New Study Shows Wellness May Be Hazardous to Your Health
Our book title Surviving Workplace Wellness was intended to be figurative, but a new study shows it should be taken literally.
In the issue of Annals of Internal Medicine published today, a study of tens of thousands of people shows that a low BMI is associated with a higher death rate than all except the highest BMIs in women. In men, the lowest quintile of BMIs is associated with the highest death rate.
The study also shows that BMI is a poor predictor of death, as compared to body fat composition. This conclusion mirrors that of another study published last month.
Once again, the wellness industry strikes out. Their obsession with reducing BMI might actually be leading to a higher death rate among their customers’ employees. We say “might” because the study was careful to say that low BMIs “were associated with” a higher death rate, not “led to” a higher death rate. Wellness vendors and consultants love to conflate correlation and causality, but we can easily resist that urge, thanks to our triple-digit IQs.
Naturally, ShapeUp is one of the worst offenders. As you can see, they automatically associate “improved health” with lowering BMI.
So is workplace wellness killing people by getting them to reduce their BMI? Unlikely. It’s not just that the link may not be causal. There is a more important reason: ironically, wellness is too ineffective to harm people. Since basically no one ends up actually keeping the weight off using the pay-for-performance methods embraced by wellness promoters, there is no meaningful long-term reduction in BMIs. So even if low BMIs caused premature death, employees have nothing to fear from these programs.
And even those poor Highmark employees subjected to ShapeUp’s get-thin-quick scheme advertised below probably have nothing to worry about: the “163 employees” mentioned above only represent about 1.5% of participants, and given that Highmark fired ShapeUp, it’s likely that most of them gained the weight back anyway.
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Read what Actual People Say about Workplace Wellness
Visit this website, www.conscienhealth.org. Read the posting, and then go to the list of the people working with them. What you’ll see — uniquely in this field — is no one in this group has an ax to grind. There are no “hidden agendas” trying to push people into various wellness or diet programs.
Quite the contrary, these are real, qualified, dedicated people. And they are driven by science and evidence, as opposed to profit. Their mission is to bring science to bear to the subject of food, health, and obesity. They wish to educate people that:
(1) Being overweight/obese is not a personal failing, but rather is driven by a set of variables that are far more complex than the wellness industry could ever understand;
(2) Calories in-calories out may work as math–but biochemistry isn’t math, and that’s what the wellness industry doesn’t understand;
(3) Paying people to lose weight, telling them that they just have to “work harder” at it, or “change their attitude” etc. are failed solutions.
Naturally they have no use for the workplace wellness industry…and especially for the Johnson & Johnson “Fat Tax,” which we recently deconstructed in Harvard Business Review.
Read for yourself.
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Does the New York Times Now Support Corporate Fat-Shaming?
To my knowledge, the New York Times didn’t just get hacked. It’s not April 1st yet. And, as anyone who has been following politics knows, it certainly isn’t a slow news day.
So I am out of explanations as to why — in their upcoming Sunday Review feature ironically labeled “Gray Matter” — they would encourage corporate fat-shaming. The Times is a publication to which we have previously given multiple accolades for being way out in front of the emerging consensus that conventional wellness –and corporate fat-shaming in particular — doesn’t work. And yet…
Jumping the Shark
Three researchers from the University of Pennsylvania published a study in Health Affairs showing that you can’t fine or pay people to lose weight. It was a great study, and completely confirmed our own findings. Had they left it at that, it would have been one more nail in the “corporate weight loss challenge” coffin. But instead of reaching the obvious conclusion, based on the clear data, that incentives and penalties don’t work, they concluded that we simply haven’t found the right incentives yet.
No mention that maybe, just maybe, if it were possible to lose weight via behavioral economics, you wouldn’t need to treat employees like lab rats to get them to succeed at it.
Next, they did a small, non-peer-reviewed study of 281 employees in their own organization, and found that 15% of them would take some extra steps during a day if you paid them and then fined them–as compared to the alternative, which is what a normal organization would do: get really annoyed that these researchers are pestering their employees about the way they walk.
Oh, yes, and — exactly as most people, like Jon Robison, would predict — as soon as the incentives/penalties ended, the participants returned to their previous walking patterns.
The major questions left unanswered in this whole situation are:
(1) How do employees feel about being treated like the aforementioned lab rats?
(2) Why is it necessary to draw attention to employees’ weight, if they are getting the job done?
(3) Why should an employer care about any of these findings in the first place?
We can answer the last: they shouldn’t. First, there is no correlation between employee weight and corporate performance. Second, almost no medical spending is avoidable by wellness programs.
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Finally, Some Pushback against the Proposed Johnson & Johnson “Fat Tax”
Usually it’s an uphill battle to get high-end business media outlets to publish opinion pieces. Not so with the Johnson&Johnson Fat Tax. Here is Insurance Thought Leadership on this topic, and here is Harvard Business Review.
Some background on the cabal that is proposing it. Vitality Group can’t even get its own employees to lose weight. PepsiCo’s program is notorious for losing money. And of course Ron Goetzel now admits that way more than 90% of wellness programs fail.
And yet they are trying to get companies to stigmatize overweight people, pry into their personal lives to learn whether they are depressed, and monitor their sleep…all so shareholders can “pressure” (their word) employers into doing wellness.
Visit the links and let readers know what you think.
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Laura Ingraham’s blog slams wellness
Who says the country is polarized? In wellness, bipartisanship rules!
Having just been eviscerated by the Guardian on Monday, today wellness got quite literally its worst coverage ever — from the blog of Laura Ingraham. Yes, the very same Laura Ingraham who has her own radio show and guest-hosts The O’Reilly Factor. This may be the only instance ever in which the left-wing Guardian agrees with the right-wing Laura Ingraham.
The wellness industry is running out of wings.
Hers is just the latest media salvo. Right, left, and center — the same media that used to fawn over this stuff (“everybody wins — employees are healthier and employers save money”) — has consistently been savaging these vendors and “pry, poke and prod” programs worse than we do, ever since Penn State.
Because we are an equal-time blog, we’ll review both the Guardian’s and Ms. Ingraham’s. However, read our entire posting. I will hint that, regardless of politics, you will think we are saving the best for last. (Actually, since we strive for 100% accuracy, we should say we are saving the better for later.)
The Left Wing
The Guardian published an extensive article on the privacy invasion that can accompany wellness programs. Much as I am not a fan of “pry, poke and prod,” I do think the folks who attack wellness on the basis of privacy substantially overstate their case. There are many things wrong with wellness, but we need to tell the truth on this site, since we are in the “integrity segment” of the market. And the truth is that wellness vendors don’t hand over employee personal health information (PHI) to employers. Not that we want to give them any ideas.
PHI can also be leaked accidentally, of course. Staywell wasn’t exactly forthcoming about this so you may not have heard about it, but they got breached. Hence we would recommend that you “stay well” away from them as a wellness vendor. Other wellness vendors have managed to keep hackers at bay. It could be airtight security measures on the part of the industry, but it’s more likely that hackers simply have no interest in wellness data because of its worthlessness.
Still, these wellness people have no one but themselves to blame when articles like this get published. Castlight, for example, is feeding this beast by boasting that they can predict who is going to become pregnant. The Guardian called them out on this. I have nothing against Castlight but that is eerily reminiscent of the Highmark/Goetzel/Penn State debacle when women were fined $1200 if they didn’t disclose their pregnancy plans on their health risk assessments.
And how did The Guardian write a couple thousand words on privacy without noticing Aetna’s employee DNA collection-and-storage program? In all fairness, it probably never occurred to them that a major company would ever do such a thing, so they didn’t think to look for it.
And basically every article ever published on privacy starts with the assumption that these programs must save money. Otherwise why would employers do them, given their cost and morale impact? So the Guardian never called out these vendors on lying about savings.
The Right Wing
The Guardian’s smackdown is figuratively and almost literally yesterday’s news. The news got worse today, for the wellness industry. The LifeZette (the name of Laura Ingraham’s website) skewered the wellness industry to a degree never seen outside this blog. The LifeZette article starts by pointing out that no one even pretends any more that there is an ROI from wellness. (We just covered that newfound wellness industry candor from a different angle, in Insurance Thought Leadership.)
The article also laments the lack of regulation in wellness, possibly the only time in history when any even loosely Fox-affiliated publication has opined that there isn’t enough government regulation of something. They are, of course, right. There is literally no defense of unregulated wellness industry practices that are more likely to harm employees than benefit them, just to line their own pockets. No doctor could get away with this.
Absent regulation, the article points out that companies like ShapeUp — specifically, ShapeUp — harm employees with their yo-yo dieting programs. The reporter, Pat Barone, extensively documents the harms that ShapeUp creates with its get-thin-quick “challenges,” and then notes many other harms wellness programs can cause.
We never take sides in politics on this site. Instead we frequently note — as in this posting — that both “wings” agree with us. But I will give a shout-out to this right-wing site here. Ms. Barone’s article absolutely nails the dishonest and harmful business practices of ShapeUp and others.
Usually we try to end these postings with a clever line of our own, but instead we’ll end with one of Barone’s:
The [new] alliance of ShapeUp with the two additional companies [Virgin Pulse being the lead dog], presumably means many more crash dieters wreaking havoc on their future health.
Please add comments here when you’re done reading it. LifeZette doesn’t take comments.
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Employee Benefit News Hits Another Home Run
I don’t think I’ve ever disagreed with EBN (except for columns authored by wellness vendors), or thought their reporting was anything other than totally professional and accurate, and I’m sure as heck not going to start today, because their columnist Linda Riddell JUST WROTE A STELLAR REVIEW OF QUIZZIFY.
Even her negative point was a good one, and we are addressing it. In the immortal words of the great philosopher Benjamin Franklin, “critics are our friends, for they help us to identify our faults.” (If wellness vendors had this philosophy, they wouldn’t have time for their Day Jobs.)
So read the review in its entirety…and operators are standing by. 781-856-3962. Or just visit the website and play the game for yourself. You may learn something right away, but even if you don’t, you’ll certainly see how others would.
I would also note that Ms. Riddell is not exactly an outlier here. Previous great reviews have been penned by Bob Merberg and Paul Levy, notable and highly respected bloggers in wellness and hospitals/healthcare leadership respectively. A pattern is starting to emerge.
They Said What? 