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How the health of Boise’s teachers deteriorated while Wellsteps was winning a Koop Award

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We’ve always made the observation that in wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.  Wellsteps attempts to prevent people from doing this by making the data almost impossible to read in the first place.

And a good thing, because watch what happens if you do figure out how to read it. (For newbies to this thread, this is the Boise School District results. We have already covered Wellsteps’ inability to understand math and their inability to understand alcohol and smoking in two previous postings. This one is about Wellsteps’ inability to understand health. You’d think that would cover all the bases…and yet we have two more posts coming next week.)

wellsteps biometrics

Start with the BMI, which of course is a dubious measure to begin with. No variances are given, so we will use the average figures. 683 people reduced their BMI, while 1641 employees got larger. The changes are trivial in any event, but do move in the wrong direction.  And according to the p-values, the changes are significant.

Systolic blood pressure is similar. 1992 people got worse, while only 360 improved.  (Diastolic did better, as did glucose.)

Likewise, cholesterol, where only 216 people improved while 1434 got worse and 691 stayed almost the same.

in all these cases, you might say, “yes, but the highest-risk people improved.” Of course, they did. The highest-risk cohort almost always shows improvement and the lowest risk cohort almost always deteriorates.  This is called the “natural flow of risk.” Taking credit for improvements while ignoring people who deteriorate is indeed the wellness industry business model. Compare Wellsteps “improvements” on the employees with the most health risks to Dee Edington’s “natural flow of risk” (also a bit inscrutable on its own). The “natural flow”  shows about half  the high-risk people improving on their own (1640 to “medium” and 678 all the way to “low”), with no program at all.

edington flow of risk

The impact on the population as a whole

In another attempt to demystify the Wellsteps results and assuming a variance of zero (since none was provided), I simply summed all the improved biometrics and compared that total with the total that deteriorated.  It turns out that 6397 deteriorated while only 5293 improved.

In other words, the physical health of the Boise School District suffered during the Wellsteps wellness program.  

And no wonder–Wellsteps was screening the stuffing out of these people, far in excess of guidelines, and encouraging unneeded annual checkups. This conclusion is reached without even taking into account the likelihood of employees lying on HRAs, cheating during the weigh-ins, or Wellsteps putting their fingers on the scale in the measurements above (“adjusted for age and sex”), as they are wont to do.

Saying that health actually deteriorated during a program would be controversial, but there is no need to take our word for this conclusion. You can ask the employees themselves.  Come to think of it, you don’t even have to ask them.  Wellsteps asked them…and they agreed: their health got worse. Keeping with the inscrutability theme, you have to squint real hard to see it on the last line, but it’s there: a statistically significant decline in self-reported health status over the two-year period:

wellsteps selfrated health

Wellsteps termed this deterioration “an improvement” but then again, Boise employees could forfeit a total of $830 by not playing along with their wellness scheme…and Wellsteps calls that figure a “small incentive.”  So in addition to having their own version of math, they have their own vocabulary.

However, there is one instance in which I would agree with Wellsteps, and that is they certainly have the following figured out:

wellsteps winning




  1. How much more ridiculous can this get? (rhetorical question) – Dr. Jon


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