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Review of “Rule the Rules of Workplace Wellness Programs,” a how-to on compliance

Do you know whether heartburn pills are safe for long-term use?

In the wellness industry, vendors are allowed — indeed, encouraged by the prospect of winning a Koop Award  — to flout clinical guidelines, pay employees to crash diet, sell franchises by bragging by the lack of qualifications needed by franchisees, and of course actually harm employees. One would think such an industry is totally unregulated. And, yet, as described in the erudite but highly readable Rule the Rules of Workplace Wellness Programs, by Barbara Zabawa, there are mind-boggling numbers of regulations. It happens that none of them actually prevent rogue vendors from harming employees, though. You’d think just by random chance one of them would, but no such luck.

This book is the compendium of everything needed to assure compliance with the myriad of sometimes contradictory regulations that govern workplace wellness. Over the years, a large number of generally disconnected laws have spawned an even larger number of regulations, opinions and interpretations of those of laws, and this book covers all of them. I was impressed by how the authors tackled the mind-boggling complexity and interplay of these rules in such a readable fashion. I myself dog-eared many pages for future reference.

For my company (Quizzify), this book has been especially helpful as, thanks to its guidance, we are able to now offer an HRA which satisfies the “reasonably designed to promote health or prevent disease” standard far better than the typical buckle-your-seat-belt-and-eat-more-broccoli HRA — and does it without collecting personal health information. Hence we avoid all the HIPAA concerns while satisfying the standard for what constitutes an HRA many times over. Absent hiring an expensive attorney, this would not have been possible for us to do without this book as a touchstone.

While designed to be read and hence not classically termed a “reference book,” the chapter most readers will want to refer to time and time again is #4, covering the laws of workplace screening and incentives. If you are going to get in trouble, that’s where it will happen. Virtually all the lawsuits filed by various employees have alleged violations of laws and regulations around screenings and incentives/penalties.

The ultimate irony is that this book is about 400 pages long.. That’s how much space is required to cover all these rules. And yet there is no rule saying that vendors can’t harm employees, which would seem like it should be the most basic if not the only rule of wellness. So Wellsteps was able to get away with harming employees of the Boise School District (and, this being the wellness industry, be rewarded for this performance with a Koop Award) and — aside from a scathing expose by ace journalist Sharon Begley in STATNews — face no consequences or liability. Yet if you don’t follow all the steps listed in here for avoiding minor transgressions (for instance, your coaches may accidentally ask people about their family histories — a useful but in most cases illegal line of inquiry) you could find yourself in violation of one or more of the laws which somehow manage to make wellness programs both more complex and less effective at the same time.

At some point, all these regulations should be shelved in favor of a “do no harm” standards as covered in the Wellness Code of Conduct (for which Ms. Zabawa is an endorser and co-author), findable at But until then, these rules rule the industry, and as the title says, you need to rule the rules.


In the immortal words of the great philosopher Pat Benatar, hit me with your best shot.

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