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Warning: Workplace Wellness Can Be Hazardous to Your Health
Sometimes we bring up the many ways in which conventional outcomes-based “pry, poke and prod” wellness programs harm employees. For the first time, we are putting all those harms in one place, a hand clip-and-save guide for journalists, regulators, and legislators.
This series now includes three. First is The Outcomes, Economics and Ethics of the Workplace Wellness Industry. The good news about this one is its exhaustive comprehensiveness in covering the industry’s misdeeds, garnished with 400 linkable footnotes. The bad news is it was published more than 9 months ago, too soon to capture the most recent swarm of misdeeds. For example, it predated Interactive Health’s scorched-earth screening program, designed to leave no employee undiagnosed. (This is literal — according to their own data roughly a quarter of employees discover “new conditions” every year. So in 4 years, every employee, on average, gets one new condition.)
The next was an expose of the economics of wellness, a compelling, fully sourced and linked proof that the whole pry, poke and prod endeavor served no economic purpose beyond enriching pry, poke, and prod vendors. (Screening according to guidelines, should a vendor ever choose to do it even though it would require sacrificing two-thirds of revenues in the name of integrity, would be exempted from this conclusion.) That’s because there is no chance that vendors “playing doctor” at work saves money.
Confucius observed that an mistake that remains uncorrected after being pointed out becomes a lie. Using that definition, two-thirds of the wellness industry –– including the Koop Award Committee and the Health Enhancement Research Organization — is lying, as they are fully aware that their very stable economic genius fantasies are nothing more than the stuff dreams are made of. That also explains why the $3 million reward for showing wellness is not an epic fail remains unclaimed.
The Hazards of Workplace Wellness
This whole thing would be hilarious were it not for all the harms and hazards of workplace wellness visited on employees who are forced to choose between, as Judge Bates noted in his epic decision in AARP v. EEOC, paying two months’ rent or forfeiting that sum by submitting to needles wielded by unlicensed, unregulated and unsupervised wellness vendors. Employees should never be forced into clearly unhealthy situations at work, at least without the hazards being disclosed, and yet, today’s American Journal of Managed Care posting covers six hazards employees face as they navigate the shoals of workplace wellness:
- Actual, well-documented, harms to an exposed population
- First-person case studies and reports
- Crash-dieting-for-money risks
- Flouting of established clinical guidelines
- “Hyperdiagnosis” leading to unneeded medical care
- Incorrect or potentially harmful advice that employees are told to take
All of this is covered in one place this month — and is totally worth the read.
Not if you don’t have a license, aren’t required to understand what you are doing, and can force employees to harm themselves or lose money
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Announcing the Winner of the Wellness Industry’s 2017 Deplorables Award: Interactive Health
Winning a Deplorables Award is no easy feat for a wellness vendor. You have to out-lie, out-harm and generally out-stupid many worthy competitors. Yet this year’s competition wasn’t even close. Fitbit might have won on lies and stupidity alone, but no one was ever harmed by wearing an activity tracker. Interactive Health clobbered them in harming employees. Like Wellsteps (the 2016 Deplorables Award Winner) they managed to do that multiple ways. This award covers the harms, the lies, and the stupidity. Truly the perfect storm of workplace wellness.
The Harms
Interactive Health’s signature move is conducting mass screens so inappropriate that doctors doing essentially the same thing — paying people to take this panoply of tests and then billing insurance — would lose their licenses.
Needless to say, when you do all sorts of inappropriate tests, you find all sorts of non-existent problems, and send all sorts of employees to all sorts of doctors. This isn’t simple overdiagnosis. This is classic hyperdiagnosis as described in our 2015 posting.
This is what we wrote in that posting, and it appears Interactive Health is the poster child for it. As compared to overdiagnosis, which is the unfortunate byproduct of well-intentioned efforts to help patients who present with symptoms, hyperdiagnosis is:
- pre-emptive — employees aren’t asking to be diagnosed, don’t have symptoms, want to be left alone, and often aren’t even old enough to have the stuffing screened out of them yet;
- either negligently inaccurate or purposefully deceptive (and IH has been requested many times to stop doing inappropriate screenings but they continue unabated);
- powered by pay-or-play employee forfeitures for non-participation, of the type about to become illegal in 2019;
- all about the braggadocio – wellness companies love to announce how many sick people they find in their screens…
…And here is Interactive Health doing exactly that:
What do you do after you round up all sorts of unsuspecting employees with inappropriate screens? Obviously, you bombard them with inappropriate advice, of course. Specifically, the huge percentage of employees at risk for diabetes — thanks to those “a1c tests for everyone” (which of course are specifically not recommended by the USPSTF) are supposed to drink full-fat dairy, not skim. And absent hypertension, they are also not supposed to avoid salt. Quite the contrary, maintaining US-average salt consumption appears to be protective against diabetes. (Not to mention that salty snacks often substitute for sweet ones.) We had no trouble finding these studies online. Hopefully Interactive Health will use some of their award money to purchase an internet connection.
Fortunately, most employees pay no attention to Interactive Health’s 1500-word single-spaced tomes, so it’s unlikely their antediluvian advice harmed anybody.
Third, speaking of harms, they also harmed me when I went in to be screened. Not just by announcing my PSA score when I specifically asked not to be tested for PSA, but by stretching my calf far enough to send it into spasm.
The Lies
The English language already has 450,000 words, the most of any language. And yet none of those words adequately describe the amount of lying done by Interactive Health, even after they’ve been caught.
They are claiming “amazing results” based on one study by an unknown, now-defunct consulting firm that couldn’t even pay its internet provider. (The consulting firm had also made up a set of qualifications in which, other than articles and prepositions and conjunctions, every word was a lie.)
Once the lies were initially exposed, they paid me to stop writing about them for a while. I agreed, provided that they stop lying — meaning that I can write about them ad nauseam.
The smoking gun for the initial lie was that they accidentally admitted that they didn’t really reduce any risk factors. You can’t save a gazillion dollars by reducing employees’ wellness-sensitive medical events if you can’t improve employees’ wellness. According to their own figures (and of course excluding dropouts and non-participants, whose risks likely climb), their risk reduction was quite trivial. How trivial? The Wishful Thinking Multiplier — savings divided by the number of risk factors temporarily reduced — exceeded $50,000.
After that expose, they sealed their front-runner status for a Deplorables Award by simply trying to suppress the evidence. They took the trivial risk reduction displays out of that study, and now only make available the bowdlerized version, which they call a “research summary.” The only way you can get the raw risk reduction data is by scrolling down this post. Rule one in wellness whistle-blowing: always take screenshots.
And most recently, they’ve become strong proponents of Wellsteps’ strategy, bragging about how many high-risk employees became low-risk without mentioning that roughly as many low-risk employees became high-risk. Suppose you flip 100 coins. It’s not enough to say that of 50 heads, 25 became tails. You also have to admit that 25 of the tails flipped to heads. At the end of the day, nothing changed. Here are the heads-to-tails, from their website. (By the way, this is also not true, even on its face.)
The Stupidity
Ask any employer what is the “new smoking” in terms of employee hazards and mortality. Most will say opioids, of course. Not Interactive Health. For them the “new smoking” is…
Hey, Interactive Health, maybe you can find a smart person to explain this particular statistic to you:
- According to the CDC, the number of annual deaths caused by smoking: 480,000
- According to the CDC, the number of annual deaths caused by sitting: 0
Here are some other differences between the two activities: Chairs don’t carry excise taxes or warning labels. If you’re under 18, you can buy a chair without a fake ID. Workers are allowed to sit inside the building. Chairs don’t make you clothes smell, cause lung cancer or dangle from the lips of gunslingers in old John Ford westerns. Sitters aren’t assessed health insurance penalties. Your Match date will not feel misled if he or she catches you taking a seat, even if your profile didn’t disclose that you sit.
And finally…
Take The Interactive Health IQ Test
Which of these images is most unlike the others?
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Should Interactive Health’s wellness advice carry a warning label?
This is the third in our series exposing the hilarious antics of Interactive Health.
Hilarious, that is, unless you are one of those unfortunate souls who are:
- paying their bills;
- believing their outcomes; or
- taking their advice.
The first and third are closely related in the sense that one would think with their fees –which rank among the wellness industry’s highest due to their industry-leading embrace of hyperdiagnosis — they could afford to train their employees in wellness.
However, since they apparently forgot to check that box, I’ll do it for them. I owe them this favor, having recently made unflattering observations regarding their botched cover-up of their invalid outcomes reporting.
First the good news
No one can accuse Interactive Health of wasting money on excessively silly, excessively gimmicky, excessively readable user interfaces. Here is the advice they give to employees, all 1350 words of it, starting with Page 1.
But wait…there’s more. Page 2
And for all those employees who simply have too much free time on their hands at work, Page 3.
More good news. They do tell this employee, after informing her that she has metabolic syndrome, to “avoid sugar.” Credit the law of averages with that — if you write 1350 words, it is likely that 2 of them — 0.14% — will be correct. These two words are in the middle of the second page, so I’m sure she saw them. Who wouldn’t?
Next, the bad news
To prevent that metabolic syndrome from progressing to diabetes, the letter also recommends “lowfat or nonfat dairy” in the diet. However, according to the the journal Circulation, people with the most dairy fat in their diets had a 50% lower risk of diabetes. Likewise, a study of 18,000 women showed lower obesity among those who consumed full-fat dairy. Journal articles are likely beyond Interactive Health’s grade level, so here are two lay summaries and two lay books:
- The Skim Milk Scam: Words of Wisdom from a Doctor Dairy Farmer
- Lowfat Dairy: Zombie Guidance
- The Big Fat Surprise
- The Bad Food Bible
It’s not just dairy fat, where the science, though perhaps not definitive, is settled enough that even the dumbest wellness vendor should know not to tell diabetics to switch to skim milk. It’s also saturated fat in general, where the change in scientific understanding over the last 10 years has caught many wellness vendors by surprise, and they haven’t had time to react.
If consumed in large quantities, perhaps saturated fat may be a heart disease risk factor nonetheless. Who are we to say? However, if it were a culprit of any significance — like trans fats or cigarettes or family history — that conclusion would be definitive by now, given the massive amount of research that’s been thrown at this question. Even if saturated fat were a minor risk factor, there is still one overriding reason Interactive Health shouldn’t be telling people with metabolic syndrome to eat less fat: what the he** do they think people will eat instead? There is a whole body of literature on how telling people to eat less fat helped create the obesity epidemic.
In all fairness to Interactive Health, they recommend eating only less dairy and other saturated fat, not less total fat. However, that is a subtlety that can get lost in those 1350 words brimming with all sorts of random advice. For instance, on the subject of abnormal thyroid function, the letter says: “Talk with your healthcare provider about possible treatment options for this condition.” Sound advice indeed — if in fact the person in question had abnormal thyroid function, but according to this report (bottom of Page 2), her “thyroid was normal.”
More bad news
Even though this person does not have high blood pressure, the letter also recommends eating less salt. For people without high blood pressure and especially people like her who have other diabetes and cardiac risk factors, avoiding salt is likely a bad idea.
Other than the answer being different for different people and different ethnicities (subtleties overlooked by almost all wellness vendors, which prefer to give blanket advice), the science is unsettled. It does, however, increasingly point to the importance of salt — something humans have been consuming in large quantities ever since way before the Roman Empire paid its soldiers in salt — in the diet. This is especially the case for people with, or at risk for, diabetes or heart disease (which this person is). In particular, for people without hypertension, reducing salt intake to a level much below the US average:
- is associated with higher risk of death among diabetics
- may increase insulin resistance
- may increase risk of death from heart disease
- may increase total and “bad” cholesterol
Among other limitations, most of these studies are correlative, not causative, and rely on self-reporting rather than controlled environments. So we can’t conclude with certainty that avoiding salt is a bad idea. Nonetheless, my suspicion is that companies paying Interactive Health millions of dollars — and basically forcing their employees to choose between submitting to them or losing money — have assumed that the advice they are giving employees is settled and likely correct, rather than controversial and likely incorrect.
Other studies, generally older ones, recommend low-salt diets to prevent high blood pressure, so it is still at least arguably fair to say salt science is conflicted. But the overriding reason for Interactive Health stop telling employees at risk for diabetes to eat less salt and less saturated fat is, what the he** do you think they are going to eat instead? Since most proteins come with saturated fat (and salt), there is only one thing left to eat: carbohydrates.
The bottom line is that anyone who actually takes Interactive Health’s advice on how to avoid diabetes is likely to increase their odds of getting diabetes.
Fortunately, most employees will have the good sense to ignore their advice, if for no other reason than it is quite a Herculean task to plow through it all. How do I know this? By definition, any employee reading this blog is more health-conscious than average. And yet the particular employee who, after reading my blog post on them, sent me this letter originally sent me only the first and third page. She hadn’t even realized there was a second page, since Interactive Health printed it on the back of the first page.
Ironically, that was the page where it said “avoid sugar.”
The “coaching” call
In addition to the letter, this employee did receive a coaching call, described as follows:
When they called to offer me advice they simply said, “ Do you know you have high cholesterol?” I said, “yes.” Then she proceeded to ask me what I was going to do about it . I said : “I thought you would tell me what to do.” She had nothing to say. Then I received another call a few weeks later as a follow up and I wanted nothing to do with them as they had already discredited themselves with the first call.
In yet another installment (which will have to wait until 2018 since December is devoted to highlighting the best-in-shows of the wellness industry and of course the Deplorables Awards) we’ll explain how Interactive Health translates ignorance of clinical guidelines, bad dietary advice and massive hyperdiagnosis into quite literally the most inflated savings in the wellness industry this side of Wellsteps.
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Final installment: 3 more stories of wellness shame and harms
Included in this concluding batch is yet another wellness program debacle regarding eating disorders. The irony is, this one takes place at an addiction facility. I’ve always maintained that, along with facts, integrity, math, data, employees and me, another thing the wellness industry has no appreciation of is irony. Examples:
- The most recent Koop Award for the best wellness program went to Wellsteps, who according to their own data made employees worse;
- Vitality pitches its weight-loss program even though by their own admission they couldn’t get their own employees to lose weight;
- The wellness industry’s own trade association, whose job is to show wellness saves money and improves morale inadvertently admitted that wellness loses money and damages employee morale.
This final set of case studies concludes with a statement from an actual named, LCSW who specializes in the treatment of eating disorders.
Links to previous installments:
- Part 1: Recovering executive with anorexia nervosa begs not to be weighed…DENIED
- Part 2: Recovering technologist with bulimia told to “fit into his skinny jeans”
- Part 3: Recovering employee with anorexia nervosa told “nothing tastes as good as skinny feels” and advised to eat only half her lunch.
- Part 4: Recovering employee with bulimia and a severe grain allergy penalized for eating too many natural fats, as correctly prescribed by her dietitian…and begins purging again.
Joan
The school where I work recently instituted a wellness program. In order for our insurance premiums to not increase, we had to go through a series of tests: total cholesterol, blood pressure, BMI, LDL cholesterol and fasting glucose. If we did not “pass” 4 out of 5 of these biometric screenings, we had to go through six weeks of phone therapy and then have the screenings done again after that time.
If, after the six weeks of phone therapy, the results did not change, our insurance would go up about $50.00/month.
The whole experience was a nightmare. They conducted the screenings in the music room at school, with different tables and stations set up. About 10 or 12 teachers and staff members were in the room at one time, so there was little privacy.
We moved from one station to the next as each of our results was written down and passed to the next person.
When we got to the end, a wellness “counselor” went over our results. The lady saw my triglycerides number and immediately asked, “Does diabetes run in your family?” “Is obesity an issue in your family?” I asked why. She said that a high level of triglycerides means that the body has “too many fat cells” and that I am at an “increased risk.”
To someone who has struggled with an eating disorder, as I have, this was tantamount to saying “Because of your high triglycerides, you are fat. You are obese.”
Being weighed is always a humiliating and shameful experience for me, as it is for many people with eating disorders, and it can trigger exacerbations of my disorder (treating professionals familiar with eating disorders are well aware of this phenomenon and structure treatment accordingly). To have to be weighed in front of my peers made that experience even worse.
This biometric screening triggered my disorder. I was in tears by the time I got to the last “counselor” and had a very hard time controlling my feelings. Right after this, I needed to get into my classroom and be with my kids. I had to “suck it up,” until the end of the day.
It was horrible and it makes me wonder what is in our future in regard to all of this.
Katie
My workplace, an addiction treatment facility, has an employee “wellness” program.
If employees want to obtain the insurance “wellness rate” (the lower of two rates available to employees), we are required to start every year in January with a “health fair” and a “know your numbers screen” where they check weight, blood pressure, glucose levels and cholesterol. Then we are “advised” by a registered nurse to exercise more and eat less (as if that had never occurred to anyone previously).
This year, the medical assistant drawing my blood engaged in numerous behaviors that would trigger most people with an eating disorder. She informed me she “used to be as big as” I am until she “got bypass surgery.” Despite mentioning several times that I see a nutritionist who recommends that I not weigh myself or know my weight, I was asked to guess my weight before I stepped on the scale. I turned around when I stepped on the scale to avoid seeing my weight, but the assistant nonetheless chattered on about my weight.
I was reminded of embarrassing weigh-ins with school nurses and weight loss programs before I was exposed to eating disorder recovery.
This year we are also assigned to a “wellness team” where everyone is supposed to wear pedometers every day and log their steps weekly on a website. Everyone can see everyone else’s steps on the site and a competitive spirit is encouraged.
I am especially saddened and concerned that we have this potentially damaging environment that encourages obsession with weight and numbers in a facility that treats addiction, where one would hope we would be steered away from, rather than toward, the process of addiction to disordered eating.
I have worked with hundreds of patients over the 13 years during which I have worked with people with eating disorders. In the past two years, I have seen a number of patients who were quite negatively impacted by the wellness programs at their place of work.
In one instance, a patient with binge eating disorder reported that she would be financially penalized if she didn’t set weight loss as a goal and make progress toward this goal. However, this was in direct conflict with her treatment goals to stabilize eating and set any goals for weight loss aside. This patient could see how focusing on weight loss increased her binge eating; however, she felt shame and anxiety as a result of these pressures put on her by her employer. She did not feel that as a larger-sized person she could speak up about this injustice.
In another instance, a patient reported that her employer required her to complete a health screening or be charged $600.00, and when she didn’t meet the health targets she was given an opportunity to still get the monetary “rewards” by meeting with a dietician three times. She was also informed that she could get a “Healthy Weight Improvement Reward” by losing five pounds since her last health screening. Again, this is a patient with binge eating disorder whose condition is destabilized by focusing on weight loss. She too felt that as a larger-sized person she could not speak up about how this program could cause her harm.
What now?
Next week, and with the help of others, we will ask, what does this all mean? What can be done to prevent or discourage wellness vendors from harming employees?
And once again, kudos to the good guys, the vendors who are not implicated in this series at all, and indeed would never do such things to people:
American Institute of Preventive Medicine, Health Advocate, HealthCheck360, It Starts with Me, Limeade, Redbrick, SelfHelpWorks, Sterling, Sonic Boom, Sustainable Health Index, US Health Centers, US Preventive Medicine
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Wellness vendor penalizes employee with severe grain allergy for eating too much fat. (Part 4)
Imagine if you were a recovering alcoholic. You hadn’t taken a drink in quite some time, attended AA meetings conscientiously, and were getting on with your life. Then your employer had a drinking contest and told you that you weren’t drinking enough. Further, if you failed to drink more, you would be fined.
Preposterous? Yes — but that is exactly what people with eating disorders are forced to endure in many wellness programs. They are told to eat less to become thinner, docked points or money if they don’t, and are made to feel inadequate by vendors who have no idea what they’re talking about.
This is the fourth in the series of major wellness harms perpetrated on employees by wellness vendors and indifferent employers. These narratives have been painstakingly compiled, edited only lightly, and with no detail omitted other than the victim’s name and employer. I won’t tell you who the perps are yet, other than to say that the vendors I have consistently noted to be the best — American Institute of Preventive Medicine, Health Advocate, HealthCheck360, It Starts with Me, Limeade, Redbrick, SelfHelpWorks, Sterling, Sonic Boom, Sustainable Health Index, US Health Centers, US Preventive Medicine — are not among them.
See:
- Part 1: Recovering executive with anorexia nervosa begs not to be weighed…DENIED
- Part 2: Recovering technologist with bulimia told to “fit into his skinny jeans”
- Part 3: Recovering employee with anorexia nervosa told “nothing tastes as good as skinny feels” and advised to eat only half her lunch.
Sue
I struggle with bulimia. My employer instituted a wellness program that requires employees to undergo yearly medical screenings of cholesterol, blood sugar, blood pressure, and body mass index. We also have to fill out an annual health questionnaire. Employees who undergo the screenings and complete the questionnaire receive a reduction in their health insurance premiums, whereas employees who decline to do either of these things cannot receive this reduction. If an employee’s spouse is covered under his or her insurance, the spouse must undergo the screening as well in order for the employee to receive the premium reduction.
The program recommends that you join coaching and weight management classes if the screening identifies your body mass index as “too high.” It suggests that being thin means being healthy, and being heavier means being less healthy, even though this is far from true for many people. For individuals who have struggled with eating disorders, it is particularly troubling to be labelled as having a weight problem or a problem with body mass index despite having worked closely with treating professionals to manage the disorder. Telling such individuals that they have a weight problem is precisely the type of response that professionals who treat eating disorders know to avoid. When nurses with no knowledge of our treatment history or progress, and no knowledge of eating disorders generally, respond this way, it undermines our treatment and progress. It is even worse when that undermining happens at one’s place of work.
Like the screenings, the health questionnaire inappropriately suggests that thinner is always better. Based on my answers, the wellness program assumes that I have unhealthy eating habits, but it does not account for the fact that my diet is carefully prescribed by my treating doctor in response to a multitude of food allergies. I am allergic to all grains, and as a consequence, in 2013 I switched to a natural fat, unprocessed, grain-free diet. My health markers began to improve at that time. The wellness program, however, identified my eating as unhealthy because of the fats included in my diet. As a result, I was docked “health points” and was given recommendations such as “eat less,” “unsupersize your meals,” and “go Mediterranean to transform your health and your weight,” and attend Weight Watchers. After receiving these messages that suggested I was overweight and eating poorly, I began experiencing greater symptoms of my eating disorder and began purging. While the wellness program did not start my eating disorder, it has certainly made it worse.
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Victims of Wellness Programs Tell Their Stories of Shame and Harm — Part 3
This is the third in the series of major wellness harms perpetrated on employees by wellness vendors and indifferent employers. These narratives have been painstakingly compiled, edited only lightly, and with no detail omitted other than the victim’s name and employer. I won’t tell you who the perps are yet, other than to say that the vendors I have consistently noted to be the best — American Institute of Preventive Medicine, Health Advocate, HealthCheck360, It Starts with Me, Limeade, Redbrick, SelfHelpWorks, Sterling, Sonic Boom, Sustainable Health Index, US Health Centers, US Preventive Medicine — are not among them.
See:
- Part 1: Recovering executive with anorexia nervosa begs not to be weighed…DENIED
- Part 2: Recovering technologist with bulimia told to “fit into his skinny jeans”
Mary
I used to work for a county health program that established a workplace wellness program. One cold January morning, I returned to work for the first time in nearly eight weeks. I had taken a leave of absence after a suicide attempt and inpatient treatment for chronic depression and anorexia. I had gained a few pounds and my depression had stabilized, and I was looking forward to returning to work I found meaningful.
But when I walked in the door, I was inundated with signs about our workplace weight loss contest—a “Biggest Loser”-style competition. For someone who was struggling desperately to gain weight, this was nothing less than an affront. Signs told me that “Nothing tastes as good as skinny feels.” Besides being the same slogans plastered all over the anorexia-enabling websites I used to visit, I had spent the past decade feeling exactly how skinny could make you feel—miserable enough to complete a near-lethal overdose.
I pulled my chin up, set my things down at my desk and walked into the break room for a hot cup of coffee. There, on a big sheet of blue posterboard, was a tally of how much weight everyone had lost. Veronica in accounts receivable had already lost 3.4 pounds. Then, flooding in my inbox were the emails encouraging us to only eat half our lunch, and to try to sneak in an extra workout during our lunch break. Never mind that these behaviors were exactly what had landed me in the hospital. Now, I had a prescribed diet developed in consultation with my dietitian.
For several months, I tried to grin and bear it, but eventually, the madness was just too much. I couldn’t bear the meetings about how good steamed broccoli was. I couldn’t stand working in an external environment that was, quite possibly, more toxic than the internal chatter I endured all day. The poster listing everyone’s weight loss statistics was removed upon my request, but the fact remained that the workplace wellness program had created an environment that was anything but healthy. I had to quit my job.
Perhaps my experience is an unavoidable side effect of a war against obesity that some have determined should be won at all costs (and regardless of strong evidence that existing wellness programs don’t work).
But when you consider that around one in 20 Americans will struggle with an eating disorder at some point in his or her lifetime, that’s a lot of collateral damage.
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Victims of Wellness Programs Tell Their Stories of Shame and Harm — Part 2
This is the second in a series of first-person narratives of harms caused by wellness vendors. These narratives have been painstakingly compiled, unretouched except for formatting, and with no detail omitted other than the victim’s name and employer. I won’t tell you who the perps are yet, other than to say that the vendors I have consistently noted to be the best — American Institute of Preventive Medicine, Health Advocate, HealthCheck360, It Starts with Me, Limeade, Redbrick, SelfHelpWorks, Sterling, Sonic Boom, Sustainable Health Index, US Preventive Medicine — are not among them.
John
I’m 37 and have put a lot of work into recovering from bulimia. I have been in treatment for bulimia for 12 years. I see a therapist, a doctor specializing in eating disorders, and a psychiatrist.
For the last five years, I’ve worked at a technology company. I’ve noticed that every year, their “wellness program” has become more and more triggering, as it has become increasingly tied to health biometrics and “rewards” on my paycheck. The “rewards” for taking answering the health risk assessment, taking various biometric tests, and meeting certain health outcomes are so significant that I felt I had to participate. These rewards now come to a total of $2470 per year for taking the tests and meeting all of the health targets. With a family and a child in day care, I cannot afford to forego such a large amount of money.
A couple of years ago, the wellness program started to require that employees’ weight, triglycerides, and blood pressure be checked. These biometric screenings happen every year, and I dread it. If my body mass index does not fall into what the program considers “normal,” then I don’t get a “reward” on my paycheck—or, to put it another way, I get penalized. If I forego even one part of the biometric screens, such as the weight check, I lose the reward for all of the screenings. In addition, the program’s instructions for employees, including to keep their meal portions “as small as possible” (to “fit into your skinny jeans”) are inconsistent with and undermine all the work that I have done to overcome my disability.
The wellness program allows employees to have their own physicians perform the screenings. When my doctor heard about the screenings, he was incredulous. He indicated that, out of concern for my health, he did not want me to participate in these tests. But I felt compelled to do so given the large sum at stake. My doctor wrote a letter explaining that having me step on a scale and having my weight read out loud would be extremely damaging. After three months of requests and negotiations, I was ultimately able to get the program to permit me to apply for the incentive without my doctor filling out the screening form (a special “manual process” was used), but this process was extraordinarily stressful and I have no assurance that I will be permitted to do this in the future. I was the first person who was able to forego the screening without losing the incentive—and to my knowledge, the only person. And guess what? It’s time to do the entire thing again for this year’s screening!
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Victims of Wellness Programs Tell Their Stories of Shame and Harm
This begins a series of first-person narratives of harms caused by wellness vendors. These narratives have been painstakingly compiled, unretouched except for formatting, and with no detail omitted other than the victim’s name and employer. I won’t tell you who the perps are yet, other than to say that the vendors I have consistently noted to be the best — American Institute of Preventive Medicine, Health Advocate, HealthCheck360, It Starts with Me, Limeade, Redbrick, SelfHelpWorks, Sterling, Sonic Boom, Sustainable Health Index, US Preventive Medicine — are not among them.
Jane
I am a corporate executive in a Fortune 500 company. My employer operates a wellness program. Every year, as part of that program, we are required either to have blood drawn and have our weight, height, blood pressure and other things measured or contribute more toward our health insurance. This testing is done on site at the workplace.
I have anorexia. I have been in treatment for four years. Over the years I have built a relationship with my dietician, my therapist, my psychiatrist, and my medical doctor. Their familiarity with my needs, including what helps and what triggers the symptoms of my disability, is critical to ensuring that I receive effective treatment.
In contrast, the wellness program at my workplace is operated by people who have no familiarity with my particular needs and no knowledge of how to address them. Among other things, the program requires employees to undergo weight-related screenings administered in a manner that undermined the treatment regimen carefully designed by my treating professionals and resulted in my relapse and admission to an intensive outpatient treatment program.
I would never have participated in this wellness program of my own accord, but due to the large financial incentives to participate, I felt like I had no choice but to do so. When I found out that the wellness program required me to be weighed, I told my dietician, who was extremely concerned. She wrote a letter indicating that I was receiving intensive nutrition therapy with her and that I should not be weighed or have my body mass index measured by the program, as that would be detrimental to the progress that I had made under her care.
The wellness program nurse read the letter but proceeded to weigh me and, despite my stepping on the scale backward so I would not see my weight, she announced how much I weighed and what my body mass index was. She remarked that “it wouldn’t hurt you to enroll in our healthy eating program.” This is precisely the type of trigger that my treatment – and the treatment of people with similar eating disorders – is designed to avoid. She was telling me I was fat—exactly what I needed to hear to stop eating again.
After this incident, I stopped eating for two weeks and ultimately ended up in an intensive outpatient treatment program. My dietitian was furious about the damage caused by the wellness program.
I am dreading participating in the wellness program again this year. I am uncomfortable about having to tell my employer about my eating disorder – a very personal matter—and I do not want to repeat the experience of questions and screening that are counterproductive to my treatment. If I don’t participate, however, I will have to pay an additional $750.00 for my health insurance, so I cannot afford to avoid it.
They Said What? 