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Because I didn’t mention any names, I published this one on the Corporate Health and Wellness Association blog. So you’ll have to click through. SPOILER ALERT: the bad news is that there are a boatload of things — 10, to be exact — that wellness vendors don’t know about BMI.
The good news is, there some things wellness vendors do know about BMI, like how to spell it. This is a big accomplishment, because spelling is right up there — along with arithmetic, integrity, behavior change, and of course wellness itself — on the list of things that most befuddle wellness vendors. We’ve chronicled many examples, such as Wellsteps’ Steve Aldana calling award-winning journalist Sharon Begley a “lier.”
This is the second part in the series on wellness vendors and the US Preventive Services Task Force (USPSTF).
Q: Why do vendors ignore or flout the USPSTF?
There are five reasons, three of which are unfortunate:
- Many vendors don’t understand the entire concept of screening, neither the science nor the arithmetic described in Part 1. Healthcare is hard, and the USPSTF can’t be expected to dumb themselves down so that wellness vendors, for whom simple math is a challenge and who don’t have to meet any educational or licensing requirements other than eight days of training, can understand it.
- Obviously, the more vendors screen, the more money they make. Guidelines propose infrequent screening for fewer blood values than most vendors do. That means vendors who abide by guidelines can collect much less money from employers than those who charge what the market will bear. Examples of companies screening the stuffing out of employees include Total Wellness, Interactive Health, Star Wellness, Healthfair, and Healthfairs USA. Needless to say they make a lot of money. (Quizzify is very jealous! Doing the right thing and guaranteeing savings isn’t remotely as profitable as ripping off employers.)
- Many wellness vendors are dishonest. We’ve already pointed out that Wellsteps bragged about how they screen every Boise employee every year for everything, with no mention of USPSTF guidelines. But after they got caught, they admitted they knew that the guidelines say the opposite. And Optum’s Seth Serxner insisted — out loud, on tape, that they would be happy to screen according to guidelines, if only employers would let them. And yet, here is Optum’s ad, saying exactly the opposite: if you want us not to raise your rates as much on insurance, it’s a “requirement” to pay us even more than you would save on insurance, to do annual screens. (Naturally they are quoting two sources that they know to be false as well.)
Q; Those are three bad reasons. What are the two good reasons?
I would like to credit Pete Arens for bigly influencing my answer on this. It’s rare that someone does that, and even rarer that I admit it. However, in this case, huge credit where credit is due. Pete’s the man.
USPSTF publishes guidelines, not requirements. It is perfectly OK not to follow them — as long as you have a good reason. The reasons above — ignorance, dishonesty and greed — would clearly not qualify. However, here are some excellent examples of reasons that would:
- You work in a high-stress environment, like a law firm. Making blood pressure screening available easily and much more frequently than once a year, even having some discreetly placed cuffs, might be a good idea. (Some maintain that stress doesn’t cause high blood pressure. Perhaps not, but to them I say, watch Episode 5 of The People vs. OJ Simpson.)
- Your workforce is largely outdoors. Skin cancer and Lyme Disease screens might be indicated.
- You have alternatives to screening (like Quizzify) for younger employees, but encourage and educate older employees and other employees at high risk to get screened. The USPSTF doesn’t say, “no screens.” It says screens should be age- and risk-appropriate. You offer both to everyone (that’s the law) but steer some employees one way and some the other.
- Your company is in the chemical dye or railroad industries. A bladder cancer screen or at least educational session to raise awareness might be advisable. (Bladder cancer can be identified and easily treated very early.)
Mr. Arens raised the question specifically of obesity screens. Are they appropriate at all, especially in a workplace? And that brings us to the other good reason to flout the guidelines: you think they’re wrong. In that situation, make your case. But it has to be a real case, and obesity screening could very well be such a case:
- The Employee Health and Wellness Code of Conduct specifically says, don’t embarrass or single out employees. This would be a perfect example doing exactly that;
- You are unable to find any meaningful literature or technique that is even remotely shown to successfully address obesity for more than a short, clinically meaningless period of time, so why screen for something you can’t address?
- To the extent you, in a corporate setting, do want to make your workplace healthier, you don’t need screens to do that. Encouraging exercise and avoidance of sugary foods at work would have the same impact.
Read carefully: we aren’t saying specifically you have to pass on obesity screens for those reasons. We are saying that if you differ with USPSTF on any screen, disclose the reasons and/or cite the literature, so it looks like a thoughtful decision. This is an example in which we would differ with guidelines.
Q: What would be a funny example of a vendor who tries to attack the USPSTF but falls on its sword?
Glad you asked. That would be Healthmine, whose credibility, um, collapsed as a result. Rule of thumb: to attack USPSTF credibly, a good start would be spelling their name right. We’re just sayin’…
Q: What would be a funny example of a vendor who flouts the USPSTF recommendations?
You’re asking all the right questions. That would be Angioscreen. The only screen they offer, for carotid artery disease, is D-rated by USPSTF.
Q: I don’t see what’s so funny about that. Stupid, yes. Harmful, yes. Expensive, yes. But what makes them so funny?
They admit right on their website that employees shouldn’t get these screens.
Honestly, I’m not sure which of those two things is dumber — offering the screen or admitting working-age people shouldn’t get it. But at least no one can accuse them of lying.
Q: They also can’t spell “New England Journal of Medicine.”
Good point. I didn’t even notice that until you brought it up. Maybe their head of their advisory board can help them with spelling, since “quality control is extremely important” to them.
Q: What does the USPSTF think of the wellness industry?
Their guidelines are intended for use by real doctors and medical practitioners. My guess is that they are horrified by the idea of an entire industry, unsupervised and uneducated, “playing doctor” with employees. Meanwhile, the National Business Group on Health, a vendor-fest if ever there was one, lobbies against the USPSTF for not understanding the importance of screening the stuffing out of employees.
Q: Why do employers go along with overscreening?
That’s a great question. They need only look at their own hospitalization rates to see that hospitalizations from diseases they are trying to prevent by screening, like diabetes and heart attacks, are already ridiculously low. However, rather than look at their own data, they prefer to spout the “86% of illness is caused by chronic disease” meme, which was already discredited when it was 75%, before the CDC decided to jump it up to 86%.
Anybody who reads that article can see that either is an impossibly stupid statistic. Most hospitalizations at most employers have something to do with birth events, and most expense at most employers can be traced to one-time items not addressable through eating more broccoli (neonates, transplants, cancer) or employees who either have a rare disease or more likely have a dependent with a rare disease.
Q: Maybe This isn’t fair, and vendors screen more than guidelines because they don’t think cost should be an issue and that employees should get all the prevention they can possibly use regardless of price
Actually, the USPSTF specifically does not include cost in its analysis. It balances harms and benefits, not costs and benefits. Screening according to guidelines will therefore lose money, as Ron Goetzel just admitted, even if over the long run more employees may benefit from screens than are harmed.
Quite the opposite. Tons of vendors obsess with hyperprevention because they are totally ignorant of the science and math involved. Our favorite is one called: “HEALTHIER is WEALTHIER and ASSOCIATES.” Along with the usually assortment of wellness industry THC-infused folderol (“our program, if followed diligently for a year, will decrease your employee health cost by as much as $24 for every pound of weight loss, an amount quoted by Dr Michael Roisen [sic] MD, Chief Wellness Officer and Chairman, Cleveland Clinic Wellness Institute”), they want to screen employees every three months. Don’t believe us?
Stay tuned for Part 3: Vendors who understand the USPSTF
Recently we described how to cheat one of those worthless, hazardous corporate crash-dieting contests, like the ones run by Wellness Corporate Solutions or HealthyWages or Virgin Pulse (nee ShapeUp). But we didn’t interview any employees who actually did.
Journalist and wellness expert Pat Barone, writing in LifeZette (Laura Ingraham’s popular online magazine) managed to do just that. She found some employees who “confessed” (bragged about) the ways they snooker these vendors — and of course their own employers –every year, starting again in most cases next month.
These employers, like Schlumberger, think they are creating a culture of wellness when in reality they are creating a culture of deceit, diet pills and dyspepsia. Why would any employer sponsor one of these contests? Simple: in wellness, stupid is the new black.
I don’t want to spoil your fun reading the article by giving away all the punchlines, but the keywords are carbs, sodium, and rocks. All the things that employees should eat, as part of a healthy diet. OK, maybe not too many vitamins but certainly lots of minerals.
If we were real journalists here, we’d have killed a lot of trees in the cause of exposing the massive amount of lying and cheating by wellness vendors. However, as mere bloggers, all we do is kill millions of defenseless atoms.*
And yet we’ve sacrificed nary a single electron to the cause of exposing the massive amount of lying and cheating by the employees themselves. And massive it is. My very own extended family members are swapping fitbits around to increase their steps. Less for the money than for bragging rights about who can game the contest the best.
Indeed, these corporate “challenges” are really mental challenges, not physical ones, to see who can do the best job outsmarting the wellness vendor. Outsmarting wellness vendors, as past columns have shown, isn’t exactly a heavy lift: we have often observed that the good news about wellness is that NASA employees don’t have to worry about their job security because wellness vendors aren’t exactly rocket scientists.
To that end, the Wall Street Journal wrote an entire article about employees cheating in wellness programs. Apparently, employees are enlisting puppies, hamsters, even power tools and a ceiling fan in their quest to undermine their company’s wellness program. One enterprising employee posted a youtube showing how to cheat on these programs. A Midwestern cadre of truly dedicated employees took cheating a bit farther than most, and got themselves indicted for defrauding Kansas City out of $300,000 by lying on wellness programs.
30-second shameless plug time
Of course, there is one surefire way to avoid the downside of cheating: design cheating into the program. And that’s exactly what Quizzify does. The way to cheat on Quizzify is to look up the answers and learn about health literacy — which is exactly what we want employees to do!
How to cheat in a crash-dieting contest
Employees especially like to cheat in crash-dieting contests, enough so that countermeasures are needed. For instance, a vendor named Healthywages is bragging about how it ferrets out “fraudulent participants.” I figured I’d see what the internet has to offer on corporate biggest loser program cheating, because, after all, these days almost every search generates tons of hits. I say “almost” because if you search on “honest wellness vendors” and “Wellsteps,” there is only one hit: my observation that the latter could never be confused with the former.
In particular, the search found a group called www.healthstatus.com, which has given this topic altogether too much thought, thankfully. In all fairness to the HealthStatus folks (who do seem very well-intentioned and on the level), before they list their recommendations, they provide a cigarette-type warning label, as these programs richly deserve:
It’s getting to be New Year’s resolution time and many companies will try and “encourage” weight loss with a “Biggest Loser” type contest. Frankly, this is really a bad idea, as it can create all kinds of bad habits and damaging activities by the participants, as they starve, dehydrate and supplement themselves in an effort to win.
Having gotten the grownup stuff out of the way, here are their “recommendations” for employees whose employers, like Schlumberger, somehow got the impression these contests are a good idea, perhaps because their mothers didn’t listen to enough Mozart when they were in the womb. A few recommendations are fairly harmless, like drink a lot of water starting 3 days early and don’t pee (or do number twosies) before your weigh-in. And, of course, wear heavy clothes, carry lots of change in your pockets etc. You know, your typical garden-variety dishonesty that is probably woven into the culture of any employer that sponsors these contests. (These employers think they are “creating a culture of wellness” when in reality they are creating a culture of deceit.)
By contrast, some of these other recommendations boggle our minds, and, having written exposes on the wellness industry for two years now, our minds are not easily boggled:
The day before the weigh-in, ideally about 17 hours or less before your weigh-in time, you want to get yourself a good salty snack. A bag of chips, you know the ones that if you eat too many your lips hurt from all the salt and a nice tray of cheese and crackers.
For your dinner meal you want to load up on the proteins and a big glass of whole milk, also, this is a day you want to skip the fiber. This is one day of eating like this, we don’t encourage it, but a binge day also sets up your metabolism to know that is not starving, and can help in when we start burning fat after the weigh-in.
The day of the weigh-in, minimize your activity, another big glass of whole milk with your breakfast that contains some salty options will help you retain more water.
“At this point,” they observe, “you should be a big bloated sloshing mess that needs to go to the bathroom really bad. This is the perfect time to get weighed and measured.” They also remind you to accentuate poor posture, since the long-since discredited Body Mass Index measure still preferred by most of these vendors is a height/weight ratio. (HealthStatus also offers hints for contests that use waist circumference.)
In other words, do all the wrong things — eat badly, slouch, and don’t exercise. Be as unhealthy as possible. So you’re already obsessing with your weight and abusing your body horrendously in the name of wellness…and the contest hasn’t even started yet!
I hate to leave everyone hanging but HealthStatus hasn’t published the rest of its recommendations yet, meaning advice on how to cheat during the contests themselves.
And a good thing because I don’t know how much more wellness a fellow can take.
Since self-abuse is actually a very serious topic, I would like to step out of character here and offer a few serious notes. First, no wonder Optum and HERO and other Wellness Ignorati are stonewalling the Employee Health Program Code of Conduct. Nothing violates it more than their cherished corporate crash-dieting contests. And a particular call-out of the biggest-loser worst offenders: Virgin Pulse (nee ShapeUp), Wellness Corporate Solutions and HealthyWages. You ought to be ashamed of yourselves, even relative to other wellness vendors like Wellsteps, which had just recently established a new plateau for harming employees, that you people are blasting right through.
*Just for the record, we know that writing blogs does not kill or even injure atoms. And while Keas might find that being used in blog posts stresses them out, we would disagree. Quite the opposite: if they enroll in wellness programs, they can live to be 100.
Yes, we know you read this blog for the chuckles. Our most popular and funniest posts are usually the ones showcasing the wellness industry’s race to the bottom. And despite heavy competition, very few industry scams can beat corporate get-thin-quick schemes to that inexplicably coveted nadir:
- Here is Healthywage discussing its newest schemes, like “dieting for dollars” and “paying for pounds.” They also describe how to prevent “fraudulent participants,” a category presumably comprised of zombies and dead voters in Chicago.
- “In Wellness, Stupid is the New Black” shows how Healthywage can’t even read a scale.
- “Shape Up falls down trying to do math for Highmark,” about a weight-loss program so clueless that it got covered by the Pittsburgh Post-Gazette.
- Perhaps our favorite is Wellness Corporate Solutions. We won’t ruin the punchline for you.
In sum, we say: “To call corporate crash-dieting contests a joke is an insult to jokes.”
Unfortunately for those of you seeking a few chuckles, this is not that situation.
Quite the contrary, Rebecca Johnson has penned one of the best articles on corporate weight loss programs we’ve ever seen, so we can’t dismiss it with our usual clever if by now overexposed putdowns like: “She should have had this reviewed by a smart person before publishing it,” or “Perhaps her subscription to the internet expired.”
Instead, rarely have we seen more intelligent observations packed into a tighter space, more thoroughly sourced and clearly explained. To summarize:
- Corporate crash-dieting contests are much more likely to harm employees than benefit them;
- They don’t produce an ROI;
- Our mothers were right. Eat a balanced diet. There are more benefits than one would think to not obsessing with what are the “best” and “worst” foods. (Having said that, some people seem to do very well on a low-carb diet. We leave that debate to others and recommend The Big Fat Surprise to readers with an interest in that topic.)
- It is better to be fit and fat (“health at every size”) than to yo-yo diet, for sure.
She goes on to explain her particular approach to mindful eating. I myself have no expertise in that area so I can’t critique the specifics, except to say that Healthywages, ShapeUp (now Virgin Pulse), and Wellness Corporate Solutions should definitely find a smart person to explain this approach to them, even if it means having to pay for an internet connection.
It simply isn’t news any more when a publication aimed at the human resources market publishes an article slamming wellness. It just means a reporter (Bruce Shutan in this case) is actually reporting the facts, rather than assuming a “false equivalence” between wellness critics and wellness apologists. While reporters “take sides” frequently these days in wellness, it’s a rarity when writing on other topics. Normally, reporters use “he said-she said” because a good rule of thumb is that most but not all debates do indeed have two sides. The exceptions to that rule are wellness,* evolution, and Trump University.
Below are the article’s highlights.
Our $1-million reward has gone unclaimed.
Obviously, if the Wellness Ignorati–and we are reviving that phrase by popular demand (for the uninitiated, it means wellness apologists who knowingly ignore facts in order to snooker) — really thought that “pry, poke and prod” programs work, they would have claimed it by now.
Wellness vendors deliberately flout guidelines to make more money
If they were to adhere to US Preventive Services Task Force guidelines, they would be screening appropriately–but make much less money. Optum’s Seth Serxner stood up on camera to blame employers for making Optum flout the guidelines, while HealthMine takes great pride in their ignorance of them. Either way, employees and employers lose.
Ron Goetzel is still flogging weight loss as the answer to an employer’s health cost problems
We aren’t listing everything wrong with Mr. Goetzel’s position, in order to leave space on the internet for other things, such as Google and Amazon.
In a nutshell, according to:
- his own awards that he gives to his friends,
- the Vitality Group (that he is on the board of, but which couldn’t even get their own employees to lose weight), and
- Health Affairs…
…employee weight loss programs don’t work.
He is also still calling McKesson a best practice in wellness, even though their employees gained weight (as noted below), their glucose increased (ditto) and their analytics consultant speaks in tongues.
Additionally, according to his own company’s data compiled for the federal government, even if these crash-dieting contests did work, they would have a trivial effect on health spending, which is mostly unrelated to an employee’s weight in any event. Ron has also backed off his 3-to-1 ROI claims and is now down to 1-to-1 as a goal.
HERO is caught telling the truth
HERO (the Health Enhancement Research Organization — truly the belly of the wellness beast, led by Paul Terry, Ron Goetzel and Seth Serxner) said wellness loses money. Being the one instance in which a wellness organization has told the truth, naturally they tried to walk it back. First, they said, with a straight face, they fabricated their data. They said we should substitute real data for this admittedly fabricated data. We did–and the losses skyrocketed. Then they circulated a “poison pen” letter to the media in which they blamed me for reading their report carefully.
In any event, their argument was undone when the state of Connecticut admitted they lost more than a dollar for every dollar they spent on the program.
And make sure to read to the end–Quizzify is presented as part of the solution.
A bit of a “correction” is in order here, because the article is slightly inaccurate. Please see the Quizzify landing page for the very specific language vis-a-vis Quizzify and Harvard Medical School. Harvard Medical School doesn’t “partner” with vendors. We are the only population health company that is even allowed to use their shield at all.
*Maybe I can’t judge wellness fairly. The Wellness Ignorati would accuse me of bias due to my heritage–my parents were smart.
Wellsteps may be best-known for insulting the intelligence of its customers, by writing outcomes reports that show costs going up and down at the same time, and creating “ROI Models” that anybody can see are blatantly fabricated. However, their customers deserve what they get. No one is forcing them to retain Wellsteps. For example, if the Boise School District can’t figure out they got snookered, they need to go back to school.
On the other hand, overweight and obese people, like perhaps 2/3 of Boise’s teachers, who find themselves forced to submit to these programs at the pain of significant financial forfeitures, don’t have the option of firing Wellsteps or even walking away from them. In order to avoid forfeiting money, they must agree to be coached by a company that just announced that the reason people can’t lose weight is that: “It’s fun to be fat. It’s fun to be lazy.”
And: “Not everyone likes the taste of fresh fruits and vegetables, they would prefer chocolate, soda, and Cheetos.”
These lines were penned by Wellsteps’ Troy Adams, who proudly asserts as his qualifications that he “spent 11 years in college as a student and another 20 years as a professor.”
After a while, Mr. Adams realized that letting employees know how they really feel was a bad idea, so he went back in and removed the first line. He then apologized for Wellsteps’ insensitivity and complete lack of understanding about wellness.
Haha, good one, Al.
Obviously they didn’t apologize. To paraphrase the immortal words of the great philosopher Ryan O’Neal or maybe it was Ali MacGraw (I wouldn’t know because about halfway through the movie, I had to leave the theater to go puke), being a wellness vendor means never having to say you’re sorry. They just did the Ron Goetzel thing where you go back in and quietly doctor the original once you realized how much trouble you could get into by leaving the original original up. (The difference is, Ron does that with other people’s originals. At least Wellsteps only did it with their own.)
The Comments Say It Best…
Wellsteps didn’t exactly have an epiphany. They removed the line following scathing comments to the post. Adele Hite wrote:
This is reminiscent of arguments that the unemployed just don’t want to work (it’s fun to be poor! sleep late every day!). I thought we gave that up for more enlightened thinking, but I guess I was wrong.
Another health educator, Erica Thomas, wrote:
This article is appalling. “Fun to be fat”, “fun to be lazy”?! How do you conduct business with that mindset?
A third wrote:
Dear Mr. Adams, Do you truly believe that getting fat is fun and pleasurable? Have you ever been around anybody in this culture who has gotten fat? Do you truly believe that will power is all there is to the issue of fat?
The Regulators Will Sanction Wellsteps (not)
Yes, of course the comments are right, but there’s nothing we can do about Wellsteps. They will remain prominent on the Koop Award Committee (where the key qualification is having no qualifications) and of course the Health Enhancement Research Organization. There won’t be any sanctions by regulators because this industry is completely unregulated. Wellsteps can continue to pitch this line to unsuspecting employers as long as they can get away with it, and as long as employers don’t care about the morale of the 2/3 of employees who are overweight or obese.
As for Mr. Adams, his total lack of contrition indicates that there is no chance he has learned anything from this episode. Ah, well, to paraphrase the immortal words of the great philosopher Bluto Blutarski, 11 years of college down the drain.