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In workplace wellness, fat-shaming is the new black.
This posting is a request to self-anointed wellness industry leaders to pleeease stop picking on people because of their weight. It’s like you’re still in kindergarten, no offense intended.*
2016 was the year in which weight-shaming, weight discrimination and a generally dismissive and outright misanthropic attitude towards two-thirds of the country’s employees became a wellness industry thing. This started in January at Davos, where the head of a wellness vendor named Vitality announced what quickly became known as the Fat Tax.
Here’s how the Fat Tax would work. Companies would tell shareholders how many fat people they employed. Employers, presumably feeling shame over this disclosure, would be motivated to pay a “tax,” in the form of a fee to a wellness vendor — such as, coincidentally, Vitality — for screening and weight loss programs.
In addition to the out-of-pocket fee, employers would pull employees off the job for an hour too, to obtain this screening. In addition, there would be all the administrative time — making the rules and exceptions, catching cheaters (see below), getting the auditors involved, and so on.
All this for what, again?
J&J would have people believe that shareholders are demanding thinner employees. In reality, of course, shareholders could care less about the weight of employees, for the simple reason while weight makes no difference to most businesses (as we’ve proven), the cost impact described above of mass weigh-ins and disclosures would be quite high.
More important is the morale impact. Suppose an employee owns shares and the stock price is down. Next, suppose that shareholders have just been informed how many employees are overweight…and the guy in the next cubicle is obese. Suddenly, that employee can start blaming his co-worker for the loss in value of his 401K.
Your stock price is down, you need to rally the troops. Instead, the troops are turning on one another.
Incredibly, this idea did originally have momentum: along with a few drug companies that make obesity drugs that saw a potential market opportunity in the Fat Tax, IBM and even Pepsico were willing to put their names on it. The Fat Tax cabal also knows the value of the Harvard name: they paid a little-known instructor at the Harvard School of Public Health (HSPH), so that they could co-opt that moniker, just like the sugar industry used to do. Only the latter had a big enough budget to bribe two full professors rather than one lowly instructor.
However, the momentum quickly died once word leaked out that the very same Vitality that wants to collect money from others to administer weight loss programs couldn’t even get their own employees to lose weight.
Oh, and if you guessed that Ron Goetzel’s fingerprints were all over this one — just like almost every other debacle since Penn State — you obviously know the way the wellness industry works.
Ah well, as management guru Peter Drucker said, the only thing worse than a poorly conceived idea is a poorly conceived idea that is poorly executed.
Actually he never said that, likely because he was never enrolled in Vitality’s program.
Possibly because of the initial exposure the Fat Tax idea got, hazardous crash-dieting competitions came back into vogue this year. Crash-dieting competitions are the type of thing that gives idiocy a bad name. Let’s leave aside the fact that employees cheat, as this article shows. They don heavy clothes, fill their pockets and down bottles of water before the initial weigh in, and do the opposite before the final one.
And leave aside the fact that vendors can’t read scales. How hard is it to figure out that it is not possible for the majority of your crash-dieting teams to lose exactly 16.59% of their body weight? The odds of winning the lottery are about 1000 times better.
But the biggest problem is that corporate crash-dieting contests are much more likely to harm employees than benefit them. Money is on the line for successfully bingeing before the first weigh-in and starving oneself before the last. Companies are paying their employees to yo-yo diet. Jon Robison has recommended, and I agree, that crash-dieting contests (and other corporate weight-loss programs) should carry a label warning of potential harms.
These harms are fairly self-evident, but just to be on the safe side, Rebecca Johnson laid out the health hazards quite thoroughly in Corporate Wellness, in case anyone needs a refresher course, which apparently Omada does.
Yes, despite the perverse incentives and physical hazards of paying people to lose weight, Omada Health is proposing that health plans do just that. According to Omada, a health plan can save “billions of dollars” — that’s “billions” with a “b”, not “millions” with an “m” or “stupid” with an “s” — by trying to prevent diabetes, including paying members to lose weight. A health plan that offered members this pay-to-diet option would soon find itself deluged with enough takers to require a rate increase for everyone else.
In case anyone is wondering about Omada’s math, the median-sized health plan can’t save billions of dollars by getting people to lose weight because the median-sized health plan doesn’t even spend “billions of dollars.” And I don’t mean on diabetics, I mean in total.
Next, it appears that this year’s presidential campaign has made fat-shaming great again. One of the first vendors to jump on that bandwagon was Wellsteps, with the immortal words: “It’s fun to get fat. It’s fun to be lazy.” Eventually they took those words down, if only because a number of comments embarrassed them into it.
However, as Maya Angelou said, if someone shows you who they really are, believe them.
Finally, with his editorial in the American Journal of Health Promotion, Michael O’Donnell has out-stupided Vitality, Omada and Wellsteps: He is calling for employers to make employees pay for their health insurance per pound, sort of like buying lobster or sending packages. People say we make fun of the ideas the Wellness Ignorati come up with, but really all we do is repeat them — and occasionally illustrate them so that even the dumbest wellness industry leader can follow along:
*No offense intended to kindergarteners, that is, most of whom have better manners than this.
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Another Expert Slams Fat-Shaming Corporate Weight-Loss “Challenges”
While vendors like HealthyWage are pushing company weight challenges onto unsuspecting and poorly advised wellness directors — and wellness promoters at the University of Pennsylvania are subjecting their own employees to weight-loss experiments to encourage corporations to do more of them — real researchers are urging a halt to these activities. They do more harm than good.
We, of course, have been calling out fat-shaming for months on this site–with specific attention to companies like Johnson&Johnson, ShapeUp, and Vitality Group, all companies that want to profit from fat-shaming in various ways. In particular, we wrote a very well-received Huffpost on this topic three months back.
And a year ago, we called for an end to these fat-shaming programs, showing that they made no impact on health expenses, productivity or profitability.
However, we did not explore this topic remotely as well as Pat Barone, in today’s LifeZette. (While LifeZette is Laura Ingraham’s publication, Pat Barone lives in the People’s Republic of Madison, so the politics cancels itself out.) We urge everyone take a looksee here…and then when you’re ready to sue your wellness vendor and need an expert witness, who you gonna call?
We invariably get fast settlements. No vendor wants to face me in court, where even wellness vendors are required to tell the truth. Facts, as we often say, are the wellness industry’s worst nightmare.
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Has the “Epidemic of Chronic Disease” Gone MIA from the Workplace?
Looks like employers have been fighting the wrong battle: fat employees are not the bad guys. So stop letting wellness vendors harass your employees about their BMIs, and start creating a safer, healthier work environment instead, using the tips below.
Wellness vendors live by the mantra that “75% of healthcare spending is due to preventable chronic disease.” Some variation of this appears 200,000 times on google. For instance, Johnson & Johnson (the same Johnson & Johnson proposing that companies disclose the number of fat employees to shareholders) says: “chronic diseases, most of which are preventable, account for 75%” of healthcare spending.
Leading wellness defender Ron Goetzel, in our soon-to-be-released debate tape, upped the ante. He says companies should do wellness because 80% of their cost is due to mostly preventable chronic disease.
A few observations about this claim. For starters, if I had one of the many non-preventable chronic diseases afflicting mankind, I might be offended by this blame-the-victim generalization, but maybe that’s just me being hypersensitive. And wouldn’t this statistic literally mean that if you eat broccoli, wear Fitbits, and (as recommended by Johnson & Johnson, among others) get your annual useless and possibly harmful checkups, you can live forever?
Plus, that whole 75%-(or 80%-)of-spending-due-to-chronic-disease epidemic-in-the-workplace cliche turns out to be a complete urban legend.
But rather than argue with these people, we will simply quote them, since the wellness industry’s own worst enemy is their own data. It turns out that healthcare is not about the broccoli. And Ron Goetzel’s own company, Truven, has published exactly the opposite of his sound bite — wellness-sensitive hospitalizations are rare in commercially insured populations. In the HCUP database that Truven maintains for the government, the top 25 commercially insured hospitalizations are:
To paraphrase the immortal words of the great philosopher Clara Peller, where’s the broccoli?
There is none. instead, the corporate mania of massive overscreening, broccoli, Fitbits and the now-fully-discredited employee BMI jihad is distracting companies from noticing exactly what actually does drive hospital spending and hence where prevention opportunities arise. Here are some random observations about Truven’s revelation:
- The musculoskeletal category certainly has many preventable opportunities. Ergonomics is one. Exercise classes, for sure. Benefits design and education to include encouraging access to lower-cost care is another. Reference pricing is one more. And opiate abuse is also tied into this category…but doesn’t get remotely the attention accord to cholesterol, or even seat belts.
- A lot of items on this list shouldn’t be there at all. Spinal fusion? Stents? Hysterectomies for non-cancers? Many of these procedures are unnecessary and/or harmful. (We know it’s not always about us, but the Quizzify business model helps educate employees on avoiding harms.)
- The wellness industry is ignoring the actual preventable hospitalizations in order to focus on the only thing that generates revenues for them, which is to”pry, poke and prod” employees, make them try to lose weight, and insist that they “know their numbers.” And when employees fail, they forfeit money back to their employer, which is what finances these programs in the first place.
- Why hasn’t Ron Goetzel told his wellness friends about this database his company maintains? Why is he running away from his own company’s great insights? Why doesn’t the Koop Award recognize companies that address these issues? Why is there not a single mention of this database in any of his writings?
- Despite the wellness industry’s breathless hyperdiagnosis of cardiometabolic disease due to rising BMIs, there are no diabetes events on this list. And the only cardiac events are arrythmias (no amount of broccoli will prevent them) and heart events other than heart attacks. Those events (like angina) have warning signs and symptoms, so you don’t need to hunt for them at great expense. (Heart attacks themselves are way down at #70 and #85.)
- Hospital infections appear twice on this list (#12 and #23). These could be addressed with benefits design: pay hospitals a few dollars more for each case, but don’t pay them at all for hospital errors and infections…and sit back and watch them clean up their acts, literally and figuratively. Speaking of which, why doesn’t every major employer join the Leapfrog Group and quit the National Business Group on Health instead, which still promotes biggest-loser competitions and overscreening?
- Finally, why is the government (both President Obama’s EEOC and the GOP-controlled Congress) encouraging employers to harass their employees with “pry, poke and prod” programs instead of helping employers and employees avoid low-value care? Employers can demand intrusive medical exams and even employee DNA. But they can’t simply tell employees: “You need to complete this education module before demanding low-value care.” (Quizzify has created some workarounds here, of course.)
Isn’t the right approach to look at the actual data before racing ahead with a program? Of course, but the wellness industry prefers the Yogi Berra approach: “We don’t know where we’re going, but we’re making good time.” Isn’t the right approach to tailor the solution to the problem? Of course.
But they won’t. In the immortal words of the great philosopher Upton Sinclair, you can’t prove something to someone whose salary depends on believing the opposite.
A commenter suggested doing this by costs instead. You get different DRGS…but still no wellness-sensitive medical events:
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Overweight? Johnson & Johnson’s Dream Is Your Worst Nightmare
Every time I think wellness promoters can’t possibly match their previous shock-and-awe levels of egregious statements and proposals, they come through with another one. This post is from the employee’s viewpoint. To see it from the employer’s viewpoint, view the posting on the Proposed Johnson & Johnson Fat Tax. That company wants corporate America to pay them to count the number of overweight employees a corporation has.
PS Obviously we don’t have any money to oppose this with, so please share it on social media.
Suppose there were: (1) a widely held but false perception that gays had lower productivity and higher healthcare costs than straights; (2) false literature that companies with gay conversion programs outperformed the stock market; and (3) a proposal that companies disclose to shareholders the percentage of gays they employ.
Obviously, many corporate CEOs would stop hiring gays, de facto require gay conversion among current employees, and fire gays who failed the program, in order to maximize stock price and hence their own net worth.
Preposterous? Of course, but if Johnson & Johnson (J&J), Vitality Group and a few pharmaceutical companies get their way, this exact same scenario will befall overweight employees. Indeed, two-thirds of this dystopian scenario is already in place:
- Despite proof to the contrary, the popular misperception is that working-age thin people have higher productivity and spend less on healthcare than working-age overweight people;
- To help bring weight discrimination into the boardroom, some wellness apologists — led by Ron Goetzel, of course — published a facile and misleading study in a third-tier journal (that had already admitted poor peer review practices) showing companies with wellness programs (the obesity equivalent of gay conversion in ineffectiveness, and almost as likely to harm participants) outperformed the stock market. The opposite is actually true, if one uses sector indexes as benchmarks. (This is the correct methodology with small numbers of companies concentrated in a few industries. And it’s the correct result given the fact that conventional “pry, poke and prod” wellness loses money, period.)
To complete this trifecta of weight discrimination, all that remains is to convince publicly traded corporations to disclose the weight of their employees…and that’s exactly what this cabal — led by J&J and Vitality — proposed at Davos. (They also want companies to disclose their stress levels. I have no idea how one measures stress. The one company that tried measuring stress, Keas, failed both miserably–and, this being the wellness industry, hilariously.)
Weight measures used by companies are also facile and misleading. Typically — as with Vitality Group, an outspoken advocate of this proposed regulation — they use the Body Mass Index, or BMI. The BMI was invented by a mathematician 200 years ago, using a simplistic formula that he could never really justify…and yet has been the de facto standard for measuring overweight ever since. It’s misleading along many dimensions. Further, it now turns out that the whole workplace BMI obsession might be pointless, as people with normal BMIs are at higher risk than people with high BMIs, if their weight is distributed badly. Most recently, it’s been shown to be just plain wrong, doing a horrible disservice to overweight people and, in some workplaces, costing them money,
While I can’t explain why PepsiCo would be signing on other than for corporate image reasons, the agendas of J&J and Vitality are quite clear: disclosing weight to shareholders would encourage publicly traded companies to use “pry, poke and prod” workplace wellness services, which they coincidentally happen to provide. (The drug companies involved, such as Novo Nordisk, stand to benefit from selling more drugs.)
Unintended Ironies: A Hallmark of Wellness
Ironically, though, during that same Davos meeting, Vitality also candidly admitted that their wellness services don’t work even in the best-case scenario of their own employees. That admission undermines the entire fiction that this scheme would somehow benefit the employees being fat-shamed.
Here is another irony. (One hallmark of the wellness industry is its obliviousness to its own many ironies.) This industry thrives on being totally unregulated — uniquely in healthcare, wellness companies and individuals face no licensing, education, training, oversight or certification requirements. Consequently they can and do get away with whatever they want. And yet now they want every other company to make more disclosures in regulated filings, for no purpose other than enhancing their own bottom lines.
Still another irony: The prime schemer behind this initiative, David Yach of Vitality, assured STATNews that existing laws would prevent employees from bring fired due to weight. But “existing laws” don’t prevent anything in wellness now. A federal court says it’s fine to deny insurance to employees for failing to participate in wellness. And despite flouting federal health guidelines with impunity, no wellness vendor has ever been prosecuted for doing things to employees that would get doctors sent to jail. And as Health Fitness Corporation learned, you can lie to states as much as you want about anything — including saving the lives of cancer victims who don’t have cancer — and not be prosecuted. Indeed, no wellness company or program has ever been successfully prosecuted or sued for anything under “existing laws.”
The Inevitable Result: Institutionalized Weight Discrimination
Many things in life have unforeseeable consequences. However, the consequence here is perfectly foreseeable: If you are overweight or especially if you are obese, you should be able to keep your current job if your company likes your work. But your chances of getting hired anew by a publicly traded company — if you are competing for the job with an almost-but-not-quite-equally qualified thin person — would nosedive.
I rarely editorialize in this blog, because I don’t have to — facts are the wellness industry’s worst nightmare. (See the Vitality example above. I don’t need to come out and say they’re clueless. I merely highlight the data they themselves helpfully provided to make that conclusion self-evident.) However, I’ll make an exception here: I find it appalling that J&J, Vitality, and Novo Nordisk advocate subjecting huge numbers of employees to institutionalized discrimination and to programs that they admit don’t work, simply to make a few bucks.
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Johnson & Johnson accepts our analysis that wellness loses money
Newsflash: Someone from Johnson & Johnson named Michael Schmidt responded to our posting that the HERO Report shows wellness loses money. This is the first time anyone associated with HERO has strayed from the tried-and-true Wellness Ignorati strategy of ignoring us. We were concerned that he might have found a mistake in our math, which no one has ever done.
Fortunately, our math is OK with Mr. Schmidt, and — by implication, since he is writing on their URL — J&J itself. His point is different. He argues that we write these columns to do the following: generate business. Touche!
He also says that the headline is inflammatory and that we will turn off more people than we turn on. That is probably accurate. However, the people we would turn off — traditional “pry, poke, prod and punish” wellness vendors such as Johnson & Johnson — have had and would have no interest in paying us to find out that wellness is worthless.
In any event the headline “The Wellness Wars Are Over. Wellness Lost” captures exactly what the HERO report says — and was edited by the ITL editor. Headlines, as Mitt Romney found out when his New York Times op-ed was entitled “Let Detroit Go Bankrupt,” are the purview of the editor, not the author.
The curious thing is, Johnson & Johnson is listed as one of the “endorsers” of the HERO report. So as an endorser of the report, Johnson & Johnson is tacitly nonetheless acknowledging that the report is right–wellness loses money.
In case there is some ambiguity, here is the screenshot of the first set of comments
They Said What? 