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Do employees cheat in outcomes-based wellness programs? Of course not. Who would ever gain weight in order to be paid to lose it? That would be dishonest and unhealthy.
Haha, good one, Al.
Yes, obviously employees cheat in outcomes-based wellness programs and crash-dieting contests. But here are two things that aren’t so obvious:
- Cheating is far more widespread than employers would like to believe;
- This massive scale of cheating — two-thirds of all employees cheat in wellness — is well-known but suppressed by self-proclaimed “scientists” in the field, whose livelihoods would be in jeopardy if they acknowledged the scale of the cheating.
Cheating is widespread
How do we know this? Bloggers receive data from WordPress on hits for each post. Not just the number of hits, but the specific sources of the click-throughs — other bloggers or else “search engines.”
In any given week, the current posts and the home pages get the most hits. However, for the year as a whole, it’s a different picture. Take a looksee at our total hits for 2018:
Our typical blog post — not including home pages and related pages — gets about 2500 hits over the course of the year in which it is posted. But you’ll see that #3 on the 2018 list is: “How to cheat in a corporate weight-loss contest.” Almost every day that particular post racks up 15-25 hits, giving it 6388 for 2018. I used to assume that some other, more popular, blog was linking to it, but I can see linked blogs too on the Site Stats page, and there weren’t any.
Here are the 2019 stats through yesterday.. A new cycle of wellness programs and crash-dieting contests is about to start, so despite New Years week being a very slow week for TSW (like other HR blogs), that post is #1:
Further, even though these stats are 2018 and 2019, this blog was posted November 2016.`
What is driving this continuing popularity?
It turns out that the source of these click-throughs is indeed “search engines.” Seems that even though the target audience for this posting was the narrow HR/benefits community, employees themselves are googling on “cheating in wellness programs” and finding this post right on the first page of hits:
That also explains how we could get so many hits and yet so few comments and Facebook reposts. No one wants to be caught.
You might say: “That’s only 6,388 employees for a full year. The rest are honest.” Nice try, but consider:
- “Only 6,388 employees” clicked through despite noting from the first lines (as you can see) that this article really wasn’t a guide to cheating.
- This post is way down at the bottom of the front page.
- This was only a single year — 2018 — and the 2019 rate arithmetically projects to about 20,000 hits (though much of this posting’s hits are seasonal)
- The #2 source of click-throughs to this article is Slate’s masterful expose called Workplace Wellness Programs are a Sham, also on the first page of google hits above, which itself links to us–meaning that employees are also clicking through on that article in the same search.
- The 6,388 excludes the gazillion employees who don’t need to google anything in order to realize that the winning strategy in any outcomes-based wellness program or crash-dieting contest is to binge before the initial weigh-in and crash-diet before the final one — and of course lie on the risk assessment.
- The keywords that drive traffic to this site, according to Alexa? #3 — after Bravo and Wellsteps, two vendors who are “in the news” constantly — is “Healthywage Cheating.” Healthywage is the leading crash-dieting contest vendor.
The scale of cheating…and the suppression of the evidence by the wellness industry
Employees who don’t drink, smoke, use drugs, or occasionally indulge in foods other than broccoli and kelp have no need to cheat. They will also derive no benefit from wellness programs and employers will save no money on them, not even any make-believe savings that wellness vendors routinely claim. It is estimated that only 3% of people do everything right, health-wise. That mean the pool of potential cheaters is 97%.
How many of the potential cheaters are actually cheating? Review your own statistics yourself. 70% of employees drink, including 10% who drink more than 30 drinks a week. How many of your employees indicated on their HRA that they drink that much? Zero, you say? What a coincidence! That’s what all the other employer-administered HRAs conclude as well.
How many employees admitted drinking at all? If you said 20%, that would match the number claimed by Wellsteps for their award-winning program. That means slightly more than 2/3 of all drinkers — half your employees — are lying. Not because they’re inherently dishonest, but because you are basically asking them to lie in order to stay out of trouble. What kind of trouble? Wellsteps called consumption of any alcohol a “worst health behavior,” shaming employees who admitted to even occasional social drinking. Nonetheless they fully accepted as fact the 20% drinking rate statistic.
By encouraging all this lying, Wellsteps helped this employer, the Boise School District, create a culture of deceit instead of a culture of health. Kudos.
Now consider smoking. For that we turn to the industry’s leading source of alternative facts, Ron Goetzel. He “found” that for the years 2012-2014, 5.5% of his surveyed workers smoked, overlooking the statistical 12.3% of employees — roughly 2/3 of all smokers — who lied. Yet, like Wellsteps with the drinking, Mr. Goetzel presented this statistically impossible 5.5% as fact.
It’s not a coincidence that roughly the same proportion of smokers and drinkers lie. Nor is it a coincidence that these two “scientists,” as they call themselves, decided not to disclose the lies. Since they claim to be “among the most credible and conscientious scientists and practitioners working in corporate wellness today,” this is much more likely to be a deliberate omission than a rookie mistake, especially since I’ve informed them of this disparity and many other obvious misstatements many times and they usually just doubled down.
Admitting that their data is basically worthless means their entire conclusions are basically invalid, which in turn means that outcomes-based wellness itself is a fraud, which by the way it is
Lying to employers about personal behaviors is human nature. Most employees don’t want to disclose potentially damaging information, and think, quite justifiably, that if they give their employer 100% during working hours, their off-hours behavior is none of their employer’s business.
How can cheating in wellness be prevented?
For those two studies, Mr. Goetzel and Wellsteps were only encouraging employees to lie to their employers and cheat on the programs. The majority of employees responded predictably. By contrast, when you run an outcomes-based wellness program with large fines, or hold annual crash-dieting contests, you’re not just encouraging employees to lie and cheat. You’re practically begging your employees to lie and cheat. In crash-dieting contests, employees form teams, and strategize on how to binge and then crash-diet, allowing them to lose far more weight in 8-16 weeks than is healthy. Any team not intending to cheat wouldn’t even bother to compete. Teams that do want to compete will visit websites teaching them how to cheat, and which appetite suppressants and weight-loss pills to buy in order to win.
Wouldn’t it be great if there were a wellness vendor which, instead of denying human nature about cheating, channeled it? Instead of bragging about ferreting out “fraudulent participants,” made cheating part of the fun? There’s a word for that, and it’s not “impossible.” It’s “Quizzify.” Employees can rack up points for correct answers…and they are encouraged to look them up before selecting their response from the multiple-choice list. That way they are more likely to remember them.
And, unlike “how to cheat in wellness,” if you google on “How to cheat on Quizzify,” you won’t find any advice on cheating — other than Quizzify’s own rules urging employees to do exactly that.
Note that this blog post is my personal posting and does not necessarily represent the views of any organization with which I am affiliated, other than the one with which I am most closely associated, and of which I am one of the founders. I am referring, as everybody knows, to the Needham Frisbee Club. People who play Ultimate 3 times a week don’t need no stinkin’ checkups.
Why Wellness Vendors Hate Information: A New Theory
I have no clue why wellness vendors hate information so much. Perhaps they are repressing childhood memories of being bitten by a librarian.
A far-fetched theory, perhaps, but there is simply no other explanation for half the things half these very stable geniuses insist upon doing. In many cases, reams of information demonstrating the futility, fallacies and even harms of what they do is right there — begging to be googled — and yet no one in the wellness industry (or at least the wellness companies “profiled” on this site — there are plenty of exceptions listed at www.ethicalwellness.org) does.
Before we get into the checkups, consider some other information gaps, like the eight-glasses-of-water urban legend. Anyone with an internet connection can easily learn that you do not have to drink eight glasses of water a day, and the whole meme was completely made up. 70 years ago someone estimated that humans require that much water a day — but also that basically everyone with access to water already gets that much without having to force themselves to drink when they aren’t thirsty.
Yet try telling that to a wellness vendor (excluding the ones who have signed the Code of Conduct, of course). One vendor, Provant, even provides an infographic in case the employees they are harassing can’t count to eight:
Wellness Corporate Solutions — no stranger to these pages — has gone one step farther. Along with their crash-dieting contests, they offer what they call “healthy competitions” to see who can drink the most water:
Water-drinking “healthy competitions” may or may not make employees “more aware of their health status,” but they certainly make employees “more aware that this meeting better end really soon.”
Maybe WCS should combine those two competitions — along with their massive overscreening campaigns — to create a competition to reward employees for doing the most stupid things to themselves.
Failure to understand that thirst is your brain’s signal that you need a drink of water is not an isolated oversight. Wellness vendors take great pride in their ignorance of wellness generally. Consider their propensity to screen the stuffing out of employees. There are clinical guidelines for optimal screening frequencies and lists of biometrics that should be screened for, that most wellness vendors (It Starts with Me, US Preventive Medicine, and Limeade being three huge exceptions) have apparently never laid eyes on. If it helps, here they are:
There are a few subtleties beyond these words. “People at risk for diabetes” (under “Diabetes test”) would include people with high blood pressure or family history (which wellness vendors can’t ask about). It would also include people who are overweight or obese. Additionally, “members of certain ethnic/racial groups may be at increased risk at a lower body mass or a younger age.” Otherwise, it’s quite clear that cardio screenings should begin at 35 for males and 45 for females, and take place “at least once every five years” after that.
Some people should get that frequency, others a higher one. But like most other things in healthcare, the answer is not the same for every employee of every age and every health status, and you do not just screen people because you make money on each screen, so the more you screen, the more you make. Otherwise you end up like Interactive Health, one of the most expensive vendors, positively hyperventilating about all the false positives they’ve found:
Finally, let’s once again review the aforementioned crash-dieting contests, a staple of many wellness programs besides Wellness Corporate Solutions. Schlumberger, for example, pays out thousands of dollars to the team which does the best job packing on the pounds in December and then taking them off in January. “Just plain fun,” is how their ironically named vendor, HealthyWages, describes it. None of these vendors have apparently seen the CDC’s advisory memo warning that crash-dieting is futile, likely counter-productive, and possibly harmful.
What about annual checkups?
Let’s cut to the chase: there is not one shred of evidence that annual checkups are a good idea for asymptomatic working-age employees. There are many good reasons to go to the doctor — you notice a change in some aspect of your body, you want to develop a plan to improve your health, you need help managing a chronic disease, or even that you’re sick — but here’s what’s not among them: the earth completing a revolution of the sun.
New England Journal of Medicine says that while the major benefit is “less patient worry,” checkups “may actually be harmful.”
“Less worry” is not necessarily a good thing. An employee (name on request after an NDA — not a made-up person) had a checkup in order to collect a wellness incentive…and as a result of being told not to worry, ignored heart attack symptoms about a week later.
The Journal of the American Medical Association says offers of health checks did not reduce any kind of mortality, but “may be associated with more diagnoses and drug treatments.”
Choosing Wisely says: “Annual checkups usually don’t make you healthier,” and “tests and screenings can cause problems.”
None of this takes into account the cost of annual checkups — which often lead to more unneeded and expensive tests and prescriptions, as JAMA notes — but we have definitely observed that wellness vendors and even some HR departments don’t really care about costs. It’s not their money. Here is Reuters on the high and unneeded cost of prevention.
Meanwhile, I’ve yet to find a wellness program that does not either pay employees to get checkups or fine them if they don’t — or shunt them into a worse health plan unless they submit to an annual physical.
I would also note that, however useless annual checkups are to begin with, they are likely even more useless if someone is visiting the doctor because their benefits department is forcing them to do so, against their will.
Finally, there isn’t exactly a surplus of primary care doctors. Why are we paying healthy employees to take up clinician time that unhealthy employees might actually need?
What is the argument in favor of checkups?
If checkups don’t actually prevent anything, why make employees undergo them? Two reasons have been proposed. One is that employees can “build a relationship” with their PCP. This of course assumes that neither the employee nor the PCP ever retires, moves or changes jobs. It also assumes that somehow the things that affect employees can be prevented by having a “relationship” with a PCP. However, if you look at the list of the most frequent reasons for hospitalization among the working-age population, it’s kinda hard to find anything that fits that description.
Can you think of any disease in your own life that would be cured by a relationship with a PCP? I can’t think of only one problem — chronic heartburn — that my PCP could have prevented. But she didn’t. The PCP was perfectly happy to keep me on Prevacid, which, as Quizzify teaches (right on the home page quiz!), is likely harmful in long-term use. Fortunately, I happened to run into a yogurt salesman one day, who told me about active-culture yogurt. Within days my heartburn was gone, never to return.
The second argument in favor of checkups, proposed by the CEO of Bravo Wellness, Jim Pshock, is as follows:
The hope is that the [Bravo] program will get people to proactively see their physicians to manage their health risks. Yes, this will, hopefully, mean more prescription drug utilization and office visits, but fewer heart attacks and cancers and strokes.
It isn’t his money, so he is perfectly fine with employees “hopefully” spending more on drugs and office visits. On the other hand, there is no information supporting his claim that all this spending and all these checkups will prevent all these diseases. Quite the contrary, 100% of available information reaches the opposite conclusion — especially JAMA, which specifically measured mortality due to heart attacks, cancers and strokes and found no improvement. You’ll fine zero information suggesting the contrary finding, no matter how hard you search.
Perhaps when he was a toddler, Mr. Pshock’s parents threw him into an entire cage of librarians.
What is the best frequency for checkups?
The literature is quite adamant: not at all. That seems a bit extreme and I would bet the people who write these articles do occasionally get a checkup. For the most reasonable compromise I would turn to Quizzify, the leading health literacy vendor. They recommend a simple mnemonic: get two checkups in your 20s, 3 in your 30s, 4 in your 40s, 5 in your 50s, and annually after that. Quizzify’s advisory colleagues, doctors at Harvard Medical School, approved this recommendation too. As with most other questions, this one carries the HMS “shield.” (Quizzify also reports that this question is the one most likely to be removed by its customers, which is an option for all questions in their database before they get seen by employees.)
So what’s the solution?
In three parts, it’s:
- Screen according to guidelines
- Send employees to the doctor at age-appropriate and health-appropriate intervals
- Pay the fines on overdue books.
In the wellness industry’s epidemic of very stable geniusitis, Healthywage is Patient Einstein.
Somehow they recruited Russian trolls to convince Schlumberger that the best thing they could do to reverse their four-year stock price decline…
…would be to: encourage their employees to binge and then crash-diet. So far Schlumberger is halfway through its 8-week crash-dieting contest. In case you’re keeping score at home following our initial posting, here are the standings:
Pound Town has lost 10% of its weight in 4 weeks. Figure — as a conservative estimate — the average participant weighed 200 pounds at weigh-in. A 9.86% loss of body weight equates to more than 19 pounds, almost 5 pounds a week. The Centers for Disease Control (CDC) recommends 1-2 pounds/week.
The better CDC recommendations include not crash-dieting at all, but rather improving your health and fitness, at your current weight, because rapid weight loss likely leads to rapid weight regain, and possibly even slows metabolism so that one could regain more than one loses.
However, the CDC recommendations didn’t take into account that weight regain is a big part of what makes this contest work. Employees can win the $10,000 in 2018 — and then regain the weight in order to enter again in 2019. Is this a great country or what?
Health has nothing to do with it, of course. It’s about making Schlumberger shareholders proud again.
Once again, they are ignoring every iota of research that says crash-dieting is a complete waste of time. It may also harm you. Once again, they are offering a whopping $10,000 prize to the winning team.
The relevant language from the Wellness Code of Conduct
Here is the relevant language from the Employee Health and Wellness Program Code of Conduct. The language that the group agreed upon — “may have negative effects on their health” — was intended to be as acceptable as possible to what has become an delightfully large Ethical Wellness group:
Research shows that the vast majority of people who participate in weight loss programs will eventually gain their weight back after the program ends. Many will also gain back more than they lose. The weight cycling that occurs with repeated participation in weight loss programs may have negative effects on their health.
It’s also slightly possible that offering a $10,000 prize (for a team of five) could exacerbate the harms of weight-cycling just a tiny bit by encouraging employees to binge, bloat, salt and constipate themselves before the first weigh-in. But no team would ever do that, right? After all, it’s not worth sacrificing your ethics or harming yourself in order to win a measly $2000/team member.
Haha, good one, Al.
The relevant language from Here’s How to Win a Corporate Biggest Loser Contest
On the weigh-in day, avoid the bathroom before weigh-in if you can, and minimize your activity, another big glass of whole milk with your breakfast that contains some salty options will help you retain more water. If you are also going to get your waist measured, drink about half a can of root beer. Sounds gross, but the carbonation and salt will give you are really good belly bloat…If they are measuring your waist, wear some pants that are snug around the waist, or add a tight belt that hits below your belly button, this will create some fluid buildup in your belly area. At this point 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. If you are getting measured, poor posture can get you another inch and a half, so go for it.
To their credit, even the group that gives this advice has a more adult sense of responsibility than Schlumberger and HealthyWage, as they preface a few pages of advice with:
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.
The relevant language from Schlumberger’s vendor, HealthyWage
Let’s look at the marketing pitch from HealthyWage, the outfit that runs this contest and epitomizes everything that makes the wellness industry what it is today:
That equates to over 50 pounds per person, in their 12-week contests — more than 4 pounds a week.* This means one of five things:
- Employees are indeed binging, bloating, salting and constipating themselves before the contest to maximize their odds of winning, since losing 50 pounds in 12 weeks would be a Herculean task without a bunch of extra weight that will be as easy to take off as it was to put on, thanks in part to websites that show you how to gain weight rapidly in preparation for corporate crash-dieting contests;
- Healthywage is unfamiliar with the CDC guidelines that recommend steady weight loss at 1-2 pounds per week;
- Healthywage is betting that employers don’t know that the odds of keeping weight off are 1 in 200 for males and 1 in 100 for females;
- Heathywage is counting repeat contestants more than once, meaning that the same employees binge, crash-diet, regain the weight and then do it all over again;
- Heathywage is lying.
Of course, this being the wellness industry, it may be all five.
*How does a 50-pound weight loss compare to other companies? Pfizer won a Koop Award because its participating employees were able to lose — get ready — four ounces. Six if you measure against the two ounces gained by non-participants. In all fairness, Pfizer’s program was not exactly intensive. “Participate” was defined as “open an email with a message in it.” The good news is that opening an email isn’t going to harm anyone.
Plus you never know what a message will contain. Open this link to see an example.