New research bolsters idea that workplace wellness programs are a bust

Here at the University of Southern California, employee wellness has become a major focus. To promote healthier, more productive employees, the university — the largest private employer within Los Angeles County — recently began offering financial incentives for its almost 20,000 employees to participate in an annual health assessment that includes cholesterol, blood pressure and diabetes screenings. The university also offers programs and resources to support employees who want to make lifestyle changes.

USC is far from alone. According to the Kaiser Family Foundation’s 2018 Employer Health Benefits survey, U.S. employers devote considerable attention to the wellness of their employees. Almost two-thirds of large firms (more than 200 employees) conduct an employee health risk assessment that examine health status, lifestyle behaviors and medical history. Half of the firms that do such assessments include biometric screening — an in-person examination involving tests such as cholesterol and blood pressure measurements, body mass index and detailed lifestyle questions — for their employees, and more than 80% provide health and wellness prevention programs, such as smoking cessation, weight management or lifestyle coaching.

These employer wellness programs — aimed at improving employee well-being and efficiency — are pervasive and probably well-intended, at least in most cases. If employees improve their health, organizations boost productivity and lower health care costs. The only problem? There is surprisingly little evidence that they work.

This month in JAMA, Harvard researchers report on one of the first rigorous assessments of a large workplace wellness program. The analysis focused on an initiative at BJ’s Wholesale Club, a retail warehouse company that employs approximately 26,000 workers across more than 200 sites throughout the East Coast. As part of the program, employees were offered the opportunity to participate in eight wellness modules, each led by registered dieticians, over an 18-month period. The modules lasted 4 to 8 weeks each, and focused on lifestyle changes, such as healthy eating, physical activity, stress reduction and disease prevention. The program included both “individual and team-based activities and challenges,” and participants received incentives, such as $25 BJ’s gift cards, for each module they completed.

The Harvard researchers randomly selected 20 BJ’s worksites, totaling more than 4,000 employees, to receive the wellness program. A separate group of 140 randomly selected sites, with almost 29,000 employees, served as controls. At the conclusion of the 18-month study period, a slightly higher proportion of employees at the intervention sites (69.8% versus 61.9%) reported engaging in regular exercise, while 69.2% of employees at the intervention sites versus 54.7% of controls reported actively managing their weight.

But aside from these differences, the program did not result in any improvements on other self-reported health outcomes, such as overall health, sleep quality or food choices; clinical markers such as lipid levels, blood pressure or body mass index; or measures of medical and pharmaceutical spending. Nor did they help with absenteeism, job tenure or job performance.

It is also worth noting that numerous prior studies of regular health assessments and biometric screenings have repeatedly failed to result in meaningful health benefits. Instead, these programs simply trigger additional unnecessary testing and interventions.

These findings are sobering. Despite a comprehensive investment in employee well-being, the study authors concluded that BJ’s program failed to generate “significant differences in clinical measures of health, health care spending and utilization, and employment outcomes” and “may temper expectation about the financial return on investment that wellness programs can deliver in the short term.”

While these results may sound discouraging, for those familiar with the wellness literature, the findings won’t come as a surprise. With the exception of a handful of intensive lifestyle interventions targeting highly motivated participants (such as the diabetes prevention program), most rigorously studied wellness programs – even when initiated by health systems, public health departments and community organizations – have resulted in similarly disappointing results.

It is also worth noting that numerous prior studies of regular health assessments and biometric screenings have repeatedly failed to result in meaningful health benefits. Instead, these programs simply trigger additional unnecessary testing and interventions.

In our Slow Medicine columns, we frequently write about the importance of rigorously assessing medical interventions before they are widely implemented. We believe that employer wellness programs represent yet another classic example of an intervention with intuitive appeal gaining momentum without adequate supporting evidence. The new JAMA findings, along with other rigorous assessments of workplace wellness and testing programs, raise serious questions about widely utilized employer wellness initiatives.

What should employers hoping to improve the health of their employees take away from these latest findings?

First, and most importantly, stop wasting precious resources on ineffective health assessments, screenings and employee lifestyle programs. Second, instead of offering generic wellness programs like the one BJ’s initiated, evidence suggests that these resources might be better used for highly motivated employees who are committed to participating in intensive evidence-based smoking cessation or weight loss programs. Finally, from a common sense perspective, employers can likely impact their employees’ health by creating a healthful work environment. Simple measures like eliminating unhealthy vending machine options and offering break areas with exercise equipment and space for walking will make the workplace both healthier and more enjoyable.

Many Americans spend more time at work than anywhere else. Workplaces undoubtedly offer an opportunity to help employees improve their health. But as with all medical interventions, let’s not rush ahead of the evidence.

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