The final Rand Inc. report on Workplace Wellness Programs is now out. The report was mandated by Congress and provided to the Departments of Labor and Health and Human Services. It was leaked to Reuters shortly before finalization of the Administration’s regulations implementing the employer wellness provisions of the Affordable Care Act.
The report is just as negative on wellness programs as Reuters reported. The Rand Research Report is based on a review of the scientific and trade literature, a national survey of employers with at least 50 employees, statistical analysis of health plan claims and wellness program data from several employers. Five case studies round out the report.
The study found that nearly 80% of employers offer nutrition and weight activities, such as Weight Watchers group meetings, weight loss competitions and personalized phone support from health coaches. However, uptake is poor. Fewer than half of employees undergo clinical screening or complete a health risk assessment. Of those identified for an intervention, less than one-fifth choose to participate. For weight and obesity programs, the participation rate is 10%.
The researchers found that, “one year participation in a weight control program is significantly associated with a reduction in body mass index (BMI)(kg/m2) of about 0.15 in the same year, and the effect persists for two subsequent years. As illustrated in Figure S.4, this change in the first three years corresponds to a weight loss of about 0.9 pound in an average woman of 165 pounds and five feet four inches in height, or about one pound in an average man of 195 pounds and five feet nine inches in height.” The researchers note that an average non-participant would see an increase in BMI of approximately 0.5. (Of course, the fourth year data is much worse.)
The Rand report goes on to observe that employers overwhelming expressed confidence that workplace wellness programs reduce medical costs, absenteeism and health-related productivity losses. “But,” states the authors, “at the same time,” only about half stated that they have evaluated program impacts formally an only 2 percent reported actual savings estimates…Our statistical analyses suggest that participation in a wellness program over five years is associated with a trend toward lower health care costs and decreasing health care use. We estimated the average annual difference to be $157, but the change is not statistically significant.”
The authors conclude, “Consistent with prior research, we find the lifestyle management as part of workplace wellness programs can reduce risk factors, such as smoking, and increase healthy behaviors, such as exercise.” They calculate that, compared to non-participants, continuous participation in weight control program for five years would result in a relative weight loss of 10 pounds in an average woman or 13 pounds in an average man.”
This is a rather meaningless calculation. “Continuous participation” assumes continuous motivation, no plateaus and no rebound. Not likely. No where do the authors indicate a familiarity with the well-established physiological propensity for weight regain after weight loss. (See, Weiss, EC, Galuska, DA, Kettel Khan L, et al, Weight regain in U.S. adults who experienced substantial weight loss, 1999-2002, Am J Prev Med 2007;33(1):34-40)
The accompanying figures indicate that employers pay an average of $188 incentive for participation in a program and $ 144 in a results-based program.
One interesting finding used the database of the Care Continuum Alliance, an industry association, and looked at exercise. It found that in the initial year, participation in the exercise program is associated with a significant increase in exercise activities of 0.15 days of at least 20 minutes exercise per week. But it falls off to 0.11 in the second year and has no effect thereafter.
Cite: Mattke, Soeren, Hangsheng Liu, John Caloyeras, Christina Y. Huang, Kristin R. Van Busum, Dmitry Khodyakov and Victoria Shier. Workplace Wellness Programs Study: Final Report. Santa Monica, CA: RAND Corporation, 2013. http://www.rand.org/pubs/research_reports/RR254. Also available in print form.