WHEN IT COMES TO HEALTH CARE BENEFITS SAVINGS – THINK LONG TERM, NOT WEIGHT
A Commentary By Ragen Chastain
It’s New Year’s Resolution time. If this year’s resolution involves saving money on employee benefits and helping employees be healthier and more productive then a focus on healthy habits is the key.
It has become increasingly popular to use a “carrot and a stick approach” for benefits cost savings. The goal is encouraging employees to become healthier by making benefits more expensive for those who are perceived as unhealthy using measurements like Body Mass Index, cholesterol, and blood pressure. These programs charge more to people who don’t measure up, either by giving discounts to employees who who are perceived as healthy (carrot), or penalizing those perceived as less healthy (stick).
As a former CEO and Operations Consultant, I get that this looks attractive from a cost savings perspective, but I also know better than to buy into the latest thing without doing my research. It turns out, in the long term, these programs are most likely to leave employees less healthy, less productive and cost much more. The best chance for happy, healthy employees and long term cost savings is to encourage healthy habits.
Full disclosure – were I employed by a company using this approach I would be paying higher premiums. Not because I’m not healthy – all of my metabolic health markers are in the exceptional range. And not because I’m not active – I’m a three time National Champion Dancer who can do the splits and leg press almost four times my body weight. But my BMI puts me in the obese category. The problem is that BMI was created to compare relative body size among large populations and we incorrectly use it as measure of individual health. I’m not the only healthy person who would be caught by the use of this poor measuring tool – Arnold Schwarzenneger, Matt LeBlanc and many professional athletes would be paying up with me.
Studies since 1959 have shown that intentional weight loss, whether it’s called a diet, eating plan, or lifestyle change fails 95 percent of the time in the long term. So if employees are encouraged to lose weight, 95 percent of those who try will be heavier with worse metabolic health than they started within a couple of years. Plus, it encourages employees to participate in unhealthy behaviors to “make weight” for the annual evaluation which can lead to health dangers including weight cycling (yo-yo dieting) and even eating disorders. In what other area of business would we look at these numbers and decide to move forward?
Organizations including the American Heart Association, American Cancer Society, Obesity Action Coalition and National Women’s Law Association have come out against these programs because of legal issues. Employees are starting to challenge these programs using the Americans with Disabilities Act because blood pressure, cholesterol and body size can be caused by genetics or diseases over which employees have no control. They are also suing employers who partner with programs like Weight Watchers that have been successfully sued by the Federal Trade Commission for deceptive trade practices. It’s going to get messy and expensive and nobody wants a piece of that action, especially considering there are much better, more cost effective ways to increase health and save money.
Evidence strongly suggests that focusing on fitness rather than weight is the best chance for long-term health. Researchers have found that fitness trumps fatness and just about everything else. Encouraging healthy behaviors without focusing on weight is the only thing that’s been shown to produce short and long term success in creating healthier employees. What can be done for workplace health?
- Hold a beginning of the year meeting and announce the company’s commitment to employee health at every size and announce the options being implemented.
- Research shows 30 minutes of walking, five days a week, creates massive health benefits. Start walking groups after lunch to help employees get their 30 minutes and beat the 2 p.m. slump.
- Setting goals around fitness rather than weight loss means employees succeed early and often and are more likely to stick to their fitness program. Create office contests based on fitness goals rather than weight loss.
- Bring people into a conference room to teach dance, pilates, yoga, or martial arts for the hour before and/or after work – employees get healthier and miss the rush hour.
- Provide “lunch and learns” focusing on the benefits of healthy behaviors instead of on losing weight.
People only take care of their bodies if they believe those bodies are worthy of care; by providing opportunities for healthy behavior, a truly healthy workplace is on its way.
Ragen Chastain, a retired Operations Consultant and Corporate CEO, is based in Austin. She is now a nationally recognized speaker and writer on the topics of self-esteem, body image and Health at Every Size (HAES). Visit www.danceswithfat.org.
An excellent examination of this topic. Ms. Chastain correctly points out the risks of implementing such a plan to the overall health of the employee base of any organization.
I would also note that there are other initiatives marketed as cost-saving which in reality result in increased overall costs to the corporation.
I am speaking specifically of annual health surveys and the information given to the employee as a result of filling them out (I am leaving aside the effectiveness of the reduction of the insurance premium offered for filling out the survey). For one, the truthfulness of responses to the surveys is difficult to measure (due to the financial incentive). Additionally, these surveys also offer information to the employee that could be medically inappropriate or, worse, may praise the employee for a measure that could indicate he or she has a problem.
Specifically, and following the rationale offered for these programs, employees who enter a height and weight leading to a BMI of less than 18.5 should be cautioned that their weight is too low and this could be unhealthy. At minimum, they should see a doctor to rule out any illness leading to low weight. This is the mirror image of the information that is offered to employees with a reported height and weight leading to a BMI of over 25 (i.e. — they are told to lose weight and offered commercial programs). In reality, the low-weight employees do not receive any information in most implementations of these programs. They DO receive the financial benefit.
The quality of these programs and adherence to the rationale which is marketed to corporate customers is, thus, questionable at best. Therefore, the value of the program to the corporation providing benefits to the employee is reduced or completely negated by the poor quality of the programs.
Excellent article! I’ve heard of this company practices and find them ridiculous. At work, we should be allowed to focus on our jobs, not our weight. It’s good to know employees are standing up for themselves and fighting back.
Excellent post and this is not the first time I’ve heard something like this. Here’s a youtube video created by a doctor after his study of health. He has a lot of great information about the fitness aspect and the amounts that are needed to decrease negative health issues and increase overall fitness in both slender and obese individuals. Thought I’d make a great visual to go along with Ragen’s wonderful article!
http://www.youtube.com/watch?v=aUaInS6HIGo
Nice piece. I’d like to add to your list of suggestions that there be time built in to the day to take 30 minutes to be healthy. Too many employees eat at their desk or feel like corporate culture keeps them from taking time to do the things that they need to do to be healthy. Before and after work is great, especially if opportunities are offered onsite. However, allowing 30-60 minutes of “free” (as in get out of jail free) time to take a walk or move that encouraged and IS NOT a part of the lunch break, would prove even more beneficial. You have to change corporate culture to walk the walk. Otherwise, it is just corporate talk.
Thanks for not only critiquing the carrot and stick approach, but also offering specific things a company can do to promote health at every size. It’s helpful to see how easy it is to do this.
Ragen, you make a lot of good points. I have worked for companies that have sponsored workplace weight watchers groups and “greatest loser” contests (massive group yo-yo dieting!). Much like you, I’m an physically active, healthy person with a high BMI. I avoid these programs like the plague.
Here’s the thing. When I’m hired to do a job, I’m hired to be at work at certain times and to get things done. Work – doing my actual job – typically takes up at least 8 hours a day, 5 days a week. As long as I’m able to perform my job to a high standard, what I do outside of work and what is going on with my body are none of my employer’s business.
I am not a slave. I am a free woman who is being paid for her time and expertise. If I had poor health that was causing low productivity and missed work, then I would expect to discuss that with my employer. If I’m performing my job well, then the condition of my body is not his/er concern. I would not want or expect my employer to waste valuable time thinking about my health.
If I like my coworkers and there’s a company sports team or activity that I’m interested in, then I might take part. However, for the most part I prefer to keep my personal life separate from my work. I do not want to be competing with my coworkers at the gym. I do not want to be reporting to my boss on what I eat. A full time job already takes up a lot of space in a person’s life, and I am 100% against expanding that. I value my family, I value the separate social groups that revolve around my hobbies, I value my friendships, and I value the freedom to manage my health as I see fit. Bodily autonomy is a basic right that adults have in a free society.
Hands off, employers! Don’t waste your time or money on something that you are not responsible for.
I’ll second Mhlia’s idea of company-sponsored time to move. Let’s walk that fitness talk!
Excellent article – company leaders looking at the long term and actually caring about the over all wellness of their company (INCLUDING respecting the individual employees) will lead to an atmosphere with tons of positive benefits. Cheerful, fit, hard working employees who feel as though they matter and have a healthy balance between brain and body? Win-Win I believe.
These are all good arguments. But the real issue is why companies have to be responsible for their employees’ health in the first place, in terms of paying for their health care. For as long as health care has to be paid for by an employer, employees are going to be judged on things that have absolutely nothing to do with their working ability, such as whether they are at risk for diseases that are expensive to treat. There must be many companies who have chosen not to employ exceptional employees, because those employees have a health history that would drive up premiums. The real solution to this nonsense is not for a company to take an intrusive interest in their employees’ lives, but to have a heath care system that doesn’t burden businesses in this way.
I love the ideas you present in this piece about how to get employees more active and healthy. I would attend a walk group after lunch and before-work yoga or pilates, as long as it was completely optional. I worked for a company that would hold an optional group warm-up routine after closing for the night stocking crew; it was optional, but few people missed it. Our night crew was famous in the district for lack of injuries.
“Bring people into a conference room to teach dance, pilates, yoga, or martial arts for the hour before and/or after work – employees get healthier and miss the rush hour.”
This is also great for team-building. I’ve experienced this both as the teacher (after-work dance classes) and as a participant (lunchtime yoga at my day job).
It gives your employees a chance to get to know each other as people, rather than as their roles. And that is great for building trust and getting people to communicate.
You can bring someone in from outside, or poll your employees – my lunchtime yoga class was taught by a coworker.
Ragen,
Thank you for this wonderfully worded article. I do not run a company. I do not work for a company that has one of these incentive plans…but I’ve been terrified that they’ll want to start one. Your article now gives me a tool to share with them when/if it comes up to show them a HAES-based structure for such a plan. Thank you!
This is definitely spot-on. I think the worst thing is that we basically know this practice is unfair and unhealthy – remember that Frasier episode where the radio station crew participates in a weight loss contest and ends up fainting and smoking and nearly killing themselves for it? There’s no easy answer, and it seems like no one is willing to do the work and invest the time to seek real health instead of quick-fix pretend health. The suggestions made in this article could go a long way toward helping with that… now let’s see if anyone has the guts to implement them!
Thank you for speaking out and pointing out that focusing on weight-loss is the surest way to actually make people less healthy. In the long run, encouraging healthy behaviors and respecting personal choices is the best way to go.
I love the idea of work time to walk. Walking meetings would be great. Instead of sitting around the conference room table noshing on the dessert of the day, you could head out into the fresh air. Or even walk in treadmills at the office gym! As long as the walking wasn’t mandatory and becomes some sort of punishment, of course!
I think the author of this article makes some excellent points about making sure that business practices are based on evidence rather than “common sense.”
Although it seems intuitive that fat people must be unhealthy and using more health insurance (and costing employers more), the evidence is to the contrary. If you are physically active, there is no difference in health on average in people who are thin and those that are fat. Additionally, it has been shown that high BMI people do not, on average, use more health care than low BMI people. There are healthy and unhealthy people at all sizes, and diseases correlated with BMI are not absent from people with low BMIs. So, you cannot look at someone and know their health status.
Also, getting into the legality of penalizing an employee on a genetic trait (like cholesterol) that is irrelevant to job performance could be sticky. Best to just encourage healthy behaviors, since as an employer you cannot control the rest. And I agree with the commenter above who believes that activities outside of work and job performance should at most be “encouraged” and not “required” since they are irrelevant to the terms of employment.
Thank you for the thoughtful article!
Companies that want to lower their health care costs should start by creating an atmosphere in which everyone is valued and accepted and no one’s job is unmanageable. Stress and depression feed into unhealthy choices far more than organizations are willing to admit.
I’d never thought of it that way before; I’d always thought that if people were fat, they should suck it up and pay higher premiums than the rest of us. But if an athlete with great numbers on all her medical tests, can be considered obese–then you know what? The BMI is not the best tool for measuring weight vs health.
Great article! You explain well the pitfalls of “carrot-stick” approaches to health, particularly when they are geared to weight and not health at all.