'The Feel-Good Promise of Wellness Programs' - false promise

[Esther12]

A bit OT, but also seems to chime in with a lot of biopsychosocial stuff.

'Wellness' programmes are supposed to improve health by encouraging people to improve their lifestyles, take responsibility for their health, etc - but they don't seem to be very good at achieving this, and instead can end up just penalising people.

Excerpt:

Now let’s consider what wellness programs might do: reduce health-care spending and improve health. In general, the evidence is weak that they will. Why? Conceptually, factors within workers’ control make only a small contribution to rising health-care costs, so there’s only so much such a program can do, even if it works perfectly. Empirically, the track record of wellness programs’ efficacy is mixed at best.
In a recently released white paper, health economists Dennis Scanlon and Dennis Shea reviewed the evidence on what drives health-care cost growth. A leading factor is health-care technology. Expansion of third-party payment (i.e. insurance coverage) and income growth have also, historically, played large roles. The evidence suggests that disease prevalence may explain 25 percent of health-care spending growth, only a portion of which is due to modifiable lifestyle factors.
Disappointing Research

So, yes, wellness programs designed to motivate lifestyle modifications may, theoretically, help control the growth of health-care spending, but only a little. How we live is just one component, and it’s far from the largest one. It raises the question of just how much an organization can reduce spending by focusing on wellness.
The research to date is disappointing. For a variety of reasons, most studies of wellness programs are of poor quality and consider only their short-term effects, leading to results that can’t be trusted. Many, such as those that Penn State cites as evidence in support of its program, are written by the wellness industry itself -- hardly an unbiased source.
More rigorous studies find that wellness programs in general don’t save money. With few exceptions, they often don’t improve health, either. The additional screenings that such programs encourage can lead to overuse of care, pushing spending higher without improving health.

http://www.bloomberg.com/news/2013-09-16/the-feel-good-promise-of-wellness-programs.html

 

[Snow Leopard]

One of the problems with most 'wellness' programmes and similar health promotion campaigns is that they are implemented in a top down way, essentially blaming the individual, rather than the overall social situation that led to the individual choosing unhealthy behaviours in the first place.

 

[vamah]

I have always hated these programs for their invasion of privacy and assumption that the only thing preventing everyone from having perfect health is a company or government monitoring their every move. People like us, with chronic health problems that are not easily identified or treated, are especially vulnerable to abuse under these programs.

 

[alex3619]

Aren't there whole books now on the topic of positive thinking and how it harms us?

In order to tackle issues like obesity, in which we do not understand the driving forces, but for which there are very simplistic but popular theories, we need better scientific investigation. This is happening in the case of obesity, but not all issues get the research they need.

Facts do not persuade people on the whole. People have to be receptive to new information to really use it. One of the issues though is that the messages given, the advice for wellness, may be misguided and do harm. Who is then accountable? Public health messages tend to be overly simplistic. How simplistic is the advice given in these programs? I do not know enough about them to be sure.

 

[xchocoholic]

Why not take a more effective approach to wellness and provide healthier
foods at a reasonable price ? And make it easier to obtain ?

I have to drive an hour and 15 minutes to a Whole Foods for fresh organic
meat. All I can get around here is vacuum sealed and typically frozen.

I thought the title of this article was misleading. The fact is that a healthier
lifestyle is good for our bodies, but the author justified his title by
quoating stats on the financial gains and losses.

 

[vamah]

Why not take a more effective approach to wellness and provide healthier
foods at a reasonable price ? And make it easier to obtain ?

I have to drive an hour and 15 minutes to a Whole Foods for fresh organic
meat. All I can get around here is vacuum sealed and typically frozen.

I thought the title of this article was misleading. The fact is that a healthier
lifestyle is good for our bodies, but the author justified his title by
quoating stats on the financial gains and losses.

The point of the article isn't whether it is worthwhile to make healthy lifestyle changes. The point was that the type of coercive programs that some employers are implimenting and justifying by saying they lower health care expenses, really aren't saving money or improving employees' health. I know people who work places where participation in the "wellness program" is part of their performance evaluation for work. If you have a healthy lifestyle, but don't feel like sharing your health information with your employer because its none of their business, you can be penalized. Likewise, I know of a workplace weight loss contest where at least one person intentionally gained weight before the contest, so she could have more to lose.

 

[Esther12]

Yeah - people often dislike being 'managed'. There will be unintended consequences with attempts to do so, particularly when done without informed consent.

To some extent, I worry that people are becoming somewhat more docile, and that this will have harmful long-term effects. Who knows though?

 

[xchocoholic]

The point of the article isn't whether it is worthwhile to make healthy lifestyle changes. The point was that the type of coercive programs that some employers are implimenting and justifying by saying they lower health care expenses, really aren't saving money or improving employees' health. I know people who work places where participation in the "wellness program" is part of their performance evaluation for work. If you have a healthy lifestyle, but don't feel like sharing your health information with your employer because its none of their business, you can be penalized. Likewise, I know of a workplace weight loss contest where at least one person intentionally gained weight before the contest, so she could have more to lose.

I just said that the TITLE was misleading. I expected more info
on how this program had failed to motivate employees to
live healthier lives.

I'm pro wellness programs. Why should
people who take charge of their health pay as much as those who don't ?

 

[vamah]

I just said that the TITLE was misleading. I expected more info
on how this program had failed to motivate employees to
live healthier lives.

I'm pro wellness programs. Why should
people who take charge of their health pay as much as those who don't ?

There are a number of reasons. For one, how can you tell if someone is taking charge of his health and someone else is not? I would think members of this forum are more aware of health issues and more serious about taking charge of their health than the average person, but from the state of our health you would think the opposite. Many of us have no diagnosis to explain our symptoms or suffer from diseases such as chronic lyme, that many doctors say don't exist. This leaves us vulnerable to charges of laziness or hypochondriac behavior. Many of us can't exercise. That would seem to label us as choosing an unhealthy lifestyle if you are not familiar with this illness.

Secondly is a personal choice issue. I don't object to programs that make, for example, exercise classes available to employees who want them. The problem is that when your participation is part of your job performance evaluation, it becomes coercive and punishes those who choose to exercise by themselves, or at their own gym, or with friends. After a long day at work, do you really want to be forced by your employer into doing yoga with the same coworkers who drive you nuts all day?

Thirdly, is the privacy issue. If you are able to perform your job, are other aspects of your life any of your employer's business? I say no. And don't use the argument that if they are paying part of your health insurance that it is their business. They don't pay that out of the goodness of their hearts. It is part of a compensation package (along with your salary) that indicates how much the job you are doing is worth. If they did not offer insurance they would have to pay more to attract employees willing to do the job. It should not be an employer's business what anyone eats, how much and what type of exercise they get, how much they weigh (unless it effects job performance) or anything else.

The fact that these programs are of questionable effectiveness is simply the final straw.

 

[lansbergen]

It should not be an employer's business what anyone eats, how much and what type of exercise they get, how much they weigh (unless it effects job performance) or anything else.
.

I agree

 

[Esther12]

Another rambling post - sorry:

I just said that the TITLE was misleading. I expected more info
on how this program had failed to motivate employees to
live healthier lives.

I'm pro wellness programs. Why should
people who take charge of their health pay as much as those who don't ?

I added the 'false promise' bit to the title, as I thought that otherwise people would not realise it was critical of 'Wellness Programs'.

One aspect of the article was emphasising how much less control people have over their health than many expect, so it's really difficult for people to really say that they have 'taken charge' of their health.

Also, I wonder to what extent hardship correlates with unhealthy behaviour: eg - people feeling worse have feel like they need to quick and easy burst of satisfaction that comes from a donut; or people who have less money have less opportunity to engage in feel good healthy behaviour, so have to choose more between healthy and pleasurable behaviour.

I don't know, and I'm not really well informed about a lot of this stuff.

Before falling ill, I lived a pretty healthy life-style, but without really making any effort to do so. It was just easy and pleasurable to do certain healthy things, and I think a lot of that stemmed from being at Uni, having plenty of energy, having a good social network, having lots of time to socialise, and having a lot of easy opportunities to be healthy. I don't really feel like I was being a 'good' person who should have been rewarded then, rather, I was a lucky person.

It is difficult though, and personal responsibility, etc are all complicated topics. I still try to eat healthily, and resist sugary stuff... but I wonder if some of that stems from me having other nice things to do. Maybe it would be harder if I didn't? When I do eat more sugar, I do feel more 'addicted' to it, and it's easy to see how that could become a cycle.

I am a bit confused and uncertain about where I stand on a lot of this stuff, and having seen the BPS approach to CFS, I am also deeply sceptical of claims by those with power that their attempts to 'manage' the lives of others are likely to be anything but harmful.

 

[xchocoholic]

well said. I agree but didn't have the energy to elaborate. tc .. x