Workplace wellness programs — ones designed to help employees adopt healthier lifestyles and improve their health — do not appear to be effective, according to a major new study published this week in the Journal of the American Medical Association (JAMA).
The study — a randomized controlled trial, which is considered the gold standard of research — found that after participating in workplace wellness programs for 18 months, employees reported that they were doing a better job at maintaining a healthy weight and exercising, but they did not score better on objective measures of health, such as lower blood pressure, lower blood sugar levels and a lower body mass index (BMI).
Nor did the programs appear to have any effect on employee job performance or absenteeism.
“Our findings show that health behaviors can respond to a workplace wellness program, but they also temper expectations of realizing large returns on investment in the short term,” said Dr. Zirui Song, one of the study’s authors and an assistant professor of health care policy and medicine at Harvard University, in a released statement.
Avoiding past pitfalls
That investment has been significant, especially after the Affordable Care Act incentivized U.S. employers to offer wellness programs to their workers. In 2018, four out of five large companies and more than half of small businesses offered their employees some kind of program, according to national survey.
The workplace wellness industry is now an $8-billion-a-year industry.
Despite that large financial investment by companies, research on the effectiveness of workplace wellness programs has not been very rigorous, and the findings from previous studies have been mixed. Indeed, most of the studies that reported wellness programs in a positive light were observational and came with many important limitations, including the lack of a comparison “control” group and selection bias.
Those studies can’t rule out the fact that employees who voluntarily sign up for a wellness program are likelier to be healthier and more motivated to change their behavior than their peers who didn’t sign up — thus skewing any study’s findings.
By designing their study as a large randomized controlled trial, the authors of the current study avoided some of those pitfalls.
“We wanted to explore the causal effects of workplace wellness programs using the rigorous methods of an experimental design in order to help policymakers and employers make informed decisions about investing in wellness,” says Song.
How the study was done
For their study, Song and his co-author, health economist Katherine Baicker, now dean of the University of Chicago Harris School of Public Policy, partnered with BJ’s Wholesale Clubs, a big-box retailer that employs about 33,000 workers at 160 outlets across the country.
The researchers randomly assigned employees at 20 of the company’s outlets to a wellness program that included eight modules, or classes, on various health-related topics, such as nutrition, exercise and stress reduction. The employees also filled out a questionnaire to assess their health risks and underwent several medical tests, such as for blood pressure and blood glucose.
To encourage participation in the classes, employees were given a $25 BJ’s gift card for completing each one. (Most workplace wellness programs come with some kind of financial incentives.)
The study followed the participants for 18 months, from January 2015 through June 2016. At the end of that period, they were re-tested and filled out another questionnaire. The medical claims they had made through their company insurance program and their employment data were also analyzed.
When the study ended, the BJ’s Wholesale Clubs outlets that offered a wellness program had 8.3 percent more employees say they were exercising regularly and 13.6 percent more say they were actively managing their weight than the other outlets in the chain.
But there were no significant changes in 27 other self-reported health and behavioral measures, such as how the employees felt about their overall health, the quality of their sleep, the amount of alcohol they consumed and whether they had made improvements in their food choices.
Nor were there any significant changes in 10 clinical markers of health, including blood pressure, blood glucose, cholesterol and BMI.
Annual medical spending per employee was similar for employees in the outlets that were offered the wellness programs and those in the outlets that weren’t. Also similar were the two groups’ work productivity, absenteeism (how many sick or personal days they took off from work) and tenure (whether or not they remained with the company).
Those factors have all been used to sell workplace wellness programs to companies.
Limitations and implications
The study involved employees at one company. Its findings, therefore, may not be applicable to broader groups of workers.
In addition, the financial incentive offered to B.J.’s employees for participation in the wellness program ($25 for completing each class) was relatively small.
Still, the study’s findings are similar to those of a slightly smaller randomized controlled trial (12,500 employees) whose results were published by University of Illinois researchers in 2018. That study also found that workplace wellness programs did not save in medical costs or improve the productivity, absenteeism or retention of employees.
The 2018 study followed its participants for a year. The current study tracked its participants for 18 months. Both of these studies may not have been long enough to see benefits from workplace wellness programs.
It may also be that larger monetary incentives are needed for such programs to have any impact on employee’s health-related habits and behaviors.
“As we grow to understand how best to encourage health behavior, it may be that workplace wellness programs will play an important role in improving health and lowering the cost of health care,” says Song. “For now, however, we should remain cautious about our expectations from such interventions.”
FMI: You’ll find an abstract of the study on JAMA’s website, but the full study is behind a paywall.