My recent request to review health risk assessments (HRAs) brought a number of responses. I’m grading the HRAs that I was able to access, on both advice and readability.
Optum’s, the second to be reviewed, receives “F” in advice and, as will be shown below, F- in readability. The scoring system is laid out here.
Advice: Chronic Pain
Optum offers the single most genius piece of advice of any of the very stable HRAs I’ve taken. By way of background, I took this HRA in 3 states where doctors are notorious for regularly giving out opioids as his or her treatment plan to follow, to people who currently have chronic pain. I checked off that I had “currently have chronic pain” just to see if they would say something worth blogging about, and was richly rewarded for that effort:
So this HRA is basically advising me to go get more opioids. The bad news is that they aren’t directing people to Quizzify’s painkiller awareness quiz. The good is that employees who want more opioids will give their program a high satisfaction rating.
This advice to switch to lowfat dairy is more likely to cause harm than to create benefit. Full-fat dairy is preferable to fat-free for most people. As this summary, with links to the studies, shows, full-fat dairy probably offers protection against diabetes.
The advice regarding “lower-fat meats” is controversial but is presented as fact. There is a whole body of research saying the opposite of what Optum says. Once again, we aren’t taking sides except to note that coercing employees to complete HRAs implies that the HRAs should be beyond challenge.
“Avoiding adding extra fats/oils when preparing food or at the table,” besides the questionable sentence structure, is simply wrong. Olive oil is on everyone’s good list, for example, while (aside from trans fats) other fats and oils have their advocates. A much better answer — how hard would it have been to come up with this? — might be “substitute olive oil for other fats and oils.” A bigger point: fats and oils make food taste good. And enjoyment of meals will lead to happier employees.
“Avoid added sugar” is decidedly unhelpful advice. Food companies go through a lot of trouble to hide “added sugar” specifically so people don’t avoid it. See this article: The Extraordinary Science of Addictive Junk Food. Optum’s go-to weapon against this cutting-edge neuroscience is: “Avoid added sugar” ?
Alas, Optum’s HRA is silent on how one goes about accomplishing this feat. This decidedly unhelpful advice runs up against the reality that people have no idea where these “added sugars” lurk, since very few products these days advertise: “An excellent source of added sugar.” By way of contrast, Quizzify does teach employees how to avoid added sugar — see the example right on the home page — and a good thing, because Quizzify’s test-takers, while improving greatly over time, originally score as follows:
- 52% think granola bars are healthy (they’re candy)
- 62% didn’t recognize synonyms for sugar (malted barley extract, dextrose, evaporated cane juice, maltodextrose)
- 68% didn’t realize that the first ingredient in a Clif Bar, organic brown rice syrup, is — you guessed it — sugar.
By contrast, this Optum “avoid added sugar” advice is about as helpful as just asking employees to rate their diet, which would be a useless question no HRA would ask. Oh, wait:
“An excellent diet is low in total fat” is simply wrong information. While saturated fat is controversial, the “low in total fat” myth was killed off decades ago.
While some people’s blood pressure is quite sensitive to changes in sodium intake, blanket recommendations of low-sodium diets are the subject of a great deal of controversy too. The ongoing Framingham Heart Study correlates high sodium intake with low blood pressure, the opposite of what Optum says.
So they’ve told employees to avoid fat and salt. Just to belabor the obvious — and in wellness, the obvious needs a lot of belaboring — what the bleep do they think people are going to eat instead of salty food or fats??? Are they gonna reach for kale, kelp, or a kiwi? Unlikely. They’re going to — get ready — eat something full of that very same added sugar, likely, as noted above, without even realizing it.
Congratulations, Optum. Your HRA greenlights the two biggest no-nos for employees: opioids and sugar. Fortunately for you, few employees take HRAs, seriously, so you probably aren’t doing any harm. This is especially true of yours, because even if someone did want to take yours seriously,you’ve thrown up one more roadblock: people can’t figure out what you’re saying, and that brings us to…
The complete scale for readability is here. Or so I thought, until I read Optum’s, which requires adding an “-” to the “F” on the scale . I took this HRA multiple times and each time it was an exercise in frustration.
Among other things, there were literally 100 screens that had to be scrolled through. And if you “saved” your work-in-process, you had to scroll through them all again to get back to where you left off.
Here is my favorite screen:
Stay with me on this one:
- If you are a good person, by definition, you check off the following: “I strongly agree that I am a good person.”
- If, by contrast, you are a bad person, by definition, you check off the following: “I strongly agree that I am a good person.”
After all, isn’t the whole point of being a bad person is to pretend you’re a good person? Bad people don’t exactly announce that fact on their Linkedin profiles. Sometimes they don’t even know themselves they are bad people. Walter White thinks he is a good person.
What does this mean?
Stay with me on this one.
- If you do not have asthma, meaning you are at the lowest risk, you check off the third box: “No, not being treated or taking meds.”
- If you do have asthma but are ignoring it, meaning you are at the highest risk, you check off the third box: “No, not being treated or taking meds.”
It’s also not clear how one would get treated for asthma without taking meds, making the second box a head-scratcher too.
Optum repeated this three-box choice for every other chronic disease as well, including diabetes. Diabetes, of course, is a disease that is very common to have but not be treated for. Indeed, it is so common to have diabetes and not be treated for it that there is an entire industry — that would be your industry, Optum — devoted to bribing, coaxing, cajoling or threatening every single suspected diabetic into treatment.
And yet somehow diabetes is nonetheless not common enough for you to draw an additional box on a screen that people can use to distinguish between whether they have diabetes and are not being treated for it, or whether they don’t have diabetes at all.
Indeed, one would think, with 100 screens to scroll through that could easily be consolidated into half that number (for instance, if you don’t use nicotine, you shouldn’t need to scroll through four screens to make your point), the disease inquiry category would be the wrong place to try to economize on electrons by causing people to check off the same box for opposite answers.
To summarize, I’m not following the advice on this HRA, either because it is terrible advice but I need it, or because it is great advice but I don’t need it.