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I have several new posts ready to go — the usual suspects acting out in their usual hilarious fashion — but this is a serious post.
It is time for wellness vendors to stop harassing employees about their weight.
A new article summarizing the voluminous data on the futility and harms of weight-shaming just appeared. It doesn’t contain new data, but rather presents the existing evidence in a clear and compelling format.
This article finds fault in the physician community, but the wellness industry (the outcomes-based companies and their enablers at the Health Enhancement Research Organization (and their enabler-in-chief, Ron Goetzel) is even worse because they tie money to weight loss. They give employees a financial reason to binge before the first weigh-in and then dehydrate themselves and crash-diet before the last one.
This does nobody any good, except of course the outcomes-based wellness vendors — like Interactive Health, Wellsteps, Wellness Corporate Solutions, Staywell, Bravo, Total Wellness, Star Wellness, Health Fitness Corporation and probably a host of others. And there is a special dishonorable mention for HealthyWage, whose entire business model is corporate crash-dieting contests.
They aren’t going to agree to stop on their own, any more than Monsanto stopped making DDT on its own volition. They need to have it made clear that this behavior won’t be tolerated any more.
A starting point is this linkedin post. Like it, comment on it, share it. Once we get to 100 likes and comments, and we’re already more than halfway, I can probably generate media attention.
Note that this personal blog post does not necessarily represent the views of any organization with which I am affiliated, other than the one with which I co-founded. I am referring, of course, to the Needham Frisbee Club, where everyone is welcome to join and play and become fitter — since fitness at any size, not corporate crash-dieting contests, is the key to health.
By now, many facts are well-known about weight and weight loss programs:
- Variations in body size do not correlate with variations in willpower
- No one really knows why the country has gotten fatter since 1986, reversing the trend through 1985, and without understanding the causes of this fairly sudden reversal, it’s not possible to address it. (We do know that the lowering of cutoffs in 1989 created an additional 30 million “overweight” people in the U.S. overnight. http://www.cnn.com/HEALTH/9806/17/weight.guidelines/)
- It is much better to be “fit and fat” than to try to diet your way to health
- The vast majority of people who lose weight gain it back
- 1/3 to 2/3 gain back more than they lose
- No wellness vendor has discovered the secret to weight loss that has eluded researchers for decades
- The often quoted 90-95% failure rate of programs is likely underestimated.
Further, while perhaps not proven, there is growing evidence, also here, and here, that weight cycling may be hazardous to health. (This would likely be particularly true when an employer ties incentives to gaining weight for the first weigh-in in order to lose it by the second weigh-in.)
And, yet, a number of the workplace wellness industry’s very stable geniuses have chosen to body-shame employees. The individuals and companies listed below are the wellness industry’s leading body-shamers, charter members of the Body-Shaming Hall of Shame. No surprise that wellness luminaries are leading the charge towards body-shaming, as their industry has repeatedly been called words like “sham” and “scam” by Pulitzer Prize-winning media outlets not otherwise known for name-calling.
Where possible, we have provided contact information, that you can use to let the appropriate people know how you feel about endorsing body-shaming in the workplace. Obviously, one can never eliminate discrimination based on body type, but hopefully this exposé, and creating the Body Shaming Hall of Fame, will reverse the trend towards employer support of weight discrimination in wellness programs.
Troy Adams, Wellsteps
Wellsteps is known in general for harming employees, and won a Deplorables Award in 2016 for harassing Boise School District employees. Mr. Adams cemented his and Wellsteps’ candidacy for this list by declaring: “It’s fun to get fat. It’s fun to be lazy.” After receiving many complaints, he took that article down. But he never apologized and Wellsteps continues to pitch “wellness or else” programs in which employees are fined if they can’t lose weight.
Ignorance of physiology (fines and incentives have never cured any disease known to mankind) is quite consistent with the rest of Wellsteps’ philosophy. They also have no understanding of arithmetic (costs can’t increase and decrease at the same time), drinking (it is OK to have wine with dinner or a beer at a ballgame), smoking (smokers don’t take their first steps to quitting by smoking only on weekdays), nutrition (“one more bite of a banana” will not improve your health), and arithmetic again.
You can let Wellsteps’ largest client know how you feel about this by writing to the Boise School Committee at Jeannette.email@example.com and copying the editor of the local newspaper, Rhonda Prast, at firstname.lastname@example.org.
Michael O’Donnell, American Journal of Health Promotion
Michael O’Donnell served, until recently, as the prevaricator-in-chief of the industry trade publication, the American Journal of Health Promotion, which might as well be called the American Journal of Self- Promotion, for the simple reason that – despite the overwhelmingly poor economics of “pry, poke and prod” programs and their strong likelihood of harming employees – they have published only one single sentence critical of wellness…and when that was discovered to have slipped through pre-publication review by their thought police, they walked it back in the next issue.
Mr. O’Donnell was voted into the Hall of Shame thanks to his proposal to charge employees for insurance based on BMIs, a “pay what you weigh” approach, like ordering lobsters or sending a package.
- Prospective new hires should be subjected to an intrusive physical exam and hired only if they are in good shape. OK, not every single prospective new hire — only those applying for “blue collar jobs or jobs that require excessive walking, standing, or even sitting.” Hence, he would waive the physical exam requirement for mattress-tester, prostitute, or outcomes analyst for a wellness company – because those jobs require only excessive lying.
- Employees above his ideal weight would pay per pound.
- He would “set the standard for BMI at the level where medical costs are lowest.” Since people with very low BMIs incur higher costs than people with middling BMIs, Mr. O’Donnell would fine not only people who weigh more than his ideal, but also employees with anorexia.
If employees didn’t already have an eating disorder, what better way of giving them one — and hence extracting more penalties from them — than to levy fines based on their weight?
We aren’t making this up. Here is an excerpt:
He claims that all these weigh-ins and fines will create an “insanely great program” for employees, whether they like it or not.
Vitality Group, Johnson & Johnson – and Ron Goetzel
Where would a wellness-related Hall of Shame be without Ron Goetzel? Name a debacle or scandal in wellness, and his fingerprints are on it. Penn State, Nebraska, McKesson, Bravo/Graco, and of course Wellsteps come immediately to mind.
He was also the very stable genius behind the Johnson & Johnson Fat Tax. The Fat Tax was supposed to be a game-changer, ostracizing overweight folks with the misfortune of working for publicly traded corporations. In this scheme, companies would weigh their employees and then disclose those weights to shareholders. The shareholders would presumably reward those companies doing the best job of reducing employee weight, creating more profit for the wellness vendors, like Vitality or Johnson & Johnson, who would help employees lose weight. Ultimately it would be a tax, in that every employer that did not hire a wellness company and/or fire fat employees would see its stock price tumble, making wellness a mandatory fee.
While this “fat tax” would go a long way towards achieving the Wellness Ignorati’s goal of monetizing body-shaming, bringing financial disclosure into the picture raises all sorts of regulatory issues. Could you force employees to be weighed in order to meet SEC disclosure rules? What if employees cheated on the weigh-in, as employees are wont to do? Would that create a Sarbanes-Oxley violation?
There are three ironies here. It turns out that companies that are obsessed with prying, poking and prodding their employees, like McKesson, watch their stock prices tumble. And companies specifically obsessed with goading their employees into crash-dieting contests, like Schlumberger’s chart below, have the worst stock performance of all.
Second, it turns out that Vitality can’t get its own employees to lose weight, and yet they want you to hire them to get your employees to lose weight.
Finally – and this shouldn’t come as a surprise to anyone – there is zero correlation between employee weight and corporate performance.
Mr. Goetzel works for Johns Hopkins and often places their name on his essays. If you have an opinion on whether Johns Hopkins should be supporting institutionalized body-shaming, you can express your opinion by writing to Dean Ellen MacKenzie at email@example.com .
Dr. Delos “Toby” Cosgrove, president of the Cleveland Clinic. After commenting that he would not hire smokers at the Clinic, he added that he would not hire obese people if he could legally deny them jobs.
So he doesn’t want to work with obese people, except if they happen to be president.
Dr. David Katz coined the term “oblivobesity” because apparently, he feels we have not yet made larger people feel bad enough about themselves to force them to do something about their weight – the difficulty of which has apparently been overstated because, according to Katz writing in the Huffington Post:
“There are rare cases of extreme weight loss resistance and such, but by and large, we can lose weight and find health by eating well and being active. Really.”
He deftly rebuts 30-plus years of consistent and conclusive research to the contrary by adding “really” to the end. Because everyone knows that makes a statement true. Really.
He also continues to illustrate his postings with pictures of headless fat people. And then there is his defense of Dr. Oz.
Please feel free to contact us about additional “shamers” you would like to add to the list along with the reasons why.
In the wellness industry’s epidemic of very stable geniusitis, Healthywage is Patient Einstein.
Somehow they recruited Russian trolls to convince Schlumberger that the best thing they could do to reverse their four-year stock price decline…
…would be to: encourage their employees to binge and then crash-diet. So far Schlumberger is halfway through its 8-week crash-dieting contest. In case you’re keeping score at home following our initial posting, here are the standings:
Pound Town has lost 10% of its weight in 4 weeks. Figure — as a conservative estimate — the average participant weighed 200 pounds at weigh-in. A 9.86% loss of body weight equates to more than 19 pounds, almost 5 pounds a week. The Centers for Disease Control (CDC) recommends 1-2 pounds/week.
The better CDC recommendations include not crash-dieting at all, but rather improving your health and fitness, at your current weight, because rapid weight loss likely leads to rapid weight regain, and possibly even slows metabolism so that one could regain more than one loses.
However, the CDC recommendations didn’t take into account that weight regain is a big part of what makes this contest work. Employees can win the $10,000 in 2018 — and then regain the weight in order to enter again in 2019. Is this a great country or what?
Health has nothing to do with it, of course. It’s about making Schlumberger shareholders proud again.
Once again, they are ignoring every iota of research that says crash-dieting is a complete waste of time. It may also harm you. Once again, they are offering a whopping $10,000 prize to the winning team.
The relevant language from the Wellness Code of Conduct
Here is the relevant language from the Employee Health and Wellness Program Code of Conduct. The language that the group agreed upon — “may have negative effects on their health” — was intended to be as acceptable as possible to what has become an delightfully large Ethical Wellness group:
Research shows that the vast majority of people who participate in weight loss programs will eventually gain their weight back after the program ends. Many will also gain back more than they lose. The weight cycling that occurs with repeated participation in weight loss programs may have negative effects on their health.
It’s also slightly possible that offering a $10,000 prize (for a team of five) could exacerbate the harms of weight-cycling just a tiny bit by encouraging employees to binge, bloat, salt and constipate themselves before the first weigh-in. But no team would ever do that, right? After all, it’s not worth sacrificing your ethics or harming yourself in order to win a measly $2000/team member.
Haha, good one, Al.
The relevant language from Here’s How to Win a Corporate Biggest Loser Contest
On the weigh-in day, avoid the bathroom before weigh-in if you can, and minimize your activity, another big glass of whole milk with your breakfast that contains some salty options will help you retain more water. If you are also going to get your waist measured, drink about half a can of root beer. Sounds gross, but the carbonation and salt will give you are really good belly bloat…If they are measuring your waist, wear some pants that are snug around the waist, or add a tight belt that hits below your belly button, this will create some fluid buildup in your belly area. At this point you should be a big bloated sloshing mess that needs to go to the bathroom really bad. This is the perfect time to get weighed and measured. If you are getting measured, poor posture can get you another inch and a half, so go for it.
To their credit, even the group that gives this advice has a more adult sense of responsibility than Schlumberger and HealthyWage, as they preface a few pages of advice with:
It’s getting to be New Year’s resolution time and many companies will try and “encourage” weight loss with a “Biggest Loser” type contest. Frankly, this is really a bad idea, as it can create all kinds of bad habits and damaging activities by the participants, as they starve, dehydrate and supplement themselves in an effort to win.
The relevant language from Schlumberger’s vendor, HealthyWage
Let’s look at the marketing pitch from HealthyWage, the outfit that runs this contest and epitomizes everything that makes the wellness industry what it is today:
That equates to over 50 pounds per person, in their 12-week contests — more than 4 pounds a week.* This means one of five things:
- Employees are indeed binging, bloating, salting and constipating themselves before the contest to maximize their odds of winning, since losing 50 pounds in 12 weeks would be a Herculean task without a bunch of extra weight that will be as easy to take off as it was to put on, thanks in part to websites that show you how to gain weight rapidly in preparation for corporate crash-dieting contests;
- Healthywage is unfamiliar with the CDC guidelines that recommend steady weight loss at 1-2 pounds per week;
- Healthywage is betting that employers don’t know that the odds of keeping weight off are 1 in 200 for males and 1 in 100 for females;
- Heathywage is counting repeat contestants more than once, meaning that the same employees binge, crash-diet, regain the weight and then do it all over again;
- Heathywage is lying.
Of course, this being the wellness industry, it may be all five.
*How does a 50-pound weight loss compare to other companies? Pfizer won a Koop Award because its participating employees were able to lose — get ready — four ounces. Six if you measure against the two ounces gained by non-participants. In all fairness, Pfizer’s program was not exactly intensive. “Participate” was defined as “open an email with a message in it.” The good news is that opening an email isn’t going to harm anyone.
Plus you never know what a message will contain. Open this link to see an example.
Because I didn’t mention any names, I published this one on the Corporate Health and Wellness Association blog. So you’ll have to click through. SPOILER ALERT: the bad news is that there are a boatload of things — 10, to be exact — that wellness vendors don’t know about BMI.
The good news is, there some things wellness vendors do know about BMI, like how to spell it. This is a big accomplishment, because spelling is right up there — along with arithmetic, integrity, behavior change, and of course wellness itself — on the list of things that most befuddle wellness vendors. We’ve chronicled many examples, such as Wellsteps’ Steve Aldana calling award-winning journalist Sharon Begley a “lier.”
This is the second part in the series on wellness vendors and the US Preventive Services Task Force (USPSTF).
Q: Why do vendors ignore or flout the USPSTF?
There are five reasons, three of which are unfortunate:
- Many vendors don’t understand the entire concept of screening, neither the science nor the arithmetic described in Part 1. Healthcare is hard, and the USPSTF can’t be expected to dumb themselves down so that wellness vendors, for whom simple math is a challenge and who don’t have to meet any educational or licensing requirements other than eight days of training, can understand it.
- Obviously, the more vendors screen, the more money they make. Guidelines propose infrequent screening for fewer blood values than most vendors do. That means vendors who abide by guidelines can collect much less money from employers than those who charge what the market will bear. Examples of companies screening the stuffing out of employees include Total Wellness, Interactive Health, Star Wellness, Healthfair, and Healthfairs USA. Needless to say they make a lot of money. (Quizzify is very jealous! Doing the right thing and guaranteeing savings isn’t remotely as profitable as ripping off employers.)
- Many wellness vendors are dishonest. We’ve already pointed out that Wellsteps bragged about how they screen every Boise employee every year for everything, with no mention of USPSTF guidelines. But after they got caught, they admitted they knew that the guidelines say the opposite. And Optum’s Seth Serxner insisted — out loud, on tape, that they would be happy to screen according to guidelines, if only employers would let them. And yet, here is Optum’s ad, saying exactly the opposite: if you want us not to raise your rates as much on insurance, it’s a “requirement” to pay us even more than you would save on insurance, to do annual screens. (Naturally they are quoting two sources that they know to be false as well.)
Q; Those are three bad reasons. What are the two good reasons?
I would like to credit Pete Arens for bigly influencing my answer on this. It’s rare that someone does that, and even rarer that I admit it. However, in this case, huge credit where credit is due. Pete’s the man.
USPSTF publishes guidelines, not requirements. It is perfectly OK not to follow them — as long as you have a good reason. The reasons above — ignorance, dishonesty and greed — would clearly not qualify. However, here are some excellent examples of reasons that would:
- You work in a high-stress environment, like a law firm. Making blood pressure screening available easily and much more frequently than once a year, even having some discreetly placed cuffs, might be a good idea. (Some maintain that stress doesn’t cause high blood pressure. Perhaps not, but to them I say, watch Episode 5 of The People vs. OJ Simpson.)
- Your workforce is largely outdoors. Skin cancer and Lyme Disease screens might be indicated.
- You have alternatives to screening (like Quizzify) for younger employees, but encourage and educate older employees and other employees at high risk to get screened. The USPSTF doesn’t say, “no screens.” It says screens should be age- and risk-appropriate. You offer both to everyone (that’s the law) but steer some employees one way and some the other.
- Your company is in the chemical dye or railroad industries. A bladder cancer screen or at least educational session to raise awareness might be advisable. (Bladder cancer can be identified and easily treated very early.)
Mr. Arens raised the question specifically of obesity screens. Are they appropriate at all, especially in a workplace? And that brings us to the other good reason to flout the guidelines: you think they’re wrong. In that situation, make your case. But it has to be a real case, and obesity screening could very well be such a case:
- The Employee Health and Wellness Code of Conduct specifically says, don’t embarrass or single out employees. This would be a perfect example doing exactly that;
- You are unable to find any meaningful literature or technique that is even remotely shown to successfully address obesity for more than a short, clinically meaningless period of time, so why screen for something you can’t address?
- To the extent you, in a corporate setting, do want to make your workplace healthier, you don’t need screens to do that. Encouraging exercise and avoidance of sugary foods at work would have the same impact.
Read carefully: we aren’t saying specifically you have to pass on obesity screens for those reasons. We are saying that if you differ with USPSTF on any screen, disclose the reasons and/or cite the literature, so it looks like a thoughtful decision. This is an example in which we would differ with guidelines.
Q: What would be a funny example of a vendor who tries to attack the USPSTF but falls on its sword?
Glad you asked. That would be Healthmine, whose credibility, um, collapsed as a result. Rule of thumb: to attack USPSTF credibly, a good start would be spelling their name right. We’re just sayin’…
Q: What would be a funny example of a vendor who flouts the USPSTF recommendations?
You’re asking all the right questions. That would be Angioscreen. The only screen they offer, for carotid artery disease, is D-rated by USPSTF.
Q: I don’t see what’s so funny about that. Stupid, yes. Harmful, yes. Expensive, yes. But what makes them so funny?
They admit right on their website that employees shouldn’t get these screens.
Honestly, I’m not sure which of those two things is dumber — offering the screen or admitting working-age people shouldn’t get it. But at least no one can accuse them of lying.
Q: They also can’t spell “New England Journal of Medicine.”
Good point. I didn’t even notice that until you brought it up. Maybe their head of their advisory board can help them with spelling, since “quality control is extremely important” to them.
Q: What does the USPSTF think of the wellness industry?
Their guidelines are intended for use by real doctors and medical practitioners. My guess is that they are horrified by the idea of an entire industry, unsupervised and uneducated, “playing doctor” with employees. Meanwhile, the National Business Group on Health, a vendor-fest if ever there was one, lobbies against the USPSTF for not understanding the importance of screening the stuffing out of employees.
Q: Why do employers go along with overscreening?
That’s a great question. They need only look at their own hospitalization rates to see that hospitalizations from diseases they are trying to prevent by screening, like diabetes and heart attacks, are already ridiculously low. However, rather than look at their own data, they prefer to spout the “86% of illness is caused by chronic disease” meme, which was already discredited when it was 75%, before the CDC decided to jump it up to 86%.
Anybody who reads that article can see that either is an impossibly stupid statistic. Most hospitalizations at most employers have something to do with birth events, and most expense at most employers can be traced to one-time items not addressable through eating more broccoli (neonates, transplants, cancer) or employees who either have a rare disease or more likely have a dependent with a rare disease.
Q: Maybe This isn’t fair, and vendors screen more than guidelines because they don’t think cost should be an issue and that employees should get all the prevention they can possibly use regardless of price
Actually, the USPSTF specifically does not include cost in its analysis. It balances harms and benefits, not costs and benefits. Screening according to guidelines will therefore lose money, as Ron Goetzel just admitted, even if over the long run more employees may benefit from screens than are harmed.
Quite the opposite. Tons of vendors obsess with hyperprevention because they are totally ignorant of the science and math involved. Our favorite is one called: “HEALTHIER is WEALTHIER and ASSOCIATES.” Along with the usually assortment of wellness industry THC-infused folderol (“our program, if followed diligently for a year, will decrease your employee health cost by as much as $24 for every pound of weight loss, an amount quoted by Dr Michael Roisen [sic] MD, Chief Wellness Officer and Chairman, Cleveland Clinic Wellness Institute”), they want to screen employees every three months. Don’t believe us?
Stay tuned for Part 3: Vendors who understand the USPSTF
Recently we described how to cheat one of those worthless, hazardous corporate crash-dieting contests, like the ones run by Wellness Corporate Solutions or HealthyWages or Virgin Pulse (nee ShapeUp). But we didn’t interview any employees who actually did.
Journalist and wellness expert Pat Barone, writing in LifeZette (Laura Ingraham’s popular online magazine) managed to do just that. She found some employees who “confessed” (bragged about) the ways they snooker these vendors — and of course their own employers –every year, starting again in most cases next month.
These employers, like Schlumberger, think they are creating a culture of wellness when in reality they are creating a culture of deceit, diet pills and dyspepsia. Why would any employer sponsor one of these contests? Simple: in wellness, stupid is the new black.
I don’t want to spoil your fun reading the article by giving away all the punchlines, but the keywords are carbs, sodium, and rocks. All the things that employees should eat, as part of a healthy diet. OK, maybe not too many vitamins but certainly lots of minerals.