Coming to a workplace near you: Fines for being fat?









Unlike smoking, high blood pressure, and glycemic control -- issues that physicians have a range of options to treat and control -- there are no clinically proven pharmaceutical or treatment protocols for obesity, says Downey. Moreover, the federal regulations proposed under health care reform contemplate such possibilities as an employer requiring its entire workforce to achieve a body mass index of 27, and fining those who cannot meet the standard or make consistent progress toward it. 

A majority of adult Americans are overweight or obese. Most fail in their attempts to lose weight, researchers find, but the majority of those who succeed return to baseline weights within five years. "The majority of American women are on a diet at a given time," says John Cawley, a Cornell University economist and public policy professor. "It's not that people don't know, and it's not that they aren't trying. It's that these are really hard behaviors to change." 

A recent study of a workplace program that offered financial incentives for losing weight to 2,635 workers found only modest weight loss and a high dropout rate, according to Cawley, who published this study with Joshua Price of the University of Texas at Arlington. "We're at an early stage with figuring out how to optimally design these incentive schemes," says Cawley. 

Culture and level of trust within an organization are the most important elements of a wellness program, according to Winkler. Rewards or penalties around healthy behavior must be give in the context of information, interventions, and programs that make it possible for employees to reach their health goals. Programs that are personalized to the workers' personalities, health risks, and other variables are more likely to be successful -- but are also harder to administer. 

Eight primary risks can drive up health care costs and lead to diseases: smoking, sedentary lifestyle, unhealthy diet, excessive alcohol use, lack of preventive screenings, patient non-compliance, inadequate sleep, and poor stress management. Rather than tackle all eight at once, an employer should assess where the greatest risks and costs exist among their employees and go from there, Winkler says. 

But don't expect the same old glossy brochures and HR-speak as new programs roll out. Organizations are getting creative. "Employers that have had success in connecting with people to change behavior have used marketing tactics as opposed to traditional HR benefits communications," notes Winkler. 

Rather than simply threatening or bribing employees, a growing number of employers are launching competitions and gaming applications that encourage achieving health goals in a fun way. The Hewitt study found that 22% of employers surveyed are interested in incorporating gaming concepts into their wellness programs. 

Keas believes that penalties don't work in changing individuals' behavior, says Bosworth. Rather, the company has found success through a fun and social rewards-based approach that combines games, achievable goals, healthy habit building, and small coworker teams that support health goals. A case study Keas conducted at a Florida hospital found that 46% of employee participants improved their fresh produce intake and exercise, 16% improved their stress level, and 30% lost a modest amount of weight. 

Also going beyond monetary rewards or penalties is the Global Corporate Challenge, in which teams of employees compete in their virtual progress walking around the world, with a 16-week jump-start period beginning May 23 and another nine months of follow-up. "Payment doesn't encourage personal responsibility; it actually compromises it," argues GCC president and founder Glenn Riseley. 

At the end of previous years' challenges, participants lost an average of 9.9 pounds; 66% reported decreased stress; and of those with high-risk blood pressure, 54% had reached low-risk levels. Past participants include Pearson, Warner Brothers, and Rolls Royce, according to the GCC web site. 

The vast majority of American companies, 83% according to Hewitt's survey, already offer incentives for participating in wellness programs. Expect more to expand those rewards and penalties to cover healthy behaviors and eventually to rest on specific results. 

"A lot of people will feel that it's somehow mean to do this," says Cawley. "What's not fair is the current system where everybody else in the health insurance pool is subsidizing the health care costs of the morbidly obese."