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Workplace wellness program did not improve clinical measures of health nor reduce health care spending and utilization
Clinical Question
Do workplace wellness programs improve health outcomes or reduce health care costs?
Bottom line
A workplace wellness program implemented in a large US retail company resulted in significantly greater rates of self-reported positive health behaviors, including exercise and weight management. There were, however, no significant differences in clinical measures of health, including lipid levels, hypertension, obesity, health care spending and utilization, or employment outcomes, after 18 months. 1b
Reference
Study design: Randomized controlled trial (single-blinded)
Funding: Foundation
Setting: Population-based
Synopsis
Evidence on the effectiveness of workplace wellness programs is mixed, with most controlled studies failing to show any significant health outcome benefits. As part of a comprehensive workplace wellness program at BJ's Wholesale Club, these investigators randomized (concealed allocation assignment) selected subsets of worksites to an intervention group (wellness programming; 20 sites, 4037 individuals), a matched primary control group (no wellness programming; 20 sites, 4106 individuals), or an unmatched control group (no wellness programming; 120 sites, 24,831 individuals). An established wellness vendor, Wellness Workdays, implemented the program which comprised 8 modules over 18 months that focused on key elements of health and wellness, including nutrition, physical activity, stress reduction, and prevention. For both the treatment group and primary control group, participant self-reported health and behaviors data, including exercise, diet, smoking, and alcohol use, were collected via health assessment surveys. Clinical measures, including body mass index, blood pressure, blood glucose, and cholesterol levels, were obtained by biometric screenings. Administrative data were obtained from all 160 worksites for health insurance claims, health care spending, work performance evaluations, and employee absenteeism and tenure. Using intention-to-treat analysis, significantly more participants in the wellness programming group reported engaging in regular exercise and weight management compared with patients in the combined control groups (69.8% vs 61.9% and 69.2% vs 54.7%, respectively). However, there were no group differences in clinical measures of health, including hyperlipidemia, hypertension, and obesity. In addition, wellness program exposure did not have any detectable effect on health care spending or utilization, absenteeism, work performance, or tenure. Finally, there were no differences in outcomes between men and women.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Is 18 months really enough to analyze this honestly?
I look at this and see that the patterns of healthy living in the participants are just beginning by the time the research is giving a "conclusion".
My concern is that this will make us as doctors question the benefits of a program like this, and maybe even advise against it. But this "evidence" is barely even evidence at this point. This is important research that can guide our society and should be well done and carried out for longer periods.
For me to believe in this research conclusion, I would want to see the program ongoing for about 5 years before a true analysis can be made. Healthy living is not a short-term fix-all, but sustained long term in an individual's life is bound to make a difference.
At 18 months participants are only beginning!
18 months is far too short to evaluate lifestyle change.
Most of the diseases and health issues impacted by lifestyle change develop (or are prevented) by lifestyle over many years. Therefore an 18 month study is far to short to provide any meaningful information about the impact of healthy living programs. The pertinent clinical questions are things like "what are the rates of metabolic disease 30 years after involvement in healthy living programs?". This study is like trying to evaluate change in the incidence of stroke after 2 weeks of treatment with antihypertensive medication.