Incentives fail to motivate workers to lose weight

Promising workers lower health insurance premiums for losing weight did nothing to help them take off the pounds, a recent study found.

At the end of a year, obese workers had lost fewer than 1.5 pounds on average, statistically no different from the minute average gain of a tenth of a pound for workers who weren't offered a financial incentive to lose weight.

'Our study highlights some of the weaknesses' of workplace wellness programs, said Dr. Mitesh Patel, assistant professor at the University of Pennsylvania's Perelman School of Medicine and the study's lead author.

The study, published this month in the journal 'Health Affairs,' reported the results of a yearlong randomized controlled trial to test the effectiveness of financial incentives to encourage weight loss among 197 obese employees of the University of Pennsylvania health system.

Participants were asked to lose five percent of their weight. Each was assigned to one of four study groups.

The control group wasn't offered any financial rewards. The three other groups were offered an incentive valued at $550.

One group was told they would begin receiving health insurance premium discounts on a bi-weekly basis immediately after reaching their weight-loss goal, while another was told they would receive bi-weekly premium adjustments the following year if they reached their goal. The final group was eligible for a daily lottery payment if they met their daily weight-loss goal and weighed in the previous day.

At year's end, no group had met the 5 percent weight-loss target. Participants' average weight virtually was unchanged, whether or not they had a financial incentive to lose pounds. Nineteen percent of participants did meet the 5 percent target, but they weren't concentrated in any particular group.

The study was structured to reflect typical employer workplace wellness plans.

'Our study showed that the incentive is not what motivated people, at least in this design,' Patel said.

Eighty-one percent of employers with 200 or more workers that offer health insurance offered weight-loss, smoking-cessation or lifestyle coaching programs, according to the 2015 employer health benefits survey by the Kaiser Family Foundation and Health Research and Educational Trust.

About two-thirds of large companies offered workers cash or merchandise for participating in these programs, the survey found, with 34 percent offering lower premiums or cost sharing. (Kaiser Health News is an editorially independent program of the foundation.)

The health law encourages wellness incentives by increasing the maximum reward for outcomes-based wellness incentives from 20 to 30 percent of the cost of health coverage, and up to 50 percent if the program is aimed at reducing tobacco use.

This study shows that how incentive programs are designed can make a big difference in how effective they are at changing behavior, Patel said.

The program may have failed for a number of reasons, he said. The $550 premium discount may not have been large enough.

Bundling the financial reward into the insurance premium on a paycheck rather than making a separate payment to the worker may have affected how it was perceived. Other details — such as the fact that participants weighed themselves at work rather than at home — may have been off-putting to some participants.

Patel also noted that many employer plans don't pay workers anything until they reach their goal, a situation similar to this study.

'Someone should be encouraged along the way,' he said. 'We've found from studies that if you want to motivate people, they need regular feedback.'

What some businesses are doing

From on-site health clinics to healthy food options, companies are spending big bucks to help their employees get healthy. About 70 percent of U.S. employers offer a corporate wellness programs, according to a 2015 report by the Society for Human Resource management.

What's more, the report found about 40 percent of those companies increased their investment in wellness initiatives in 2015 compared with previous years. Their hope — that wellness plans can be used to retain employees and improve the businesses' bottom lines by decreasing sick days and boosting productivity.

Here's a look at what some of the Corridor's employers are trying and the success they're seeing.

GreatAmerica Financial Services, 470 employees

What does your company's wellness program look like?

We'll have professionals give presentations on things like weight loss and skin cancer as well as do evaluations. We want all employees to have this benefit.

We also have a gym reimbursements and offer healthy food options in a new cafeteria we just opened. We offer at-desk exercise balls, desk-cycles and standing desks. We have a Biggest Loser competition periodically where we measure the percent of body fat loss rather than pounds and employees can earn small prizes.

We cover 100 percent of smoking cessation, offer free mental health counseling and have other presentations around financial management or how to create a will.'

What kind of results have you seen?

We've had a lot of conversations around whether or not we should measure against metrics. We've decided not to at this time. There's been a lot of debate about if that works or not. We are working to promote mental and physical health.

We've also seen there is that there is a correlation between an engaged workforce and a healthy workforce ... But we feel good about what we're doing.'

 -- Diane Vanis, vice president of human resources

ACT, with 1,200 employees

What does your company's wellness program look like?

We launched our program in early 2012. It was part of a larger cultural shift and we wanted to use it as a retention tool. We wanted it to be holistic ...

We offer wellness educations, typically quarterly presentations. We have a good partnership with the University of Iowa — someone will be coming to talk about heart health next month. We've had Hy-Vee dietitians talk about nutrition.

It's a broad spectrum. ... We have an on-site clinic staffed several times a weeks. We renovated a space that opened in May 2015 that has a cardio and weight room as well as fitness room.

What kind of results have you seen?

About 90 percent of employees take part in some kind of wellness event. About 50 percent of employees have access to a sit-to-stand desk. We know that sitting is the new smoking. We also have walking workstations at each of our buildings on campus. We want to make resources available.

... We use to offer a $100 wellness bonus to employees who took an on-site risk-assessment. This year that will be going away, mostly because there's mixed research on the effectiveness of incentives and, being a non-profit, we're mindful of our budget. About 40 percent of employees participated in (the on-site risk assessment). We looked at the costs of those who did participate versus those who did not and found those who got screenings had health care costs about half of those not getting screened.

We're now working on a recognition program that launched this month and recognizes employees who take steps to stay healthy.

--Sandy Stewart, wellness manager

MercyCare Business Health Solutions, 2,500 employees

What does your company's wellness program look like?

We offer a variety of things at Mercy. We have a full-fledged yearlong program where employees get incentives, which is a discount on their insurance. Employees earn points by getting preventive exams, participating in challenges and events, and getting biometric screenings. We also provide coaching to anybody, but cater to those who don't get all of their points ...

We have an on-site health clinic, which is very convenient, and an employee health center. We also have an educational component because it's really about engaging. People know what they need to do to be healthy, that's why coaching is the most important tool. Employees create their own goals with their coach — so if someone is 50 pounds overweight but doesn't want to work on losing weight, they don't have to.

What kind of results have you seen?

About 98 percent of employees participate. Many of our employees work long hours and on a variety of shifts, which definitely causes health problems. We've seen a negative trend line, and we've worked to have all the right things in place.

I think incentives works, but it's not the only thing that's important. Some companies offer the same incentives and they don't work. That's because no two companies are alike and need different programs. It's all about trial and error.

--Kathy Keana, manager