Experts call for more study, say programs can vary and deliver other benefits

Randomized clinical trial (RCT) data revealed that workplace wellness programs have no significant impact on clinical outcomes, though they did slightly change health beliefs and may have led to an uptick in people seeking out primary care providers.

“This individual-level RCT of a 2-year comprehensive workplace wellness program demonstrated that the program significantly improved employee beliefs about their own health and increased the proportion of employees reporting that they have a primary care physician,” wrote Julian Reif, PhD, an economics researcher at the University of Illinois at Urbana-Champaign, and colleagues, in JAMA Internal Medicine. “However, no significant effects were found on biometrics, medical diagnoses, or medical use after 24 months… These results complement recent RCT evidence that workplace wellness programs affect some self-reported outcomes but have limited effects on clinical or administrative outcomes.”

In 2019, 84% of large U.S. companies offering health benefits also offered a wellness program, Reif and colleagues noted. And yet, there is no strong causal evidence to suggest that workplace wellness programs actually improve employee health or well-being. In their study, Reif and colleagues assessed workplace wellness program enrollees based on various clinical metrics, health beliefs, self-reported behaviors, and claims-based diagnostic and utilization data over the 2-year study period.

Among 4,834 participants (2,770 women; mean [SD] age, 43.9 [11.3] years), 786 (16.3%) were nonwhite, 963 (19.9%) were faculty, and 1,172 (24.2%) earned less than $40,000 per year. The wellness program in the study was designed, Reif and colleagues wrote, “to be representative of typical comprehensive wellness programs offered by employers, included 3 annual components: an onsite biometric screening and survey, an online health risk assessment (HRA), and a choice of wellness activities.”

Participants who were randomized to the treatment group (n=3,300) received incentives to participate in the wellness program, while those in the control group (n=1,534) did not participate. Measures taken at 12 and 24 months included biometrics on 16 clinical outcomes; claims data related to diabetes, hypertension, and hyperlipidemia; medical use (office, inpatient, and emergency visits) data; and self-reported health behaviors and beliefs along 14 outcomes. People in the treatment group were eligible to participate in all 3 intervention components and randomly received cash awards of up to $200 for completing an annual screening and HRA, and were then made to participate in 1 wellness activity class (such as exercise, nutrition, and stress management) per semester.

At both the 1- and 2-year marks, those who were in the treatment group saw no major changes in biometrics (including body mass index, blood pressure, cholesterol, and glucose level), medical diagnoses, or medical use. Further, there were no significant changes in hypertension, diabetes, or hyperlipidemia diagnoses at 12 or 24 months. Reif and colleagues saw declines in systolic blood pressure (95% CI -1.48-1.18 mm Hg) over 24 months, but the decline of 1.48 mm Hg was ultimately nullified when it was compared with a control group mean of 122.4 mm Hg. The same finding held true for hyperlipidemia diagnoses, which went down after 24 months (95% CI -2.47%-3.07%) in the wellness program group but were again negated when compared with the control group’s mean decrease of 26.5%.

The proportion of participants in the treatment group that reported having a primary care physician increased by 6.1 percentage points (95% CI 3.0-9.2 percentage points; adjusted P=.002) at 24 months when compared to baseline.

Generally, personal health beliefs among wellness program participants met the threshold for significant change, though that difference did not persist to individual measures. When standardized into a single treatment effect, a smaller portion (0.07 SDs [95% CI −0.12 to −0.01 SDs; P=.02]) of treatment group participants believed they had a body mass index greater than 30, high cholesterol, high blood pressure, and impaired glucose levels. Still, health beliefs did not change significantly around any one measure. There were no significant effects on self-reported tobacco use, physical activity, or mood, or any category of clinical encounter analyzed.

Study limitations identified by Reif and colleagues included the fact that the results may not be generalizable to other workplace settings with different populations and wellness programs.

Reif and colleagues also pointed to other RCT data with similar findings, observing that “a growing body of evidence” points to the programs’ ineffectiveness.

In an accompanying editorial, Jean Marie Abraham, PhD, of the University of Minnesota School of Public Health, who was not affiliated with the study, wrote that although the evidence from Reif and colleagues is “valuable,” more study — including longer-term investigation — is needed. In the meantime, Abraham wrote, wellness programs can still achieve myriad benefits apart from specific clinical outcomes.

“In the near term, employers may question their current investments in wellness programs,” Abraham wrote. “However, it is premature to reach a conclusion on the effectiveness of wellness programs. Program designs can vary extensively across employers in the scope and intensity of offered components, mode of delivery (online vs in person), availability and structure of incentives to encourage participation, and how organizational leaders implement them… According to the Centers for Disease Control and Prevention, comprehensive wellness programs should not only offer screening and educational activities, but should also be integrated with other fringe benefits [that] align with organizational policies and practices.”

  1. A workplace wellness program slightly improved health beliefs but not clinical outcomes, according to the results of a randomized clinical trial.

  2. Researchers reported no significant impact on body mass index, hypertension, hyperlipidemia, or glucose levels, among other measures.

Scott Harris, Contributing Writer, BreakingMED™

No source appearing in this article disclosed any relevant financial relationship with industry.

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