The good news is that the wellness industry is finally coming around (kicking and screaming at times) to the realization that their programs are not a health care cost savings strategy………………..
WELLNESS 2018: The Good, The Bad, and The Just Plain Silly
Published on December 26, 2018
By Jon Robison
A review of 2018 reveals a wide range of health, wellness and wellbeing messages and approaches, either introduced or reinforced, that run the gamut from the good to the bad to the just plain silly. Both the shout-outs and the critiques are my own personal ones. I have chosen 5 for each category, listed in no special order and not meant to be inclusive by any means. For simplicity, I will use the term wellness, since the three terms really have strikingly similar meanings anyway. Of course, everyone will likely have their own entries and I invite readers to add those to the various categories.
THE GOOD
The world we live in today is barely recognizable from that of 50 or even 25 years ago. We have moved rapidly into The Information Age and the approaches we used in The Industrial Age simply do not apply in the volatile, uncertain, complex and ambiguous VUCA world of today. We desperately need paradigm pioneers to help move our outdated approaches into the 21st century. The good news is that many brave individuals and organizations are stepping up to address the task.
- Employer Health Care Costs. The good news is that the wellness industry is finally coming around (kicking and screaming at times) to the realization that their programs are not a health care cost savings strategy. The great news is that we have paradigm pioneers like Dave Chase and David Contorno and organizations like Health Rosetta that are making lower health care costs for businesses and employees a reality. The solution has little if anything to do with wellness programs or individual health behaviors, and everything to do with a poorly incentivized, unfairly constructed health care system. Dave Chase’s book, The CEO’s Guide to Restoring the American Dream: How to Deliver World Class Healthcare to Your Employees at Half the Cost, is a must read for every business owner. Chase is fond of telling leaders that they run a health-care business whether they like it or not. American business magnate Warren Buffett concurs:
“GM is a health and benefits company with an auto company attached.” In fact, it spends more on health care than steel, just as Starbucks spends more on health care than coffee beans. For most companies, health care is the second largest expense after payroll.”
- 21st Century Wellness – Individuals. There is a growing movement afoot to help usher wellness, particularly at the workplace, out of the dark ages and into the 21st century. While there are many paradigm pioneers leading the charge, a special shout-out to Bob Merberg whose LinkedIn posts always intelligently and powerfully challenge the status quo. And of course, Al Lewis continues his somewhat snarkier but always science- (and math) based challenging of the wellness industry. He is, perhaps more than any other single person, responsible for the fact that, although it used to be common, almost no one in the wellness industry is willing to publicly lie about their outcomes any more. Finally, a well-deserved shutout for metrics maven, Vice President Strategic Initiatives Validation Institute and Population Health Specialist Linda Riddell for keeping an ever watchful eye to make sure that data is being used to create valid, accurate measures of population health and/or to accurately measure the impact of policy changes, interventions, or other programs. Given my rather dismal results on the math SATs decades ago, she and Al are my go-to sources when I have questions involving data.
- 21st Century Wellness – Organizations. Increasing numbers of organizations are also helping to usher in more progressive ways of promoting health. A special shout-out to Ryan Picarella as he continues to, with dogged determination, steer the rather massive WELCOA barge into the 21st century. And just as of this month, The National Wellness Institute also has a new face at the helm. In am excited to see what Interim Executive Director Chuck Gillespie will do to usher this old and venerable organization into the 21st century. On the wellness vendor front, a shout-out to Limeade and Aduro for embracing the FUSION of employee and organizational wellbeing and helping broaden the focus of workplace wellness approaches. And finally, an additional shout-out to CBIZ paradigm pioneer Abby Stevenson for her recent powerful piece on weight and health. Let’s make this the year we switch the focus from weight to wellbeing. Even the Centers for Disease Control and the Society For The Advancement of Psychotherapy are beginning discussions about moving into the 21st century when it comes to helping people who are struggling with weight-related concerns.
- Nutrition Sanity. From Paleo to Vegan to Keto to Clean, seems like there is never any let up in the pronouncements of “experts” arguing about the best and worst nutrition recommendations. So very thankful for the ongoing work of Dr. John Ioannidis of Stanford University. Ioannidis reviews scientific studies in clinical medicine and social science. He is one of the most-cited scientists in the literature and has often weighed in on the specific set of problems and pitfalls commonly occurring with nutrition research. In a recent article in The Journal of The American Medical Association he provided an in-depth critique, suggesting that the emerging picture of nutritional epidemiology needs radical reform in order to reconcile it with good scientific principles, concluding that:
“Studies of nutritional epidemiology continue to be published regularly, spuriously affect guidelines, and confuse the public through heated advocacy by experts and nonexperts.
And that:
“Resources for some of these studies could have been better spent on unambiguous, directly manageable threats to health such as smoking, lack of exercise, air pollution, or climate change.
To drive his point home, Ioannidis calculated life-extending results from some recent nutrition studies. Estimating from the research that eating 12 hazelnuts daily would prolong life by 12 years, drinking three cups of coffee a day would provide an additional 12 years and eating a single mandarin orange every day would add five more years, he then concluded:
“If you were to gain all the benefit speculated by each one of these studies, we would be able to live for 5,000 years.”
- FUSION 2.0 – Inspiring Humanity at The Workplace. Full disclosure up front – this was a new conference for which my company Salveo Partners was a major sponsor. Nearly 200 people attended from 34 states and 3 countries. Professionals from HR, wellness, organizational effectiveness/OD, safety/risk management, training & development and leadership let down their guards and showed up fully human; they set aside “selling themselves” to learn, grow, and build meaningful connections with others. Sessions were connected by synergy, and helped people see what is possible, why re-humanizing workplaces is essential, and ways to lead and influence change. We began to see more clearly that when it comes to creating a thriving, human experience at work, there are common practices that are effective.
THE BAD
With “the war on facts” raging out of control across our nation, it is perhaps not surprising that wellness would continue to put forth their fair share of claims that either cannot be supported by or are directly contradictory to what we know conclusively from the research.
- Wellness Companies Acting Badly Credit to Al Lewis who just posted The 2018 Deplorable Awards for actors in the wellness industry that excel at fabricating outcomes, flouting guidelines, and harming employees. A tie this year. Click on the link above to read about the winners!
- “Wellness or Else.“ With the AARP lawsuit against the EEOC, guidelines for what are and are not acceptable levels of incentives for coercing employees to participate in wellness programs or punishing them for not are still up in the air, but for clinical programs, employers are safer from liability the lower the incentive or penalty. Regardless of the final outcome, the more important issue is that extrinsic motivation does not result in sustained change, encourages cheating, lying and taking shortcuts and diminishes creativity and intrinsic motivation. If this is what you want for your employees, go ahead and take the risk. And if your wellness provider says that you can avoid these negative consequences by using carrots instead of sticks (or forks) – you might consider switching to a different provider.
- Obsession with Personal Responsibility The obsession with promoting individual behaviors as the primary determinants of health status continues, usually focused on some sort of shaming or fear mongering to coerce change, distracting us from underlying issues that need to be addressed. The lack of understanding of this critical issue by health professionals never ceases to amaze me (although I never heard a word about it either during schooling for my three graduate health degrees). During a recent discussion on LinkedIn about the relative contributions to health of various factors, a medical doctor responded to me this way:
“Dr. Jon – Are you for real, or are you teasing when you write, “You are where you live” being more appropriate and accurate than “You are what you eat?” Is one to then believe that the nutrition of someone who lives in rich quarters, like a 5-star hotel, (or the White House) is healthier than someone who is impoverished and lives in a slum?”
Luckily, many people are aware that medical doctors are not always or even usually the best place to turn for nutrition information. Furthermore, as this graphic from the Centers for Disease Control’s own website clearly demonstrates, the answer to the good doctor’s questions is a resounding YES!
- Depressing View of Employees by Wellness Professionals. I have written previously here and here about the disheartening reality of wellness professionals speaking disparagingly about the employees they are supposed to be serving. The latest example comes from a recent webinar in which the CEO of a well-known wellness vendor commented on the fact that employees often intensely dislike their wellness programs:
“This is like saying your kid doesn’t like school if you ask me. It doesn’t mean you should say ok sweetie you don’t need to go to school if you don’t like it. We know they might not like getting out of bed at 7 in the morning and heading back to school, but we’ve got a responsibility to help them get educated. So, let me just throw that in there as a quick little two cents, that if you are looking for a program that everybody loves on a survey, its probably not going to require them to lose weight, but if you have a program that helps them lose weight, motivates them, incentivizes them to lose weight and its well-designed, they will lose weight and they will reduce risk and your company will benefit. And usually they’ll thank you at some point. But don’t look for them to say they love their wellness program, if it’s really focused on risk reduction.”
That this or any wellness vendor has a weight loss program that “works ” (long term) for any but a small percentage of participants is, of course, simply not true. But above and beyond that, is very difficult for me to imagine why an organization would have any interest in being involved with someone who feels that way about their employees – what do you think?
- The Difference between Managers and Leaders. Many in both the wellness and business fields continue to confuse and conflate these two terms – though they often have diametrically opposed connotations. Perhaps the best distinction is provided by Simon Sinek, who defines the two terms this way:
Management – is the practice of manipulating people for personal gain.
Leadership – is the responsibility of inspiring people for the good of the group.
From the wellness perspective, the often-repeated narrative that to promote engagement and organizational effectiveness it is critical for managers or leaders to participate in wellness offerings is oversold at best. Much more important is they inspire a culture of trust and create the conditions that promote autonomy and mastery and purpose for those that they serve.
JUST PLAIN SILLY
Finally we have the just plain silly category. These are the kinds of suggestions and even research that are either far too good to be true, make no sense at all, or are just plain ridiculous.
- Meaningless Name Changes. No other way to describe this one for sure! Weight Watcher’s changed its name this year to – wait for it – WW. Apparently, they wanted to expand their reach into the Wellness industry by re-branding themselves as “Wellness that Works” (WW?). And why did this icon of the weight loss industry decide to make this monumental change? According to Fast Company
“They learned that the term ‘diet’ was rife with negative connotations. What once worked with generations past now felt restrictive and reactive.”
There isn’t a shred of evidence that Weight Watchers “worked” (sustained weight loss) in the past for any but a small minority of participants. And as this emphatic statement from their CEO makes clear, their bottom line focus is still their bottom line focus.
“We will never abdicate our authority and our position as the best healthy, sustainable weight loss program on the planet,”
A very, very low bar indeed! One might wonder if the new name will last longer than the change that International House of Pancakes (IHOP) made recently when they very temporarily became the International House of Burgers (IHOB). Because if there is anything we need more of in this country, it is another wellness company and another burger joint!
- Sitting is The New Smoking For some reason, people in the health fields, including unfortunately some wellness vendors, seem to be quite fond of identifying behaviors about which people should be terrified, regardless of whether there is any science to support the contention. This year’s prize for the silliest such contention goes to “sitting is the new smoking.” It really boggles the mind to believe that anyone would buy into this given that 50% of people who smoke cigarettes die from them – almost 500,000 deaths yearly in the United States. As one health care expert noted, other differences between the two activities include:
“Chairs don’t carry excise taxes or warning labels. If you’re under 18, you can buy a chair without a fake ID. Workers are allowed to sit inside the building. Chairs don’t make you clothes smell, cause lung cancer or dangle from the lips of gunslingers in old John Ford westerns. Sitters aren’t assessed health insurance penalties. Your Match date will not feel misled if he or she catches you taking a seat, even if your profile didn’t disclose that you sit.”
- Obesity as a “Catchable” Germ. Speaking of behaviors about which people should be terrified, how about hanging around with fat people? The social contagion theory of obesity has been around since 2007, suggesting that if you socialize with such folks, you are likely to “catch” their fatness. I know it may at first sound ridiculous (because it is) but somehow the claim made originally by a couple of Harvard researchers continues to rear its ugly, unscientific head over and over again. And, if you are thinking, Robison you must be exaggerating their claim, here is exactly what the lead researcher said:
“It’s almost a cliché to speak of the obesity epidemic as being an epidemic. But we wanted to see if it really did spread from person to person like a fashion or a germ, “And the answer is, ‘Yes, it does.’
Not much we can add to that! Although it is true, as you can read about here, that this research has since been debunked.
- Small Plates and Painted Kitchens. Speaking of “silly” posing as real research, there is no better example than the widespread pronouncements of Brian Wansink, professor at Cornell University’s College of Business where he runs the Food and Brand Lab. For the past few years, Wansink has been making tsunami level waves by applying behavioral economics approaches to nutrition, claiming for example that people can lose weight simply by eating off smaller plates or painting their kitchens a different color. As with other examples in the “silly” category, at first blush it seems like a real stretch to think that messy, complex, nuanced nutrition and weight issues might be so readily solved with such simplistic solutions. And as with those other examples that is because it is! As a practicing nutrition professional for more than 3 decades, it has always made me chuckle (under my breath because such claims are not without negative consequences) why anyone would put a stitch of credibility behind these kinds of claims. Well, it turns out that silliness is the least of Wansink’s worries, as his research has now been outed as flawed – to say the least – as discussed in more detail here and here; reminding me of the old saying – if it seems to good to be true – it probably is!
As a side note, it is interesting (at least to me as a nutrition professional) that Wansink is a Professor of Marketing (not science) in Cornell’s College of Business. He is not associated with Cornell’s Food Science Department. I have written before about how almost everyone who eats seems to think they are entitled to dispensing nutrition counsel, which is interesting given that those same people would be very unlikely to take their sick cat or dog to a mechanic!
- Pay No Attention To the The Man Behind the Curtain. No list of the just plain sillywould be complete without an entry from Dr. Oz and his ongoing miracle weight loss claims. The one that caught my attention this year, as it repeatedly splashed across my computer screen: Dr. Oz’s 4 dollar weight-loss miracle. Apparently the good doctor must be feeling that his grilling by the Congress in 2014 was something he wanted to repeat. At that time, he had introduced at least 16 such miracle cures in the previous 5 years on his television show. While many have exotic sounding names like green coffee extract, garcinia cambogia and raspberry ketones, one thing none of them have is any science to back up the claims.
TAKE HOME
Quite a year – 2018! I hope you have found this information helpful and perhaps humorous as well. My fervent wish for 2019 is that we more stringently apply science to our health, wellness and wellbeing claims so that we can maximize the help and minimize the harm that we bring to those we serve. Happy Holidays! – Dr. Jon
