Addressing the COVID-19 pandemic is by far the most pressing health policy issue of the day. But when we get through this crisis, we will still be left with the epidemics of chronic conditions, such as diabetes, heart disease, and obesity. Focusing on health care alone is likely to be insufficient. Healthy diets, regular exercise, and other health behaviors are key levers for managing these conditions—but progress on these dimensions has proved difficult to achieve.
There has been a great deal of enthusiasm for workplace wellness programs as a way to help increase awareness and improve health behaviors—and, ultimately, improve health. Many adults spend most of their waking hours at work, so it is a promising setting for trying to foster behavior changes that need to be implemented day in, day out. Most privately insured people get their insurance through their jobs, so employers have a stake in this. Workplace wellness programs might result in a healthier, more productive workforce and lower health insurance costs.
All of this has led the administration of workplace wellness programs to be a thriving, multibillion-dollar industry. Most large employers have some wellness program, though the content of these programs varies widely, as do the financial stakes involved. There are many claims that these programs result in lower health care costs, lower worker absenteeism, and more. But are these claims justified?
Comparing only the health and employment outcomes of people who participate in workplace wellness programs with those who do not can be very misleading. When an employer offers a free gym membership, for example, people who take up the offer tend to be—unsurprisingly—people who like to go to the gym. The free membership is great for those gym users but may not change their behavior much. In other words, self-selection means that people who participate in the wellness program probably work out more than people who do not participate, but it is not because of the offer of the free gym membership.
This is of course a very naive way to look at the data, and there are many studies that deploy more sophisticated approaches to account for confounding factors. For example, some studies compare companies that have wellness programs with those that do not—which is a better approach but still presents a potentially muddied picture because the type of companies that implement such a program may be different (or have different workforces) from those that do not. Overall, many of these studies1 have suggested that wellness programs might reduce costs and improve productivity, but limitations in the body of evidence made it difficult to assess the true effect of the programs themselves.
Thanks to a partnership with BJ’s Wholesale Club, Zirui Song, MD, PhD, of Harvard Medical School and I had the opportunity to assess the effects of an employer wellness program using a clustered randomized controlled design. Among 160 BJ’s clubs—each an individual worksite—we randomized 25 to the treatment group (in which an on-site wellness program was made available to employees) and 135 to the control group (in which employees were not offered such a program). Comparing outcomes at those worksites shows the effect of the wellness program itself because other individual characteristics that might affect outcomes (such as preexisting exercise patterns) were balanced between the 2 groups.
Working with the wellness vendor Wellness Workdays, we implemented a multifaceted wellness program for employees in the treatment group (the 25 randomly selected treatment-group clubs, with more than 7000 employees), whereas workers in the control group (the remaining clubs, with more than 40 000 employees) did not have such a program. The program ran for almost 3 years and had a series of different program units focused on exercise, healthy eating, health education, and stress reduction. About 28% of employees in the worksites with the program participated in at least 1 of these units.
We then gathered a wide range of data, including employment outcomes, such as job tenure and absenteeism; self-reported health behaviors, such as exercise and healthy eating; health care use and spending (for those insured through BJ’s); and health outcomes, such as blood pressure, blood glucose level, and obesity.
In many ways, what we found was not encouraging. We did not detect any substantial changes in employment outcomes, health care spending, or health outcomes. What we did see at both 18 months2 and 3 years3 were improvements in health behaviors. For example, the wellness program increased the share of employees who reported actively managing their weight by about 18% and getting regular exercise by 16%. However, those changes in self-reported health behaviors did not translate to lower blood pressure or weight.
There is a huge range of “wellness” programs implemented across very different workplace settings, and no single study can determine definitively whether such programs categorically do not work. There may be more effective program designs or more responsive employer settings. That said, the study adds to a growing body of evidence built on similarly strong research designs that is cause for tempering expectations. The study deployed the program sitewide at randomly selected worksites (because many wellness programs involve team challenges or workplace-level changes). However, another study4 looking within an employer found similarly limited effects. That complementary study enrolled almost 5000 University of Illinois employees who were individually randomized to a treatment or control arm, with 2 years of wellness programming available to the treatment group. Although treatment-group members perceived themselves to be in better health, the authors found no discernable effects on health spending or health outcomes—though they did find significant self-selection into program participation based on prior health care use and behaviors.
Does this mean that employers should abandon wellness programs? It depends on what they are trying to achieve. Workers seemed to value the benefit, and they were more attuned to the importance of healthy behaviors and made efforts to act accordingly. If employers are seeking to add benefits that workers value—or to attract the type of workers who value those benefits—the programs may be worth it. But if the goal is to save money by reducing health care costs and absenteeism or to improve chronic physical health conditions, such as high blood pressure, diabetes, or obesity, there is little evidence that this type of program delivers the desired results.
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Baicker K. JAMA Health Forum.
Corresponding Author: Katherine Baicker, PhD, Harris School of Public Policy, University of Chicago, 1307 E 60th St, Chicago, IL 60637 (firstname.lastname@example.org).
Conflict of Interest Disclosures: Dr Baicker reported receiving grants from the National Institute on Aging (R01 AG050329) and serving on the board of directors for Eli Lilly and Mayo Clinic.
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Baicker K. Do Workplace Wellness Programs Work? JAMA Health Forum. 2021;2(9):e213375. doi:10.1001/jamahealthforum.2021.3375