Workplace Wellness

Oh fuck I gotta have a catchphrase huh? Oh for first time doing this. It's been a minute. Uh, hi everybody and welcome to Maintenance Phase the podcast that won't charge you extra if you're fat or disabled to have a job. That was a very direct one. I know your thoughts on this matter. This is one where I am not coming in fresh and it's one where I have strong feelings already and I'm looking forward to having those feelings fed.

I am Michael Hobbes. I'm Aubrey Gordon. If you would like to support the show you can do that at patreon.com slash maintenance phase or you can buy t-shirts, mugs, tote bags, masks, all kinds of stuff at T-Public. Both of those are linked for you handy dandy in the show notes. You can also listen to Mike's new show if books could kill wherever you get podcasts and you can pre-order my new book.

Uh, you just need to lose weight and 19 other myths about fat people. Both of those are also linked for you in the show notes and Michael today. We're talking about workplace wellness programs. Yes. I interrupted your rant to make you talk about logistics. I was like, oh right, housekeeping. Yeah, that's where we're here. Yeah. For your pronouns on your name tag that's what are your thoughts on workplace wellness, Aubrey.

So many, many workplace wellness programs, not all of them, but many of them will provide folks with either bonuses or lower healthcare premiums based on their participation in or higher marks on specific health and wellness metrics. And I was talking to a friend of mine who works in like a municipal government. One of her people who sort of works in her department came to her and was like, hey, I did our workplace wellness thing.

And like I haven't eating disorder and starting the day with getting weighed was like, yeah, doing it at work. Right. In front of your co-workers in a non hippas sort of setting, right? Like I think it's worth questioning why on earth this is the job of an employer to do. Oh my god, you're spoiling something that I was saving for like the last five minutes of.

But like, yeah, it just feels like a real boundaryless mess of a system. And it's a real boundaryless mess of a system that has just permeated. Almost every major workplace that I'm aware of. Dude, 92% of employers in the United States have some form of workplace wellness programs. Shut the fuck up, are you kidding me? It's somewhere between like a four billion and a ten billion dollar industry. Holy shit.

What is wild to me is that workplace wellness programs have been around four decades. We will get into it. And there is no fixed definition of what workplace wellness actually means. Get fucked. So this is a like natural foods thing. Yeah, so exactly. So like a lot of the articles that you read, they're like, uh, some employers say like, yes, we have a workplace wellness program. But what they mean by that is that there's like a poster in the break room being like eat five fruits and vegetables.

Uh-huh. And then other employers have these like really comprehensive, you get this incentive. And there's this BMI bonus. And there's this discount on your health insurance. Really, really hardcore programs, but they're both labeled as workplace wellness. Yeah, the two that I remember most clearly and feel like the most galling examples to me. One is the Whole Foods BMI discount, which was you would get a greater employee discount if you had a lower BMI.

And I believe it was visible on the card too. So other employees could actually like, I think it would come up at the register to be like, oh, this person gets 15% off. The fucking barf. Yeah, it's really barf. And the other was a brand of chocolate that I have otherwise enjoyed in my life. Tony's chocolate lonely had a BMI bonus where they would just straight up pay people more money if you had a lower BMI.

And they got enough blowback on it that they've changed it to be a maintain your BMI bonus. So if your weight stayed the same, then you would get that bonus. Which is also still garbage. It's also discriminates against people like me who are trying to get huge, bro. What about the dudes who are going for gains, bro? I know what about the skinny shaming throughout our society? Oh, yeah. What about that? No one wants to talk about that. Yeah, nailed it.

So I want to start out by just trying to define what this is because especially for people that do not live in the United States. This is like completely fucking baffling. You know, they do have workplace wellness programs, even in other countries and other countries where they are. They have more socialized medicine like this is a cancer that has taken over the employer employee relationship basically everywhere, which is quite shocking.

But it's much more prevalent in the United States because roughly 60% of the population in the United States gets their health insurance through an employer, either your own employer or your spouse's employer. So like this is most Americans. Yeah. The closest thing to a definition of workplace wellness that I could find is any program carried out by an employer that promotes healthy behaviors.

In some of the articles about the history of workplace wellness and the components of workplace wellness, that'll include stuff like occupational health and safety programs. Which like no, that's a lot of that legal compliance anyway. And sometimes you see histories of this that will say like the 40 hour work week is a workplace wellness program.

Right. Are you kidding me? No, that's I mean, people who were doing that before it was a legal compliance issue were mostly doing that to get more productivity out of their workers. So workplace wellness kind of has to be something above and beyond like what you have to do as an employer or just something you're you're only doing explicitly to get more productivity out of your workers. So like that's what we're talking about is like this extra stuff.

And we're also not talking about you have a boss who won't shut up about their diet or you have a co-worker who's like talking about what everyone else is eating. We're talking about formal institutionalized workplace wide programs that either strongly suggest or incentivize or mandate employee participation. Yes. And when we talk about workplace wellness programs, it's a mix of good, neutral and extremely bad things.

Interesting. We put out a call toward the beginning of the research for this episode of like tell us your workplace wellness stories back when I thought this was going to be like a fun freewheeling episode. You thought you were going to do something laid back and you fell out of a real rabbit hole.

No, it's not. We got 700 emails. So we are going to do a bonus episode where we go further into like what workplace wellness programs actually entail right now and the like utterly fucking to range stories that we heard from our listeners. But there's a couple of broad categories that we found when we started getting emails and when I was reading up on this. So arguably there are some workplace wellness programs that are good.

So a lot of employers will provide free flu shots. Oh, great. I don't love that being provided at an employer, but also like more people getting vaccinated against the flu is a good thing. I feel like I don't know. It continues this sort of like insidious sort of thing of like your employer is kind of your health care provider. Exactly. So it's like blurring some lines. And also I think the number one reason that certainly that people I know don't get a flu shot is just the inconvenience.

We also heard from listeners whose employers started giving them more time off or kind of personal days like one listener said that her workplace gives you like Friday afternoons off like no questions asked if you just like need to take some time for yourself. So like cool. That's great. The last example of a good one that I have is a lot of employers also you know try to have like healthier food and the cafeteria.

Having an option for people that has like I don't know more vegetables and it or whatever that seems fine to me like great. Sure. But I would say the probably the largest category is programs that are like really dumb but like kind of benign. So a lot of employers offer subsidized gym memberships. Oh, it's the kind of thing that like if my employer didn't offer that I wouldn't ask for it but also like sure.

Yeah, I would also accept an employee discount for a Netflix membership. You know, exactly what it means to me discounts on stuff sure sure sure sure sure sure some people said that their workplace will like bring in people to do you know yoga sessions during work voluntarily. One person said their work brought in a masseuse once a month to give free massages to employees but they worked at a cafe as a parista.

There was no room in the back so they would just get a massage like in the cafe in front of all the customers shut the fuck up. But I guess the customers will be like I'm next. She's like no. Yeah, I'm sure I don't think it's really doing much for your health particularly but also just like yeah time that you're getting paid and you get a free massage at work whatever right.

And then a lot of employers do things where like they'll have a bowl of fruit at their reception desk they'll send out like a weekly health tip to employees. They seem pretty dumb to me but also they they seem harmless right and you can say that like okay they're entrenching this paradigm and like we'll get into it.

But also like the amount of just dumb shit that your employer does and you have to deal with at work. It's like having a couple bananas at their reception desk seems like fairly low on that ladder to me. I think listen it's hard for me to talk about workplace wellness programs without grading on a real sharp curve. Yeah, like of course on its face a lot of these are things that I don't think really have an appropriate place in the workplace.

Yeah. And if we had better healthcare systems none of this would be in the workplace to begin with and we think of this as a weird thing. Well this brings us to like the bad stuff. Yeah, tell me the main one is yes these financial incentives that essentially if you meet certain health quote unquote parameters you pay less for your insurance premiums.

And oftentimes this is done in like a fairly public way. So one email that we got from listeners said my last job would give you roughly $200 if you lost a specific amount of weight over the course of a year. You would go into a practitioner in the office to do a full health screening and whatever they determine is an appropriate amount of weight you should lose is your health marker goal for the next year.

You get money when you join the program and every year after if you continue to do the health screenings and lose weight it's gross and I hate it. Yeah. So it's like that sort of stuff where we're bringing in like extremely personal health information and this whole fucking weight paradigm.

Basically into your relationship with your employer and in some cases you're like direct boss. Yeah. Some people described having these like wellness plans that they put together with their boss and it covers things like oh you have to go to acupuncture chiropractor whatever once a week. And you'll actually get a discussion with your boss if you missed one of your wellness appointments. Jesus fucking Christ.

Wildly inappropriate. The boundarylessness of all of this. Yes. Exactly. Fucking staggering. Like think about how much you hate to answer to your fucking mom about your body or your health and wellness shit at like the holidays. Now imagine that's your boss and it's every time you talk to your boss that's a conversation that's all the table. Trying to think of like the people I want involved in my relationship with my body the least like my boss and my employer. Yeah. Yeah. Exactly.

Another really common one is Fitbit challenges or like Fitbit metrics. So the idea is if you get 10,000 steps you get a discount off of your health insurance which like on the surface at first glance I can see how that sounds kind of like fun. Right.

We're all going to try to move more whatever. But first of all it's effectively a form of surveillance. Yeah. Right. It's your activities outside of work. Now playing into the way that you're assistant work. And also a huge number of people cannot participate in these challenges. Right. Due to disability issues due to having a second job due to childcare responsibilities.

And all of this requires those people to just close this to their boss. Right. You're basically creating something that's like, oh, it's going to be fun. We're going to walk together. But you're putting people into a situation where they either have to walk 10,000 steps a day outside of work or they have to tell you why they can't.

There's also as you can imagine this also drives a lot of like really fat phobic and like condescending bullshit at work. So people sent in photos of like various posters that their bosses put up at work. One of them had a sign on the elevators that said push yourself not the button take the stairs when possible, which is also like a specific favorite of yours is the take the stairs.

Like the idea that like if fat people took the stairs up to flights of stairs or whatever every day that suddenly we would not be fat people anymore. Exactly. Get the fuck out of here. It also just makes you super conscious of if you're a fat person at work of your fatness like other people you know you're all waiting for the elevator together. Right. And it's like, oh, I'm going to see you're supposed to be taking the stairs.

Like it just it all this does is drive bullying and drive a culture at work of everyone like assessing each other's bodies and like health behaviors. Absolutely. And like listen, if people get it into their head that it is part of everyone's job description to look healthy in a way that is legible to mostly thin, mostly non disabled people. You are then being enlisted in a project of making other people feel like shit.

Do you want to hear the worst like surveillance category of workplace bonus bullshit that we got? Okay. This one's fucking unbelievable. I worked for a large organization who had a third party company who ran health challenges on their behalf.

It was operated through an online portal where people could accumulate points for doing things like getting their annual health checkup, etc. Pretty benign until they introduced a forum where you could post photos of co-workers you caught being unhealthy and tag them in it. Shut the fuck up. That's right. They built in a public shaming feature with no way for the person you took a photo of to opt out. Okay. Guys. So guys, I am going to start throwing up, crying and punching.

I need the address of this building so that I can burn it down. That's turning everywhere into fucking eight champs. So we're going to circle back to the worst of workplace wellness and the myriad reasons why it's bad. But we have to go through the history. Basically, as long as we've had workplaces, we've had weird wellness efforts, buy bosses, imposing them on their employees. Wait, really?

Yes. So Milton Hershey, the guy like the Hershey's chocolate guy, had a leisure park connected to the chocolate factory where he expected employees to go and do calisthenics during the day. Pilates before Pilates, calisthenics, yeah. The National Cash Register company, which was like hot shit in the late 1800s and early 1900s, offered horseback rides to employees before and after work. That sounds good to me. That's one of the good ones. I go on a little horse ride.

But then I don't know if these actually count as workplace wellness programs because they're basically companies that have like too much profit and founders that have these like eugenics adjacent ideas about higher quality. Like the right kinds of workers. Uh-huh. These programs eventually expand to things like helping workers quit smoking, helping workers quit drinking. But I'm not sure those count either because they're like pretty straightforwardly productivity measures, right?

The idea is that if somebody's drinking, they're probably showing up late. And the smokers, you don't want people taking smoke breaks. Yeah. And also it's pretty isolated. It's really only like the largest and most profitable companies that are really doing this in the first half of the 20th century. Right. But so the first explosion of these programs happens just after World War II with the rise of employer sponsored health insurance.

Before World War II, only 10% of the US population had health insurance of any kind. And during World War II, firms were prohibited from offering higher wages to employees because everything was controlled by the government to get like wartime stuff out. So employers started offering health benefits as basically a way of attracting workers, right? Because we can't pay you more, but we can get you free health insurance.

Once all of this kind of manufacturing sector stuff started to get entrenched, it then became something that unions started asking for. Health insurance benefits became something that was a mainstay of collective bargaining agreements. And in the late 1940s, the government also recognized them and like made them tax free. So the government, the employers and the employees all wanted health benefits to come through employers.

That's fascinating. And feels like continued adaptation to we're going to let capitalism run our health care system. Yeah. We start bargaining for this in employer contracts when you don't see any path to any other way to get health care and health insurance. Profits in health. What did go wrong? Yeah. So the real ramp up to modern workplace wellness programs begins in the 1970s when two interlinked things happen.

The first is that the cost of health care explodes. In 1960, companies were spending about 25% of their payroll on health benefits. And by 1980, they were spending 41%. Wow. I read a bunch of papers about why health care spending exploded in the 70s and 80s. And it seems to be a combination of the population getting older, much more access to health care services like it was expanding to rural areas.

Also, the consolidation of health care services, they're basically starting to merge and starting to realize that you can charge literally anything for health care, which is like the situation that we're in now. But the point is Americans started spending way more money on health care and employers were starting to get really nervous in the 70s and 80s. Like, this is becoming a problem. The second factor that contributed to this was the invention of wellness.

So we are going to watch a clip from 60 minutes from 1979. I think I have seen this clip. Is it the Dan Rather one? Yes, where he's like, what is wellness? Yes. Dude, it's such a fascinating artifact. Oh my god. It's so fucking good. I love it so much. It's great. They're like, they call it self care. It's incredible. Okay. Okay, here it is. It's a movement that is catching on all over the country among doctors, nurses and others concerned with medical care.

Wellness is really the ultimate in something called self care in which patients are taught to diagnose common illnesses and where possible to treat themselves. More than that, it is a positive approach to health. What one doctor calls recognizing that health is not simply the absence of disease. I had been in and out of the Cleveland Clinic. I had seen numerous specialists in various areas. And I just was so tired and so fed up being in so much pain that I'd spent.

I would give you a ballpark figure of about $35,000 over the last nine years in medical care. Traditional medical care. Yes. And I'd achieved nothing. 152, 3. Julio Esposti joined self care for the same reasons. He's an executive with a major West Coast firm. For years, he suffered from constant headaches and physical pain. Doctors told him it was due to stress in his work, but any test or x-ray doctors administered to Julio proved negative.

Like to resume, Julio says he didn't find relief until the editor program called wellness. Is what you're into a substitute practice of medicine? No, absolutely not. It is an adjunct too. And quite different from the practice of medicine. We don't treat diagnose or prescribe. Our role is to help the person discover why they're sick. Travis does this by looking at a person's whole lifestyle. Their diet, work habits and physical activities. What solved Julio's illness problems was biofeedback.

Is it on? Yes. Lower your warming. And you just raised your hand temperature one degree. Biofeedback basically is an electronic device used to measure the amount of tension or stress in a person's body. After several sessions, Julio learned not only how to relieve his pain, but also how to handle stressful situations at work. Mike, when did you join self care? I started caring for myself.

This video has the tone of my dad repeating back to my nephew. What my nephew has just told him about Pokemon evolutions. All right. So, uh, Charmander becomes Charzar? Uncertain but like emotionally invested. Like here for you, but not sure about all this, you know? Also how I conceive of heterosexual intercourse. Like the seems important, but I don't know how it works.

It's really fascinating to me that like part of the reason that this like weird shitty economy of stuff exists is that it is accounting for medical institutions not being responsive or feeling responsive in a way that patients can like wrap their arms around and feel cared for. I also love that it's it's this perfect distillation of where we are with wellness now where it's like it starts with a good concept of like health is obviously something more than just like the absence of disease.

I want to feel good as a person and also here's this quack shit that's going to measure the quota, quote, attention in your body and it has like bio in the name so you think of scientific. But I mean this, this shift is something that we've talked about on the show before and I think we're going to return to a million more times that you had this shift in the understanding of public health throughout the first half of the 1900s.

You had the eradication of polio you had mass vaccinations after World War II you get penicillin what we thought of as disease wasn't infectious disease anymore it wasn't like you drank some tainted water and you got sick and now we need to make sure the water isn't tainted it became much more about these lifestyle factors this was also the time when we start getting the framing ham study and saturated fat causes heart attacks right and.

We also get this sense that what you are doing on a day to day level affects how healthy you are and this really becomes like the dominant paradigm of health yeah it's a really fascinating thing because I think wellness as a concept is one that tends to thrive on the left and it is predicated on an extremely conservative bootstraps kind of narrate right right which is both like you can't really trust these institutions.

But also what you need to do is get yourself together and you need to find the right practices for you and if you did then you wouldn't be sick or you wouldn't be.

Right like it is extraordinarily ruthless kind of logic that underpins a lot of this well I think a lot of the precepts of it are true right so you know heart disease and cancer are to number one and number two killers of Americans so like obviously we should be taking those things seriously right and like of course our lifestyles affect our health right there's a lot of it.

We're not just going to be taking the risk of our health right like there's there is truth at the heart of this but I think the adoption of this and especially the take up of this by industry ends up smuggling in what the the researchers call the lifestyle risk paradigm yeah the fact that your lifestyle affects your risk for disease is like pretty unobjectionable but eventually it became that your lifestyle is the only thing that affects your risk for disease yeah we then

sick must have done something to deserve it I think the context here is really important which is then as now we live in a world that has really really taught us to judge and brush aside and think less of fat people and disabled people right right if you hear a health and wellness message that feels really good to you it's worth unpacking why it feels really good to you and what it allows you to believe about yourself and the world and your place in it right.

Right. Well also this stuff almost immediately gets taken up by corporations in various ways yeah for sure you know skin care marketing but also behind the scenes at the same time we have this explosion in health care costs and we have this galloping understanding of health as due to lifestyle factors and so corporations look at these two things together and they say well the way that we can bring our health care costs down is by

changing the lifestyles of our employees so I'm going to send you an excerpt of a really insightful article about this that was published in 1988 it's amazing to me how often I dig into a topic on this show to be like ooh this is really ripe for debunking and then you find the like journal articles that have debunked the shit out of it and they're like 40 to 70 years old I know you're like oh man we've known this whole time

I know you're like 10 minutes after it happens somebody's like this seems bad and then we have to make a podcast 40 years later here's this okay in the 1980s American industry has adopted cost containment as a key to corporate health policy the incentives are substantial for if companies can reduce their medical insurance and disability claims they may be able to lower their health costs and potentially reduce their insurance premiums corporations and their insurers have developed a lot of things and they're going to be able to do that.

So I think the insurance companies and insurers have developed multi pronged plans to control health costs including more cost sharing with employees second opinions for many elective surgical procedures incentives for outpatient surgery encouragement of alternative health providers and work site health promotion

wellness programs with their goal of keeping employees healthy and reducing medical care utilization are a part of this cost containment strategy right it's just about money very openly like corporate executives were saying this at the time it's really amazing to me what a fucking hot potato health care costs are I know everyone's doing the thing where you like put your finger on your nose and go not it yeah

like first the state did it and then employers are now like wait a minute me to it's also really frustrating because as soon as anybody talks about universal health care in this country corporations are some of the first ones to push back yeah right because they like having this as a benefit that they can offer to recruit employees so it's like you realize this isn't helping you either right

like this sucks for literally everyone and it just like keeps getting kicked down the road yeah so the next 40 years are just more and more expansion and entrenchment of this concept so in 1979 we get a surgeon general's report that identifies work sites as an appropriate setting for health promotion

we start getting companies very publicly bragging about their workplace wellness programs so Johnson and Johnson is one of the first ones in 1979 they launch this huge workplace wellness program that like they've published a number of academic articles over the years about like how it's so great and their cost went down and morale is up and absenteeism is down and everything's great

and we start getting studies throughout the 80s and up until the 2000s showing that the saves money for employers so one of the early ones finds that companies save a dollar and 43 cents for every dollar that they spend on workplace wellness another one comes out showing a three dollars and 27 cents savings for every dollar they spend on health promotion the most outlandish when I found was one that said that employers save $11

this is starting to look like something that is just kind of like a win win it's good for employees it's good for employers and it pushes this responsibility off of the government so the government loves it too but also $11 for every $1 is some real 400,000 Americans die of obesity every year kind of math where you're like how

Aubrey don't don't imply that we're going to debunk these numbers later I don't believe that you assume that I'm giving you some numbers but leaving out relevant context I can't believe that you would question an 11 to 1 return on investment the betrayal my own co-host at to Aubrey so the next chapter of this story is basically the government having a bunch of opportunities to tamp down on this and do the right thing and just not doing it so that's fun

so the 1990 Americans with Disabilities Act includes a specific carve out for workplace wellness programs get the fuck out of here mandatory physical examinations are prohibited by the Americans Disabilities Act however it includes an exemption for voluntary medical examinations including voluntary medical histories which are part of an employee health program available to employees at the work site

so it's like as long as it's voluntary it's chill as long as you're opting in to getting paid for if you're not disabled like I'm just like this is fucked so that's 1990 in 1996 we get HIPAA which is mostly known now is like the reason why your doctor can't give information about you to other people but it also includes all these provisions to prevent discrimination in employer provided health insurance

but again it includes a carve out for workplace wellness programs garbage as long as workplace wellness programs do not result in more than a 20% incentive so it all goes back to this issue of whether they're voluntary right because if your insurance is five times more expensive if you don't pass all of these biometric things

you can say like well it's not meaningfully voluntary right you're basically co-worsing people into this with like they have to pay more money yeah so HIPAA says 20% if health insurance is costing people 500 bucks a month you can give them an incentive of up to a hundred dollars a month

gotcha that way it's voluntary because it's not that much money or at least that's the idea yeah although like listen we live in a country where in some cases your health care costs can rival your housing costs right oh yeah so 20% of one of the biggest expenses in your life I get where they're going with this logic but it feels like it doesn't actually play out in people's real lives right like the idea that like a hundred dollars a month is a negligible amount of money

I know it's like bonkers it's also a very weird upside down a tea in that everyone would understand like hey disabled people have to pay more for this as discrimination that's just like straightforward discrimination right yeah but non-disabled people pay less for this yeah that's fine somehow great cool good how they're different right ultimately at the end of the day disabled people are paying 500 bucks a month and non-disabled people are paying 400 bucks a month

whatever you call that there's a material reality that is being created here yes absolutely another thing this is for foreshadowing alert a woga tippa refuses to impose any regulations on workplace wellness programs so this isn't a really good history of this that I read the final regulations added language providing that if a program has a reasonable chance of improving the health of participants is not overly burdensome is not a subterfuge for discriminating based on a health factor

and is not highly suspect in the method chosen to promote health or prevent disease it satisfies the standard there does not need to be a scientific record that the method promotes wellness to satisfy the standard so basically if you're trying to promote health you can do any of these workplace wellness programs that you want there's no quality assurance to offer this monetary incentive to employees

Jesus Christ there's a long pause there I was like did Aubrey die did I kill Aubrey no I'm just tired so like I used to work on this kind of stuff right the law is a broad statement of purpose and where the law gets implemented is through regulations which is where you go through all the stuff of like okay we told employers they can do this

where are we specifically setting the boundaries around that yeah you pass a law people think that's the end of the work that's the start of the work wait Aubrey what what I'm I skipping ahead they do actually revisit this so you're about to be very happy

that they do visit this but they make it worse I have I have an excerpt for you send me an excerpt so context HIPAA passes in 1996 fast forward Obama is elected in 2008 and one of his major campaign promises was reforming the healthcare system so throughout 2009 2010 there's of course this huge

debate of like what is healthcare reform going to look like in the midst of this debate in 2009 the Wall Street Journal publishes an op-ed by an executive it's safe way entitled how safe way is cutting health care costs market based solutions can reduce the national health care bill by 40%

and I am going to send you a very boring and very long excerpt from this quote our plan utilizes the provision in the 1996 HIPAA law that permits employers to differentiate premiums based on behaviors currently we are focused on tobacco usage healthy weight blood pressure and cholesterol levels

safeways healthy measures program is completely voluntary and currently covers 74% of the insured non-union workforce not foreshadowing employees are tested for cardiovascular disease cancer diabetes and obesity and receive premium discounts for each test they pass

if they pass all four tests annual premiums are reduced seven hundred and eighty dollars for individuals and one thousand five hundred and sixty dollars for families should they fail any or all tests they can be tested again in 12 months wow so you get nothing but you can take the test again once your congratulations you were diabetic this time but maybe not next time have you tried biofeedback

the numbers speak for themselves our obesity and smoking rates are roughly seventy percent of the national average and our health care costs for four years have held constant today we are constrained by current laws from increasing these incentives we plan we reward plan members three hundred and twelve dollars per year for not using tobacco yet the annual cost of ensuring a tobacco user is fourteen hundred dollars

reform legislation needs to raise the federal legal limits so that incentives can better match the true incremental benefit of not engaging in these unhealthy behaviors holy shit the number of logical fallacies here like our workforce has seventy percent of the national average of x y and z thing right but those costs haven't gone down nationally so that just means you're employing more people who already had low health care costs stop following the

stop knowing things sorry sorry sorry this is like astonishing and is like the narrative here is so fucking smart which is the law is standing in the way of employers who just want their employees to be as healthy as possible we can only offer twenty percent incentives that's not enough we got to be able to reward for a lot of ones right and all of this is both predicated on and reinforcing the idea that again thin people and non disabled people are doing right things

and that any costs that an employer shoulders are the faults of fat people and disabled people yes this is totally been very old but like this was a huge part of the debate over obama care in two thousand nine to ten really yeah republican started attacking

obama and saying like all companies would like to offer more incentives to incentivize healthy behaviors but they can't do to government regulations it's a really amazing to me that all of them turned into like missus love joy from the simpsons and they all started going

won't someone please think of the safe way CEO like thank you and do it and this I mean this became like a huge deal like this safe way CEO basically did a like tour of capital Hill and met with a bunch of legislators including obama and in two thousand ten when they were debating

the version of the affordable care act that they had they included something called the safe way amendment shut the fuck up that increased the incentives to thirty percent in twenty fourteen the average cost of insurance for a worker was six thousand five hundred dollars a year

and the incentives are worth between two thousand dollars and thirty two hundred dollars so like we're talking about a lot of money like that's what my first car cost holy shit so basically I mean this this past this is in the affordable care act I'm curious about in your research of this did you find much in the way of critiques of not how workplace wellness programs sort of are implemented or regulated but critiques of the existence of or the structure of workplace wellness

programs not until later what was really frustrating in the reading for this episode was how much the cost logic seemed to dominate everything how much return do you get for like this dollar of investment I mean there's a million of these and there's like a million estimates of this but qualitative research of like what are these programs and what does it feel like and what are some of maybe the unintended harms of these almost nothing it's

fascinating to me to because I think this is one of the major narratives that drives our understanding of and response to fat people in the world fat people are most frequently discussed as a cost right and no in those conversations writ large is anyone going I wonder how fat people feel about this or right I wonder if this is making things better or worse for them right so people instead of having a conversation that is in

any way grounded in anyone's humanity or in anyone's like actual needs and responding to those needs or anything those are treated not only as immaterial but as distractions from solving the real problem which is an economic problem so before we debunk everything that we just went over we're going to talk a little bit about like the harms that have emerged and like the forms of these programs that are like

really shitty and have started to proliferate this is an excerpt from a congressional hearing in 2013 when the EEOC was like thinking about doing something about this and ultimately decided not to this is the qualitative experience that just nobody is interested in for like years good

quote Terry suffers from diabetes and although she passed all five fitness tests she didn't meet the body mass index of 24 as a result her employer imposed an increase in her family's insurance premium from $175 to $320 a month after the birth of her baby Terry's doctor warned

that any weight loss was medically inadvisable while she was trying to manage both her diabetes and breastfeed since Terry's employer refused to exempt her from the BMI target and required her to work with a trainer outside of working hours Terry was required to pay out of pocket for all

these sessions and she continues to pay significantly more for her family's health insurance a financial burden not placed upon other employees yeah yeah fucking fix it for Terry so you basically have somebody who's like she has diabetes

and she's paying more yeah this is exactly the scenario that three different laws now have sought to avoid right so like any person with a chronic illness will be able to plug in somewhere to this story but I would also like to propose that any person who has given birth

and cared for an infant can also fucking plug into this story and go hey imagine if your employer said on top of caring for an infant you also need to show up with a personal trainer a number of times a week and pay for it out of pocket why the fuck out of here there's also

an interesting sentence here where it says Terry's employer refused to exempt her from the BMI target so in HIPPA it says that if you're not able to participate in these wellness programs you get an exemption right so if your workplace is doing one of these things where you get a bonus

for doing 10,000 steps a day and you're in a wheelchair obviously you can't participate in that so you get an exemption however it didn't define who's qualified for an exemption what an exemption counts as when it should be offered etc it just says like employer should offer an exemption

but what we find in the real world is that oftentimes when employees ask for exemptions I have another job I can't do 10,000 steps they're often not given them because they're not considered to be a quote unquote real reason Jesus this is an excerpt from a very good legal analysis

of all three of these laws that I read and how they relate to workplace wellness programs and you can like hear the exasperation in this paragraph it says wellness programs are difficult to reconcile with a number of federal laws that aim to restrict employers ability to discriminate among their employees in the provision of health insurance. Good. After all the point of wellness programs is to discriminate.

Those employees who adhere to the wellness program whether by filling out a detailed health assessment taking a blood test or attending smoking cessation courses pay less for their health coverage those who do not pay more. Yeah. It's this amazing article that's just like a legal scholar looking at all this shit and being like guys I think this is illegal that quote the point of these programs is to discriminate is a real say it louder for the people in the fucking back. That's what they do.

That is what they are here to do. So the last like excerpt from our emails that I want to read there's Aubrey there's so much here. There's like so much they were going to cover in the bonus episode these these programs are so fucking trash but one of the main things that we heard especially from fat listeners was the sheer cancerousness of weight loss contests. Yeah. The number of workplace biggest loser competitions that are out there make me want to like just barf myself to death.

I don't even know. It's so bad. It's so repulsed. This is just one of the emails that we got. I've been with the same company for 20 years and the last five there has been some sort of get healthy new years resolution. Last year it was a diet bet if you're not familiar it's done via an app a group creates a diet bet everyone puts their money in and the people who hit their goal weight at the end split the pot.

As one of the few fat people at my workplace it was 1000% expected that I would participate. I did not because eating disorder and also fuck all of that are the same sort cool but it's only $10 don't you want to get healthy with us you feel so much better you would be so inspirational to everyone not kidding about that last one.

Finally it started without me but for the two months it went on no one would shut up about their food and exercise measurements and weight alternately talking about what they were going to eat when it was over calling it a lifestyle change growing about feeling so much better and quietly crying because they were fucking hungry.

All jokes aside it was awful and stressful and the amount of side I got for eating normal amounts of food led me to never again eating anything in front of co workers still don't. I was imagining it but it felt like waves of anger coming from a starving mob that might in fact push me down a flight of stairs for my lunch do not do this to people in the workplace not eating in front of people is such a deep fat people thing yeah

it is a direct result of how other people treat you and it is also a thing that is a direct path to eating disorder behavior or eating disorder relapse behavior is like hiding your food or eating in private or in secret right yeah fat people do that not because of some internal drive maybe

sometimes but overwhelmingly that is prompted by direct behavior from people in their lives like that's fucking horrible I'm so sorry to this listener I'm breaking my own rule and reading one more because I can't help myself great good this is a really awful one I feel like is such a like perfect example of why these are so bad a couple years ago we had an open cubicle where someone would bring in treats and there was a coffee maker too someone had put a scale on the floor and

a food diary slash chart to track their intake I posted a paper near it saying this is a communal food space and having the scale and food diary is inappropriate and could be upsetting for people experiencing eating disorders I did it anonymously because I didn't want to be the fat lady complaining about a scale I was able to over here when

someone reported it to the manager who then talked to HR I saw the email response from HR to the manager and their stance was basically if someone has an eating disorder they need to report it and get an accommodation what would an accommodation for that even be so this is another thing that comes up in a lot of the emails that we got from fat people and disabled people was that these workplace wellness programs even though technically they are supposed to provide exemptions for people who can't

or don't want to participate what they do is they make you disclose disabilities to your manager one lady who had IBS had to like tell her boss like I have IBS and like I can't do this because I have to go to the bathroom a lot but like that's not something you necessarily want to disclose to your manager who's in charge of like promotions and shit like this is an invitation to discriminate against people like hi there there's this thing that people to get

to do is that you're not going to be discriminated against a lot and I have it what and also like to the email that you sent to me about the person doing this diet bet business you don't need an exemption from that that is a voluntary program this person opted out and it's still made things

for them exactly listen I understand that this is not the legal definition but like I would interpret on an emotional personal level all of this shit as an extraordinarily hostile workplace oh super duper yeah and it's this hostility that's like what's your problem it's fun yeah it puts you in this position where you have to be like this isn't fun for me totally it feels like there's something about that like come on we're just having a good time that feels like an echo of what alcohol

will describe when they tell someone they're not going to drink right people go come on loosen up it's just one drink blah blah and I'm like why are you so invested in overriding this person's own decision about how to relate to this situation yeah is really astonishing and feels like again there are these moments around fatness and disability and a number of these issues where even the most thought

of the sort of relational people even the people with the sharpest interpersonal radars will just turn their fucking brains off when it comes to this issue and it's for your own good why aren't you grateful we're just having a good time I'm just concerned about your health which is why I have to like keep ignoring what you're directly asking me not to do and do it anyway so we've talked about some of the harms of these programs but we should also say on the other hand

there is no evidence that they work at all at least in fairness they might be entirely useless completely useless at best so the first thing we needed to bunk of everything we've gone over in the history of this is that safe way was fucking lying yeah there we go yeah so it turns out that safe ways health

care costs did in fact decrease they decreased in 2006 three years before they launched their workplace wellness program because they shifted a bunch of the costs to employees yeah they did what every major employer was doing at that time right which is breaking it to their employees that they are going to have to chip in like hundreds of dollars a month for some time that was previously free or way lower cost so it's like they raise your

deductible they have different like yearly limits like a lot of employers do this in like the sneaky way also when they said in that excerpt that it was like our non union health and employees it turned out to be something like 2% of their workforce right non union either means they have such a low level of hours that they're not represented right or it means they're

not just a representative picture so just complete bullshit the most amazing and frustrating thing about this is that the Washington Post investigation that reveals all of this and like interviews some like sub CEO person at safe way who's like oh yeah we were lying just like so long it's like oh yeah when we said that we were lying basically all of that came out months before the

Affordable Care Act was passed so like when the Safeway amendment was put into the law we knew that Safeway was fucking lying and it just didn't matter the second thing that we know now and pretended not to know then is that none of these programs really work so I read a million like meta analyses whatever of like the weight loss stuff this is a paragraph from health affairs that I feel like either one of us could

be looking lip sync along to it says a meta analysis of seven trials found that workplace financial incentives were associated with a mean weight loss of 0.88 of a pound at 12 months and 1.5 pounds at 18 months and a weighted mean gain of 4.2 pounds at 30 months although none of the results were significant great I love the like little like hey guys here all the amazing

that's not of the more significant there's another meta analysis that finds a reduction of 2.8 pounds after 12 months which if you look at the average weight of like you know the average American it's something like 175 pounds so this is a 2% weight loss good good good good good good good also none of the money saving like $3 for every dollar you spend none of that

ends out so there's a 2013 health affairs study that says program savings may not in fact derive from health improvements instead they may come from making workers with health risks pay more for their health care than workers without health risks I can gross charge in them more there's a 2013 Rand study that says at this point in time there is insufficient objective evidence to definitively assess the impact of workplace wellness on health outcomes and cost good in

2018 there's yet another health affairs meta analysis that says we conclude that these programs increase rather than decrease employer spending on health care with no net health benefit the programs also cause over utilization of screening and checkups put unduestress unemployees and incentivize unhealthy forms of weight loss it's not just discriminatory it's also ineffective wonderful shit I wanted to briefly about why these don't appear to work there's four reasons why none of this shit has

been handed out the first is selection bias if you go through Google Scholar and you just type in like workplace wellness program most of them show that it works like there's one from home depot that works there's one from Pepsi that works is one from IBM that works but the problem with all of these is that they're voluntary to participate yeah so what you have is you have

really low participation rates the IBM one only has 4.8% of the workforce participates there's one at the University of Illinois where 25% of people participate the first year but then it's down to 10% by the second year and these are basically doing is they're selecting for people who are already quote unquote healthy to begin with so like someone like me like I already go to the gym if my workplace says like oh we're going to pay your gym membership

and you have to you know go to three zoom meetings a year and we'll pay 90 bucks a month for your gym membership tax free I'd be like yeah sure totally but it's like I'm somebody who already has a gym membership I am also somebody who would not go to a fucking gym not because I don't enjoy to do any of the things that happen at a gym but because aside from a very few and very select exceptions

gyms are like terrible fucking places to be as a fat person like the social experience of being at a gym means maybe somebody takes your picture because they think it's funny to watch you working out maybe somebody else feels pity for you and thinks that the best thing they could do for you is go good for you keep it up you'll get there and on top of that if you also had any kind of mobility issues if you also had any specific accessibility needs

you couldn't and wouldn't take that discount because it doesn't fucking work for you because the gym doesn't work for you so basically when you go back and you reanalyze the numbers from all of these like it worked studies what you find is that most of the people who have lower healthcare costs after the program had lower healthcare costs before the program

right because these are people without chronic illnesses and disabilities and stuff they're like the the quote unquote healthy people anyway so all you're really doing is giving more money to the healthy people

so that's reason one that these don't work the second reason this like doesn't fit the format all that well but I just wanted to talk about it with you because it's hella funny great most of the studies are based entirely on self report data which as we've discussed in the show 10,000 times is just like complete fucking garbage so there's a couple of actually like genuinely well designed studies that are randomized

there's one at a warehouse company that is an 18 month program and people are randomized either in it or not in it so it's like a pretty good design and at the end of 18 months they find that the only difference between treatment and control is a higher proportion of people who reported engaging in regular exercise and who reported actively managing their weight the study did not affect cholesterol levels hypertension obesity absenteeism or performance

so the measurable the stuff that we can measure right so what it does do is make more people tell us what we told them we wanted to hear exactly would pay them if they told us those things but then this is something we come across all the fucking time on this podcast these studies will say like well it affected these like totally bullshit indicators and it didn't affect these real indicators and what we set out to do so the findings are mixed

right it's like so the conclusion of this study says that the program affected self reported health behaviors but not health or economic outcomes may be interpreted in several ways given that workplace wellness programs focus on changing behavior and that behavior change may proceed improvements and other outcomes findings could be consistent with future improvements and health or reductions in spending

listen man the checks in the mail just hasn't gotten to you yet don't worry about it but then okay listen to this I this is maybe one too many examples but I like to have it on the record so this is the conclusion of a huge like also fairly well designed randomized control trial at the University of Illinois that that was called I thrive

and because it's like the mid 2000s it's like a little I like iPod like good good good good so the study finds essentially no benefit other than this like self reported garbage and no effect on like actual measurable health metrics

so this is a conclusion it says does this mean that employers should abandon wellness programs it depends on what they're trying to achieve workers seem to value the benefit and 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 worker who appreciates 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 there is little evidence of this type of program delivers the desired results so if you want to tell people that this works great

if you want to do something that works well I also like that it's like well employees report x y and z things and I'm like yeah employees report liking not having to spend extra hundreds of dollars every year the obvious conclusion from this is that these programs are fucking bullshit and they don't do anything but all of these papers refuse to reach the obvious conclusion there's like well you know if you're looking for something then a manages health care costs and makes people healthier

I don't know if this is the right thing for you it's like well then why are we doing what other reason is there to do it what this episode feels like to me do you know those like cartoons where like a cartoon character will like fall through the roof and then hit a floor and then the floor will give way and then it'll hit the next floor down and then finally they end up an awning and the awning gives way or whatever this feels like that as a logic model for policy making

which is like just like every possible justification for these programs has been pulled away from them right like every possible support but these could have had have been taken away and now they're just like somehow levitating in mid-air

they're still there but wait there's more oh no Mike so most of what we've gone over so far is reasons why workplace wellness programs are bad this isn't really one of them this is more just why workplace wellness programs don't work why they don't make people healthier or save employers money

uh-huh workplace wellness is a like wildly grifty sector because the hippo law refused to impose any standards on the industry right these don't have to be backed up by science so there's an entire sector that is like workplace wellness consultants

right these are usually done through third party firms and there's essentially no regulation of the content of these programs a lot of these firms are basically like use car salesmanship they bring like weird gurus into the workplace one person who wrote us said they had to be on a zoom call with somebody who said that you have to drink six glasses of water every day because if you don't you start circulating dirty water like in your body

hey man you got to flush out your boiler every week otherwise you're gonna start circulating rusty water through there wow one of the first baseline things that you have to do to get these monetary incentives is to go get a health risk assessment screening

right so the idea is you get an incentive for like going and having an annual physical and then that allows you to identify things before they become big problems as a principle that sounds totally uncontroversial right go get a health screening every year great

the problem is there's no actual standards for what constitutes an annual physical even within like the medical field this isn't very well defined and secondly these grifty ass workplace wellness consultants are sending people to get these weird fucking tests for rare strange conditions

so there's reports of people like having their kidneys removed because they tested positive for some sort of like kidney blood disease something something but it's just a false positive God this is like your workplace wellness program as designed by Elizabeth Holmes and I don't want to overstate this or make people think that getting a physical is always a bad idea the literature seems to say that if you have a condition that needs to be monitored obviously you should really see a doctor

and if you're somebody who hasn't seen a doctor in a while right so a lot of poor people in America do not have regular contact with the health care system yeah basically if there's a reason to go to the doctor like go to the doctor right but what we're talking about in these workplace wellness programs is quote unquote healthy people going to see a doctor every single year

and the more people do that the more they increase their chances of like testing positive for something so the the central problem with the incentives here is that these workplace wellness consulting firms want to demonstrate to the employers that like they're having value right so there's an Nebraska program that says we prevented it was like 400 cases of colon cancer and like oh look look we're you know we're prolonging the life of your employees and look how great this is

but later on it turns out that the firm was just faking their data shut the fuck up the problem with the US health care system is because it's a fee for service model people only get paid if they're providing a service so oftentimes people go in and the doctors like oh you need to come back next week for this thing and we're going to screen you for this just in case and some of what gets called like over treatment in America is like actually treatment for people

and this is like a kind of a fucked up and like ableist narrative but also there is a lot of over treatment in the US health care system so basically you're just like shunting people into these like grifty sectors

that are going to do a bunch of weird fucking tests and produce a bunch of positives and then have a bunch of weird follow-up procedures that like might not actually be necessary well and that also seems less like an issue of over treatment and more like an issue of bad treatment from people

who should have to have some kind of qualification right it shouldn't be going through the like beware of dirty water people those people should not be involved yeah that's right so the last reason why these don't work is basically the wellness paradigm itself throughout the 1970s and 1980s as we were getting this wellness model we were getting this list of lifestyle risk factors that affect chronic illness and what happened is we started conflating the risk factors for causes

yes well you hear a lot is that obesity is a risk factor for heart disease right so that makes you think that well if we reduce the obesity we'll reduce the heart disease but that doesn't actually turn out to be true so a lot of these studies find that fat people cost more to treat in their health care than skinny people overall however their costs do not go down when they lose weight because it is not necessarily the fact that is causing the health problems

you can't change somebody's health by changing their risk factor it's like saying you know people in Connecticut have a 10-year longer life expectancy than people in Mississippi that doesn't mean that forcing people to move from Mississippi to Connecticut will give them as individuals

10 years more on their life and to this point about over-treatment slash bad treatment right all of this business about fat people costing so much more money does not account for the very frequent experience of fat people of going into a doctor's office not getting any new diagnoses

not being diagnosed with diabetes or PCOS or any number of things but still walking out with a prescription for metformin also the cost of treatment of fat people are also kind of the cost of our assumptions about what being fat means about your health and also it also doesn't acknowledge the actual reasons that are driving US health care spending so a lot of health care spending is actually driven by hospitalizations and people have gone through and looked at these kind of chronic risk factors

and there's a study in 2012 that looked at cholesterol, blood pressure, etc all of these kind of these factors that we associate with chronic illness they only account for about 20% of health care spending and it also seems that you know sort of the further and further we go down these paths of more and better research into diabetes and heart disease and all of these sorts of things that we have been taught are the direct result of quote-unquote lifestyle factors

is that quite a few of them are much more genetically driven or driven by social determinants of health we are saying that we care about costs we are never looking at a balance sheet we're just going it's got to be fat people and disabled people get them out of here so I want to end with the one area where this does work and then a happy ending tell me the only aspect of workplace wellness that I could find that's effective here's to be these smoking cessation programs

oh interesting they're not like the most effective mostly because quitting smoking is just really hard and the relapse rates are high but like yeah people who are enrolled in smoking cessation programs have higher rates of quitting but what's interesting once you read the studies on this is it's not the fact that they're like workplace quit smoking programs they're just quit smoking programs yeah all of the stuff about you know the posters and the workplace or having your boss involved

having your employer as some sort of participant in you quitting smoking really doesn't add anything so even if you do believe that they work they work for people who have like high paying jobs with really good health benefits

but if we just had universal health care hospitals could just provide it to people who needed it I actually think that smoking is such a great example of like the original sin of these because you know smoking is very well established as like a behavior that is really bad for you

it is also in my estimation none of my employer's business if I want to smoke when I'm not on the clock who cares that doesn't affect my job performance at all so like why would my employer be anywhere within 50 feet of this decision of mine to keep smoking well and it's all an end run around this fundamental miscalculation that has been made or this fundamental like avoidance of a fundamental truth maybe is the way to put it which is that if you care about improving the health of a population

you need to provide health care and access to treatment for every part of that population we as a country keep refusing that very clear lesson like time and time and time again right people seem weirdly surprised that a health intervention designed to only reach thin rich people with office jobs

I was like wait what do you mean it's not working hang on so the happy ending of this episode we get so few of these oh what a twist basically people fucking hate these programs and there's like a massive backlash a huge number of the people who wrote into us did like tiny acts of resistance like a lot of people numerous people put their weight as like 50 pounds they're like fuck you my BMI is like nowhere near any of your business I am 5 10 50 pounds fuck you yeah yeah yeah good good job

and then what I like to see is that there's finally starting to be articles about workplace wellness programs that aren't just doing to like fake confusion thing like oh weird it turns out to like nobody lost weight on a weight loss program there's an academic article called employers should disband employee weight control programs good like people are finally coming to the obvious conclusion from years of data they just like these suck and shouldn't exist they're totally unjustifiable

we implemented them on extremely thin information the evidence is widely consistent now they don't work they suck they're making things worse for everybody let's not do this anymore yeah and on top of all that they're not only discriminatory they're not only proudly discriminatory but they are developed for the purpose of discriminating and that's their main selling point exactly if they work that is what this is not a case of like oh we've really been bamboozled into thinking this thing is okay

no everyone's been saying the quiet part loud this entire time right yeah I mean I think I'm so glad to hear that there is some kind of emerging like oh wait a minute we should stop this but Aubrey how else are we gonna know about all the dirty water