Amid rising costs to employers, interest in evidence-based strategies to promote physical, mental, and financial wellbeing of employees has grown steadily. Direct medical care cost the average employer $12,865 per employee in 2016. The indirect costs of absenteeism and presenteeism associated with overweight and obesity among American workers may amount to more than $900 billion ($6,000 per employee) in annual lost productivity. The numbers are sobering, and U.S. employers may be increasingly open to implementing policies that recognize the interconnectedness of community health, workplace environments, employee productivity, and company profitability.
In a 2016 survey of 487 American businesses with 1,000 or more employees, employers identified stress, overweight/obesity, lack of physical activity, and poor nutrition as the lifestyle-related risk factors most likely to diminish employee performance and engagement. The same survey revealed that most U.S. employers believe they should take an active role in promoting healthy lifestyles but cite lack of employee engagement as a major barrier to program success. Although large companies are more likely than small businesses (≤ 100 employees) to offer obesity-specific prevention services, utilization data from the 81% of large companies offering weight management programs indicated that only 10% of employees recommended for participation actually accessed the services.
Workplace wellness promotion can be a challenge in a country where employees generally prefer to manage their own health and are particularly wary of sharing personal health data with employers. Yet, evaluation of Johnson & Johnson’s healthy lifestyle programs suggests that coupling a holistic approach to wellness with responsive leadership can work wonders in securing employee buy-in. By providing its employees with access to a diverse portfolio of weight management tools (i.e. personal health advisor, exercise reimbursement programs, onsite access to nutritious food options), Johnson & Johnson maintains significantly lower levels of obesity and physical inactivity than its peer companies. More than 30 years of impact data indicate that the overall program has an estimated return on investment of $1.88-$3.92 per $1.00 spent. Additional case studies highlight the ability of worksite wellness programs to improve physical activity, fruit and vegetable intake, weight control, and self-reported health among participants. An investigation using wellness program data from a convenience sample of large U.S. employers found that one-year participation in a weight-control program was associated with average weight loss of one pound that persisted over three years. This finding is encouraging, as maintenance of weight loss presents as a challenge for many adults. More data are needed to assess the impact of brief wellness programs on longer-term health outcomes, productivity and medical costs.
Changing obesogenic environments—settings that simultaneously promote weight gain and hinder weight loss—requires integrated, multicomponent efforts. Models of health promotion offer employers an overview of the fundamental steps for designing and implementing effective workplace initiatives that meet the unique health needs of employees. Salient strategies to support healthy weight management typically include promotion of organizational structures, environments, policies and practices that:
- Increase the availability, affordability, and consumption of nutritious foods and beverages
- Promote physical activity and limit sedentary behaviors
- Encourage breastfeeding initiation and continuation
- Enhance coverage for obesity screening, counseling, and treatment services
While individual weight status should not be used as the basis for incentives or penalties, modest monetary rewards ($50-$100), free/discounted health services, and/or company recognition can encourage employees to complete health-risk assessments and boost engagement in lifestyle management programs. The Affordable Care Act allows employers with health-contingent wellness programs to offer rewards worth up to 30% of the cost of employee-only plan coverage. Importantly, comprehensive interventions that provide health screening, lifestyle management, and disease management services draw the highest rates of employee participation regardless of incentives. Companies that deploy multiple complementary strategies and leverage existing relationships with health plans and community partners are more likely to have a significant impact on workforce health and productivity. Systematic approaches to the promotion of wellness in worksites may be a good investment that enhances both recruitment and retention of employees.