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Employee Wellness Programs: The Carrot or the Stick?

Conversation Continues
Monday, April 23rd, 2012

Conversation Continues feature ongoing discussions or news on current health topics with links to related materials.  They are part of the Center for Advancing Health’s portfolio of free, evidence-based coverage of what it takes to find good care and make the most of it.  By Kelly Malcom, Editor, CFAH’s Health Behavior News Service.

Employee wellness programs sound like a good idea. After all, it’s in a company’s best interest to have a healthy, productive workforce and to try to keep the cost of group insurance down.  Before any benefits of such programs can be realized, however, companies need buy-in from their employees.

A recent HBNS news story reported that creating teams with potential lottery-style cash rewards motivated more employees to complete health risk assessments, a core feature of many wellness programs.   “There is often this assumption if we just give people ‘x’ amount of dollars, the bigger ‘x’ is, the more effective it will be.  One can argue that lotteries take advantage of the fact that people don’t understand probabilities very well,” said Kevin Volpp, MD, co-author of the study.

Some employers use incentives tied directly to health insurance, as Washington Post’s Sarah Kliff writes: “Some wellness programs use carrots, decreasing a worker’s health insurance premiums if they enroll in a smoking cessation program or start hitting the gym. Some use sticks, setting higher deductibles or premiums for those who can’t meet a certain body-mass index or do not quit smoking.”  Other employers forgo the carrot and the stick altogether by making wellness programs compulsory.

Kevin Volpp, a professor at the University of Pennsylvania School of Medicine, who has studied the use of incentives in health insurance programs, says, “We’re seeing a big move in this direction driven by employers’ concern about rising health costs and their sense that employee behavior has a lot to do with high cost.”  A recent USA Today/Kaiser Health News story details one such company, which subjects its employees to an annual health check to determine how much they will pay in insurance premiums.

However, Julie Appleby reports that some approaches raise the disturbing possibility of discrimination based on health status: “While supporting wellness programs in general, several patient advocacy groups warned the Obama administration last March that additional consumer protections are needed. Tying medical test results to financial incentives or penalties in premiums or deductibles could discriminate against some workers, especially those who already have health problems…”

Whether these programs can really curb health insurance costs is still up for debate, but there is growing evidence to support them.  According to a recent study in the American Journal of Health Promotion, employees who participated in a health-improvement program had fewer medical costs over three years than those who did not.

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Getting Kids to Be Active

Conversation Continues
Monday, March 26th, 2012

Conversation Continues feature ongoing discussions or news on current health topics with links to related materials.  They are part of the Center for Advancing Health’s portfolio of free, evidence-based coverage of what it takes to find good care and make the most of it.  By Kelly Malcom, Editor, CFAH’s Health Behavior News Service.

Parents, physicians and health policy makers alike recognize that getting kids to eat well and exercise will protect them against many health risks but that getting them to do so can be tough.  Two recent highly criticized efforts, an exhibit at Epcot and a rhyming book by Paul Kramer, unfortunately used shame and bullying as motivators.

In February, normally kid-friendly Disney drew fire from many for an interactive exhibit called “Habit Heroes” at Epcot, which challenged kids to help thin heroes fight fat villains named “Lead Bottom” and “The Snacker.” The exhibit has since been closed. Ottawa bariatric surgeon Yoni Freedhoff said, “The truth is, if it was that simple to manage weight, I’m pretty confident we wouldn’t have a problem.”

Everyone chuckled as Maggie got up to bat.

Maggie was not only clumsy, she was also quite fat.

Verses like those above in the newly released book “Maggie Goes On a Diet,” targeted at kids ages 9-12, attempt to raise the virtues of healthy eating, but in a wrong-headed way, according to Travis Saunders. He writes, “The book suggests that kids should focus almost exclusively on their weight, and that reducing their weight will win them friends and admirers, as well as making them athletic superstars.  It also promotes an incredibly unrealistic expectation of dramatic and rapid weight loss, and places the blame/responsibility for body weight on the shoulders of the children themselves.”

Instead of trying fat-shaming books and exhibits, recent studies show that getting kids involved in physical activity at a young age helps get them closer to the recommended 60 minutes of moderate-to-vigorous activity a day. The types of activities also seem to be important. One study covered by the Health Behavior News Service shows that girls who join organized team sports at age 11 are more likely to stay physically active as they get older. And enticing at-risk youth with activities they already view as cool or fun, like active video games or hip-hop dance, can encourage more of them to participate. On the other hand, another small recent study reveals it may take more than just access to an active video game to keep kids moving.

Can upping the cool factor of healthy eating and exercise help reach children who might not otherwise get the message? A new effort by Grammy and Emmy Award winning producer Quincy Jones III seems to think so. His new website, FeelRich.com, features urban artists and celebrities promoting the idea that health equals wealth. “Health isn’t always easy. But it’s always worth it…Because you don’t just want to feel good. You want to feel rich.”

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Worried Sick or Worried Well

Patient Perspectives
Friday, March 9th, 2012

Patient Perspectives round up recent posts from patient blogs and are part of the Center for Advancing Health’s portfolio of free, evidence-based coverage of what it takes to find good care and make the most of it. By Kelly Malcom, Editor, Health Behavior News Service

 

Anxiety can be a familiar and unwelcome companion to those with illness. Whether it’s the sudden headache that sends you searching online for possible diagnoses or the agonizing wait for test results, worrying about your health can be almost as bad as illness itself.

“A little bit of worried-well behavior is not necessarily bad,” writes Anne Polta on her HealthBeat blog. “Sometimes it can prompt people to take necessary action. Sometimes the patient even turns out to be right.” But often, especially for those with new or vague symptoms, an online search for answers leads to anxiety and sometimes requests for unnecessary tests. However, “I don’t think we’d want to return to an era when patients were told a minimum of information and paternally advised not to worry,” Polta says.

Jackie Fox at Dispatch from Second Base couldn’t agree more.  She writes, “I have often said that telling us how we should feel about our diagnosis is like telling us we should be six feet tall or have brown eyes. The same thing can apply to worrying. Some of us are just wired that way….”  For those in the midst of treatment, worrying over lab results, worsening symptoms or the possibility of a recurrence can cast an even greater shadow over one’s life. Jackie discusses her own personal approach to worry: “Some of my online buddies have shared their fears of an upcoming oncology visit or blood test, and I’ve thought of reaching out the same way, but I can’t bring myself to do it.” Her tendency to worry and not share is just part of who she is.

Even those who aren’t prone to anxiety aren’t immune from it either. Blogger WarmSocks recounts a recent appointment with her rheumatologist where she went in relatively worry free and left wondering what to make of a rash. “I waltzed into the appointment feeling great.  A few sore joints here and there, but nothing worth mentioning.  By the time I left, I sat dejectedly in my car and sighed.  What did I do to deserve this?”

How we react in the face of anxiety over illness is personal and can vary from one situation to the next. As Jessie Gruman writes in Appointment in Samarra: Our Lives of Watchful Waiting, “…people respond to such uncertainty in very different ways.  Some shut it out…Some of us find the idea of waiting in the face of an impending threat is too passive a strategy and we take matters into our own hands…The manner in which we watchfully wait may shift as the meaning of our illness and its threat change over time.  Despite our varied responses, however, we share more than just an undercurrent of anxiety.”

Whether it’s worrying about the onset of an illness or worrying about the decision to end treatment, the waiting and uncertainty can indeed be the hardest part.

Related Links:

-          The Waiting is the Hardest Part – Jessie Gruman

-          Cancer Survivorship and Fear - Andrew Schorr

-          Prepared Patient: Watchful Waiting: When Treatment  Can Wait – Health Behavior News Service

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Diabetes: “Valuable Truths about Food and Consequences”

Conversation Continues
Monday, February 13th, 2012

Conversation Continues feature ongoing discussions or news on current health topics with links to related materials.  They are part of the Center for Advancing Health’s portfolio of free, evidence-based coverage of what it takes to find good care and make the most of it.  By Kelly Malcom, Editor, CFAH’s Health Behavior News Service.

 

Recently, celebrity chef Paula Deen, famous for her high-fat and high-sugar versions of Southern-style cooking, announced that she has diabetes and will be a spokesperson for the diabetes drug Victoza.  Her announcement drew fire from those who felt it was opportunistic; that she ignored or glossed-over the fact that the very foods she championed on her cooking show were the type people who are at risk of diabetes should avoid.  Frank Bruni, former NYTimes food critic, (quoted in title) pointed out that Deen isn’t the only celebrity chef “exhorting people to pig out” (though when not in front of a camera many admit to being cautious eaters).

While some thought that the criticism lobbed Deen’s way was unfair, her announcement did get people discussing the increasing rates of diabetes.  In her article, Why Is Type 1 Diabetes Rising Worldwide?, journalist Maryn McKenna explores a diabetes conundrum.  Type 2 diabetes is linked to obesity, so it makes logical sense with rising obesity comes an increase in type 2 diabetes (also known as adult-onset diabetes).  But what about Type 1?  McKenna points out that researchers are unsure about why type 1, an autoimmune disorder typically diagnosed in children, is similarly on the rise.

This means many more people will have to learn how to manage their blood sugar, a complex task that for many involves daily injections of insulin and glucose monitoring.  Completing these tasks and maintaining appropriate blood glucose levels can be especially challenging for children with type 1 diabetes, as Michelle Katz and Lori Laffel point out in their piece, It Takes A Village: Caring for Children with Diabetes.  “Families need frequent support and extensive education in diabetes self-management in order to have the knowledge and skills necessary to successfully manage the condition…technologies offer only a form of imperfect insulin replacement, as remarkable rigor is required to orchestrate the changing treatment demands of fluctuating glucose levels in an active, growing child.”

Alleviating the toll of diabetes, which can include higher risks for kidney disease, blindness, stroke and amputation, begins with timely diagnosis and help.  The National Institutes of Health recently released a fact sheet detailing how a common test for blood glucose levels, called the A1C test, can be used to diagnose type 2 diabetes and prediabetes.  Online resources and chats with people who have diabetes can be helpful for some: Amy Tenderich of DiabetesMine and TuDiabetes are two highly respected sites.  In addition, recent HBNS stories covering diabetes research studies can be found here.

 

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