Employers have spent billions of dollars on wellness programs meant to boost general health and well-being of workers and lower overall healthcare costs by improving sleep habits, physical fitness, dietary choices and mindfulness.

However, research barriers like the lack of valid control group, small sample sizes and limited experimental design has led to a confusing lack of consensus on whether these programs actually work as intended.

A new study recently published in JAMA aimed to address these issues by designing an experiment that randomized implementation of a wellness program at the worksite level.

The randomized control trial from Zirui Zong at Harvard University and Katherine Baicker at the University of Chicago examined 160 worksites of BJ’s Wholesale Club, a large U.S. warehouse retail company.

Researchers compared 20 randomly selected treatment worksites which offered a wellness program that included lessons on nutrition, physical activity and stress reduction to 140 control worksites which received no wellness programming. Employees at treatment worksites were eligible, but not required to participate in the program.

In order to measure potential outcomes, the researchers relied on self-reported health and behavior measures, clinical health screenings, healthcare spending and utilization data and employment outcomes measured through administrative data.

What researchers found after collecting data over a period of 18 months was that while employees at treatment worksites improved in self-reported measures of exercise and managing their weight, there was largely no clinical, spending or employment difference outside of those two metrics.

Other self-reported behaviors like sleep habits and food choices, clinical health markers like cholesterol, blood pressure, and body mass index or medical or pharmaceutical utilization rates were not improved by access to the wellness program.

While many wellness program companies also tout their effect on job satisfaction and retention, administrative data showed that there was also no effect on employee absenteeism, job tenure or job performance.

The researchers said their findings stand in contrast with the majority of the literature around workplace wellness programs which tended to find large positive returns on investment but were “based on observational designs with methodological shortcomings such as potential selection bias.”

While the study authors said positive impact of the program in two self reported outcomes could potentially give credence to the idea of wellness programs as a behavior change tool, it’s unclear whether this will lead to overall health improvement or spending reduction.

“[B]ehavior change is likely easier to achieve than improvements in clinical or employment outcomes. Thus, there may remain no detectable effects on those outcomes, which would have implications for the return on investment in wellness programs,” the researchers wrote.

The study authors plan to publish three-year results to see if larger effects are seen over a longer time horizon.

Only around 35 percent of employees eligible for the wellness program took part in at least one module (out of eight) over the study period. Participation was lightly incentivized through gift cards with potential incentives across the program averaging about $250.

Of the population that completed at least one module, 60.9 percent went on to complete three modules of the program, with a mean of 3.7 modules completed.

The study’s findings of a lack of an impact of workplace wellness programs on clinical health measures, health spending or employment outcomes is consistent with results found in an earlier randomized study conducted by University of Illinois.

Still, this likely doesn’t spell the end of workplace wellness programs. Other studies have shown that larger financial incentives, for example, had a greater impact on health results.

An accompanying editorial to the research, which characterized employee wellness programs as a “work in progress” argued for more targeted approaches instead of broad based programs in order to drive more measurable health improvements and cost savings.

Picture: fizkes, Getty Images

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