Workplace wellness programs appear to have little effect on health outcomes of benefits-eligible employees

EBM Focus - Volume 15, Issue 21

Reference: JAMA Intern Med. 2020 May 26

Workplace wellness programs have become increasingly popular, with implementation of screening tests, health education, on-the-job naps, ping-pong, and other activities. Workplace wellness programs vary in the nature of the interventions, yet no studies have demonstrated an improvement in clinical outcomes and all are limited by short follow-up or observational design (Song et al. 2019, Osilla et al. 2012).

Investigators conducted a randomized trial over a two-year period among university employees to determine the impact of a workplace wellness program on health beliefs and behaviors, biometric data, and healthcare utilization. Benefits-eligible employees who volunteered for the study were randomized 2:1 to the wellness intervention or control. Those in the intervention group underwent baseline biometric screening and health risk assessment and were then eligible for two wellness activities per year for a financial incentive. Those in the control group underwent only biometric screening, including measurement of weight, blood pressure, lipid levels, and glycemic control at one and two years. Additionally, participants were asked about their perception of their health, which included self-reporting biometric data, rating their likelihood of a medical condition, and health behaviors. Of more than 12,000 eligible employees, 40% agreed to participate in the trial (3,300 randomized to intervention, 1,534 to control). Participants had a mean age of 43.9 years and most were female (57.3%) and identified as white (83.7%). Hypertension and dyslipidemia were the most commonly reported medical conditions (13.7% and 15.8%, respectively). Completion rates of the biometric screen at year 1 were 43% in the intervention group and 39% in the control group, declining to 36% in both groups at year 2. Among those who had outcome data available (1,739/4,834), there were no differences between the two groups in the individual components of perceived health or behaviors. At two years, participants in the intervention group had a similar body mass index (estimated effect -0.40, 95% CI -1.11 to 0.31) and other biometric outcomes. In subgroup analyses, participants who earned > $52,620/year and non-faculty salaried administrative and hourly employees all had results that were similar to the study population as a whole.

Employees dedicate valuable time to complete workplace wellness activities, and employers spend considerable energy and dollars on these programs. This randomized trial found no significant benefits, but was hampered by an unrepresentative sample, high attrition rates, and the limited focus on health outcomes. Although it is possible that these results may not generalize to other worker populations, these data are consistent with multiple studies that have failed to demonstrate improvement in meaningful clinical outcomes. It appears money and time would be better spent on other approaches to health promotion.

For more information, see the topic Adult Preventative Health in DynaMed.

DynaMed EBM Focus Editorial Team

This EBM Focus was written by Carina Brown, MD, Assistant Professor at Cone Health Family Medicine Residency. Edited by Alan Ehrlich, MD, Executive Editor at DynaMed and Associate Professor in Family Medicine at the University of Massachusetts Medical School, Dan Randall, MD, Deputy Editor for Internal Medicine at DynaMed, and Katharine DeGeorge, MD, MS, Associate Professor of Family Medicine at the University of Virginia and Clinical Editor at DynaMed.