Maintenance Phase - Workplace Wellness

00:00:00.000 oh fuck i gotta have a catchphrase huh oh first time doing this it's been a minute uh 0.99

00:00:16.920 hi everybody and welcome to maintenance phase the podcast that won't charge you extra if you're fat 0.99

00:00:23.500 or disabled to have a job question mark that was a very direct one i i know your thoughts on this

00:00:31.020 matter this is one where i am not coming in fresh and it's one where i have strong feelings already

00:00:36.900 and i'm looking forward to having those feelings fed i am michael hobbs i'm aubrey gordon if you

00:00:43.500 would like to support the show you can do that at patreon.com maintenance phase or you can buy

00:00:47.980 t-shirts mugs tote bags masks all kinds of stuff at t public both of those are linked for you handy

00:00:54.120 dandy in the show notes you can also listen to mike's new show if books could kill wherever you

00:00:59.640 get podcasts and you can pre-order my new book uh you just need to lose weight and 19 other myths

00:01:04.820 about fat people both of those are also linked for you in the show notes and michael today we're

00:01:11.220 talking about workplace wellness programs yes i interrupted your rant to make you talk about

00:01:15.560 logistics. I was like, Oh, right. Housekeeping. Yeah. Bathrooms are over here. Yeah. Put your

00:01:21.820 pronouns on your name tag. Let's roll. What are your thoughts on workplace wellness, Aubrey? 0.94

00:01:26.800 So many, many workplace wellness programs, not all of them, but many of them will provide folks

00:01:32.620 with either bonuses or lower healthcare premiums based on their participation in or higher marks

00:01:39.380 on specific health and wellness metrics and i was talking to a friend of mine who works in like a

00:01:47.760 municipal government one of her people who sort of works in her department came to her and was like

00:01:53.440 hey i did our workplace wellness thing and like i have an eating disorder and starting the day with

00:01:59.300 getting weighed was like not my favorite yeah doing it at work right weighed at work in front

00:02:05.720 of your co-workers in a non-HIPAA sort of setting right like I think it's worth questioning

00:02:11.140 why on earth this is the job of an employer to do oh my god you're spoiling something that I

00:02:17.900 was saving for like the last five minutes of the episode but like yeah it just feels like a real

00:02:23.820 boundary-less mess of a system and it's a real boundary-less mess of a system that has just

00:02:29.740 permeated almost every major workplace that i'm aware of dude 92 percent of employers in the 0.92

00:02:38.920 united states have some form of workplace wellness program shut the fuck up are you kidding me it's 0.99

00:02:43.720 somewhere between like a 4 billion and a 10 billion dollar industry holy shit what is wild 0.98

00:02:49.580 to me is that workplace wellness programs have been around for decades we will get into it and

00:02:54.720 And there is no fixed definition of what workplace wellness actually means. 0.99

00:03:00.780 Oh, get fucked. 0.99

00:03:01.860 So this is a like natural foods thing? 1.00

00:03:04.340 Yeah, so exactly.

00:03:05.120 So like a lot of the articles that you read, they're like, some employers say like, yes,

00:03:09.540 we have a workplace wellness program.

00:03:11.120 But what they mean by that is that there's like a poster in the break room being like,

00:03:14.900 eat five fruits and vegetables.

00:03:16.500 And then other employers have these like really comprehensive, you get this incentive and

00:03:23.120 there's this BMI bonus and there's this discount on your health insurance, like really, really

00:03:28.000 hardcore programs.

00:03:29.640 But they're both labeled as workplace wellness.

00:03:32.600 Yeah, the two that I remember most clearly and feel like the most galling examples to

00:03:38.740 me, one is the Whole Foods BMI discount, which was you would get a greater employee

00:03:45.760 discount if you had a lower BMI.

00:03:48.600 And I believe it was visible on the card, too. 0.99

00:03:50.900 So other employees could actually like I think it would come up at the register to be like, oh, this person gets 15 percent off fucking barf. 0.99

00:03:59.240 Yeah, it's really barf. 0.98

00:04:00.000 And the other was a brand of chocolate that I've otherwise enjoyed in my life.

00:04:05.480 Tony's Choco Lonely had a BMI bonus where they would just straight up pay people more money if you had a lower BMI.

00:04:14.000 And they got enough blowback on it that they changed it to be a maintain your BMI bonus.

00:04:21.020 So if your weight stayed the same, then you would get that bonus, which is also still garbage.

00:04:27.080 it's also discriminates against people like me who are trying to get huge bro what about the 0.88

00:04:31.680 dudes who are going for gains bro i know what about the skinny shaming throughout our society

00:04:36.400 what about that no one wants to talk about that yeah nailed it so i want to start out by just

00:04:41.820 trying to define what this is because especially for people that do not live in the united states

00:04:47.400 this is like completely fucking baffling even though they do have workplace wellness programs

00:04:52.020 even in other countries and other countries where they have more socialized medicine like 0.96

00:04:55.380 This is a cancer that has taken over the employer-employee relationship basically everywhere, which is quite shocking.

00:05:02.240 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.

00:05:13.760 So, like, this is most Americans.

00:05:15.740 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, they'll include stuff like occupational health and safety programs, which like, no, that's a lot of that's legal compliance anyway. And sometimes you see histories of this that'll say like the 40 hour work week is a workplace wellness program.

00:05:44.840 Oh, Christ. Are you kidding me?

00:05:46.620 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.

00:05:52.960 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 only doing explicitly to get more productivity out of your workers.

00:06:03.540 So like that's what we're talking about is like this extra stuff.

00:06:06.280 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.

00:06:14.300 we're talking about formal institutionalized workplace-wide programs that either strongly

00:06:22.740 suggest or incentivize or mandate employee participation. Yes. And when we talk about

00:06:29.960 workplace wellness programs, it's a mix of good, neutral, and extremely bad things.

00:06:37.160 Interesting. We put out a call toward the beginning of the research for this episode

00:06:42.280 of like tell us your workplace wellness stories back when i thought this was going to be like a

00:06:45.860 fun freewheeling episode you thought you were going to do something laid back and you filled

00:06:51.100 out a real rabbit hole i was like this is gonna be a cute one no it's not cute uh we got 700 emails

00:06:58.680 so we are going to do a bonus episode where we go further into like what workplace wellness 0.55

00:07:04.780 programs actually entail right now and the like utterly fucking deranged stories that we heard 0.73

00:07:09.300 from our listeners. But there's a couple of broad categories that we found when we started getting

00:07:13.700 emails and when I was reading up on this. So arguably, there are some workplace wellness

00:07:17.900 programs that are good. So a lot of employers will provide free flu shots. Oh, great. I don't

00:07:23.400 love that being provided at an employer, but also like more people getting vaccinated against the

00:07:27.520 flu is a good thing. I feel like I don't know. It continues this sort of like insidious sort of

00:07:33.320 thing of like your employer is kind of your health care provider. Exactly. You know what I

00:07:38.420 mean like so it's like blurring some lines and also i think the number one reason certainly that

00:07:43.860 people i know don't get a flu shot is just the inconvenience we also heard from listeners whose

00:07:48.680 employers started giving them more time off or kind of personal days like one listener said that

00:07:53.800 her workplace gives you like friday afternoons off like no questions asked if you just like need

00:07:58.020 to take some time for yourself so like cool that's great the last example of a good one that i have

00:08:03.460 is a lot of employers also, you know,

00:08:06.380 try to have like healthier food in the cafeteria.

00:08:09.260 Having an option for people that has like,

00:08:10.700 I don't know, more vegetables in it or whatever,

00:08:13.000 that seems fine to me, like great.

00:08:14.840 Sure.

00:08:15.040 But I would say the, probably the largest category 0.99

00:08:18.020 is programs that are like really dumb, 0.97

00:08:21.720 but like kind of benign. 0.96

00:08:23.860 So a lot of employers offer subsidized gym memberships.

00:08:28.180 Oh.

00:08:28.420 It's the kind of thing that like,

00:08:30.220 if my employer didn't offer that,

00:08:31.920 I wouldn't ask for it.

00:08:33.460 But also, like, sure.

00:08:35.680 Yeah, I would also accept an employee discount for a Netflix membership.

00:08:39.580 You know what I mean?

00:08:39.960 Like, sure, you want to give me discounts on stuff.

00:08:42.120 Sure, sure, sure, sure, sure.

00:08:43.140 Some people said that their workplace will, like, bring in people to do, you know, yoga sessions during work voluntarily.

00:08:50.960 One person said their work brought in a masseuse once a month to give free massages to employees.

00:08:57.440 But they worked at a cafe as a barista and there was no room in the back. 0.99

00:09:02.660 so they would just get a massage like in the cafe in front of all the customers shut the fuck up 0.91

00:09:08.400 but i guess the customers would be like i'm next she's like no yeah i'm sure i don't think it's 0.96

00:09:14.880 really doing much for your health particularly but also just like yeah time that you're getting

00:09:19.040 paid and you get a free massage at work whatever right great and then a lot of employers do things

00:09:24.480 where like they'll have a bowl of fruit at the reception desk they'll send out like a weekly

00:09:29.100 health tip to employees they seem pretty dumb to me but also they they seem harmless right and you

00:09:36.140 can say that like okay they're entrenching this paradigm and like we'll get into it but also like 0.99

00:09:41.820 the amount of just dumb shit that your employer does and you have to deal with at work it's like 0.99

00:09:46.360 having a couple bananas at the reception desk seems like fairly low on that ladder to me i think 1.00

00:09:52.120 listen it's hard for me to talk about workplace wellness programs without grading on a real sharp

00:09:57.800 curve yeah like of course on its face a lot of these are things that i don't think really have

00:10:04.420 an appropriate place in the workplace and if we had better health care systems none of this would

00:10:10.280 be in the workplace to begin with and we think of this as a weird thing well this brings us to like

00:10:14.460 the bad stuff yeah tell me the main one is yes these financial incentives that essentially if

00:10:20.780 you meet certain health quote-unquote parameters you pay less for your insurance premiums and

00:10:27.660 oftentimes this is done in like a fairly public way so one email that we got from listeners said

00:10:34.740 my last job would give you roughly 200 if you lost a specific amount of weight over the course of a

00:10:40.380 year you would go into a practitioner in the office to do a full health screening and whatever

00:10:45.240 they determine is an appropriate amount of weight you should lose is your health marker goal for the

00:10:50.240 next year you get money when you join the program and every year after if you continue to do the

00:10:55.180 health screenings and lose weight it's gross and i hate it yeah so it's like that sort of stuff 0.98

00:11:00.300 where we're bringing in like extremely personal health information and this whole fucking weight 0.96

00:11:05.100 paradigm basically into your relationship with your employer and in some cases you're like direct

00:11:11.420 boss yeah some people described having these like wellness plans that they put together with their

00:11:17.140 boss and it covers things like oh you have to go to acupuncture chiropractor whatever once a week

00:11:23.460 and you'll actually get a discussion with your boss

00:11:26.620 if you miss one of your wellness appointments. 1.00

00:11:29.560 Jesus fucking Christ. 1.00

00:11:32.780 Wildly inappropriate. 1.00

00:11:34.100 The boundarylessness of all of this is fucking staggering. 0.98

00:11:39.400 Like, think about how much you hate to answer 1.00

00:11:41.380 to your fucking mom about your body 1.00

00:11:43.760 or your health and wellness shit at like the holidays. 1.00

00:11:46.640 Now imagine that's your boss 0.99

00:11:48.440 and it's every time you talk to your boss,

00:11:50.500 that's a conversation that's on the table.

00:11:52.280 Trying to think of like the people I want involved in my relationship with my body the least.

00:11:57.420 Yeah.

00:11:58.140 Like my boss and my employer.

00:12:00.420 Yeah.

00:12:01.260 Yeah.

00:12:01.780 Exactly.

00:12:02.520 Another really common one is Fitbit challenges or like Fitbit metrics.

00:12:08.440 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.

00:12:19.040 Right.

00:12:19.300 We're all going to try to move more or whatever.

00:12:20.740 But first of all, it's effectively a form of surveillance, right?

00:12:24.800 It's your activities outside of work now playing into the way that you're assessed at work.

00:12:30.140 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.

00:12:42.300 And all of this requires those people to disclose this to their boss.

00:12:47.500 Right.

00:12:47.580 You're basically creating something that's like, oh, it's going to be fun.

00:12:50.360 We're all going to walk together.

00:12:51.400 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. 0.98

00:13:01.520 There's also, as you can imagine, this also drives a lot of like really fat phobic and like condescending bullshit at work.

00:13:09.880 So people sent in photos of like various posters that their bosses put up at work. 0.93

00:13:16.540 one of them had a sign on the elevators that said push yourself not the button take the stairs when

00:13:24.380 possible which is also like a specific favorite of yours is the take the stairs take the stairs

00:13:30.900 like the idea that like if fat people took the stairs up two flights of stairs or whatever 0.99

00:13:37.460 every day that suddenly we would not be fat people anymore exactly get the fuck out of here 0.98

00:13:42.060 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 guess you should 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. 0.98

00:14:01.060 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. 0.95

00:14:20.660 Do you want to hear the worst, like, surveillance category of workplace wellness bullshit that we got? 0.96

00:14:26.420 Okay. 1.00

00:14:27.120 This one's fucking unbelievable. 0.99

00:14:28.740 I worked for a large organization who had a third-party company who ran health challenges on their behalf. 0.99

00:14:36.220 It was operated through an online portal where people could accumulate points for doing things like getting their annual health checkup, etc.

00:14:41.800 pretty benign until they introduced a forum where you could post photos of co-workers you caught 0.98

00:14:49.320 being unhealthy and tag them in it shut the fuck up that's right they built in a public shaming

00:14:56.380 feature with no way for the person you took a photo of to opt out okay guys so guys i am gonna 1.00

00:15:04.260 to start throwing up crying and punching i need the address of this building so that i can burn 0.96

00:15:11.460 it down that's turning everywhere into fucking 8chan so we're gonna circle back to the worst 0.98

00:15:17.440 of workplace wellness and like the myriad reasons why it's bad but we have to go through the history 0.90

00:15:22.920 basically as long as we've had workplaces we've had weird wellness efforts by bosses imposing

00:15:29.320 them on their employees wait really yeah so milton hershey the guy like the hershey's chocolate guy

00:15:35.220 had a leisure park connected to like the the chocolate factory where he expected employees

00:15:42.080 to like go and do calisthenics during the day pilates before pilates calisthenics yeah the 0.97

00:15:48.060 national cash register company which was like hot shit in the late 1800s and early 1900s 0.59

00:15:54.160 offered horseback rides to employees before and after work that sounds good to me that's one of 0.93

00:16:00.500 the good ones i go on a little horse ride but then i don't know if these actually count as

00:16:04.220 workplace wellness programs because they're basically companies that have like too much

00:16:07.460 profit and founders that have these like eugenics adjacent ideas about hiring like the right kinds

00:16:15.720 of workers uh-huh these programs eventually expand to things like helping workers quit smoking

00:16:23.220 helping workers quit drinking.

00:16:25.080 But I'm not sure those count either because they're like pretty straightforwardly productivity

00:16:28.700 measures, right?

00:16:30.260 The idea is that if somebody's drinking, they're probably showing up late.

00:16:34.380 And the smokers, you don't want people taking smoke breaks.

00:16:36.780 Yeah.

00:16:37.140 And also, it's pretty isolated.

00:16:39.020 It's really only like the largest and most profitable companies that are really doing

00:16:42.700 this in the first half of the 20th century.

00:16:45.100 Right.

00:16:45.320 But so the first explosion of these programs happens just after World War II with the rise

00:16:52.260 of employer-sponsored health insurance.

00:16:54.940 Before World War II, only 10% of the U.S. population

00:16:57.740 had health insurance of any kind.

00:16:59.620 And during World War II, firms were prohibited

00:17:02.820 from offering higher wages to employees

00:17:04.620 because everything was controlled by the government

00:17:05.960 to get, like, wartime stuff out.

00:17:08.060 So employers started offering health benefits

00:17:11.320 as basically a way of attracting workers, right?

00:17:15.320 Because we can't pay you more,

00:17:16.700 but we can get you free health insurance.

00:17:19.020 Once all of this kind of manufacturing sector stuff

00:17:21.680 started to get entrenched, it then became something that unions started asking for.

00:17:25.500 Health insurance benefits became something that was a mainstay of collective bargaining

00:17:29.480 agreements. And in the late 1940s, the government also recognized them and like made them tax free.

00:17:36.300 So the government, the employers and the employees all wanted health benefits to come

00:17:41.720 through employers. That's fascinating and feels like continued adaptation to

00:17:47.200 we're going to let capitalism run our healthcare system. You start bargaining for this in employer

00:17:54.800 contracts when you don't see any path to any other way to get healthcare and health insurance.

00:18:00.420 Profits and health, what could go wrong?

00:18:01.940 Yeah. So the real ramp up to modern workplace wellness programs begins in the 1970s when two

00:18:09.280 interlinked things happen. The first is that the cost of health care explodes. In 1960,

00:18:17.360 companies were spending about 25% of their payroll on health benefits. And by 1980,

00:18:22.620 they were spending 41%. Wow. I read a bunch of papers about why health care spending exploded

00:18:28.400 in the 70s and 80s. And it seems to be a combination of the population getting older,

00:18:33.460 much more access to health care services, like it was expanding to rural areas. Also,

00:18:38.480 the consolidation of healthcare services they're basically starting to merge and starting to

00:18:42.840 realize that you can charge literally anything for healthcare which is like the situation that

00:18:46.840 we're in now but the point is americans started spending way more money on healthcare and

00:18:51.320 employers were starting to get really nervous in the 70s and 80s like hmm this is this is becoming

00:18:55.620 a problem the second factor that contributed to this was the invention of wellness so we are going

00:19:05.040 to watch a clip from 60 minutes from 1979 i think i have seen this clip is it the dan rather one

00:19:12.400 yes where he's like what is wellness yes dude it's such a fascinating artifact oh my god

00:19:18.900 it's so fucking good i love it so much it's great they're like they call it self care

00:19:25.100 it's incredible okay okay here it is it's a movement that is catching on all over the 0.89

00:19:33.740 country among doctors, nurses, and others concerned with medical care. Wellness is really

00:19:38.960 the ultimate in something called self-care, in which patients are taught to diagnose common

00:19:43.840 illnesses and, where possible, to treat themselves. More than that, it is a positive approach

00:19:49.720 to health, what one doctor calls recognizing that health is not simply the absence of disease.

00:19:56.220 I had been in and out of the Cleveland Clinic. I had seen numerous specialists in various

00:20:01.600 area and i just was so tired and so fed up being in so much pain i'd spent i would give you a

00:20:10.400 ballpark figure of about 35 000 over the last nine years in medical care traditional medical care

00:20:16.080 yes and had achieved nothing 152 three julio esposte joined self-care for the same reasons

00:20:25.120 he's an executive with a major west coast firm for years he suffered from constant headaches

00:20:29.840 and physical pain. Doctors told him it was due to stress in his work. But any test or

00:20:35.360 x-ray doctors administered to Julio proved negative. Like Teresa, Julio says he didn't

00:20:41.080 find relief until he entered a program called wellness. Now, is what you're into a substitute

00:20:47.360 practice of medicine? No, absolutely not. It is an adjunct to and quite different from

00:20:52.760 the practice of medicine. We don't treat, diagnose or prescribe. Our role is to help

00:20:58.960 the person discover why they're sick. Travis does this by looking at a person's whole lifestyle,

00:21:05.520 their diet, work habits, and physical activities. What solved Julio's illness problems was biofeedback.

00:21:12.440 As the tone gets lower, you're warming, and you just raised your hand temperature one degree.

00:21:18.280 Biofeedback basically is an electronic device used to measure the amount of tension or stress

00:21:23.640 in a person's body after several sessions julio learned not only how to relieve his pain

00:21:28.680 but also how to handle stressful situations at work mike when did you join self-care

00:21:35.940 started caring for myself this video has the tone of my dad repeating back to my nephew

00:21:44.300 what my nephew has just told him about pokemon evolutions all right so uh charmander becomes

00:21:52.220 charizard uncertain but like emotionally invested like here for you but not sure about all this

00:21:58.740 you know also how i conceive of heterosexual intercourse like this seems important but i

00:22:04.520 don't know how it works it's really fascinating to me that like part of the reason that this like

00:22:10.100 weird shitty economy of stuff exists is that it is accounting for medical institutions not

00:22:18.400 being responsive or feeling responsive in a way that patients can like wrap their arms around and

00:22:23.720 feel cared for i also love that it's it's this perfect distillation of where we are with wellness

00:22:29.520 now where it's like it starts with a good concept of like health is obviously something more than

00:22:34.460 just like the absence of disease like you want to feel good as a person and also here's this quack 0.82

00:22:39.960 shit that's gonna like measure the quote-unquote tension in your body and it has like bio in the 0.92

00:22:46.460 name, so you think it's scientific. Boy, oh boy, oh boy. But I mean, this shift is something that 0.99

00:22:53.280 we've talked about on the show before, and I think we're going to return to a million more times,

00:22:56.500 that you had this shift in the understanding of public health. Throughout the first half of the

00:23:02.200 1900s, you had, you know, the eradication of polio, you had mass vaccinations. After World

00:23:08.440 War II, you get penicillin. What we thought of as disease wasn't infectious disease anymore.

00:23:16.460 It wasn't like you drank some tainted water and you got sick and now we need to make sure

00:23:20.140 the water isn't tainted.

00:23:21.280 It became much more about these lifestyle factors.

00:23:25.580 This was also the time when we start getting the Framingham study and saturated fat causes

00:23:30.940 heart attacks, right?

00:23:32.000 And we also get this sense that what you are doing on a day-to-day level affects how healthy

00:23:39.320 you are.

00:23:39.840 And this really becomes like the dominant paradigm of health.

00:23:43.240 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 narrative. Right. 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 blah, blah, blah. Right.

00:24:10.840 Like, it is extraordinarily ruthless kind of logic that underpins a lot of this.

00:24:16.720 Well, I think a lot of the precepts of it are true, right?

00:24:20.180 So, you know, heart disease and cancer are the number one and number two killers of Americans.

00:24:24.340 So, like, obviously, we should be taking those things seriously, right?

00:24:27.760 And, like, of course, our lifestyles affect our health, right?

00:24:30.700 Like, there is truth at the heart of this.

00:24:33.740 But I think the adoption of this and especially the take up of this by industry ends up smuggling in what the researchers call the lifestyle risk paradigm.

00:24:45.900 Yeah.

00:24:46.040 The fact that your lifestyle affects your risk for disease is like pretty unobjectionable.

00:24:51.040 But eventually it became that your lifestyle is the only thing that affects your risk for disease.

00:24:56.440 Yeah.

00:24:56.680 We then start getting the reverse understanding, which is, well, then everybody who's sick must have done something to deserve it.

00:25:02.220 I think the context here is really important, which is then as now we live in a world that

00:25:09.580 has really, really taught us to judge and brush aside and think less of fat people and

00:25:16.500 disabled people, right? 1.00

00:25:18.060 Right.

00:25:18.300 If you hear a health and wellness message that feels really good to you, it's worth

00:25:22.520 unpacking why it feels really good to you and what it allows you to believe about yourself

00:25:27.000 and the world and your place in it.

00:25:29.100 Right.

00:25:29.200 Well, also, this stuff almost immediately gets taken up by corporations in various ways, right?

00:25:35.880 Yeah, for sure. 0.99

00:25:36.820 Bullshit, you know, skincare marketing. 0.98

00:25:38.340 But also behind the scenes, at the same time, we have this explosion in healthcare costs and we have this galloping understanding of health as due to lifestyle factors. 0.98

00:25:50.380 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.

00:26:01.400 So I'm going to send you an excerpt of a really insightful article about this that was published in 1988.

00:26:08.740 It's amazing to me how often I dig into a topic on this show to be like, oh, this is really ripe for debunking.

00:26:15.760 and then you find the like journal articles that have debunked the shit out of it and they're like

00:26:21.200 40 to 70 years old i know you're like oh man we've known this whole time i know you're like

00:26:28.640 10 minutes after it happened somebody's like this seems bad and then we have to make a podcast 40

00:26:32.980 years later all right here's this okay in the 1980s american industry has adopted cost containment

00:26:40.460 as a key to corporate health policy.

00:26:43.320 The incentives are substantial,

00:26:45.440 for if companies can reduce their medical insurance and disability claims,

00:26:49.140 they may be able to lower their health costs

00:26:51.700 and potentially reduce their insurance premiums.

00:26:55.000 Corporations and their insurers have developed multi-pronged plans

00:26:58.520 to control health costs, including more cost-sharing with employees,

00:27:03.560 second opinions for many elective surgical procedures,

00:27:07.140 incentives for outpatient surgery,

00:27:08.920 encouragement of alternative health providers and worksite health promotion thus worksite

00:27:16.000 wellness programs with their goal of keeping employees healthy and reducing medical care

00:27:20.620 utilization are a part of this cost containment strategy right it's just about money very openly 0.97

00:27:27.380 like corporate executives were saying this at the time it's really amazing to me what a fucking hot 0.87

00:27:32.840 potato health care costs are i know everyone's doing the thing where you like put your finger 0.93

00:27:38.860 on your nose and go not it yeah like first the state did it and then employers are now like wait

00:27:45.420 a minute me too it's also really frustrating because as soon as anybody talks about universal

00:27:49.280 health care in this country corporations are some of the first ones to push back yeah right because

00:27:52.880 they like having this as a benefit that they can offer to recruit employees so it's like you realize

00:27:58.720 this isn't helping you either right like this sucks for literally everyone and it just like

00:28:04.600 keeps getting kicked down the road yeah so the next like 40 years are just more and more expansion

00:28:11.860 and entrenchment of this concept so in 1979 we get a surgeon general's report that identifies

00:28:18.320 work sites as an appropriate setting for health promotion we start getting companies very publicly

00:28:25.900 bragging about their workplace wellness programs so johnson and johnson is one of the first ones

00:28:31.320 in 1979 they launched this huge workplace wellness program that like they've published a number of

00:28:37.080 academic articles over the years about like how it's so great and their cost went down and morale

00:28:42.300 is up and absenteeism is down and everything's great and we start getting studies throughout

00:28:49.200 the 80s and up until the 2000s, showing that this saves money for employers. So one of the early

00:28:56.580 ones finds that companies save $1.43 for every dollar that they spend on workplace wellness.

00:29:03.340 Another one comes out showing a $3.27 savings for every dollar they spend on health promotion.

00:29:12.020 The most outlandish one I found was one that said that employers save $11.

00:29:16.840 dollars this is starting to look like something that is just kind of like a win-win it's good

00:29:22.320 for employees it's good for employers and it pushes this responsibility off of the government

00:29:28.100 so the government loves it too well but also eleven dollars for every one dollar is some real

00:29:34.700 400 000 americans die of obesity every year kind of math where you're like how aubrey don't don't

00:29:41.760 imply that we're going to debunk these numbers later. I don't. I'm livid that you would assume

00:29:47.440 that I'm giving you some numbers, but leaving out relevant context. Wow. I can't believe that you

00:29:54.060 would question an 11 to 1 return on investment. The betrayal. My own co-host. My own co-host.

00:30:02.860 Et tu, Aubrey?

00:30:04.560 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.

00:30:18.060 So that's fun.

00:30:19.200 So the 1990 Americans with Disabilities Act includes a specific carve out for workplace wellness programs. 1.00

00:30:28.820 Get the fuck out of here. 0.99

00:30:29.840 mandatory physical examinations are prohibited by the americans with disabilities act however 0.99

00:30:35.280 it includes an exemption for voluntary medical examinations including voluntary medical histories

00:30:42.400 which are part of an employee health program available to employees at the work site nope so

00:30:47.620 it's like as long as it's voluntary it's chill as long as you're opting in to getting paid more 0.93

00:30:56.160 if you're not disabled right like i'm just like this is fucked so that's 1990 in 1996 we get hipaa 0.78

00:31:03.360 sure which is mostly known now as like the reason why your doctor can't give information about you 0.89

00:31:09.360 to other people but it also includes all these provisions to prevent discrimination in employer

00:31:14.340 provided health insurance but again it includes a carve out for workplace wellness programs

00:31:21.100 garbage as long as workplace wellness programs do not result in more than a 20 incentive so it all

00:31:30.120 goes back to this issue of whether they're voluntary right because if your insurance is 0.89

00:31:34.940 five times more expensive if you don't pass all of these biometric things you can say like well

00:31:40.740 it's not meaningfully voluntary right you're basically coercing people into this with like

00:31:45.800 they have to pay more money. So HIPAA says 20%. If health insurance is costing people 500 bucks a

00:31:51.980 month, you can give them an incentive of up to $100 a month. Gotcha. That way it's voluntary

00:31:57.920 because it's not that much money, or at least that's the idea. Yeah. Although like, listen,

00:32:02.860 we live in a country where in some cases your healthcare costs can rival your housing costs,

00:32:09.180 right oh yeah so 20 percent of one of the biggest expenses in your life i get where they're going

00:32:16.860 with this logic but it feels like it doesn't actually play out in people's real lives right

00:32:21.680 like the idea that like a hundred dollars a month is a negligible amount of money i know it's like

00:32:28.240 bonkers it's also a very weird upside downity in that everyone would understand like hey disabled

00:32:35.960 people have to pay more for this as discrimination that's just like straightforward discrimination

00:32:40.000 right yeah ah but non-disabled people pay less for this yeah that's fine somehow great but it's

00:32:47.440 like i don't see how they're different right ultimately at the end of the day disabled people

00:32:51.980 are paying 500 bucks a month and non-disabled people are paying 400 bucks a month yeah whatever

00:32:55.580 you call that there's a material reality that is being created here yes absolutely another thing

00:33:02.220 this is foreshadowing alert awoga tippa refuses to impose any regulations on workplace wellness

00:33:11.100 programs so this is in a really good history of this that i read the final regulations added

00:33:16.200 language providing that if a program has a reasonable chance of improving the health of

00:33:21.200 participants is not overly burdensome is not a subterfuge for discriminating based on a health

00:33:26.440 factor and is not highly suspect in the method chosen to promote health or prevent disease it

00:33:31.260 satisfies the standard. There does not need to be a scientific record that the method promotes

00:33:36.540 wellness to satisfy the standard. So basically, if you're trying to promote health, you can do

00:33:43.340 any of these workplace wellness programs that you want. There's no quality assurance to offer this

00:33:48.280 monetary incentive to employees. Jesus Christ. There was a long pause there. I was like, did

00:33:55.060 aubrey die did i kill aubrey no i'm just tired so like i used to work on this kind of stuff right

00:34:02.220 the law is a broad statement of purpose and where the law gets implemented is through regulations

00:34:08.260 which is where you go through all the stuff of like okay we told employers they can do this

00:34:14.040 where are we specifically setting the boundaries around that yeah you pass a law people think

00:34:19.880 that's the end of the work that's the start of the work wait aubrey what what am i skipping ahead

00:34:26.760 they do actually revisit this so you're about to be very happy that they do revisit this but

00:34:33.640 they make it worse so i have i have an excerpt for you oh send me an excerpt so context hipaa

00:34:44.120 passes in 1996 fast forward obama is elected in 2008 and one of his major campaign promises was

00:34:51.480 reforming the health care system so throughout 2009 2010 there's of course this huge debate of

00:34:56.440 like what is health care reform going to look like in the midst of this debate in 2009 the

00:35:03.480 wall street journal publishes an op-ed by an executive at safeway entitled how safeway is

00:35:10.620 cutting health care costs, market-based solutions can reduce the national health care bill by 40%.

00:35:17.360 And I am going to send you a very boring and very long excerpt from this.

00:35:24.960 Quote, our plan utilizes a provision in the 1996 HIPAA law that permits employers to differentiate

00:35:32.640 premiums based on behaviors. Currently, we are focused on tobacco usage, healthy weight,

00:35:38.360 blood pressure, and cholesterol levels. Safeway's Healthy Measures Program is completely voluntary

00:35:44.580 and currently covers 74% of the insured non-union workforce. Not foreshadowing.

00:35:51.100 Employees are tested for cardiovascular disease, cancer, diabetes, and obesity,

00:35:55.920 and receive premium discounts for each test they pass. If they pass all four tests,

00:36:02.080 annual premiums are reduced $780 for individuals and $1,560 for families.

00:36:10.580 Should they fail any or all tests, they can be tested again in 12 months.

00:36:15.120 Wow. So you get nothing?

00:36:16.500 But you can take the test again once you're healthy and clean.

00:36:18.520 Oh, congratulations. You were diabetic this time, but maybe not next time.

00:36:21.900 Have you tried biofeedback?

00:36:24.780 The numbers speak for themselves.

00:36:26.740 Our obesity and smoking rates are roughly 70% of the national average,

00:36:31.380 and our health care costs for four years have held constant.

00:36:35.780 Today, we are constrained by current laws from increasing these incentives.

00:36:40.700 We reward plan members $312 per year for not using tobacco,

00:36:47.620 yet the annual cost of insuring a tobacco user is $1,400.

00:36:52.460 Reform legislation needs to raise the federal legal limits

00:36:56.080 so that incentives can better match the true incremental benefit 0.94

00:36:59.740 of not engaging in these unhealthy behaviors holy shit the number of logical fallacies here

00:37:07.660 like our workforce has 70 of the national average of x y and z thing right uh but those costs haven't

00:37:16.780 gone down nationally so that just means you're employing more people who already had low health

00:37:22.240 care costs uh stop smiling stop knowing things sorry sorry sorry this is like astonishing

00:37:30.800 and is like the narrative here is so fucking smart which is the law is standing in the way 0.62

00:37:38.160 of employers who just want their employees to be as healthy as possible we can only offer 20 0.55

00:37:43.860 incentives that's not enough we got to be able to reward the larger ones right and all of this 0.98

00:37:50.840 is both predicated on and reinforcing the idea that again thin people and non-disabled people

00:37:57.220 are doing right things and that any costs that an employer shoulders are the fault of fat people and

00:38:05.760 disabled people right yes this has totally been memory hold but like this was a huge part of the

00:38:10.760 debate over obamacare in 2009 2010 really yeah republicans started attacking obama and saying

00:38:17.660 like oh well companies would like to offer more incentives to incentivize healthy behaviors but

00:38:22.180 they can't due to government regulations it's really amazing to me that all of them turned into

00:38:28.080 like mrs lovejoy from the simpsons and they all started going won't someone please think of the

00:38:34.220 safeway ceo like what are we doing incentives this i mean this became like a huge deal like

00:38:40.500 this safeway ceo basically did a like tour of capitol hill and met with a bunch of legislators

00:38:45.600 including obama and in 2010 when they were debating the the version of the affordable 0.97

00:38:51.860 care act that they had they included something called the safeway amendment shut the fuck up

00:38:57.000 that increased the incentives to 30 percent in 2014 the average cost of insurance for a worker

00:39:03.320 was six thousand five hundred dollars a year and the incentives are worth between two thousand

00:39:08.200 dollars and thirty two hundred dollars so like we're talking about a lot of money like that's

00:39:11.940 what my first car cost. Holy shit. So basically, I mean, this passed. This is in the Affordable 0.99

00:39:17.300 Care Act. I'm curious about in your research of this, did you find much in the way of critiques

00:39:23.240 of not how workplace wellness programs sort of are implemented or regulated, but critiques of

00:39:30.120 the existence of or the structure of workplace wellness programs? Not until later. What was

00:39:36.840 really frustrating in the reading for this episode was how much the cost logic seemed to

00:39:42.180 dominate everything. How much return do you get for like this dollar of investment? I mean,

00:39:46.420 there's a million of these and there's like a million estimates of this, but qualitative

00:39:51.400 research of like, what are these programs and what does it feel like? And what are some of

00:39:56.980 maybe the unintended harms of these? Almost nothing. It's fascinating to me too, because

00:40:02.060 i think this is one of the major narratives that drives our understanding of and response to fat

00:40:07.760 people in the world fat people are most frequently discussed as a cost right and nowhere in those

00:40:16.540 conversations writ large is anyone going i wonder how fat people feel about this or right i wonder

00:40:23.180 if this is making things better or worse for them right so people instead of having a conversation

00:40:28.340 that is in any way grounded in anyone's humanity or in anyone's like actual needs and responding

00:40:33.520 to those needs or anything, those are treated not only as immaterial, but as distractions

00:40:38.940 from solving the real problem, which is an economic problem.

00:40:43.040 So before we debunk everything that we just went over, we're going to talk a little bit

00:40:46.700 about like the harms that have emerged and like the forms of these programs that are

00:40:51.280 like really shitty and have started to proliferate.

00:40:53.480 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.

00:41:05.720 This is the kind of qualitative experience that just nobody is interested in for like years.

00:41:12.940 Good.

00:41:13.800 Quote, Terry suffers from diabetes. 0.97

00:41:16.400 And although she passed all five fitness tests, she didn't meet the body mass index of 24.

00:41:22.960 As a result, her employer imposed an increase in her family's insurance premium from $175 to $320 a month.

00:41:31.980 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.

00:41:41.960 Since Terry's employer refused to exempt her from the BMI target and required her to work with a trainer outside of working hours,

00:41:48.880 terry was required to pay out of pocket for all these sessions and she continues to pay

00:41:54.940 significantly more for her family's health insurance a financial burden not placed upon

00:42:00.140 other employees yeah yeah i can fix it for terry so you basically have somebody who's like she has 0.54

00:42:07.000 diabetes and she's paying more yeah this is exactly the scenario that three different laws now

00:42:14.260 have sought to avoid right so like any person with a chronic illness will be able to plug in

00:42:20.480 somewhere to this story but i would also like to propose that any person who has given birth

00:42:25.800 and cared for an infant can also fucking plug into this story and go hey imagine if your employer

00:42:31.540 said on top of caring for an infant you also need to show up with a personal trainer a number of 0.98

00:42:39.020 times a week and pay for it out of pocket get the fuck out of here there's also an interesting

00:42:44.660 sentence here where it says terry's employer refused to exempt her from the bmi target 0.93

00:42:49.800 so in hipaa it says that if you're not able to participate in these wellness programs

00:42:56.400 you get an exemption right so if your workplace is doing one of these things where you get a bonus

00:43:01.600 for doing 10 000 steps a day and you're in a wheelchair obviously you can't participate in

00:43:06.240 that so you get an exemption however it didn't define who's qualified for an exemption what an

00:43:13.120 exemption counts as when it should be offered etc it just says like employers should offer an

00:43:18.380 exemption but what we find in the real world is that oftentimes when employees ask for exemptions

00:43:24.840 hey i have another job i can't do 10 000 steps they're often not given them because they're not

00:43:30.280 considered to be a quote-unquote real reason jesus this is an excerpt from a very good legal analysis

00:43:35.220 of all three of these laws that I read

00:43:37.920 and how they relate to workplace wellness programs.

00:43:40.780 And you can like hear the exasperation in this paragraph.

00:43:44.640 It says, wellness programs are difficult to reconcile

00:43:47.720 with a number of federal laws

00:43:49.520 that aim to restrict employers' ability to discriminate

00:43:52.260 among their employees in the provision of health insurance.

00:43:55.180 After all, the point of wellness programs

00:43:58.480 is to discriminate those employees

00:44:00.840 who adhere to the wellness program,

00:44:02.860 whether by filling out a detailed health assessment,

00:44:04.660 taking a blood test or attending smoking cessation courses pay less for their health coverage those

00:44:09.520 who do not pay more yeah it's this amazing article that's just like a legal scholar 0.93

00:44:15.600 looking at all this shit and being like guys i think this is illegal that quote the point of 0.98

00:44:23.200 these programs is to discriminate is a real say it louder for the people in the fucking back 0.99

00:44:28.840 that's what they do that is what they are here to do so the last like excerpt from our emails that 0.95

00:44:35.840 i want to read there's aubrey there's so much here there's like so much that we're going to 0.82

00:44:40.700 cover in the bonus episode these these programs are so fucking trash but one of the the main 0.96

00:44:45.640 things that we heard especially from fat listeners was the sheer cancerousness of weight loss 0.98

00:44:53.680 contests yeah the number of workplace biggest loser competitions that are out there make me

00:45:01.200 want to like just barf myself to death i don't even know i'm so so bad repulsed this is just

00:45:08.440 one of the emails that we got i've been with the same company for 20 years and the last five there

00:45:14.580 has been some sort of get healthy new year's resolution last year it was a diet bet if you're

00:45:20.920 not familiar, it's done via an app. A group creates a diet bet. Everyone puts their money in

00:45:26.900 and the people who hit their goal weight at the end split the pot. As one of the few fat people 0.74

00:45:32.900 at my workplace, it was 1000% expected that I would participate. I did not because eating disorder

00:45:39.980 and also fuck all of that. Our listeners are cool. But it's only $10. Don't you want to get 0.99

00:45:44.860 healthy with us, you'll feel so much better. You would be so inspirational to everyone.

00:45:50.600 Not kidding about that last one. Finally, it started without me, but for the two months it

00:45:56.020 went on, no one would shut up about their food and exercise measurements and weight,

00:46:01.180 alternately talking about what they were going to eat when it was over, calling it a lifestyle 0.97

00:46:05.700 change, crowing about feeling so much better, and quietly crying because they were fucking hungry. 0.89

00:46:11.880 all jokes aside it was awful and stressful and the amount of side eye i got for eating normal 0.96

00:46:18.260 amounts of food led me to never again eating anything in front of co-workers still don't

00:46:24.320 maybe i was imagining it but it felt like waves of anger coming from a starving mob that might

00:46:30.780 in fact push me down a flight of stairs for my lunch do not do this to people in the workplace

00:46:36.200 not eating in front of people is such a deep fat people thing yeah and it is a direct result of how

00:46:45.160 other people treat you and it is also a thing that is a direct path to eating disorder behavior or

00:46:50.540 eating disorder relapse behavior is like hiding your food or eating in private or in secret right

00:46:56.520 yeah fat people do that not because of some internal drive maybe sometimes but overwhelmingly 0.96

00:47:02.660 that is prompted by direct behavior from people in their lives like that's fucking horrible i'm so 0.97

00:47:10.260 sorry to this listener i'm i'm breaking my own rule and reading one more because i can't help 0.89

00:47:14.380 myself great good this is a really awful one i feel like it's such a like perfect example of why

00:47:18.600 these are so bad a couple years ago we had an open cubicle where someone would bring in treats and

00:47:23.280 there was a coffee maker too someone had put a scale on the floor and posted a food diary slash

00:47:29.480 chart to track their intake. I posted a paper near it saying this is a communal food space and

00:47:34.660 having the scale and food diary is inappropriate and could be upsetting for people experiencing

00:47:38.840 eating disorders. I did it anonymously because I didn't want to be the fat lady complaining

00:47:43.180 about a scale. I was able to overhear when someone reported it to the manager who then

00:47:48.020 talked to HR. I saw the email response from HR to the manager and their stance was basically

00:47:53.020 if someone has an eating disorder they need to report it and get an accommodation. What

00:47:57.380 would an accommodation for that even be yeah so this is another thing that comes up in a lot of 0.98

00:48:03.040 the emails that we got from fat people and disabled people was that these workplace wellness programs

00:48:07.180 even though technically they are supposed to provide exemptions for people who can't or don't 1.00

00:48:12.420 want to participate what they do is they make you disclose disabilities to your manager one lady who

00:48:19.200 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

00:48:25.140 bathroom a lot but like that's not something you necessarily want to disclose to your manager who's 0.80

00:48:30.240 in charge of like promotions and shit like this is an invitation to discriminate against people 0.96

00:48:36.560 like hi there there's this thing that people get discriminated against a lot and i have it well and 0.59

00:48:41.480 also like to the email that you sent to me about the person doing this diet bet business you don't

00:48:48.700 need an exemption from that that is a voluntary program this person opted out and it still made

00:48:54.580 things fucking horrible for them exactly listen i understand that this is not the legal definition 0.94

00:48:59.340 but like i would interpret on an emotional personal level all of this shit as an extraordinarily 0.99

00:49:05.980 hostile workplace oh super duper yeah and it's this hostility that's like what's your problem 0.98

00:49:12.260 it's fun yeah it puts you in this position where you have to be like this isn't fun for me totally

00:49:16.960 it feels like there's something about that like come on we're just having a good time that feels

00:49:22.180 like an echo of what alcoholics will describe when they tell someone they're not going to drink

00:49:27.540 right right people go come on loosen up it's just one drink blah blah and i'm like why are you so

00:49:33.520 invested in overriding this person's own decision about how to relate to this situation yeah it is

00:49:40.400 really astonishing and feels like again there are these moments around fatness and disability and

00:49:47.380 a number of these issues where even the most thoughtfully sort of relational people, even the 0.99

00:49:53.420 people with the sharpest interpersonal radars, will just turn their fucking brains off when it 0.98

00:49:58.800 comes to this issue and go, it's for your own good. Why aren't you grateful? We're just having 0.98

00:50:03.660 a good time. I'm just concerned about your health, which is why I have to keep ignoring what you're

00:50:08.620 directly asking me not to do and do it anyway. So we've talked about some of the harms of these

00:50:15.380 programs but we should also say on the other hand there is no evidence that they work at all

00:50:21.420 so at least in fairness they might be entirely useless completely useless at best so the first

00:50:29.320 thing we need to debunk of everything we've gone over in the history of this is that safeway was 0.94

00:50:34.400 fucking lying yeah there we go yeah so it turns out that safeways health care costs did in fact 0.76

00:50:44.140 decrease they decreased in 2006 three years before they launched their workplace wellness program 0.98

00:50:50.800 because they shifted a bunch of the costs to employees yep they did what every major employer

00:50:57.840 was doing at that time right which is breaking it to their employees that they were gonna have

00:51:02.220 to chip in like hundreds of dollars a month for something that was previously free or way lower

00:51:07.500 cost so it's like they raise your deductible they have different like yearly limits like a lot of

00:51:12.280 employers do this in like this sneaky way also when they said in that excerpt that it was like

00:51:19.140 our non-union health insured employees it turned out to be something like two percent of their

00:51:26.320 workforce right non-union either means they have such a low level of hours that they're not 0.96

00:51:31.900 represented right or it means their fucking management and either way that's not a representative 0.99

00:51:38.240 picture so just complete bullshit the most amazing and frustrating thing about this is that 0.99

00:51:43.400 the washington post investigation that reveals all of this and like interviews some like sub 0.73

00:51:49.360 ceo person at safeway who's like oh yeah we were lying just like oh yeah when we said that we were

00:51:56.740 lying basically all of that came out months before the affordable care act was passed so like when 0.98

00:52:03.900 the Safeway amendment was put into the law, we knew that Safeway was fucking lying. And it just 0.97

00:52:09.160 didn't matter. The second thing that we know now and pretended not to know then is that none of

00:52:15.300 these programs really work. So I read a million like meta-analyses, whatever, of like the weight

00:52:21.100 loss stuff. This is a paragraph from Health Affairs that I feel like either one of us could

00:52:26.860 fucking lip sync along to it says a meta-analysis of seven trials found that workplace financial

00:52:33.980 incentives were associated with a mean weight loss of 0.88 of a pound at 12 months and 1.5 pounds at 0.87

00:52:41.860 18 months and a weighted mean gain of 4.2 pounds at 30 months although none of the results were

00:52:49.460 significant great i love the like little like hey guys here are all the amazing results none of them

00:52:55.520 are significant right there's another meta-analysis that finds a reduction of 2.8 pounds after 12

00:53:04.120 months which if you look at the average weight of like you know the average american it's something

00:53:08.740 like 175 pounds so this is a two percent weight loss great good good good good also none of the 0.96

00:53:16.140 money saving like three dollars for every dollar you spend none of that shit pans out so there's 0.64

00:53:21.920 a 2013 health affairs study that says program savings may not in fact derive from health 0.92

00:53:28.240 improvements instead they may come from making workers with health risks pay more for their 0.77

00:53:33.700 health care than workers without health risks fucking gross charging them more there's a 2013

00:53:40.500 rand study that says at this point in time there is insufficient objective evidence to definitively 0.93

00:53:46.200 assess the impact of workplace wellness on health outcomes and cost good in 2018 there's yet another

00:53:52.740 health affairs meta-analysis that says we conclude that these programs increase rather than decrease

00:53:59.220 employer spending on health care with no net health benefit the programs also cause over

00:54:05.640 utilization of screening and checkups put undue stress on employees and incentivize unhealthy 0.98

00:54:11.020 forms of weight loss it's not just discriminatory it's also ineffective wonderful shit i want to 0.94

00:54:17.700 talk briefly about why these don't appear to work there's four reasons why none of this shit has 0.92

00:54:24.840 panned out the first is selection bias if you go through google scholar and you just type in like

00:54:31.660 workplace wellness program most of them show that it works like there's one from home depot that

00:54:37.500 works. There's one from Pepsi that works. There's one from IBM that works. But the problem with all

00:54:41.540 of these is that they're voluntary to participate. Yeah. So what you have is you have really low

00:54:46.900 participation rates. The IBM one only has 4.8% of the workforce participates. There's one at the

00:54:54.800 University of Illinois where 25% of people participate the first year, but then it's down

00:55:00.320 to 10% by the second year. What these are basically doing is they're selecting for people

00:55:05.960 who are already quote-unquote healthy to begin with so like someone like me like i already go

00:55:12.440 to the gym if my workplace says like oh we're gonna pay your gym membership and you have to

00:55:17.500 you know go to three zoom meetings a year and we'll pay 90 bucks a month for your gym membership

00:55:21.360 tax-free i'd be like yeah sure totally but it's like i'm somebody who already has a gym membership 0.88

00:55:27.740 i am also somebody who would not go to a fucking gym not because i don't enjoy to do any of the 0.89

00:55:34.280 things that happen at a gym but because aside from a very few and very select exceptions gyms 0.99

00:55:42.700 are like terrible fucking places to be as a fat person like the social experience of being at a 0.96

00:55:49.000 gym means maybe somebody takes your picture because they think it's funny to watch you working 1.00

00:55:53.680 out maybe somebody else feels pity for you and thinks that the best thing they could do for you

00:55:58.220 is go good for you keep it up you'll get there and on top of that if you also had any kind of

00:56:05.600 mobility issues if you also had any specific accessibility needs you couldn't and wouldn't 0.97

00:56:11.080 take that discount because it doesn't fucking work for you because the gym doesn't fucking 0.81

00:56:15.360 work for you so basically when you go back and you reanalyze the numbers from all of these like 0.96

00:56:20.280 it worked studies what you find is that most of the people who have lower health care costs

00:56:25.040 after the program had lower health care costs before the program right because these are people

00:56:29.080 without chronic illnesses and disabilities and stuff they're like the the quote-unquote healthy

00:56:33.040 people anyway so all you're really doing is giving more money to the healthy people so that's reason

00:56:38.420 one that these don't work the second reason this like doesn't fit the format all that well but i

00:56:43.900 just wanted to talk about it with you because it's hella funny great most of the studies are based

00:56:48.220 entirely on self-report data which as we've discussed in the show 10 000 times is just like

00:56:54.600 complete fucking garbage so there's a couple of actually like genuinely well-designed studies 0.96

00:57:00.180 that are randomized there's one at a warehouse company that is an 18-month program and people 0.99

00:57:06.500 are randomized either in it or not in it so it's like a pretty good design and at the end of 18

00:57:12.600 months they find that the only difference between treatment and control is a higher proportion of

00:57:20.060 people who reported engaging in regular exercise and who reported actively managing their weight.

00:57:27.600 The study did not affect cholesterol levels, hypertension, obesity, absenteeism, or performance

00:57:34.200 reviews. So the measurable, the stuff that we can measure. Right. So what it does do is make more

00:57:41.700 people tell us what we told them we wanted to hear. Exactly. We would pay them if they told

00:57:47.600 us those things but then this is something we come across all the fucking time on this podcast 0.99

00:57:52.620 these studies will say like well it affected these like totally bullshit indicators and it 0.60

00:57:58.420 didn't affect these real indicators and what we set out to do so the findings are mixed

00:58:04.200 right it's like so the conclusion of this study says that the program affected self-reported

00:58:11.960 health behaviors but not health or economic outcomes may be interpreted in several ways

00:58:17.160 given that workplace wellness programs focus on changing behavior and that behavior change may

00:58:22.020 precede improvements in other outcomes these findings could be consistent with future

00:58:26.940 improvements in health or reductions in spending listen man the checks in the mail just hasn't

00:58:32.740 gotten to you yet don't worry about it but then okay listen to this i this is maybe one too many

00:58:37.940 examples but i like to have it on the record so this is the conclusion of a huge like also fairly

00:58:44.560 well-designed randomized control trial at the university of illinois that that was called i

00:58:51.400 thrive and because it's like the mid-2000s it's like a little i like ipod like good good amazing

00:58:58.580 good good so the study finds essentially no benefit other than this like self-reported garbage

00:59:04.060 and no effect on like actual measurable health metrics.

00:59:07.060 So this is the conclusion.

00:59:08.440 It says, does this mean that employers

00:59:10.580 should abandon wellness programs?

00:59:12.600 It depends on what they're trying to achieve.

00:59:14.820 Workers seem to value the benefit

00:59:16.220 and were more attuned to the importance

00:59:18.320 of healthy behaviors and made efforts to act accordingly.

00:59:21.420 If employers are seeking to add benefits that workers value

00:59:24.340 or to attract the type of worker

00:59:26.000 who appreciates those benefits,

00:59:27.660 the programs may be worth it.

00:59:29.140 But if the goal is to save money

00:59:31.400 by reducing healthcare costs and absenteeism

00:59:33.840 or to improve chronic physical health conditions,

00:59:37.120 there is little evidence that this type of program

00:59:39.160 delivers the desired results.

00:59:41.160 So if you want to tell people that this works, great.

00:59:45.900 If you want to do something that works.

00:59:48.120 Well, I also like that it's like,

00:59:49.460 well, employees report X, Y, and Z things.

00:59:51.600 And I'm like, yeah, employees report liking

00:59:54.440 not having to spend extra hundreds of dollars every year.

00:59:58.820 The obvious conclusion from this 1.00

01:00:01.080 is that these programs are fucking bullshit. 1.00

01:00:03.840 And they don't do anything. 1.00

01:00:05.060 But all of these papers refuse to reach the obvious conclusion.

01:00:09.760 They're just like, well, you know, if you're looking for something that manages health care costs and makes people healthier, I don't know if this is the right thing for you.

01:00:17.040 It's like, well, then why are we doing it?

01:00:18.120 What other reason is there to do it?

01:00:19.680 You know what this episode feels like to me?

01:00:23.060 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.

01:00:32.120 and then finally they end up on an awning and the awning gives way or whatever this feels like that

01:00:37.640 as a logic model for policy making where it's just like just like every possible justification

01:00:45.680 for these programs has been pulled away from them right like every possible support that these could

01:00:52.120 have had have been taken away and now they're just like somehow levitating in mid-air they're still

01:00:56.860 there but wait there's more oh no mike so most of what we've gone over so far is reasons why

01:01:03.160 workplace wellness programs are bad this isn't really one of them this is more just why workplace

01:01:08.320 wellness programs don't work why they don't make people healthier or save employers money uh-huh

01:01:13.320 workplace wellness is a like wildly grifty sector yeah because the hipaa law refused to impose any

01:01:22.880 standards on the industry, right? These don't have to be backed up by science. So there's an entire

01:01:29.400 sector that is like workplace wellness consultants, right? These are usually done

01:01:34.200 through third party firms. And there's essentially no regulation of the content of these programs.

01:01:39.740 So a lot of these firms are basically like used car salesman shit. They bring like weird gurus 0.99

01:01:45.280 into the workplace. One person who wrote us said they had to be on a Zoom call with somebody who

01:01:51.020 said that you have to drink six glasses of water every day because if you don't you start circulating

01:01:56.460 dirty water like in your body hey man you gotta flush out your boiler every week otherwise you're

01:02:04.240 gonna start circulating rusty water through there wow one of the first baseline things that you have

01:02:09.800 to do to get these monetary incentives is to go get a health risk assessment screening right so

01:02:14.160 the idea is you get an incentive for like going and having an annual physical and then that allows

01:02:19.960 you to identify things before they become big problems. As a principle, this sounds totally

01:02:24.560 uncontroversial, right? Go get a health screening every year. Great. The problem is there's no

01:02:29.400 actual standards for what constitutes an annual physical. Excellent. Even within like the medical

01:02:35.380 field, this isn't very well defined. And secondly, these grifty ass workplace wellness consultants 0.95

01:02:41.040 are sending people to get these weird fucking tests for rare, strange conditions. So there's 0.99

01:02:49.080 reports of people like having their kidneys removed because they tested positive for some

01:02:54.460 sort of like kidney blood disease something something but it's just a false positive god

01:03:00.340 this is like your workplace wellness program as designed by elizabeth holmes and i don't want to

01:03:06.460 overstate this or make people think that getting a physical is always a bad idea the literature

01:03:10.880 seems to say that if you have a condition that needs to be monitored obviously you should regularly

01:03:17.680 see a doctor and if you're somebody who hasn't seen a doctor in a while right so a lot of poor

01:03:22.800 people in america do not have regular contact with the health care system yeah basically if

01:03:27.480 there's a reason to go to the doctor like go to the doctor right but what we're talking about in

01:03:33.000 these workplace wellness programs is quote-unquote healthy people going to see a doctor every single

01:03:39.220 year and the more people do that the more they increase their chances of like testing positive

01:03:44.060 for something. So the central problem with the incentives here is that these workplace wellness

01:03:50.120 consulting firms want to demonstrate to the employers that like they're having value,

01:03:55.220 right? So there's a Nebraska program that says we prevented, there was like 400 cases of colon

01:04:00.380 cancer. And like, oh, look, look, we're, you know, we're prolonging the life of your employees. And

01:04:05.540 like, look how great this is. But later on, it turns out that the firm was just faking their

01:04:09.320 data shut the fuck up the problem with the u.s health care system is because it's a fee-for-service

01:04:14.520 model people only get paid if they're providing a service so oftentimes people go in and the 0.97

01:04:20.120 doctor's like oh you need to come back next week for this thing and we're going to screen you for

01:04:23.380 this just in case and some of what gets called like over treatment in america is like actually 0.64

01:04:29.200 treatment for people and this is like a kind of a fucked up and like ableist narrative but also

01:04:34.940 there is a lot of overtreatment in the US healthcare system. So basically, you're just 0.89

01:04:40.220 like shunting people into these like grifty sectors that are going to do a bunch of weird 0.85

01:04:44.800 fucking tests and produce a bunch of positives and then have a bunch of weird follow up procedures 0.59

01:04:49.580 that like might not actually be necessary. Well, and that also seems less like an issue of 0.99

01:04:54.040 overtreatment and more like an issue of bad treatment from people who should have to have

01:04:59.520 some kind of qualification, right? It shouldn't be going through the like, beware of dirty water

01:05:04.280 people. Those people should not be involved. Yeah, that's right. So the last reason why these 1.00

01:05:10.320 don't work is basically the wellness paradigm itself. Throughout the 1970s and 1980s, as we

01:05:17.480 were getting this wellness model, we were getting this list of lifestyle risk factors that affect

01:05:24.220 chronic illness. And what happened is we started conflating the risk factors for causes. Yes.

01:05:31.400 What you hear a lot is that obesity is a risk factor for heart disease, right?

01:05:35.960 So that makes you think that, well, if we reduce the obesity, we'll reduce the heart

01:05:40.760 disease.

01:05:41.360 But that doesn't actually turn out to be true.

01:05:44.540 So a lot of these studies find that fat people cost more to treat in their health care than

01:05:50.280 skinny people overall.

01:05:52.180 However, their costs do not go down when they lose weight because it is not necessarily

01:05:57.660 the fat that is causing the health problems.

01:06:00.120 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.

01:06:19.660 Well, and to this point about overtreatment 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.

01:06:45.460 Right. Also, the costs of treatment of fat people are also kind of the costs of our assumptions about what being fat means about your health. Right.

01:06:53.300 And also, it also doesn't acknowledge the actual reasons that are driving US healthcare spending. So a lot of healthcare 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. And all of these kind of these factors that we associate with chronic illness, they only account for about 20% of healthcare spending.

01:07:19.820 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.

01:07:43.140 We are saying that we care about costs.

01:07:45.060 We are never looking at a balance sheet. 1.00

01:07:46.880 We're just going, it's got to be fat people and disabled people. 1.00

01:07:50.480 Get them out of here. 1.00

01:07:51.580 So I want to end with the one area where this does work and then a happy ending.

01:07:58.000 Tell me.

01:07:58.500 The only aspect of workplace wellness that I could find that's effective appears to be these smoking cessation programs.

01:08:05.440 Oh, interesting.

01:08:06.280 They're not like the most effective, mostly because quitting smoking is just really hard and the relapse rates are high.

01:08:12.380 But like, yeah, people who are enrolled in smoking cessation programs have higher rates

01:08:17.280 of quitting.

01:08:18.700 But what's interesting once you read the studies on this is it's not the fact that

01:08:22.600 they're like workplace quit smoking programs.

01:08:25.780 They're just quit smoking programs.

01:08:28.380 Yeah.

01:08:28.540 All of the stuff about, you know, the posters in the workplace or having your boss involved,

01:08:33.840 having your employer as some sort of participant in you quitting smoking really doesn't add

01:08:39.460 anything.

01:08:40.600 So even if you do believe that they work, they work for people who have like high paying jobs

01:08:47.220 with really good health benefits. But if we just had universal health care,

01:08:51.920 hospitals could just provide it to people who needed it.

01:08:55.060 I actually think that smoking is such a great example of like the original sin of these,

01:09:00.580 because, you know, smoking is very well established as like a behavior that is really bad for you.

01:09:05.460 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 why would my employer be anywhere within 50 feet of this decision of mine to keep smoking?

01:09:23.300 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.

01:09:44.360 We as a country keep refusing that very clear lesson like time and time and time again.

01:09:50.460 right people seem weirdly surprised that a health intervention designed to only reach thin rich

01:09:57.300 people with office jobs i was like wait what do you mean it's not working hang on

01:10:02.560 so the happy ending of this episode we get so few of these oh what a twist basically people 0.72

01:10:11.440 fucking hate these programs and there's like a massive backlash a huge number of the people 0.60

01:10:17.820 who wrote into us did like tiny acts of resistance like a lot of people numerous people put their 1.00

01:10:25.240 weight as like 50 pounds they're like fuck you my bmi is like nowhere near any of your business 0.98

01:10:34.840 i am 5 10 50 pounds fuck you yeah yeah yeah yeah yeah good good job and then what i liked to see 0.99

01:10:43.700 is that there's finally starting to be articles 0.99

01:10:47.240 about workplace wellness programs

01:10:48.740 that aren't just doing the like fake confusion thing.

01:10:51.600 Like, oh, weird.

01:10:52.340 It turns out that like nobody lost weight

01:10:54.060 on a weight loss program.

01:10:55.680 There's an academic article called

01:10:57.920 Employers Should Disband Employee Weight Control Programs.

01:11:01.680 Good.

01:11:01.880 Like people are finally coming to the obvious conclusion

01:11:05.800 from years of data that just like, 0.99

01:11:08.860 these suck and shouldn't exist. 0.97

01:11:10.620 They're totally unjustifiable. 0.97

01:11:11.900 we implemented them on extremely thin information the evidence is wildly consistent now they don't

01:11:19.500 work they suck they're making things worse for everybody let's not do this anymore yeah and on 0.71

01:11:25.100 top of all that they're not only discriminatory they're not only proudly discriminatory but they 0.98

01:11:32.200 are developed for the purpose of discriminating and that's their main selling point exactly if

01:11:39.240 they work that is what this is not a case of like oh we've really been bamboozled into thinking that

01:11:45.440 this thing is okay no everyone's been saying the quiet part loud this entire time right yeah i mean

01:11:52.860 i think i'm so glad to hear that there is some kind of emerging like oh wait a minute we should

01:11:59.180 stop this but aubrey how else are we gonna know about all the dirty water

01:12:09.240 Thank you.

Maintenance Phase - December 20, 2022

Workplace Wellness

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