[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.172.195.49. Please contact the publisher to request reinstatement.
[Skip to Content Landing]

Effect of a Workplace Wellness Program on Employee Health and Economic OutcomesA Randomized Clinical Trial

Educational Objective
To understand the benefits of a workplace wellness program.
1 Credit CME
Key Points

Question  What is the effect of a multicomponent workplace wellness program on health and economic outcomes?

Findings  In this cluster randomized trial involving 32 974 employees at a large US warehouse retail company, worksites with the wellness program had an 8.3-percentage point higher rate of employees who reported engaging in regular exercise and a 13.6-percentage point higher rate of employees who reported actively managing their weight, but there were no significant differences in other self-reported health and behaviors; clinical markers of health; health care spending or utilization; or absenteeism, tenure, or job performance after 18 months.

Meaning  Employees exposed to a workplace wellness program reported significantly greater rates of some positive health behaviors compared with those who were not exposed, but there were no significant effects on clinical measures of health, health care spending and utilization, or employment outcomes after 18 months.

Abstract

Importance  Employers have increasingly invested in workplace wellness programs to improve employee health and decrease health care costs. However, there is little experimental evidence on the effects of these programs.

Objective  To evaluate a multicomponent workplace wellness program resembling programs offered by US employers.

Design, Setting, and Participants  This clustered randomized trial was implemented at 160 worksites from January 2015 through June 2016. Administrative claims and employment data were gathered continuously through June 30, 2016; data from surveys and biometrics were collected from July 1, 2016, through August 31, 2016.

Interventions  There were 20 randomly selected treatment worksites (4037 employees) and 140 randomly selected control worksites (28 937 employees, including 20 primary control worksites [4106 employees]). Control worksites received no wellness programming. The program comprised 8 modules focused on nutrition, physical activity, stress reduction, and related topics implemented by registered dietitians at the treatment worksites.

Main Outcomes and Measures  Four outcome domains were assessed. Self-reported health and behaviors via surveys (29 outcomes) and clinical measures of health via screenings (10 outcomes) were compared among 20 intervention and 20 primary control sites; health care spending and utilization (38 outcomes) and employment outcomes (3 outcomes) from administrative data were compared among 20 intervention and 140 control sites.

Results  Among 32 974 employees (mean [SD] age, 38.6 [15.2] years; 15 272 [45.9%] women), the mean participation rate in surveys and screenings at intervention sites was 36.2% to 44.6% (n = 4037 employees) and at primary control sites was 34.4% to 43.0% (n = 4106 employees) (mean of 1.3 program modules completed). After 18 months, the rates for 2 self-reported outcomes were higher in the intervention group than in the control group: for engaging in regular exercise (69.8% vs 61.9%; adjusted difference, 8.3 percentage points [95% CI, 3.9-12.8]; adjusted P = .03) and for actively managing weight (69.2% vs 54.7%; adjusted difference, 13.6 percentage points [95% CI, 7.1-20.2]; adjusted P = .02). The program had no significant effects on other prespecified outcomes: 27 self-reported health outcomes and behaviors (including self-reported health, sleep quality, and food choices), 10 clinical markers of health (including cholesterol, blood pressure, and body mass index), 38 medical and pharmaceutical spending and utilization measures, and 3 employment outcomes (absenteeism, job tenure, and job performance).

Conclusions and Relevance  Among employees of a large US warehouse retail company, a workplace wellness program resulted in significantly greater rates of some positive self-reported health behaviors among those exposed compared with employees who were not exposed, but there were no significant differences in clinical measures of health, health care spending and utilization, and employment outcomes after 18 months. Although limited by incomplete data on some outcomes, these findings may temper expectations about the financial return on investment that wellness programs can deliver in the short term.

Trial Registration  ClinicalTrials.gov Identifier: NCT03167658

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Corresponding Author: Zirui Song, MD, PhD, Department of Health Care Policy, Harvard Medical School, 180A Longwood Ave, Boston, MA 02115 (song@hcp.med.harvard.edu).

Accepted for Publication: March 6, 2019.

Correction: This article was corrected on April 16, 2019, for data errors in the Abstract and Figure and for omissions to the Additional Contributions section.

Author Contributions: Drs Song and Baicker had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design, acquisition, analysis, or interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis, obtained funding, administrative, technical, or material support, and supervision: Both authors.

Conflict of Interest Disclosures: Dr Song reported no disclosures. Dr Baicker reported receiving personal fees from Eli Lilly outside the submitted work and reported serving on the board of directors of Eli Lilly.

Funding/Support: This work was supported by the National Institute on Aging (R01 AG050329; P30 AG012810 through the National Bureau of Economic Research), Robert Wood Johnson Foundation (grant 72611), and Abdul Latif Jameel Poverty Action Lab North America. BJ’s Wholesale Club provided in-kind logistical and personnel support for the fielding of the wellness program.

Role of the Funder/Sponsor: The funders had no role in the design or conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Additional Contributions: We thank José Zubizarreta, PhD, Harvard Medical School, for his statistical guidance and contributions to the sample weights, without financial compensation. We thank Sherri Rose, PhD, Harvard Medical School, for her statistical guidance on randomization, without financial compensation. We thank David Molitor, PhD, and Julian Reif, PhD, University of Illinois at Urbana-Champaign, for guidance on the statistical software for multiple inference adjustment they created in the University of Illinois wellness study, which was used in this study, without financial compensation. We thank Ozlem Blakeley, MA, an employee of Harvard Medical School, and Kathryn Clark, BA, BS, and Bethany Maylone, MEd, employees of the Harvard T.H. Chan School of Public Health, for research assistance and project management. We also thank Josephine Fisher, BA, Jack Huang, AB, Harlan Pittell, BS, and Artemis (Yuanxiaoyue) Yang, BA, employees of the Harvard T.H. Chan School of Public Health, for research assistance. We thank Luke Sonnet, BS, University of California, Los Angeles, for replicating the study results through the Abdul Latif Jameel Poverty Action Lab’s Research Transparency and Reproducibility Initiative, without financial compensation. We thank the study partners, BJ’s Wholesale Club, and Wellness Workdays for collaboration and assistance in the design and fielding of the workplace wellness program. We thank seminar participants at the 7th Conference of the American Society of Health Economists, the Department of Nutrition at the Harvard T.H. Chan School of Public Health, and the Department of Health Care Policy at Harvard Medical School for comments and suggestions, without financial compensation.

Data Sharing Statement: See Supplement 3.

References
1.
Kaiser Family Foundation. 2018 Employer Health Benefits Survey. https://www.kff.org/health-costs/report/2018-employer-health-benefits-survey/. Published October 3, 2018. Accessed February 19, 2019.
2.
Pollitz  K, Rae  M. Workplace wellness programs: characteristics and requirements. Kaiser Family Foundation. https://www.kff.org/private-insurance/issue-brief/workplace-wellness-programs-characteristics-and-requirements/. Published May 19, 2016. Accessed October 4, 2018.
3.
Mattke  S, Schnyer  C, Van Busum  KR. A review of the U.S. workplace wellness market. RAND Corporation. https://www.rand.org/pubs/occasional_papers/OP373.html. Published November 27, 2012. Accessed October 4, 2018.
4.
Baicker  K, Cutler  D, Song  Z.  Workplace wellness programs can generate savings.  Health Aff (Millwood). 2010;29(2):304-311. doi:10.1377/hlthaff.2009.0626PubMedGoogle ScholarCrossref
5.
Goetzel  RZ, Henke  RM, Tabrizi  M,  et al.  Do workplace health promotion (wellness) programs work?  J Occup Environ Med. 2014;56(9):927-934. doi:10.1097/JOM.0000000000000276PubMedGoogle ScholarCrossref
6.
Goetzel  RZ, Ozminkowski  RJ.  The health and cost benefits of work site health-promotion programs.  Annu Rev Public Health. 2008;29:303-323. doi:10.1146/annurev.publhealth.29.020907.090930PubMedGoogle ScholarCrossref
7.
Chapman  LS; American Journal of Health Promotion Inc.  Meta-evaluation of worksite health promotion economic return studies: 2005 update.  Am J Health Promot. 2005;19(6):1-11. doi:10.4278/0890-1171-19.4.TAHP-1PubMedGoogle ScholarCrossref
8.
Pelletier  KR.  A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VIII 2008 to 2010.  J Occup Environ Med. 2011;53(11):1310-1331. doi:10.1097/JOM.0b013e3182337748PubMedGoogle ScholarCrossref
9.
Fries  JF, Harrington  H, Edwards  R, Kent  LA, Richardson  N.  Randomized controlled trial of cost reductions from a health education program: the California Public Employees’ Retirement System (PERS) study.  Am J Health Promot. 1994;8(3):216-223. doi:10.4278/0890-1171-8.3.216PubMedGoogle ScholarCrossref
10.
Leigh  JP, Richardson  N, Beck  R,  et al; The Bank of American Study.  Randomized controlled study of a retiree health promotion program.  Arch Intern Med. 1992;152(6):1201-1206. doi:10.1001/archinte.1992.00400180067010PubMedGoogle ScholarCrossref
11.
Volpp  KG, John  LK, Troxel  AB, Norton  L, Fassbender  J, Loewenstein  G.  Financial incentive-based approaches for weight loss: a randomized trial.  JAMA. 2008;300(22):2631-2637. doi:10.1001/jama.2008.804PubMedGoogle ScholarCrossref
12.
Halpern  SD, French  B, Small  DS,  et al.  Randomized trial of four financial-incentive programs for smoking cessation.  N Engl J Med. 2015;372(22):2108-2117. doi:10.1056/NEJMoa1414293PubMedGoogle ScholarCrossref
13.
Volpp  KG, Troxel  AB, Pauly  MV,  et al.  A randomized, controlled trial of financial incentives for smoking cessation.  N Engl J Med. 2009;360(7):699-709. doi:10.1056/NEJMsa0806819PubMedGoogle ScholarCrossref
14.
Cahill  K, Hartmann-Boyce  J, Perera  R.  Incentives for smoking cessation.  Cochrane Database Syst Rev. 2015;(5):CD004307.PubMedGoogle Scholar
15.
Jones  D, Molitor  D, Reif  J. What do workplace wellness programs do? evidence from the Illinois Workplace Wellness Study. NBER Working Paper Series. 2018; 24229.
16.
Mello  MM, Rosenthal  MB.  Wellness programs and lifestyle discrimination—the legal limits.  N Engl J Med. 2008;359(2):192-199. doi:10.1056/NEJMhle0801929PubMedGoogle ScholarCrossref
17.
Ware  JE, Kosinski  M, Dewey  JE, Gandek  B.  How to score and interpret single-item health status measures: a manual for users of the SF-8 Health Survey.  QualityMetric Inc. 2001;15(10):5.Google Scholar
18.
DeMets  DL, Cook  T.  Challenges of non-intention-to-treat analyses.  JAMA. 2019;321(2):145-146. doi:10.1001/jama.2018.19192PubMedGoogle ScholarCrossref
19.
Zubizarreta  JR.  Stable weights that balance covariates for estimation with incomplete outcome data.  J Am Stat Assoc. 2015;110(511):910-922. doi:10.1080/01621459.2015.1023805Google ScholarCrossref
20.
Wang  X, Zubizarreta  JR.  Minimal approximately balancing weights: asymptotic properties and practical considerations.  Biometrika. 2017;103(1):1-22. doi:10.1093/biomet/asx011Google ScholarCrossref
21.
Hirshberg  DA, Zubizarreta  JR.  On two approaches to weighting in causal inference.  Epidemiology. 2017;28(6):812-816. doi:10.1097/EDE.0000000000000735PubMedGoogle ScholarCrossref
22.
Westfall  PH, Young  SS.  Resampling-Based Multiple Testing: Examples and Methods for P Value Adjustment. New York, NY: Wiley & Sons; 1993.
23.
Ozminkowski  RJ, Dunn  RL, Goetzel  RZ, Cantor  RI, Murnane  J, Harrison  M.  A return on investment evaluation of the Citibank, N.A., health management program.  Am J Health Promot. 1999;14(1):31-43. doi:10.4278/0890-1171-14.1.31PubMedGoogle ScholarCrossref
24.
Bly  JL, Jones  RC, Richardson  JE.  Impact of worksite health promotion on health care costs and utilization: evaluation of Johnson & Johnson’s Live for Life program.  JAMA. 1986;256(23):3235-3240. doi:10.1001/jama.1986.03380230059026PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Topics
State Requirements