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Do Workplace Wellness Programs Work?

Addressing the COVID-19 pandemic is by far the most pressing health policy issue of the day. But when we get through this crisis, we will still be left with the epidemics of chronic conditions, such as diabetes, heart disease, and obesity. Focusing on health care alone is likely to be insufficient. Healthy diets, regular exercise, and other health behaviors are key levers for managing these conditions—but progress on these dimensions has proved difficult to achieve. There has been a great deal of enthusiasm for workplace wellness programs as a way to help increase awareness and improve health behaviors—and, ultimately, improve health. Many adults spend most of their waking hours at work, so it is a promising setting for trying to foster behavior changes that need to be implemented day in, day out. Most privately insured people get their insurance through their jobs, so employers have a stake in this. Workplace wellness programs might result in a healthier, more productive workforce and lower health insurance costs. All of this has led the administration of workplace wellness programs to be a thriving, multibillion-dollar industry. Most large employers have some wellness program, though the content of these programs varies widely, as do the financial stakes involved. There are many claims that these programs result in lower health care costs, lower worker absenteeism, and more. But are these claims justified? Comparing only the health and employment outcomes of people who participate in workplace wellness programs with those who do not can be very misleading. When an employer offers a free gym membership, for example, people who take up the offer tend to be—unsurprisingly—people who like to go to the gym. The free membership is great for those gym users but may not change their behavior much. In other words, self-selection means that people who participate in the wellness program probably work out more than people who do not participate, but it is not because of the offer of the free gym membership. This is of course a very naive way to look at the data, and there are many studies that deploy more sophisticated approaches to account for confounding factors. For example, some studies compare companies that have wellness programs with those that do not—which is a better approach but still presents a potentially muddied picture because the type of companies that implement such a program may be different (or have different workforces) from those that do not. Overall, many of these studies1 have suggested that wellness programs might reduce costs and improve productivity, but limitations in the body of evidence made it difficult to assess the true effect of the programs themselves. Thanks to a partnership with BJ’s Wholesale Club, Zirui Song, MD, PhD, of Harvard Medical School and I had the opportunity to assess the effects of an employer wellness program using a clustered randomized controlled design. Among 160 BJ’s clubs—each an individual worksite—we randomized 25 to the treatment group (in which an on-site wellness program was made available to employees) and 135 to the control group (in which employees were not offered such a program). Comparing outcomes at those worksites shows the effect of the wellness program itself because other individual characteristics that might affect outcomes (such as preexisting exercise patterns) were balanced between the 2 groups. Working with the wellness vendor Wellness Workdays, we implemented a multifaceted wellness program for employees in the treatment group (the 25 randomly selected treatment-group clubs, with more than 7000 employees), whereas workers in the control group (the remaining clubs, Author affiliations and article information are listed at the end of this article.