Workplace wellness programs — employer-sponsored efforts to reduce health care costs by traditionally encouraging workers to lose weight, eat better, exercise more and reduce stress — are now an $8 billion industry in the United States. According to data from the Kaiser Family Foundation, almost 90% of large employers in the United States have some kind of employee wellness program programs that cover more than 63 million employees. About half of those programs offer free screenings for body mass index (BMI), cholesterol, blood pressure and other health markers. The incentives to stay healthy are wide-ranging, from subsidized health classes to insurance discounts to cash payouts for meeting certain goals such as quitting tobacco use.

But are they working?

A number of studies over the years have provided conflicting results, with some showing savings and health improvements while others say the efforts fall far short. In perhaps the largest study on the subject, the University of Chicago and Harvard University collaborated on a research project in 2019 — published in JAMA — that tracked nearly 33,000 employees at BJ’s Wholesale Club, many of whom were participating in the company’s workplace wellness program. The study did find that workers enrolled in the wellness programs self-reported healthier behaviors than those not taking part, such as exercising more or managing their weight better. But those efforts did not result in any significant differences in health measures, such as improved blood sugar, how much employers spent on health care or how often employees missed work. Their job performance and how long they remained in their jobs also seemed unaffected.

One person who is firmly convinced that most workplace wellness programs are failing to meet their goals is Elizabeth Ablah, Ph.D., MPH, a professor of population health at the University of Kansas School of Medicine-Wichita.

“I honestly believe that most of these programs are fairly useless,” Ablah said. “Not only do the majority of them not work, but they can also actually do harm in some cases.”

Why are they falling short? Ablah and other health experts cite a number of reasons, including:

• A lack of employee engagement: If employees are not motivated or interested in participating, the program is unlikely to produce meaningful results.
• Inadequate communication: If employees are not aware of the program's benefits or how to participate, they are less likely to engage.
• Insufficient resources: Some wellness programs may lack the necessary resources, such as funding, time or dedicated personnel, to effectively implement and sustain the program.
• A one-size-fits-all approach: Most wellness programs are not tailored to the specific needs and interests of the particular workforce.
• Unrealistic expectations: Expecting immediate or dramatic improvements in employee health and productivity can lead to disappointment.
• Lack of leadership support: When leadership is not actively involved or supportive of the wellness program, it can signal to employees that the program is not a priority.
• Overemphasis on biometric outcomes: Wellness programs that heavily rely on biometric measurements (e.g., BMI, cholesterol levels) may miss important aspects of employee well-being, such as mental health and work-life balance.
• Short-term focus: Wellness programs that focus solely on short-term outcomes, such as weight loss challenges, may not address the broader health and well-being needs of employees over time.
• Lack of evaluation: Without regular evaluation and feedback, it can be challenging to determine the effectiveness of a wellness program and make necessary adjustments.

Ablah was so concerned about the apparent lack of effectiveness for most workplace wellness programs that she spent years studying where the programs fall short and how they can be improved.

Ablah said it was around 2011 when she and some colleagues began studying workplace wellness initiatives and concluded that the major ity of those programs were not leading to any real behavioral changes for participants and any reduction in health care costs for employers.

“We started going to conferences and reading up on the policies, systems and environmental changes contained in most workplace wellness initiatives,” Ablah said. “Although the intentions of the programs were good, real cultural changes around health weren’t happening. The programs had the information to help employees, but they usually returned fairly quickly to unhealthy behaviors.”

That research led Ablah to develop and launch the first iteration of WorkWell KS in 2011, a workplace wellness initiative designed to create healthier worksites in Kansas through worksite implementation of policies, systems and environmental best practices. The Kansas Health Foundation, the Kansas Department of Health and Environment and Blue Cross Blue Shield Kansas helped fund the initiative.

From the start, Ablah believed that most employee wellness programs are ineffective primarily because they target individual changes rather than wider systemic workplace changes. When she started developing WorkWell KS, she wanted to prioritize the workplace as a whole instead of the workplace’s individual employees.

Ablah said when you look at an entire institution — rather than zeroing in on its individual employees — the initiative has the potential to be more effective with longer lasting health improvements. And approaching the workplace in its entirety can allow for adjusting the wellness initiative, so it is tailored specifically for that particular workplace.

“When a worksite signs up for WorkWell KS, we have the employers complete an assessment that tells us what they are already doing at the worksite,” said Melinda Chenault, MPH, a research associate with WorkWell KS. “We then meet with them and get a feel for their culture so we can advise them on next steps. We have also created additional resources for worksites if needed and will dive further into the research if there is a specific question that needs to be answered.”

For example, Chenault said one WorkWell KS client was concerned about the high turnover rate among its younger workforce, so she looked into the evidence of why this might be the case and how the employer could address it. One of the things Chenault’s research into this dilemma discovered was a possible lack of resilience among younger employees and a need for social connectedness. WorkWell KS shared an 8-week resilience training program with the employer that it had already created for other worksites in partnership with Turning Point of The University of Kansas Health System and the Masonic Cancer Alliance of The University of Kansas Cancer Center and discussed strategies to help employees feel more connected at the worksite.

Tackling one behavior at a time

There are other ways that WorkWell KS is different from more established employee wellness programs.

“Some of the interventions we studied try to tackle multiple health behaviors— such as physical inactivity and sedentary behavior, stress and poor mental health, unhealthy foods and beverages — at the same time,” Ablah said. “With WorkWell KS, we knew from the literature and from worksites in Kansas that it would be more effective for worksites to focus on one health behavior at a time. This way, worksites can implement a more comprehensive set of interventions that fully address that one behavior to create lasting health changes.”

The WorkWell KS curricula Ablah and her team came up with is built around three modifiable behaviors — tobacco use, poor access to nutritious foods and beverages, and physical inactivity — that have major implications for health and wellness. They also look at the overall well-being of employees:

• Tobacco use raises the risk for many adverse health effects, including reproductive health outcomes, cardiovascular diseases, chronic obstructive pulmonary disease (COPD) and cancer. Smoking places a substantial financial burden on smokers, healthcare systems and society. Smoking cessation can reduce this burden, including smoking-attributable healthcare expenditures.
• Poor access to nutritious foods and beverages is a major factor in an unhealthy diet. When healthy foods are not available, people may settle for foods that are higher in calories and lower in nutritional value. Low-income and minority communities often lack convenient places that offer affordable healthier foods. Poor diets can lead to chronic illnesses such as heart disease, type 2 diabetes and obesity.
• Physical inactivity can lead to heart disease— even for people who have no other risk factors. It can also increase the likelihood of developing other heart disease risk factors, including obesity, high blood pressure, high blood cholesterol and type 2 diabetes. The Centers for Disease Control estimates that about 50% of all adults are failing to get enough aerobic physical activity.
• Well-being can lead to lower health care costs, reduced absenteeism and improved productivity. This can be achieved through reducing stress and promoting a culture of encouragement and compassion in the workplace.

The WorkWell KS curriculum is built around a 3-4-80 formula. There are three modifiable behaviors (tobacco use, poor access to nutritious foods and beverages and physical inactivity) that contribute to at least four chronic diseases (heart disease, type 2 diabetes, lung disease and some cancers), which in turn contribute to approximately 80% of the premature deaths in the United States.

To address these modifiable behaviors, a WorkWell KS strategic framework was developed to guide workplaces to first build a solid worksite wellness foundation consisting of five elements: a wellness committee, exercising leadership, communications, incentives and data.

Once this foundation is established, worksites are then encouraged to develop a comprehensive, multi-strategy intervention, focusing on one health behavior at a time. WorkWell KS collaborates with employers on determining which behavior they want to address first. The WorkWell KS staff then works with the employers on tailoring a strategy to provide employees with effective tools to counter that unhealthy behavior.

“When people realize they actually have a stake in creating a healthier worksite, that’s powerful.”

- Elizabeth Ablah, Ph.D., MPH

We never say to companies, ‘Here is our initiative…good luck,’” Ablah said. “The vast majority of the time, our interventions are implemented in stages, and we provide technical assistance and training throughout. There are check points where we see how they are doing and what questions they have and challenges they are having so we can make modifications, if needed.”

Evaluating success

Monarch is one of more than 950 workplaces across Kansas that utilized WorkWell KS to help establish or improve their wellness initiatives. While anecdotal success stories like those from Monarch are nice, Ablah said when she was designing WorkWell KS, she wanted to not only develop interventions based on evidence-based best practices, but she was also committed to continually collecting data to determine the effectiveness of the program and where adjustments needed to be made. Ablah said they are constantly gathering data on the program’s effectiveness.

There has been some published research on WorkWell KS though. In October 2023, the Journal of Occupational and Environmental Medicine published a study that attempted to determine the extent to which the WorkWell KS’s Building the Worksite Wellness Foundation workshops can assist worksites in developing their wellness infrastructure. The study found that on average, worksites that participated in the workshops and completed both assessments made significant improvements in establishing a wellness committee, exercising leadership, establishing wellness communications infrastructure, identifying incentives of interest to employees and using data to inform their initiatives. A study published in 2020 about an earlier iteration of WorkWell KS by the same journal had similar results.

In the meantime, Ablah and her team continue to work to promote WorkWell KS to employers large and small across Kansas.

“When people realize they actually have a stake in creating a healthier worksite, that’s powerful.”