Abstract
The purpose of this research was to retrospectively examine whether demographic differences exist between those who participated in an employee wellness program and those who did not, and to identify the selection of employees' choice in weight management activities. A nonequivalent, 2-group retrospective design was used. This study involved employees at a large, not-for-profit integrated health system. Of the total organization employee pool (29,194), 19,771 (68%) employees volunteered to be weighed (mean body mass index [BMI]=28.9) as part of an employee wellness program. Weight management activities available included: (1) Self-directed 5% total body weight loss; (2) Healthy Solutions at home; (3) Weight Watchers group meetings; (4) Weight Watchers online; and (5) Employee Assistance Program (EAP)-directed healthy weight coaching. Measures were participation rate and available weight management activity participation rate among obese employees across demographic variables, including sex, age, race, job type, and job location. The analysis included chi-square tests for all categorical variables; odds ratios were calculated to examine factors predictive of participation. Of the total 19,771 employees weighed, 6375 (32%) employees were obese (defined as BMI ≥30); of those, 3094 (49%) participated in available weight management activities. Participation was higher among females, whites, those ages >50 years, and non-nursing staff. In conclusion, participation rate varied significantly based on demographic variables. Self-directed 5% weight loss was the most popular weight management activity selected. (Population Health Management 2016;19:132–135)
Introduction
O
Enrollment and participation are imperative for the EWP programs to be successful; however, participation rates among employees for worksite wellness programs are less than 50%. 5,6 At Aurora Health Care, Inc. (Aurora) more than one third of the employees are obese. To help reduce the health care cost of obese employees, Aurora implemented an employee wellness program that incentivizes employees for actively trying to lose weight. The purpose of the study is to identify factors leading to participation such as sex, age, race, job type, and job location, as well as to understand what types of available weight management activities are likely to be selected. These predictors were selected to identify who is participating in the wellness program.
Methods
Design
This study utilized a nonequivalent, 2-group retrospective design (ie, participants and nonparticipants) examining demographic predictors of participation as well as participation rates in weight management activities offered within an EWP at a sizable health care system.
Sample
This research project was conducted within a large not-for-profit health care system employing approximately 29,194 employees in Wisconsin, and was considered a quality improvement project by the system's Institutional Review Board. A total of 19,771 employees volunteered to be weighed in order to qualify for a $350 financial weight-related incentive (wellness credit) that was subtracted from the employee's deductible.
Measures
The 2 main outcome measures in the study were: (1) participation rate in the EWP (weigh-in and wellness credit), and (2) the proportion of obese individuals who participated in and completed at least 1 of the 5 weight management activities. Other measures included sociodemographics and employment factors (general vs. management, and staff vs. nurse) potentially predictive of weight management activities participation.
Intervention
In January 2013, Aurora announced its EWP, incentivizing employees to be weighed in to qualify for a $350 reduction of their annual insurance premium (ie, wellness credit). In total, 19,771 employees participated by being weighed-in from January 2013 to March 2013. If the employee was obese (ie, body mass index [BMI] ≥30), he or she would not receive the wellness credit unless he or she completed one of the alternative wellness activities. The health care organization offered 5 alternative wellness activities (Table 1), and each program lasted 12 weeks. There were 2 options, including lose 5% of body weight and the Employee Assistance Program (EAP) behavioral coaching, that were no-cost options; the other 3 options had a cost to employees associated with them. Successful completion of the intervention involved finishing the 12-week program that was chosen by the employee. Employees could participate in more than 1 activity; however, for this brief report, only the option that participants successfully completed was used for these analyses.
HMR, Health Management Resources.
The organization also subsidized a portion of each activity that had a cost for the participant. Aurora reimbursed 25% of the cost of all wellness activities that had a cost associated with them. There was no cost to the participant for the self-directed weight loss and EAP programs. The 12-week cost for participants of Weight Watchers online was $60, the cost of Weight Watchers Group was $150, and the cost of Health Management Resources was $1200. Table 1 displays the available weight management activities.
Analyses
Chi-square tests of group differences were conducted to compare the proportion of individuals participating or not in each available weight management activity. Also, odds ratios were computed to examine the influence of various potential sociodemographic and employment characteristic predictors of weight management activity participation. An alpha level of 0.05 was used for all statistical tests. All statistical analysis was performed using SAS version 9.2 (SAS Institute Inc., Cary, NC).
Results
The average BMI of all wellness credit employees was BMI=28.9 (SD=6.74). The incentive conformed to the Affordable Care Act's health contingent program requirements. 6 Of the 19,771 volunteer employees who were weighed, 6375 were obese (32%). Of these, 3094 (49%) participated in EWP available weight management activities. Of these participants, 2463 (80%) employees participated in no-cost options as compared to the options that had a cost associated with them. As shown in Table 2, the participation rate was higher for females than males, which is likely because there were more female employees; age >50 years compared to ≤29 years; white compared to nonwhite; and non-nursing staff compared to nursing staff. All of these relationships were statistically significant at P<.0001. However, the participation rate was similar for urban (47%) versus rural (45%) employees (P=0.39), and general staff versus managerial staff (P=.99). The mean BMI was similar for weight management activity participants and nonparticipants whereas the mean age was higher for participants in the program (P<.001). As presented in Table 3, odds ratios revealed that participation in the EWP showed that female sex, age category (50–59 and 60–69), white, and non-nursing staff were more likely to participate in the program. The concordance index (area under receiver operating characteristic) for the regression model was 0.61. A very important finding in this study is that most employees chose activities that had no additional participation costs. Another important finding for a health care system is that fewer nursing staff participated than all other staff members.
P<.05; ** P<.01; *** P<.001; **** P<.0001.
P<.05; ** P<.01; *** P<.001; **** P<.0001.
CI, confidence interval; OR, odds ratio.
Note: The sample size for analyses was less than the total number of employee participants because of missing data.
Discussion
This study revealed several differences in the participation and completion of available weight management programs in an EWP. Women participated and completed the EWP more than men, blacks more than whites, and employees aged 40–69 years more than those ≤29 years (referent group), with those aged ≥50 years overall participating the most. Furthermore, non-nursing staff participated more than nurses. This may be related to shift work, the demands of patient care, staffing models, or other explanations, but needs to be explored further. By examining the participation rates and selection patterns of available weight management activities, the research team has concluded that this EWP, and potentially others, must attract the younger population as well as ethnic minorities and men. This may mean offering additional weight management activities.
The workplace can be a lever for social and attitudinal change in employees, particularly in the sphere of health and wellness. 7 Reinforcing healthy behaviors in employees has the potential to curb rising health care costs. The research team believes it is best practice to offer employees multiple minimal or no-cost choices to engage in wellness programs, because greater numbers of employees will participate in these options, as seen in this study.
Limitations
The study design did not lend itself to a control group, though non-enrolled employees were compared using demographic data. Those employees who were already motivated to lose weight may be a self-selected group who participated in the EWP. Direct contact with the employees was not possible because this study was conducted using de-identified data.
Conclusion
Health care cost expansion is unsustainable for payers; employers are searching for innovative solutions. Employers need a way to improve health and reduce health care costs. It is essential to end obesity, and one way this can be done is through an incentivized EWP.
Footnotes
Author Disclosure Statement
Drs. Fink, Smith, Singh, and Cisler, and Mr. Ihrke declared no conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors received no financial support for the research, authorship, and/or publication of this article.