Weight-Focused ‘Workplace Wellness’ Programs Drive Stigma and Inequity—It’s Time to End Them

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After over a year, the COVID-19 pandemic is moving into its next chapter. Industrialized nations like the United States and the United Kingdom have started reopening, and deals are being brokered to bring more vaccines to more developing nations. For many of us, this means a much-needed return to our friends, our families, our daily lives, and our workplaces. But returning to in-person work can also mean returning to coworkers who are newly self-conscious of their size. It may also mean returning to anxious diet talk and overt weight stigma.

With both weight stigma and body dissatisfaction on the rise over the last 16 months, workplace wellness programs are poised for a postpandemic comeback. For the unfamiliar, workplace wellness programs are employer-run or employer-contracted programs that ostensibly aim to increase employee wellness. Many use holistic “wellness” language in their marketing, but ultimately, a plurality of these programs focus primarily on managing employees’ weights as measured by the deeply flawed body mass index. Among employers, wellness programs have a reputation for reducing health insurance costs. (Notably, though, research indicates that wellness programs may not actually produce those much-touted cost savings.)

For an example of how this kind of program may be structured, take Whole Foods. Like many grocery stores, Whole Foods offers its employees a 20% discount. But in 2010, the supermarket began offering an up to 30% discount to workers through their voluntary Healthy Discount Incentive program. A Whole Foods spokesperson tells SELF that employees can receive this increased discount by meeting a range of biometric benchmarks including BMI below a certain threshold, no nicotine use, low blood pressure, and low cholesterol. The Whole Foods spokesperson also emphasized that the program is voluntary, saying that its goal is to increase employees’ awareness of their health and help them to lead healthier lives. Whole Foods CEO John Mackey has repeatedly laid out his thinking on health care, arguing that weight and health are matters of personal responsibility. (The Whole Foods spokesperson did not comment on Mackey’s statements.)

At first blush, workplace wellness programs may seem harmless, or even altruistic, aimed at cutting costs and improving employees’ health. But data on the effectiveness of workplace wellness programs is largely imperfect and conflicting. In 2019, the Journal of the American Medical Association published the largest study of employer-driven wellness programs to date, tracking 32,974 employees at 160 worksites. Some were offered wellness programming; others weren’t. The results were mixed at best: “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.”

The impacts of workplace wellness programs aren’t just likely ineffective; they can also compound existing inequities. First, workplace wellness programs that focus on managing employees’ weights may directly increase the wealth gap between thin people and fat people. While the numbers vary, studies have repeatedly found profound gaps in income between fat and thin employees, with some research showing people with only slightly overweight BMIs making up to $9,000 less annually than their thinner counterparts. And according to the Centers for Disease Control and Prevention, Black, Latinx, and low-income Americans are among those most likely to be fat, which means that programs like these can disproportionately impact communities that are already marginalized. In a 2021 Society for Human Resource Management article, Soeren Mattke, M.D., D.Sc., physician, professor of economics, and director of the Center for Improving Chronic Illness Care at the University of Southern California in Los Angeles, said, “With unhealthy lifestyles and poor health more frequent in lower socioeconomic strata, such incentives, especially if they go beyond token amounts, shift costs to the most vulnerable employees. And that is not responsible stewardship.”

Workplace wellness programs can also stoke stigma in the workplace, inviting more hostility toward fat workers. Research shows that even limited exposure to messaging that frames fatness as an issue of public health or personal responsibility may directly increase prejudice against fat people. Weight-centered workplace wellness programs seem to be constructed around the idea that weight loss isn’t just possible; it’s a worker’s responsibility to their colleagues and employer. That’s likely to increase antifat bias and bigotry in the workplace—which, in turn, makes the simple act of going to work a stigmatizing one for many fat people.

For those with eating disorders, workplace wellness programs can make work a minefield. Workplace wellness programs don’t just normalize deeply triggering diet talk; they often prompt and celebrate it. For people with restrictive eating disorders, these conversations are indeed frustrating, but they can disrupt months or even years of work in recovery. And for many a relapse can be a matter of life or death. People with eating disorders shouldn’t have to choose between a relapse and a paycheck. But weight-centered workplace wellness programs encourage a diet-focused work environment that too often leaves workers with eating disorders to do just that.

Even programs that aren’t explicitly weight-focused, but instead focused on activity levels, biometric screenings, or other measures can feed into eating disorders, excessive exercise (sometimes called “exercise addiction”), and other disordered behaviors surrounding food and exercise. And programs that offer financial or health care incentives for meeting biometric targets tend to systematically disadvantage people who are already disabled or chronically ill. For example, those with advanced diabetes may not be able to meet a blood glucose target designed for nondiabetic people. Workplace wellness programs that center on step counts typically exclude those who use mobility devices, like wheelchairs or walkers. Holding them to the standards of nondisabled people isn’t helping their health—it’s ignoring their disability.

But even without these specific pressures on employees, conceptually, workplace wellness programs simply don’t hold water. They often ask employees to attain and maintain a “healthy weight” BMI—something that very fat women have a 0.8% chance of doing in our lifetimes. Overwhelming evidence indicates that nonsurgical weight-loss attempts simply don’t work, whether we call them diets, lifestyle changes, or cleanses. Workplace wellness programs ask their employees to do something that science simply doesn’t know how to accomplish: to maintain long-term, major weight loss. Which means that, functionally, many programs simply reward those who were already thin and penalize and scapegoat workers who were already fat.

Ultimately, many of these workplace wellness programs set to police individual behavior in the interest of an employee’s health, but only insofar as it financially benefits the employer. Altruistic as they may seem, this kind of workplace wellness program often winds up as a shrewd attempt to undercut employer-provided health care and lower costs—even if they harm workers’ health in the process.

Life is hard enough for workers of all kinds. Weight-focused workplace wellness programs could harm employees’ mental health in the short term, their physical health in the long term, and their pay in the immediate future. As we return to in-person work, let’s make the choice to decrease stigma and increase equity. Let’s leave workplace wellness programs in the past where they belong.

 

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