Weight-loss programs attempt long-term behavior change

Although recent data from the Centers for Disease Control and Prevention showed an encouraging drop in the obesity rate among young children, overall obesity rates remain unchanged. The CDC reports more than one-third (34.9%) of U.S. adults are obese. Maintaining a healthy weight and battling obesity-related conditions such as heart disease, diabetes and high blood pressure remain a priority for many organizations.

For the Government Employees Health Association, the effort to engage plan members and change behavior started with messaging. In 2009, the GEHA started using DPS Health’s Virtual Lifestyle Management, an online weight management program that helps improve obesity-related health outcomes.

“We have to reach them with a message that speaks to them, then provide education in relevant, manageable bites,” says Kathy Ross, manager of care management at GEHA, the second-largest national health plan for federal employees and retirees. “Provide an opportunity to track current food intake and weight and see the changes, build relationships through personalized coaching, and then given people enough time to work the plan so that it becomes a way of life.”

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According DPS Health founder and chief medical officer Dr. Neal Kaufman, program uses evidence-based approaches for obesity prevention and “takes those approaches and puts them into a different delivery mechanism.” Kaufman, who spent 27 years in academic medicine at the UCLA Schools of Medicine and Public health, says the virtual lifestyle management program looks to affect change among moderate risk groups of employees, which include individuals that have three or four chronic conditions such as high blood pressure, high cholesterol, pre-diabetes, arthritis and sleep apnea.

“[These are] conditions that are causing increased cost, not because the person is actually very sick, it’s because they are seeing the doctor often, getting a lot of medication to control their condition and using a lot of durable medical equipment,” Kaufman explains.

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Currently, the GEHA covers about 620,000 lives in its medical plans and the target outreach for the virtual lifestyle management program is about 50,000 members who are obese or who have at least one chronic illness related to diabetes.

The program’s interventions translated into a reduction in paid claims by $1,049 per enrolled member in 2011 and $2,495 per enrolled member in 2012 when compared to pre-intervention periods, Ross says.

Kaufman says that a lot of the success comes from the program’s “structured flexibility” process that permits individuals to customize actual interventions. Typical programs call for 16 weekly lessons to start and eight monthly lessons after the initial start. One coach typically helps 40-50 people per year.

VLM is based off the National Institutes of Health’s Diabetes Prevention Program, which found that high-risk populations can delay or avoid type 2 diabetes by losing weight.

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“GEHA, like other payors, is interested in reaching members who have early disease, but are not yet seeing the impact of the disease,” says Ross. “We feel there is opportunity to engage this group now and delay progression of disease and decrease the long-term costs associated with co-morbidities.”

Online vs. in-person

Finding the right balance between online and in-person meetings in workplace weight-loss programs has been a challenge from the start. Weight Watchers International, Inc., a name synonymous with weight loss, looks to engage diabetes patients through its Weight Watchers for Diabetes program. 

“Weight Watchers is tried and true, and has the most sustainable weight loss results out there,” says Christy Pearson, chief operating officer of human resources at Orlando Health. “We also liked the fact that people didn’t have to purchase special food to participate in Weight Watchers, and they had a digital and in-person option.”

Orlando Health, based in central Florida, has 13,000 employees at six different hospital locations. It was the first organization to sign up to the new Weight Watchers Health Solutions program, which plans to offer the services of a certified diabetes educator to complement the company’s traditional weight loss program.

“People have questions about a variety of issues around  weight loss and diabetes, so it doesn’t mean you have to have a coach every day or every week for life, but that beginning part is really important,” says Gary Foster- co-chief science officer at Weight Watchers.

Geared at leveraging the more than 40,000 Weight Watcher meetings held weekly across the nation as well as online meetings, Foster says the Weight Watchers Health Solutions program is offered to employers with 5,000 or more employees.

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According to Pearson, the relationship with Weight Watchers, first established in January 2013, has seen some significant results, even though data linked to cost savings are still unavailable. Currently, 1,200 participants have lost a combined 11,000 pounds with Weight Watchers, both by using online and in-person meetings. Pearson says that online users have shed a few more pounds than those attending traditional meetings.

“When you do the math, it probably just makes the point that people using the online system can be as successful as those going to meetings,” she says.

But when calculating risk and health care costs, does it pay to target your programs to your workforce’s health conditions? Bruce Elliott, manager of compensation and benefits at the Society for Human Resource Management, says it does.

“Companies have begun to figure out that there is a [return on investment] to these plans,” Elliot says. Effective wellness programs, he adds, tend to have a “direct correlation to what’s going on in the health plan.”

“For instance, if you see in your health plan that you have a high instance of prescription for things like high cholesterol and hypertension, you may want to gear your wellness programs towards that and towards those populations,” he says.

Incentive vs. punitive

Common practices in the industry today include providing incentives for wellness program participation either through offering discounts to employees in their health plan, as well as penalizing employees – often through higher premiums – for not participating. According to Elliot, taking a punitive approach is a losing battle for employers, especially for self-insured companies. 

“You find that you will get a better result using a carrot as opposed to a stick,” Elliot says.

Alan Pollard, CEO of The Vitality Group, an incentive-based wellness provider agrees. “We tell [employers] to focus on some awards that we will put in front of [employees]. That in itself gives people motivation to start engaging in a healthier lifestyle,” he says.

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Right now, as the benefits of incorporating wellness to combat the impending effects of the ACA are argued, many employers are currently stuck in “the reward and punish mode,” says Barry Hall, a principal with Buck Consultants.

Hall believes that incentive-based wellness programs do little to affect behavior change.

“Frankly, I don’t think there’s a lot of data out there that says those methods are universally effective,” Hall says. “I think there are some examples where they have worked pretty well, and there are many more examples, at least from our research, where they’re not working as intended.”  

Hall explains that employers and health care providers need to move to the “next generation” of incentives and punitive methods in employee wellness efforts; this next phase all comes down to health culture.

“If you look at the companies who can tell a great story, how they’ve managed to get the metrics and manageable results, you’re going to see a difference in terms of the culture,” Hall says.