Alternatives to monetary incentives for employee weight loss.

Employers are increasingly interested in improving employee health, with the goals of reducing health care costs and increasing productivity. As of 2010, 74% of employers who offered health insurance also offered a wellness program, and the prevalence is increasing. However, there is vigorous debate about whether employee wellness programs actually work to improve health. Although proponents assert that welldesigned programs can benefit employers and employees, many raise concerns about weak study designs (e.g., lack of control groups) in research on employee health programs and argue that their effectiveness is greatly overstated. Nonetheless, wellness programs have been given a boost by the Affordable Care Act (ACA). The ACA funds several programs to help companies initiate wellness programs, and allows employers to incentivize employees with monetary rewards and penalties. Previously, employers could entice employees to join a wellness program by offering as much as a 20% reduction in their health insurance premiums. With passage of the ACA, this incentive can be up to 30%. Wellness programs can take various forms, such as smoking-cessation groups, walking programs, or online programs that include setting and achieving personal health goals. One approach that is increasingly being used to incentivize employees is to pay employees (through insurance rebates) for achieving weight, cholesterol, or blood pressure goals. In response, concerns have been raised that these programs will result in unhealthy employees subsidizing healthy employees’ health care costs and may unfairly discriminate against people with obesity. In addition, this approach does little to effectively improve public health, given that such initiatives do not address the strong forces of the obesogenic environment: