A hostof studies over the years have provided conflicting results abouthow effective wellness programs are. (Photo: Shutterstock)

Workplace wellness programs have become an $8 billion industryin the U.S. But a studypublished Tuesday in JAMA found they don't cut costs for employers,reduce absenteeism or improve workers' health.

Most large employers offer some type of wellness program — with growth fueled byincentives in the federal Affordable Care Act.

A host of studies over the years have provided conflictingresults about how well they work, with some showing savings andhealth improvements while others say the efforts fall short.

Related: Survey says: Wellness pays off for recruitment andretention

Many studies, however, faced a number of limitations, such asfailing to have a comparison group, or figuring out whether peoplewho sign up for such wellness programs are somehow healthier ormore motivated than those who do not.

Now researchers from the University of Chicago and Harvard mayhave overcome these obstacles with one of the first large-scalestudies that is peer-reviewed and employs a more sophisticatedtrial design.

They randomly assigned 20 BJ's Wholesale Club outlets to offer awellness program to all employees, then compared results with 140stores that did not.

The big-box retailer employed nearly 33,000 workers across all160 clubs during the test.

After 18 months, it turned out that yes, workers participatingin the wellness programs self-reported healthier behavior, such asexercising more or managing their weight better than those notenrolled.

But the efforts did not result in differences in healthmeasures, such as improved blood sugar or glucose levels; how muchemployers spent on health care; or how often employees missed work,their job performance or how long they stuck around in theirjobs.

“The optimistic interpretation is there is no way we can getimprovements in health or more efficient spending if we don't'first have changes in health behavior,” said one study author,Katherine Baicker, dean of the Harris School of Public Policy atthe University of Chicago. (Dr. Zirui Song, an assistant professorof health policy and medicine at Harvard Medical School, was itsco-author.)

“But if employers are offering these programs in hopes thathealth spending and absenteeism will go down, this study shouldgive them pause,” Baicker said.

The study comes amid widespread interest in wellnessprograms.

The Kaiser Family Foundation's annual survey of employers found that 53 percent ofsmall firms and 82 percent of large firms offer a programin at least one of these areas: smoking cessation, weightmanagement and behavioral or lifestyle change. (Kaiser Health Newsis an editorially independent program of the foundation.)

Some programs are simple, offering gift cards or other smallincentives to fill out a health risk assessment, take alunch-and-learn class or join a gym or walking group. Others arefar more invasive, asking employees to report on a variety ofhealth-related questions and roll up their sleeves for bloodtests.

A few employers tie financial incentives to workers actuallylowering risk factors, such as high blood pressure or cholesterol —or making concerted efforts to participate in programs that mighthelp them do so over time.

The Affordable Care Act allowed employers to offer financialincentives worth up to 30% of the cost of health insurance, leadingsome employers to offer what could be hundreds or even thousands ofdollars off workers' deductibles or premiums to get them toparticipate. That led to court challenges about whether those programs are trulyvoluntary.

In the study reported in JAMA, the incentives were modest.Participants got small-dollar gift cards for taking wellnesscourses on topics such as nutrition, exercise, disease managementand stress control. Total potential incentives averaged $250. About35% of eligible employees at the 20 participating sites completedat least one module.

Results from those workers — including attendance and tenuredata, their self-reported health assessment and results from labblood tests — were specifically compared with similar reports from20 primary comparison sites where workers were not offered thewellness gift cards and classes. Overall employment and healthspending data from all worksites were included in the study.

Wellness program vendors said details matter when consideringwhether efforts will be successful.

Jim Pshock, founder and CEO of Bravo Wellness, said theincentives offered to BJ's workers might not have been large enoughto spur the kinds of big changes needed to affect healthoutcomes.

Amounts of “of less than $400 generally incentivize thingspeople were going to do anyway. It's simply too small to get themto do things they weren't already excited about,” he said.

An accompanying editorialin JAMA noted that “traditional, broad-based programs like the oneanalyzed by Song and Baicker may lack the necessary intensity,duration, and focus on particular employee segments to generatesignificant effects over a short time horizon.”

In other words, don't give up entirely on wellness efforts, butconsider “more targeted approaches” that focus on specific workerswith higher risks or on “health behaviors [that] may yield largerhealth and economic benefits,” the editorial suggested.

It could be, the study acknowledges, that 18 months isn't enoughtime to track such savings. So, Baicker and Song also plan topublish three-year results once they are finalized.

Still, similar findings were recently reported in anotherrandomized control trial conducted at the University ofIllinois, where individuals were randomly selected to be offeredwellness programs.

In one interesting point, that study foundthat wellness-program participants were likely already healthierand more motivated, “thus a primary benefit of these programs toemployers may be their potential to attract and retain healthyworkers with low medical spending.”

Everyone involved in studying or conducting wellness agrees onone thing: Changing behavior — and getting people motivated toparticipate at all — can be difficult.

Steven Aldana, CEO of WellSteps, a wellness programvendor, said that for the efforts to be successful they must cutacross many areas, from the food served in company cafeterias toincluding spouses or significant others to help people quitsmoking, eat better or exercise more.

“Behavior is more complicated than simply taking a few wellnessmodules,” said Aldana. “It's a lifestyle matrix or pattern you haveto adopt.”

Kaiser Health News isa nonprofit news service covering health issues. It is aneditorially independent program of the Kaiser Family Foundation,which is not affiliated with Kaiser Permanente.

Read more: 

• Is your wellness program full of tricks ortreats?
• Successful wellness programs start at thetop
• Real ROI is hard to find: Valuing employeewellness