Ethics of Wellness and #247Health

Feb 22 2013 Published by under General Health

Since Science Online, I have been trying to summarize our session on Mobile Health, a discussion that raised more questions than it answered (like all good Science Online sessions). We started out with two major questions:

  1. How can we use smart phones and other mobile technology to improve health management?
  2. How can we harness this flood of data to learn more about health (and disease) without compromising privacy?

A number of ethical concerns came up, including who owns health data once it's logged? Who profits from data? How do we use these tools responsibly for mental health? Finally, how do we improve access if we do find that mobile health improves outcomes?

Yesterday I heard an interesting interview on NPR with Morgan Downey, an advocate for people with obesity and editor of the Downey Obesity Report. He discussed employee wellness programs:

Well, wellness programs come in two varieties: voluntary, participatory programs, where the employer may provide classes on smoking cessation or diet or lifestyle, maybe a membership in a gym - totally voluntary. And the rewards there are usually, you know, a baseball cap or tickets to a movie or a baseball game, or something like that.

The other type of program is a mandatory program where employees take a biometric, it's called - like blood pressure, for hypertension; like body mass index, for obesity - and set a target for what change they want to see. And if the employee meets the target, the employee would receive a benefit, an incentive. But if he or she doesn't, then they could be charged, in effect, up to 30 percent of their health insurance premium.

Click to enlarge

Click to enlarge

Corporate wellness programs are the new frontier and a prime method for generating profits in mobile health. The device I use, the Fitbit, clearly wants this market as shown in the picture. They promise that 88% of employees will take more steps with their tracking device; based on prior experiments with pedometers and other devices, I tend to believe this number. They then note that 69% of participants will improve their health. I have no idea what they mean by this statement. It could be some particular biometric parameter or merely a subjective reporting of health.

Given the number of hours we spend in the workplace, and the US employer-based insurance system, it makes sense that our bosses want us to improve our overall health. It is scary that what we pay for our benefits could depend on our performance in the gym.

Obesity treatment tops the list for most wellness programs. Certainly, excess body fat is associated with (and almost certainly causes) diabetes, cardiovascular disease, stroke, and other major causes of death and disability. Our treatment of obesity is not particularly impressive. A recent review of the medical evidence showed that most diets produced modest weight loss of 4-6 kg (8-13 lbs). All successful programs required calorie restriction of some sort, increased activity, and usually some sort of behavior modification. Most studies included less than 2 years of follow-up, so the long-term results are less clear. Modest weight loss can produce significant health benefits, even if the subject remains overweight. Will that accomplishment be sufficient for a corporate overseer? I have no idea. What if a participant regains the weight? Will there be financial penalties?

Right now I use my FitBit linked with a number of health apps to track my diet and exercise and other goals. I'm taking baby steps to my goals, but I am very glad that my employer is not following my efforts or linking my insurance rates to my success. I have enough to worry about with my job without making my fitness part of my career.

2 responses so far

  • Travis says:

    One thing that's worth noting is that if a person (with or without obesity) increases their level of physical activity, they will generally improve their health, whether or not there is any change in body weight. We also know that it's probably better to be "fat but fit", rather than skinny and unfit. So for those reasons I'd really rather that workplace wellness programs focus on behaviours that people *can* change (at least in theory) like eating well or being more active, and focus much much MUCH less on things like body weight or other outcomes which we just are not that good at managing.

    That's not to say that a program focusing on physical activity levels is going to be perfect (the idea of my boss monitoring my movement all the time seems a bit troubling), but I think that it will ultimately lead to more effective programs than ones that simply focus on body weight or other health outcomes.

    • Pascale says:

      I agree that the focus should be on something within the individual's control, like activity level. Even with an active lifestyle, extra pounds can be hard to shed (I can personally attest to that truth). Also, even with diet and activity changes, blood pressure may remain elevated and require medication.

      I also agree that my boss having access to m;y training and diet records sounds creepy. I certainly don't want that much information about folks I supervise.

Leave a Reply