Step It Up: A Blog About Employee Wellness Innovation

Last week, we announced Dr. Rajiv Kumar’s incredible study on how weight loss spreads through groups. Along with ShapeUp co-founder Brad Weinberg and a team of Brown researchers, Dr. Kumar proved that weight loss competitions like ShapeUp and The Biggest Loser are effective not just because they provide the framework for behavior change, but because weight loss is actually contagious among team mates.

But you know what else spreads like wildfire? Good news. And that must be why our study is everywhere! Click the links below to read several separate viewpoints on Dr. Kumar’s study, and then let us know what you think in the comments:

• WebMD
• The HuffingtonPost
• The Atlantic
• The Boston Globe
• Allure
• Cosmopolitan

WELCOA (Wellness Council of America) has just released the full transcript of a conversation between Dr. Rajiv Kumar and Dr. David Hunnicutt, the president of WELCOA and executive editor of Absolute Advantage, a national corporate wellness magazine.

The article answers the following questions:

Is exercise medicine?

How are employers being affected by the average American’s lack of exercise?

What is the benefit of focusing on prevention rather than treatment?

How does ShapeUp’s program help both employees and employers?

And this is just the beginning. To read the entire article, please click here to view the PDF.

We recently heard the good news from the peer-reviewed scientific journal Obesity that our latest study was accepted for publication. While not yet in print (you can view the temporary version online), I couldn’t wait to share the results with the world. In short, our study shows that social influence fuels weight loss and that when one person in a group loses weight, the others in the group are more likely to do so as well. In other words, one person’s weight loss spreads to others.

I co-authored the study, “Teammates and social influence affect weight loss outcomes in a team-based weight loss competition,” with prominent researchers Drs. Tricia Leahey and Rena Wing from the Weight Control and Diabetes Research Center, as well as my ShapeUp Inc. co-founder Dr. Brad Weinberg. The study was based on the results of Shape Up Rhode Island, a statewide, employer-based wellness program that I founded back in 2005 when I was a medical student. We looked at the weight loss outcomes for 987 teams made up of 3,330 program participants, the majority of whom were sponsored to participate as part of their employer’s corporate wellness program, over a twelve-week period in 2009.  Our findings provided further proof that health-related behaviors spread within social networks and that understanding the dynamics of peer-to-peer relationships is critical to successful health promotion.

The results showed us that overweight or obese participants who completed the program, which took the form of a weight loss and exercise competition, lost an average of 4.2% of their initial body weight. We learned that when an individual had a higher number of team members who were also trying to lose weight, weight loss outcomes were improved. We discovered that when a person reported that her team members had an influence on her weight, she was more likely to lose weight as well. In addition, the achievement of clinically significant (5%) weight loss tended to cluster within teams. In other words, participants were more likely to lose weight when their team members were also losing weight. Based on our findings, it has become even more clear that harnessing and maximizing influence within social networks may provide the key to enhancing behavior change and healthy outcomes in large-scale population health interventions.

What’s exciting for me is that all participants in the program utilized ShapeUp’s proprietary online wellness platform, which is also being used by hundreds of employers and hundreds of thousands of employees around the world. At ShapeUp, our company’s mission is “to create a healthier world by leveraging social influence to engage people in healthy activities.” This study is one more proof point that, in order to improve the health of a population, we must consider behavior change through a social lens that takes into account the fact that what one person does has real and measurable impact on the others in her social network. And it provides further evidence that the behavior change platform we’ve been building and improving constantly over the past 6 years truly works.

Below is a video of lead author Dr. Tricia Leahey discussing the results and their implications for population health.

 

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One of the topics we frequently discuss with our clients is the return on investment they can expect from using ShapeUp to improve the physical health of their employees. While just looking at physical health improvement doesn’t get anywhere near quantifying the full benefit of our program (increased productivity, improved morale, and higher employee retention come to mind), it does help provide a guideline from which the results can be measured by a CFO or an executive management team.

A handful of landmark studies have been conducted to determine the return on investment for employee wellness programs in general, including:

• Dr. Dee Edington’s findings in his 2006 study Association of Healthcare Costs with Per Unit Body Mass Index Increase. This study is broadly recognized as the industry standard, and using a population of nearly 36,000 employees, it showed that an individual’s body mass index (BMI) is highly correlated with medical and pharmaceutical claims costs. Even a slight decrease in an employee’s BMI of just one point is associated with a $202.30 decrease in medical and pharmaceutical claims costs over one year.
• Leonard Barry, Ann Mirabito, and William Baun published a study about Johnson & Johnson employees in the Harvard Business Review. They cited that J&J sees a return of $2.71 for every dollar spent on wellness.

But we at ShapeUp wanted our clients to know specifically about the ROI for our program. We know that our solution has been clinically proven to produce weight loss, healthy BMI shifts, and sustained behavior change, so we decided this would be the starting point for our analysis.

Clinically Significant Outcomes
Our employee wellness program has been studied by renowned weight loss expert Dr. Rena Wing, Ph.D, director of the Weight Control & Diabetes Research Center at The Miriam Hospital & The Warren Alpert Medical School of Brown University. Dr. Wing analyzed the results of thousands of ShapeUp participants and found that:

• Participants achieve approximately 5% weight loss, on average, in the first four months of the program
• 57.9% of participants in the program lose 5 or more pounds in this time
• 30.2% of participants lose 5% or more of their total body weight
• 7.3% of participants moved from the obese Body Mass Index (BMI) category to the overweight category
• The number of participants in the healthy BMI category increased by 8.5% within four months

Dr. Wing’s findings were published in Obesity, a peer-reviewed scientific journal. Following this analysis, though, Dr. Wing wanted to study if the results of our program lasted over the long term.

Sustainable Behavior Change Dr. Wing followed-up on her original study to see whether the initial participant weight loss was sustained over time. In the second round of research, Dr. Wing found that 73% of weight loss was maintained at the 10-month mark. It is suggested that sustained weight loss is a result of the supportive social environment that ShapeUp helps participants cultivate.  Dr. Wing proved that ShapeUp’s positive weight loss and physical activity results are contagious. Our team-based structure and social tools facilitate the spread of healthy behaviors from one employee to the next, and this has profound implications for transforming the health of an employee population (more on this from our chief medical officer coming soon to this blog).

Once we had the results that showed that ShapeUp’s program produced sustainable behavior change, we were then able to tie these changes to a return on investment for employers.

Return on Investment
To prove a return on investment associated with these clinically-significant weight loss and physical activity findings, ShapeUp partnered with an independent, third-party consultant to conduct a claims-based analysis on one of our largest client populations. This analysis found that our client’s spending on diabetes, hypertension, depression, and Crohn’s Disease decreased year-over-year among participants in the ShapeUp program. It was also found that medical and prescription costs decreased by $50 per year per ShapeUp participant while these costs for non-participants increased by $200, meaning that ShapeUp’s program contributed to a $250 reduction in health care costs per participant per year.

We’ve also collected more evidence of return on investment success with our program. We recently worked with OptumHealth—who identified our program as the best-in-class social wellness solution—to conduct a “Fall for Fitness” wellness challenge for all employees at UnitedHealth Group. The ROI analysis of this program (pdf) cites:

With more than 8,000 program participants achieving a one BMI point reduction, Fall for Fitness delivered significant value. According to OptumHealth’s analytics research validated by Emory University, a one-to-five percent body weight reduction is associated with approximately $140 per participant in annual medical expense savings. By that measure, we estimate that Fall for Fitness will generate a savings of over $1.2 million in cost avoidance.

While return on investment measurement for employee wellness programs is still in the early stages of development (you can see this from the comments in our annual Large Employer Wellness Survey), we’ll continue to advance the research in this field and work with our clients to define a quantifiable return for their wellness program investment.

While they offer employee wellness programs to drive high engagement and improve the health of their entire population, employers told us in our annual Large Employer Wellness Survey that they struggle to reach certain groups within their workforce. The inability to reach these groups represents a major hurdle for employers in their quest to build a company-wide culture of health.

Unhealthy, High-Risk Employees
It’s almost always the case that a small number of employees drive the vast majority of health care costs for large, self-insured employers. Unfortunately, employers find this group of people particularly difficult to engage with their current wellness programs. The people who need to hear the message the most are often the hardest to reach. Employers were fairly blunt about the problem.

“We need to educate our employees. In the first 6 months of this year we had another 58 pre-diabetic employees transition into diabetes.”
“We have an older population with an average age of 49 and it is 80% male. Most of them have lousy health habits and they don‘t go to the doctor. 25-30% of our population is high risk.”

Male Employees
It’s no secret that men take less care of their health than women. While males have higher rates of obesity than women in every single state in the nation, they are significantly less likely than women to admit they have a weight problem. That’s why Weight Watchers and Nutrisystem are spending so much money targeting their advertising specifically to men. Employers told us that they face the same challenges as these commercial programs.

“We are 70%+ male and an engineering organization – a tough population to get engaged with wellness.”
“Engagement is tough. Males in particular are very hard to engage.”

Remote & Offline Employees
Large, self-insured corporations rarely house all of their employees under one roof at corporate headquarters. Many employees find themselves working in small, remote offices. An increasing number of people are telecommuting from home on a regular basis. And of course, many of the largest employers are in sectors like retail, manufacturing, and transportation where employees don’t sit in front of a computer all day. Scattered and unplugged employees represent a major obstacle to wellness communication.

“It is always a challenge for us to reach everybody. We have a diverse workforce with many field sites or manufacturing sites. That‘s why on-site connection is important.”
“We have a vast majority of employees that don‘t have a computer but do need to lose weight.”

Global Workers
In the era of globalization, most of America’s largest employers have employees scattered around the world. But geographical, language, and cultural barriers make engaging global employees a challenging task. One size doesn’t fit all when it comes to a global workforce.

“We have a tough time because of the diversification of multiple cultures. Different cultures are harder to engage.”
“We have to think about the geographic nature of employees; what is culturally acceptable and what is unique and relevant for this country.”

The inability to communicate with large groups of employees is just one more on a long list of challenges that employers face when trying to improve the health of their workforce. In the coming months, ShapeUp will use this blog to highlight specific solutions—especially those driven by technology—that are reaching previously untapped audiences and offering real hope to employers that they can indeed engage all of their employees.

Want to learn more about the findings in ShapeUp’s employer wellness survey? Download the full report, watch the webinar, and check out the infographic.

In his second appearance on Healthy Business Radio, Dr. Rajiv Kumar, our fearless founder and chief medical officer, tells the story of how he started ShapeUp with his friend and fellow medical student Brad Weinberg, and details the philosophy behind both our technology and the work we do every day.

You may perhaps already be familiar with ShapeUp’s creation story, but during the interview Rajiv also speaks at length about some of our new, innovative, cutting edge developments, including our mobile capabilities, integration with best-in-class health apps and devices, “real time rewards” incentives strategy, and ground-breaking engagement numbers.

Alongside advice to leverage motivated employees, Dr. Kumar suggests that corporate wellness directors “relinquish control a little bit and give power to employees,” thereby crowd sourcing the most relevant employee wellness program possible. To hear more specific advice, and to learn about ShapeUp’s plans for the future, listen to the full interview below.

Since a key part of our business is making clients look good by helping them achieve their objectives, we asked in our Annual Employer Wellness Survey about what achievement would make a wellness program manager look like a hero in the eyes of his or her boss. Three major achievements rose to the top of the list: achieving high engagement, increasing exercise and weight loss, and reducing health care costs.

Achieving high engagement
Many employers focused in on the importance of reaching as many employees as possible and achieving maximum participation. These employers drew a line in their minds between participation and eventual outcomes, but viewed engagement as the sine qua non for ultimate success. They made statements including:

“Get 80% of our people engaged and really making a difference in their health.”
“We want our programs to make people excited about working for [our company]. In our space we need to build trust and build engagement.”
“It‘s about engagement – how to light a fire under people and get them energized.”

Increase exercise and weight loss
Several employers went beyond engagement and said they would be a hero if they could demonstrably increase physical activity and lower the overall prevalence of obesity within their population. These employers analyzed their employees’ medical claims and realized that conditions like diabetes, heart disease, and certain forms of cancer, caused in large part by lack of exercise and unhealthy eating, were driving the rise in health care costs. These employers told us exactly how they could earn superhero status with their boss:

“If I could change our obesity numbers which are at 46%.”
“If I could figure out how to make the population half the size. We‘re having remarkable success with smoking but weight loss is treading water.”
“If I figured out how to get everybody exercising and get people off the couch.”

Reduce costs
A few employers were thinking mostly about the end-game. They felt that they would be viewed as a hero not just for engaging their employees or getting them up off the couch but for producing measurable results in the form of cold, hard financial savings. Here’s what they said:

“If I could figure out a way to lower medical costs. Our budget goes up like clockwork every year. If you could keep it from going up or going up as much, it would be huge.”
“If I figured out how to decrease the health insurance premium.”
“Fix health care costs.”

Engagement, health outcomes, and cost savings each sit at various points, in sequence, on the same spectrum of wellness success. With engagement as the starting point, health outcomes fall in the middle, and the far end is where we find cost savings. While various employers focus on different parts of the spectrum, they’re united by the common outcome they’re all ultimately promoting: improving the health of their employee population.

Want to learn more about the findings in ShapeUp’s employer wellness survey? Download the full report, watch the webinar, and check out the infographic.

Corporate wellness program vendors – listen up! In our Annual Employer Wellness Survey, we asked companies what’s important to them when selecting a wellness program vendor and how they go about making their decisions. In a crowded marketplace, how do employers sort through the noise and zero in on solutions that will meet their needs? The top three vendor criteria mentioned were integration capabilities, flexibility, and innovation. Here are some examples of what they told us:

Integration Is Key
“We need someone who will play in the sand with us and who is willing to share and integrate with other vendors.”

Customization Matters
“We like to do a lot of customization. We want to know if a program will resonate with our employees.”
“I get frustrated when vendors tell me what I want. I want them to work with me to figure out what works best for my needs.”

Innovative Ideas Wanted
“I have some ideas on what we could be doing better but we‘re always looking for suggestions on how to improve.”
“We would welcome suggestions from what worked with other similar organizations.”
“We want creative vendors. We are forward-thinking in terms of wellness and we want to work with vendors who have the same mindset.”

We were also interested in how employers were manging their current vendors and if they had specific views on selecting one comprehensive vendor for their entire program versus carving up their program across multiple vendors.

Nearly all companies choose best-in-class vendors for lack of a satisfactory all-in-one vendor.
“We would like to use a one-stop shop, but we also understand the limitations of that. When a company gets too big, the quality goes down significantly.”
“Every vendor I speak with says that they can do anything. I don‘t think anyone can do that yet, so we are forced to piece a wellness program together.”

But companies cite managing multiple vendors and logistical issues as a major pain point.
“I would prefer to spend less time managing vendors and more time researching how to make our vendors better.”
“I spend a lot of time on damage control. There are always little incidents and people always go to HR with problem.”
“I spend too much time on logistical issues. We‘re not staffed to do logistical planning, implementation work or responding to escalations.”

It’s clear that vendor selection and management is a complex undertaking for large employers seeking to improve the health of their employee populations. And these employers have set a very high bar for vendors who want to work with them. Wellness vendors are not only being asked to be flexible and innovative but also to be responsive, easy to work with, and to help reduce the workload for wellness program managers. It’s a tall order, which means that few companies will qualify to play. But those that listen to what employers want and focus on providing the best service to their clients will ultimately win the game.

Are you sitting down? You may want to, cause we’ve got some big news:  ShapeUp is now fully integrated with Fitbit. We know, it’s a lot to take in. So let’s break it down for you.

Fitbit is a health gadget. Arguably the best health gadget there is. It is worn like a pedometer but does oodles more; aside from tracking steps, it can account for distance walked, activity intensity, sleep quality, and flights of stairs climbed. It is a bit of a genius.

And now ShapeUp participants get to use the Fitbit in the service of both their personal health and team challenges. Our software is now fully integrated with Fitbit’s, meaning that Fitbit wearers registered through ShapeUp will have their steps and exercise minutes automatically logged into the platform through any Fitbit charger, which doubles as a wireless hotspot. No need to sign in! No need to type a single keystroke! Just put on your Fitbit and walk some miles. All data from Fitbit devices will be 100% accurate, making it a reliable alternative to self-reported results.

There are four ways Fitbits are accessible to ShapeUp users:

1. Participants already own a Fitbit. Perfecto. Easily integrated in one easy step!

2. Participants decide to buy one. Links to purchase a Fitbit are included on our platform, making it as easy as possible for interested buyers to get a device.

3. Participants win one through ShapeUp/an employer. Many of our clients give Fitbits as prizes for participation or positive outcomes in wellness programs.

4. Employers buy them for employees. We actually cannot think of a better way to inspire engagement and participation.

We’re so pleased about this new partnership, as it makes ShapeUp even more accessible and easy for our users.  In addition, it means that those with different device preferences can all work together on our platform, and boy do we ever like being inclusive.  It’s a win-win-win. We love when that happens. And for these reasons, this is just the tip of the iceberg. Look for more integration announcements in 2012!