Is Whole Foods' Get Healthy Plan Fair?

Upscale store draws fire for new employee health program.

January 27, 2010, 6:14 PM

Jan. 28, 2010— -- Several months after Whole Foods CEO John Mackey drew fire for his opposition to President Obama's push for health care reform, the company is dredging up some more controversy with a new program it says promotes a healthier lifestyle for its employees.

The program, known as the Team Member Healthy Discount Incentive Program, offers employee's additional discounts on groceries purchased at the chain. While all Whole Foods employees receive a 20 percent discount on groceries from the store, if they meet certain health related benchmarks, they can get a discount of up to 30 percent.

"Vitality and health is what a lot of people are looking for," Margaret Wittenberg, global vice president of quality standards for Whole Foods Market, told "[Employees] like the incentive aspect of it and the opportunity to get an extra discount out of it is helpful as well. "

"We have tiers because we're trying to have it very achievable for people," she said. "Every small step is huge and really makes an impact on one's health."

Details of the program, were first posted online by In a letter to employees, Mackey says rewards are given if employees agree to be monitored to meet thresholds across four categories: blood pressure, cholesterol level, not smoking and body mass index (BMI). Commenter's flooded the board, many angry at what they considered a discriminatory policy.

Experts viewed the program in a slightly different light, even if they shared some of the concerns.

"It's an interesting initiative," said Dr. Kevin Volpp, director of the Center for Health Incentives at the University of Pennsylvania. "I think it speaks to employers' very real concerns about health costs being high and unhealthy behaviors contributing to it."

But Volpp and other experts say that while the program may be looking in the right direction, it has flaws that could very well lead it to benefit already healthy people without improving employees' health uniformly.

"I would think that the main effect would be to reward employees who already satisfied these metrics," said Joseph Newhouse, an economist with the department of health care policy at Harvard Medical School.

"Employees that were far away from any of these metrics or who otherwise would find it hard to get there, it would not affect them," he said. "So it would depend on how many employees could actually achieve these metrics without a great deal of effort."

Improvements Needed?

Experts expressed two primary concerns about the program, tied the measurements to be used and the strength of the incentives behind the program.

Some of the strata for different discount levels, said Volpp, were based on very fine distinctions that may not make a difference in the real world.

"Clinically, there's very little evidence that differences that small have any significant impact on health outcomes," he said.

With cholesterol for example, he said "If it's an average risk person, guidelines call for LDL less than 130."

And while the incentives program might ask for that to be lowered further, will doing so improve the employee's health significantly? "The data to support that are, let's just say, not very strong," said Volpp.

The use of BMI drew similar criticisms.

Wittenberg pointed out that the World Health Organization uses BMI as a standard when measuring obesity in populations, research has pointed out it is less effective when used to measure an individual's overall health.

"It's a population tool," said Dr. Michael Benedict, a physician in private practice in Richland, Wash., who has studied the effectiveness of health incentives programs. "It can be misleading on an individual basis because it doesn't take into account body composition."

For example, a person who had a high BMI but began an exercise regimen may still have the same BMI as they lost fat but gained muscle.

"If you did BMIs on NFL players, they would probably be pretty high," said Volpp. "[But] they're in superb physical condition."

In the Whole Foods program, a person who had a very high BMI but low cholesterol, low blood pressure and who did not smoke might not earn a higher discount, although most doctors would say a person meeting these criteria would be in good health.

Healthy Incentives

"If I were advising them I would have advised them to reward both levels in changes, and changes at the better end of the spectrum more," said Newhouse.

Benedict agreed, explaining that while a 10 percent change in weight makes a difference in health, it might not be attempted by someone with a BMI of 35, since lowering that figure significantly is not realistic.

"I might do it a little bit differently," he said.

Newhouse explained that the incentives themselves are not particularly strong, since even the maximum change -- from a 20 to 30 percent discount, would only impact an employee's budget by 2.5 percent, assuming the employee spent 25 percent of his or her budget on food and all of the food was bought at Whole Foods.

For the same reason, some critics say, the program would not appear to be effective if it were a covert way for Whole Foods to avoid hiring employees who may not be in great health.

"I don't think [that] is likely, because this is a very gentle incentive," said Volpp.

"I would guess it would have a pretty minimal effect on who actually comes to work [at Whole Foods]," said Newhouse. "I don't have any evidence," he said, but "just looking at it, the magnitude of the dollars on the table seem likely to be offset just by other working conditions."

And also, he said, "Probably in this economy, lots of people would be happy with any job."

And that may be lucky for the company, said Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University, given what would happen if the program led people to quit.

"To the extent the company gains anything by this policy they will lose by narrowing the number of qualified people who will work there," he said, noting that two-thirds of American are overweight or obese. "Losing a qualified employee costs the companies money."

Positive Feedback

Benedict noted that for a program hoping to change health behaviors to work, education, recruitment and follow-up would all be necessary.

Those are steps Whole Foods said it is taking.

"Along with this program, we have a tremendous amount of educational opportunities for our team members," said Wittenberg.

She explained that cooking classes and programs with doctors would be offered.

Benedict explained that programs to help employees develop better health habits have worked in other areas as well.

"There's very good data for return on company's investment in smoking cessation programs," he said. "Those things pay for themselves fairly quickly."

And despite the many critiques of the program, Volpp noted it should be praised because it "involves carrots instead of sticks."

"It is important to note that all these concerns are mitigated somewhat by the fact it's a voluntary program," he said. "This is just something where if you do well on these measures, you can get a better discount."

"I think it resonates with what's going on in terms of the roles of unhealthy behaviors on increasing healthcare costs," said Volpp.

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