Tagged Public Health

Liver Illness Strikes Latino Children Like A ‘Silent Tsunami’

Saira Diaz uses her fingers to count the establishments selling fast food and sweets near the South Los Angeles home she shares with her parents and 13-year-old son. “There’s one, two, three, four, five fast-food restaurants,” she says. “And a little mom and pop store that sells snacks and sodas and candy.”

In that low-income, predominantly Latino neighborhood, it’s pretty hard for a kid to avoid sugar. Last year, doctors at St. John’s Well Child and Family Center, a nonprofit community clinic seven blocks away, became alarmed by the rising weight of Diaz’s son, Adrian Mejia. They persuaded him to join an intervention study run by the University of Southern California and Children’s Hospital Los Angeles (CHLA) that weans participants off sugar in an effort to reduce the rate of obesity and diabetes among children.

It also targets a third condition fewer people have heard of: fatty liver disease.

Linked both to genetics and diets high in sugar and fat, “fatty liver disease is ripping through the Latino community like a silent tsunami and especially affecting children,” said Dr. Rohit Kohli, chief of gastroenterology, hepatology and nutrition at CHLA.

Recent research shows about 1 in 4 people in the U.S. have fatty liver disease. But among Latinos, especially of Mexican and Central American descent, the rate is significantly higher. One large study in Dallas found that 45% of Latinos had fatty livers.

The illness, diagnosed when more than 5% of the liver’s weight is fat, does not cause serious problems in most people. But it can progress to a more severe condition called nonalcoholic steatohepatitis, or NASH, which is linked to cirrhosis, liver cancer and liver failure. This progressive form of fatty liver disease is the fastest-growing cause of liver transplants in young adults.

The USC-CHLA study is led by Michael Goran, director of the Diabetes and Obesity Program at CHLA, who last year made an alarming discovery: Sugar from sweetened beverages can be passed in breast milk from mothers to their babies, potentially predisposing infants to obesity and fatty livers.

Called HEROES, for Healthy Eating Through Reduction of Excess Sugar, his program is designed to help children like Adrian, who used to drink four or more sugary drinks a day, shed unhealthy habits that can lead to fatty liver and other diseases.

Fatty liver disease is gaining more attention in the medical community as lawmakers ratchet up pressure to discourage the consumption of sugar-laden drinks. Legislators in Sacramento are mulling proposals to impose a statewide soda tax, put warning labels on sugary drinks and bar beverage companies from offering discount coupons on sweetened drinks.

“I support sugar taxes and warning labels as a way to discourage consumption, but I don’t think that alone will do the trick,” Goran said. “We also need public health strategies that limit marketing of sugary beverages, snacks and cereals to infants and children.”

William Dermody, a spokesman for the American Beverage Association said: “We understand that we have a role to play in helping Americans manage consumption of added sugars, which is why we are creating more drinks with less or no sugar.”

Michael Goran is the director of the Diabetes and Obesity Program at Children’s Hospital Los Angeles and the principal investigator for the HEROES study. “I support sugar taxes and warning labels as a way to discourage consumption,” Goran says, “but I don’t think that alone will do the trick.” (Rob Waters for KHN)

In 2016, 45 deaths in Los Angeles County were attributed to fatty liver disease. But that’s a “gross underestimate,” because by the time people with the illness die, they often have cirrhosis, and that’s what appears on the death certificate, said Dr. Paul Simon, chief science officer at the L.A. County Department of Public Health.

Still, Simon said, it was striking that 53% of the 2016 deaths attributed to fatty liver disease were among Latinos — nearly double their proportion of total deaths in the county.

Medical researchers consider fatty liver disease a manifestation of something called metabolic syndrome — a cluster of conditions that include excess belly fat and elevated blood pressure, blood sugar and cholesterol that can increase the risk of heart disease, stroke and diabetes.

Until 2006, few doctors knew that children could get fatty liver disease. That year Dr. Jeffrey Schwimmer, a professor of pediatrics at the University of California-San Diego, reviewed the autopsies of 742 children and teenagers, ages 2 to 19, who had died in car crashes or from other causes, and he found that 13% of them had fatty liver disease. Among obese kids, 38% had fatty livers.

After Schwimmer’s study was released, Goran began using MRIs to diagnose fatty liver in living children.

A 2008 study by another group of researchers nudged Goran further. It showed that a variant of a gene called PNPLA3 significantly increased the risk of the disease. About half of Latinos have one copy of that high-risk gene, and a quarter have two copies, according to Goran.

He began a new study, which showed that among children as young as 8, those who had two copies of the risky gene and consumed high amounts of sugar had three times as much fat in their livers as kids with no copy of the gene. Now, in the USC-CHLA study, he is testing whether reduced consumption of sugar decreases the fatty liver risk in children who have the PNPLA3 gene variant.

At the start of the study, he tests kids to see if they have the PNPLA3 gene, uses an MRI to measure their liver fat and catalogs their sugar intake. A dietitian on his team educates the family about the impact of sugar. Then, after four months, they measure liver fat again to assess the impact of the intervention. Goran expects to have results from the study in about a year.

More recently, Goran has been investigating the transmission of sugar from mothers to their babies. He showed last year that in nursing mothers who drank beverages sweetened with high-fructose corn syrup — the primary sweetener in standard formulations of Coca-Cola, Pepsi and other sodas — the fructose level in their breast milk rose and stayed elevated for several hours, ensuring that the baby ingested it.

This early exposure to sugar could be contributing to obesity, diabetes and fatty livers, based on previous research that showed fructose can enhance the fat storage capacity of cells, Goran said.

At Torrance Memorial Medical Center, Dr. Karl Fukunaga meets with a patient, Margarita Marrou, a retired medical clerk originally from Peru. She was diagnosed several years ago with a severe form of fatty liver disease and has cut down her sugar consumption and lost weight. (Rob Waters for KHN)

In neighborhoods like South Los Angeles, where Saira Diaz and Adrian Mejia live, a lack of full-service markets and fresh produce makes it harder to eat healthily. “Access to unhealthy food options — which are usually cheaper — is very high in this city,” Derek Steele, director of health equity programs at the Social Justice Learning Institute in Inglewood, Calif., told Kaiser Health News.

The institute has started farmers markets, helped convert two corner stores into markets with healthier food options and created 109 community gardens on public and private lands in South L.A. and neighboring Inglewood, which has 125 liquor and convenience stores and 150 fast-food outlets.

At Torrance Memorial Medical Center, 10 miles down the road, Dr. Karl Fukunaga, a gastroenterologist with Digestive Care Consultants, said he and his colleagues are seeing so many patients with fatty liver disease that they plan to start a clinic to address it. He urges his patients to avoid sugar and cut down on carbohydrates.

Adrian Mejia and his mother received similar advice from a dietitian in the HEROES program. Adrian gave up sugary beverages, and his liver fat dropped 43%. Two months ago, he joined a soccer league.

“Before, I weighed a lot and it was hard to run,” he said. “If I kept going at the pace I was going, probably later in my life I would be like my [diabetic] grandma. I don’t want that to happen.”


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Ups And Downs Of Artificial Intelligence: IBM Stops Sales, Development Of Watson For Drug Discovery; Hospitals Learn From EHRs

While revenue and earnings have been lackluster for Watson for Drug Discovery, other companies are making profits in developing software that improves the clinical trials process for drugs. Also in the news: Hospitals are making improvements by using data from certain electronic health record systems.

Ups And Downs Of Artificial Intelligence: IBM Stops Sales, Development Of Watson For Drug Discovery; Hospitals Learn From EHRs

While revenue and earnings have been lackluster for Watson for Drug Discovery, other companies are making profits in developing software that improves the clinical trials process for drugs. Also in the news: Hospitals are making improvements by using data from certain electronic health record systems.

Supreme Court Asked To Take Up Louisiana Abortion Law Requiring Doctors To Have Admitting Privileges

The justices voted in February to put the law on hold. It is similar to a Texas law the court struck down in 2016. News on abortion looks at a Florida bill requiring parental consent, an investigation into family planning funding for anti-abortion groups, and plans of a civil rights protector to defend abortion opponents, as well

Supreme Court Asked To Take Up Louisiana Abortion Law Requiring Doctors To Have Admitting Privileges

The justices voted in February to put the law on hold. It is similar to a Texas law the court struck down in 2016. News on abortion looks at a Florida bill requiring parental consent, an investigation into family planning funding for anti-abortion groups, and plans of a civil rights protector to defend abortion opponents, as well

Scam Alert: Seniors, Low-Income Neighborhoods Targeted By People Claiming To Collect DNA Swab Samples

People are going to these communities in vans and offering to swab residents’ cheeks purportedly for DNA checks for cancer and other diseases. It’s not clear who is behind the reported activity. In other public health news: asbestos, candida auris, prostate drugs, three-parent pregnancies, syphilis, and more.

Scam Alert: Seniors, Low-Income Neighborhoods Targeted By People Claiming To Collect DNA Swab Samples

People are going to these communities in vans and offering to swab residents’ cheeks purportedly for DNA checks for cancer and other diseases. It’s not clear who is behind the reported activity. In other public health news: asbestos, candida auris, prostate drugs, three-parent pregnancies, syphilis, and more.

‘It’s A Game Changer’: Scientists Find Success In Using Gene Therapy To Treat ‘Bubble Boy’ Syndrome Without Causing Cancer

The process aimed at helping patients born with a severe immune-system deficiency involves removing some blood cells, using a modified HIV virus to insert a missing gene, and returning the cells through an IV. When doctors first tried it 20 years ago, the treatment had unintended effects on other genes, and some patients later developed leukemia.

Watching Media Coverage Of Mass Shootings Becomes Vicious Cycle In Terms Of Mental Health Trauma

A new report finds that people watching the coverage can develop symptoms of post-traumatic stress — but they just can’t look away from the news. And the stress from being glued to coverage ends up spreading through the society like a virus. In other news, as the Columbine anniversary approaches, survivors of that school shooting reach out to help other victims. And the woman who sparked a massive manhunt over possible threats to Colorado schools was found dead.

As Syphilis Invades Rural America, A Fraying Health Safety Net Is Failing To Stop It

When Karolyn Schrage first heard about the “dominoes gang” in the health clinic she runs in Joplin, Mo., she assumed it had to do with pizza.

Turns out it was a group of men in their 60s and 70s who held a standing game night — which included sex with one another. They showed up at her clinic infected with syphilis.

That has become Schrage’s new normal. Pregnant women, young men and teens are all part of the rapidly growing number of syphilis patients coming to the Choices Medical Services clinic in the rural southwestern corner of the state. She can barely keep the antibiotic treatment for syphilis, penicillin G benzathine, stocked on her shelves.

Public health officials say rural counties across the Midwest and West are becoming the new battleground. While syphilis is still concentrated in cities such as San Francisco, Atlanta and Las Vegas, its continued spread into places like Missouri, Iowa, Kansas and Oklahoma creates a new set of challenges. Compared with urban hubs, rural populations tend to have less access to public health resources, less experience with syphilis and less willingness to address it because of socially conservative views toward homosexuality and nonmarital sex.

In Missouri, the total number of syphilis patients has more than quadrupled since 2012 — jumping from 425 to 1,896 cases last year — according to a Kaiser Health News analysis of new state health data. Almost half of those are outside the major population centers and typical STD hot spots of Kansas City, St. Louis and its adjacent county. Syphilis cases surged at least eightfold during that period in the rest of the state.

At Choices Medical Services, Schrage has watched the caseload grow from five cases to 32 in the first quarter of 2019 alone compared with the same period last year. “I’ve not seen anything like it in my history of doing sexual health care,” she said.

Back in 1999, the Centers for Disease Control and Prevention had a plan to eradicate the sexually transmitted disease that totaled over 35,000 cases nationwide that year. While syphilis can cause permanent neurological damage, blindness or even death, it is both treatable and curable. By focusing on the epicenters clustered primarily throughout the South, California and in major urban areas, the plan seemed within reach.

Instead, U.S. cases topped 101,500 in 2017 and are continuing to rise along with other sexually transmitted diseases. Syphilis is back in part because of increasing drug use, but health officials are losing the fight because of a combination of cuts in national and state health funding and crumbling public health infrastructure.

“It really is astounding to me that in the modern Western world we are dealing with the epidemic that was almost eradicated,” said Schrage.

Grappling With The Jump

Craig Highfill, who directs Missouri’s field prevention efforts for the Bureau of HIV, STD and Hepatitis, has horror stories about how syphilis can be misunderstood.

“Oh, no, honey, only hookers get syphilis,” he said one rural doctor told a patient who asked if she had the STD after spotting a lesion.

In small towns, younger patients fear that their local doctor — who may also be their Sunday school teacher or basketball coach — may call their parents. Others don’t want to risk the receptionist at their doctor’s office gossiping about their diagnosis.

Some men haven’t told family members they’re having sex with other men. And still more have no idea their partner may have cheated on them — and their doctors don’t want to ask, according to Highfill.

It’s even hard to expect providers who haven’t seen a case of syphilis in their lifetime to automatically recognize the hallmarks of what is often called the “great imitator,” Highfill said. Syphilis can manifest differently among patients, but frequently shows up for a few weeks as lesions or rashes — often dismissed by doctors who aren’t expecting to see the disease.

Since 2000, the current syphilis epidemic was most prevalent among men having sex with men. Starting in 2013, public health officials began seeing an alarming jump in the number of women contracting syphilis, which is particularly disturbing considering the deadly effects of congenital syphilis — when the disease is passed from a pregnant woman to her fetus. That can cause miscarriage, stillbirth or birth deformities.

Among those rising numbers of women contracting syphilis and the men who were their partners, self-reported use of methamphetamines, heroin or other intravenous drugs continues to grow, according to the CDC. Public health officials suggest that increased drug use — which can result in a pattern of risky sex or trading sex for drugs — worsens the outbreaks.

That perilous trend is playing out particularly in rural Missouri, argues Dr. Hilary Reno, an assistant professor of medicine at Washington University School of Medicine in St. Louis who is researching syphilis transmission and drug use in the state. Tracking cases from 2015 through June 2018, she found that more than half of patients outside of the major metropolitan areas of Kansas City and St. Louis reported using drugs.

Less Money, More Problems

Federal funding for STD prevention has stayed relatively flat since 2003, with $157.3 million allocated for fiscal year 2018. But that amounts to a nearly 40% decrease in purchasing power over that time, according to the National Coalition of STD Directors.

In Missouri, CDC annual funding has been cut by over $354,000 from 2012 to 2018 — a 17% decrease even as the number of cases quadrupled, Highfill said.

Iowa, too, has seen its STD funding cut by $82,000 over the past decade, according to Iowa Department of Health’s STD program manager George Walton.

“It is very difficult to get ahead of an epidemic when case counts are steadily — sometimes rapidly — increasing and your resources are at best stagnant,” Walton said. “It just becomes overwhelming.”

Highfill bemoaned that legislatures in Texas, Oregon and New York have all allocated state money to raise awareness or provide transportation to local clinics. Missouri has not allocated anything.

Schrage says she can barely keep the antibiotic treatment for syphilis, penicillin G benzathine, stocked on her shelves.(Bruce Stidham for KHN)

A New Playing Field

In the digital age, fighting syphilis is much harder for public health responders, said Rebekah Horowitz, a senior program analyst on HIV, STDs and viral hepatitis at the National Association of County and City Health Officials.

The increased use of anonymous apps gives people greater access to more sexual partners, she said. Tracking down those partners is now much harder than camping out at the local bar in town.

“We can’t get inside of Grindr and do our traditional public health efforts,” she said.

That’s not to say Highfill’s department hasn’t tried. It has engineered a series of educational ads on Instagram, Grindr and Facebook displaying messages such as “Knowledge looks good on you.”

Highfill would love to do more — if Missouri had the money.

Public health clinics nationwide have also had to limit hours, reduce screening and increase fees that can reach $400. And some run by health departments across the country have been forced to close — at least 21 in 2012 alone, according to CDC data.

In Missouri, restrictions on Planned Parenthood’s Medicaid reimbursements that were passed last year in the legislature, and are again under debate, mean the nonprofit organization cannot be reimbursed for STD treatment for some patients.

That is another crack in the already failing public health infrastructure, said Reno, the Washington University professor who also serves as the medical director of the St. Louis County Sexual Health Clinic.

“We have a system that’s not even treading water,” she said. “We are the ship that is listing to the side.”

What you need to know about syphilis:

  • Syphilis is a bacterial infection spread through oral, vaginal and anal sex. It is treatable and curable with antibiotics.
  • Syphilis causes sores that are usually painless but can spread the bacterium to other people. It can also be passed from an infected pregnant woman to her fetus, risking miscarriage, stillbirth or birth deformities. The second phase of the disease can cause a skin rash, swollen lymph nodes and fever. Final stages of the disease can cause permanent neurological damage, blindness or death.
  • Despite a Centers for Disease Control and Prevention plan in 1999 to eradicate the disease, infectious syphilis cases have skyrocketed in recent years, jumping 76% nationally from 2013 to 2017.
  • A combination of cuts in national and state funding, crumbling public health infrastructure, greater mobility, continued stigma and increasing drug use is driving the uptick.
  • The best way to prevent syphilis among those who are sexually active is to use latex condoms or dental dams during sex.

Michigan AG Promises That In ‘Likely’ Event Roe Is Struck Down She Won’t Enforce State Abortion Ban

Michigan is among 10 states that still have pre-Roe abortion bans on the books. “I will never prosecute a woman or her doctor for making the difficult decision to terminate a pregnancy,” Michigan Attorney General Dana Nessel said. Abortion news comes out of Oklahoma, Texas and North Carolina, as well.

The Battle Over Kratom: Is It A Life-Saver For Recovering Opioid Users Or Just Another Drug To Become Addicted To?

The substance has offered hope to those recovering from opioid addiction, but the FDA contends that there is no evidence to indicate that kratom is safe or effective for any medical use. The CDC weighed in last week with a new report citing a significant death toll linked to kratom. In other news about the crisis: the Sackler deposition has gone mainstream, CVS is fined for its Percocet prescription practices, President Donald Trump will appear at a summit in Atlanta to discuss the epidemic, and more.

Planned Parenthood’s ‘Risky Strategy’ To Update Its Image

PROVIDENCE, R.I. — The Trump administration is pushing ahead with its reproductive health agenda. It has rolled out changes to the Title X program, which funds family planning services for low-income people, that are designed to have a chilling effect on organizations that provide abortions or include this option in counseling. It also has nominated federal judges widely believed to support state-level abortion restrictions.

Against that backdrop, Planned Parenthood, known as a staunch defender of abortion rights, is working to recast its public image. Under its president, Dr. Leana Wen, who took office in November, the nation’s largest reproductive health provider is highlighting the breadth of care it provides — treating depression, screening for cancer and diabetes, and taking on complex health problems like soaring maternal mortality rates.

This strategy, analysts say, could buttress Planned Parenthood against the efforts by the White House and other abortion opponents. But it’s complicated. Even as the organization leans into its community health work, Wen isn’t abandoning the abortion-related services that have helped form the organization’s identity — and its opposition.

“We cannot separate out one of our services. That’s not how medicine works,” Wen told Kaiser Health News.

This effort to thread the needle could, if successful, change the public’s perception of Planned Parenthood. But if it backfires, it could make the organization even more vulnerable. Some people are skeptical of the payoff, given how polarizing abortion politics are.

“The minute you start talking about abortion, it’s a risky strategy,” said Karen O’Connor, a political scientist at American University who studies the politics of reproductive health care. It’s likely to attract strong reactions from people who see abortion providers not as reproductive health professionals but as “baby killers,” she said.

“If I was doing it — and this is as somebody who studies social movements and women’s organizations — I would take abortion out of the equation and talk about ‘reproductive health is health care.’”

Already, the new strategy is drawing fire from abortion opponents, who dismiss Planned Parenthood’s positioning as a frontline community health provider.

“This framing is simply a PR exercise,” said Mallory Quigley, vice president of communications at the Susan B. Anthony List, a Washington-based anti-abortion group. “I don’t think this campaign will be successful, and I don’t think it will last long.”

Reproductive health experts have a different view, saying Planned Parenthood’s effort to promote its array of health care offerings — including abortion — is consistent with reality and in line with top medical standards. To bolster this message, Wen, a former Baltimore health commissioner and the first physician to take the group’s helm, has embarked on a national listening tour.

“It’s who we are. We are a health care organization,” Wen said. “That’s what all of our affiliates do around the country, is meeting people where they are with the health services they need.”

So far, Wen and other Planned Parenthood officials have visited 17 affiliates in locations around the country. They plan to visit several more, Wen’s staff confirmed.

The idea is not to standardize what Planned Parenthood sites offer, Wen said, arguing that each clinic should take the lead in devising its own public health programs, based on its patients. Even so, the organization’s national leadership is working to identify the health programs that could be expanded and encouraging clinics around the country to consider implementing those best practices.

Recently, Wen and her team visited the organization’s Rhode Island clinic to investigate how it is planning to expand its primary care offerings.

The clinic, a 10-minute walk from downtown Providence, serves patients of all genders and ages, its staff noted. It has upped its focus on things like wellness visits, along with its programs to make sure patients who want to have children are healthy before they get pregnant.

Wen also focused on the clinic’s efforts to reduce the area’s maternal mortality rates, a problem that afflicts low-income and black women at far greater rates. In 2018, 18.3 Rhode Island women per 100,000 births died from causes related to the pregnancy; for black women, the figure was 47.2 per 100,000, and for white women, 18.1. Planned Parenthood leadership touted proposed state legislation that would extend Medicaid coverage to doulas, non-medical birth coaches often seen as a valuable resource in reducing maternal deaths.

Dr. Leana Wen, president of Planned Parenthood, speaks with staff from Planned Parenthood Mar Monte.(Anna Maria Barry-Jester)

Wen tours a lab in the basement of a San Jose, Calif., clinic that processes tests for gonorrhea and chlamydia. “When I was in college, we did all the pipetting manually,” she told the staff.(Anna Maria Barry-Jester)

At a Planned Parenthood Mar Monte clinic in San Jose, Calif., staff members highlighted the facility’s mental health services — keeping behavioral health professionals in the building to help patients transition seamlessly into care — and its in-house testing center for sexually transmitted infections.

At both clinics, staffers talked about helping patients who face a threat of domestic violence find safe housing resources, and steering them toward available resources for things like healthy food.

Even while promoting that work — often overlooked by the public — Wen, a 36-year-old emergency doctor by training, emphasizes abortion services at each stop, trying to weave the message into the public health narrative.

In Providence, the Planned Parenthood team stopped by a news conference to talk about a local bill that, if the Supreme Court scales back Roe v. Wade, would explicitly legalize abortion protections in Rhode Island.

“Abortion is part of the spectrum of full reproductive health care, and we know reproductive health care is health care,” Wen said to applause. “And health care is a human right.”

But it’s unclear how the listening tour and messaging efforts will pan out politically. While a majority of Americans have positive opinions of Planned Parenthood, they are, polling suggests, evenly split on abortion.

“Planned Parenthood to some extent is taking a risky strategy by trying to thread these two. I see these as very different messages,” said O’Connor, the political scientist. “If you take out the ‘abortion is’ and go to reproductive health, you have a winning message that is very simple.”

In other ways, though, this branding effort perhaps comes at the right time, suggested Lucinda Finley, a law professor at the University at Buffalo. She ties the organization to what polling suggests is voters’ No. 1 concern, especially going into the 2020 election: health care.

Framing it as “‘Abortion is health care, health care is a human right’ links it to the larger debate about health care, and how we should provide health care to people in this country,” Finley said.

When asked if this messaging could politically insulate Planned Parenthood from conservative attacks — or win the organization new supporters — Wen suggested the community health emphasis is simply a response to medical needs.

“I don’t want people to think we are doing this because it’s politically the right thing to do,” she said. “It’s the right thing to do because that’s what our patients are requesting.”

Workplace Wellness Programs Barely Move The Needle, Study Finds

Workplace wellness programs have become an $8 billion industry in the U.S. But a study published 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 by incentives in the federal Affordable Care Act.

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

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

Now researchers from the University of Chicago and Harvard may have overcome these obstacles with one of the first large-scale studies that is peer-reviewed and employs a more sophisticated trial design.

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

The big-box retailer employed nearly 33,000 workers across all 160 clubs during the test.

After 18 months, it turned out that yes, workers participating in the wellness programs self-reported healthier behavior, such as exercising more or managing their weight better than those not enrolled.

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

“The optimistic interpretation is there is no way we can get improvements 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 at the University of Chicago. (Dr. Zirui Song, an assistant professor of health policy and medicine at Harvard Medical School, was its co-author.)

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

The study comes amid widespread interest in wellness programs.

The Kaiser Family Foundation’s annual survey of employers found that 53% of small firms and 82% of large firms offer a program in at least one of these areas: smoking cessation, weight management and behavioral or lifestyle change. (Kaiser Health News is an editorially independent program of the foundation.)

Some programs are simple, offering gift cards or other small incentives to fill out a health risk assessment, take a lunch-and-learn class or join a gym or walking group. Others are far more invasive, asking employees to report on a variety of health-related questions and roll up their sleeves for blood tests.

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

The Affordable Care Act allowed employers to offer financial incentives worth up to 30% of the cost of health insurance, leading some employers to offer what could be hundreds or even thousands of dollars off workers’ deductibles or premiums to get them to participate. That led to court challenges about whether those programs are truly voluntary.

In the study reported in JAMA, the incentives were modest. Participants got small-dollar gift cards for taking wellness courses on topics such as nutrition, exercise, disease management and stress control. Total potential incentives averaged $250. About 35% of eligible employees at the 20 participating sites completed at least one module.

Results from those workers — including attendance and tenure data, their self-reported health assessment and results from lab blood tests — were specifically compared with similar reports from 20 primary comparison sites where workers were not offered the wellness gift cards and classes. Overall employment and health spending data from all worksites were included in the study.

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

Jim Pshock, founder and CEO of Bravo Wellness, said the incentives offered to BJ’s workers might not have been large enough to spur the kinds of big changes needed to affect health outcomes.

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

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

In other words, don’t give up entirely on wellness efforts, but consider “more targeted approaches” that focus on specific workers with higher risks or on “health behaviors [that] may yield larger health and economic benefits,” the editorial suggested.

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

Still, similar findings were recently reported in another randomized control trial conducted at the University of Illinois, where individuals were randomly selected to be offered wellness programs.

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

Everyone involved in studying or conducting wellness agrees on one thing: Changing behavior — and getting people motivated to participate at all — can be difficult.

Steven Aldana, CEO of WellSteps, a wellness program vendor, said that for the efforts to be successful they must cut across many areas, from the food served in company cafeterias to including spouses or significant others to help people quit smoking, eat better or exercise more.

“Behavior is more complicated than simply taking a few wellness modules,” said Aldana. “It’s a lifestyle matrix or pattern you have to adopt.”

Workplace Wellness Programs Barely Move The Needle, Study Finds

Workplace wellness programs — efforts to get workers to lose weight, eat better, stress less and sleep more — are an $8 billion industry in the U.S.

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

But no one has been sure they work.

A host of studies over the years has provided conflicting results, with some showing savings and health improvements while others say the efforts fall short.

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

Researchers from the University of Chicago and Harvard may have overcome some of these obstacles with one of the first large-scale studies that employs more sophisticated research techniques. It was published Tuesday in JAMA.

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

The big-box retailer employed nearly 33,000 workers across all 160 clubs during the test.

After 18 months, it turned out that yes, workers participating in the wellness programs self-reported healthier behavior, such as exercising more or managing their weight better than those not enrolled.

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

“The optimistic interpretation is there is no way we can get improvements 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 at the University of Chicago. (Dr. Zirui Song, an assistant professor of health policy and medicine at Harvard Medical School, was its co-author.)

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

The study comes amid widespread interest in wellness programs.

The Kaiser Family Foundation’s annual survey of employers found that 53% of small firms and 82% of large firms offer a program in at least one of these areas: smoking cessation, weight management and behavioral or lifestyle change. (Kaiser Health News is an editorially independent program of the foundation.)

Some programs are simple, offering gift cards or other small incentives to fill out a health risk assessment, take a lunch-and-learn class or join a gym or walking group. Others are far more invasive, asking employees to report on a variety of health-related questions and roll up their sleeves for blood tests.

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

The Affordable Care Act allowed employers to offer financial incentives worth up to 30% of the cost of health insurance, leading some employers to offer what could be hundreds or even thousands of dollars off workers’ deductibles or premiums to get them to participate. That led to court challenges about whether those programs are truly voluntary.

In the study reported in JAMA, the incentives were modest. Participants got small-dollar gift cards for taking wellness courses on topics such as nutrition, exercise, disease management and stress control. Total potential incentives averaged $250. About 35% of eligible employees at the 20 participating sites completed at least one module.

Results from those workers — including attendance and tenure data, their self-reported health assessment and results from lab blood tests — were specifically compared with similar reports from 20 primary comparison sites where workers were not offered the wellness gift cards and classes. Overall employment and health spending data from all worksites were included in the study.

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

Jim Pshock, founder and CEO of Bravo Wellness, said the incentives offered to BJ’s workers might not have been large enough to spur the kinds of big changes needed to affect health outcomes.

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

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

In other words, don’t give up entirely on wellness efforts, but consider “more targeted approaches” that focus on specific workers with higher risks or on “health behaviors [that] may yield larger health and economic benefits,” the editorial suggested.

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

Still, similar findings were recently reported in another randomized control trial conducted at the University of Illinois, where individuals were randomly selected to be offered wellness programs.

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

Everyone involved in studying or conducting wellness agrees on one thing: Changing behavior — and getting people motivated to participate at all — can be difficult.

Steven Aldana, CEO of WellSteps, a wellness program vendor, said that for the efforts to be successful they must cut across many areas, from the food served in company cafeterias to including spouses or significant others to help people quit smoking, eat better or exercise more.

“Behavior is more complicated than simply taking a few wellness modules,” said Aldana. “It’s a lifestyle matrix or pattern you have to adopt.”