Diabetes Self-Management Blog

“One of my partner’s patients stopped taking his insulin last week to meet his employer’s weight-loss goal. A1C 13.5. He got his incentive money through his employer though.”

The quote is a comment posted on a physician-written opinion piece about corporate wellness programs in which the author questions their effectiveness in either cost savings or improved health.

A 13.5% HbA1c, by the way, is an average blood glucose level of 341 mg/dl. That dude must have been whizzing pure sugar!

His employer may have been happy the guy lost weight, but keeping the weight and getting help for his diabulimia — an eating disorder in which people with Type 1 diabetes reduce their insulin dosages in order to lose weight — would have been better for his health.

According to a really interesting article about diabulimia on Salon.com:

The mortality rate from diabetes alone is roughly 2.5% annually. For anorexia nervosa, it’s 6.5%. But patients with diabulimia — which is referred to in health-care circles as “dual diagnosis” — have a mortality rate of a whopping 34.8%, per year.

Diabulimia can lead to the usual culprits in terms of diabetes complications. Perhaps one of the most poignant descriptions of what diabulimia can do to you comes from a young woman quoted in the Salon article:

My bones are weak, I have sores on my mouth, my hair is thin, my heart flutters, it is a struggle to walk, and the docs say I will need dialysis and eye surgery by the time I’m twenty.

I am 18, and I live in a 90-year-old body.

Perhaps fortunately for us Type 2s, who generally have a weight problem, this won’t work as a weight-loss method. You have to be pretty insulin-deficient, which we’re not unless we’ve had Type 2 long enough to have burned out a whole passel of beta cells.

I believe it was back in the 1980’s (at least where I live) when companies began installing workout centers in the workplace to encourage physical activity for their employees. Truthfully, I’ve never paid a lot of attention to onsite fitness centers. As part of a university “family” for decades, that’s always been available to me. At least some, if not all, of the facilities available for students are open to faculty, staff, and their families. In some cases, the general community can use them for a fee.

Then, after years of not covering disease management education, the university where my husband teaches began offering a wellness program. For my part, it consisted of an “expert” calling me to discuss taking care of my diabetes. I finally told them to stop the calls, since I seem to have forgotten more about diabetes than the “expert” knew.

An opinion piece in the Sept. 15, 2013 Los Angeles Times noted that the Safeway grocery chain was “perhaps the most widely recognized employer wellness program” adding that President Obama liked it so much it

led to the addition of ‘the Safeway amendment’ to his health reform law. The amendment will allow employers to tie 30% of an employee’s health-care costs to wellness programs beginning next year.

(On the other hand, the “Affordable Care Act” — or Obamacare — allows employers to charge workers who have unhealthy lifestyles up to 30% more for their health-care plan.)

And what does Safeway’s program measure? Tobacco use, weight, blood pressure, and cholesterol levels. “If employees ‘pass’ all the tests, annual [insurance] premiums are reduced by up to $780 for individuals and $1,560 for families.”

I can pass the tobacco, blood pressure and cholesterol with no problem. The weight? That’s a different matter. No matter what I do, it seems that my body gains weight when it wants and loses weight when it wants. Who cares what I want?! It’s my father’s fault: You should see his family. Yikes!

So what do you think? Does your company have a wellness program? Do you believe it works? Has it saved you money or are you likely for it to cost you? What measurements do you believe the company should be covering (thinking back to the worker who lost weight at the expense of his diabetes control)? And, come to think of it, do you know anyone who worsened his or her diabetes control in order to meet an issue targeted by the company’s wellness program?

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Comments
  1. Thanks for this important piece, Jan. Employee “wellness programs” often do a lot more harm than good. They use rewards and punishments to encourage results they think are “healthy,” but are often not healthy at all for individuals. Requiring a person with Type 1 to lose weight is a horrible, really criminal thing.

    I’m going to send the link to people who are active in trying to reform employers’ practices around health.

    Posted by David Spero RN |
  2. HI Jan,
    The wellness industry is out of control with what they are doing at the worksite. Both sides of the isle and even the president drank the kool aid when the Safeway CEO claimed all those savings from their wellness program. Of course, we now know that the results were mad up - that’s right - they lied about them. The claimed savings occurred in 2006 and the program did not even start until a few years later. When it did start costs went up as they almost always do when you increase preventive measures in groups. And then, of course there is the question of whether all these HRA’s and biometric screens save money or improve health although there is no question that they do lead to increased diagnosis and treatment. If you are interested in more on this topic we are providing a free webinar next week - come join us if you like -

    http://hplive.org/events/when_wellness_worlds_collide_wellness_critics_respond_to_attack

    Posted by Jon Robison |
  3. My insurance through my employer has a wellness program you must adhere to to get lower rates. So far, I have a wellness coach/nurse call me every month to talk about different problems for which I have been marked “at risk” from my physician’s screening. They usually just suggest things to help me keep my sugar levels down and ways to do more exercise. Since I have had foot and back problems and now have a knee going out on me I haven’t been able to do any real exercise. I have to explain the same things every month and it does become annoying. But if that’s all I have to do, then I try to just be patient with them. They are very polite and easy to talk to so there hasn’t been a real problem. Last month my blood glucose was especially high at night because I was eating a total carb snack with no protein. The nurse suggested trying 15 grapes and string cheese(or any combination of fruit/protein. My bg’s have been much better and I will report that when they call again. So wellness programs may be helpful.

    Posted by Linda Martin |

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