Aetna (NYSE:AET) today announced a new team-based fitness and nutrition program for employers nationwide that uses online social networking to encourage people of all health and fitness levels to work together with their colleagues to achieve their optimal health. Powered by Shape Up The Nation, Aetna Health Connections Get Active!SM is modeled after Aetna's own Get Active Aetna employee program. The program has been exceptionally successful among Aetna's own employees, with 57 percent of employees participating in the program in 2009...Note not a single piece of data showing a successful outcome - only participation info.
Aetna has used a variety of wellness programs, including its own Get Active Aetna program, now in its third year. More than 20,000 Aetna employees actively participated in the program in 2009. In 2008, nearly 60 percent of employees participated and as a whole, participants walked the equivalent of 132 times around the earth's equator. This year, Aetna employees walked 3.9 million miles or the equivalent of circling the equator 156 times.
If it worked, they would have crowed about it.
This is simply more crap.
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The program has proven outcomes that were documented in the Journal of Obesity (a Nature publication).
View the study here
The program is provided by Shape Up The Nation a company that was started by two medical students. One of the founders, Rajiv Kumar, was recently honored by the Robert Woods Johnson Foundation as a Community Leader for his efforts to improve public health through Shape Up RI (www.shapeupri.org).
Hello, Brad and welcome to Fitness Watch. Due to Blogger limitations, I have to break this Comment up into more than one part.
As a matter of full disclosure, you are one of the “two medical students” who started Shape Up The Nation (SUTN).
It is of some interest that you chose to present yourself, arguably, as a disinterested person. Frankly, I think this speaks to your integrity. Fitness Watch readers can decide whether it speaks favorably or not or even at all.
One cannot “view the study” from your link, only the Abstract.
I will return to the study in a bit.
With sincerity, I hope that you succeed in your undertaking, which means that I hope the population-at-large will benefit.
It is my opinion that your efforts will not result in any appreciable improvements, except perhaps for your own personal bottom line.
From my perspective you and your organization fit nicely into the same pigeon-hole as the IMHO cons in the weight loss game. This is not to suggest you are doing this intentionally. It is not to suggest that you are not. I do not know. But because of the similarities in approach, this is the category in which I feel most confident placing SUTN.
To me, it is bloviation, in its lowest form, to suggest that something started by “medical students” confers credentials. This is what I take your representation to infer. Bolstering it with “They learned from their early clinical encounters that patients who were most successful at losing weight, increasing their exercise, quitting tobacco and achieving lasting behavior change…” offers me no comfort.
I am the kind of person who prefers a bit more experience than the observations of a medical student during his “early clinical” phase as support for a position, let alone reason to implement an action plan.
According to the Cleveland Clinic presentation of January 13, 2010, Rajiv was, at the time, a third year medical student. This, according to my calculations, places the amount of claimed clinical experience as a medical student around the level of squat.
I say this recognizing that there are persons out there who are so perceptive at so early an age that they can actually do great things and make great observations.
By way of SUTN, you and Rajiv do not strike me as among those individuals (except possibly to make a buck by dangling a bright, shiny technological bauble before others).
I do not consider it a form of bona fides that you tout as evidence of a “a strong interest in public health issues” your bike ride “border–to–border across China educating and raising awareness and funds to support autism research in honor of [your] younger brother,” though I do respect your effort.
I noticed on the SUTN website certain claims. For example, as to “Reporting,” you state that employers will “see a clear and honest analysis of your return–on–investment.”
I think it reasonable to assume that if your clients really experienced such a benefit, then your testimonial page would have indicated these great victories.
Instead what I found were these variations of IMHO fluff:
“The peer-to-peer engagement created by our Shape Up and Go! program has inspired thousands of Cleveland Clinic employees to get involved and get active. The Shape Up The Nation team has made it easy to implement the programs through their responsiveness and hands-on support. We look forward to many more successful programs together.”
— Susan Rapoport, MS, RD, LD, Employee Wellness Manager
“Key to the success of National Grid's 2009 programme has been the can-do attitude of the whole of the Shape Up The Nation team. This, combined with the quality of the materials, support and software, enabled us to run our most successful well–being programme to date. I would personally recommend Shape Up The Nation to any company looking to expand on traditional employee health promotion programmes.”
— Simon Boulton, Wellbeing Specialist, UK
“CVS Caremark is expanding the Shape Up program because we completely agree with the mission of Shape Up The Nation: using teamwork and healthy competition as a tool for improving the health of all CVS colleagues by increasing physical activity and developing healthier eating practices. We are undertaking plans to expand the program throughout CVS. In 2008, outcomes were astounding. The exciting thing about Shape Up CVS is that everyone sees colleagues walking, running, and eating healthier; it is a huge morale builder and adjunct to culture change!”
— Claudine Reilly, Wellness Manager
“Being a technology company, our employees were impressed with the easy online enrollment and functionality of the website. As the director of benefits, I appreciated the prepared communications and action plan provided, making implementing the program almost effortless.”
— Leo Perrone, Director of Employee Benefits
“Shape Up The Nation was a breeze to implement and communicate. I was worried about adding another program to manage on my plate, but their team has made the process very turnkey. They are simply one of my best vendors to work with. They are always one step ahead of me, sending me weekly reports and giving me program statistics I can utilize in ongoing communications. Thank you for looking out for your clients to help implement a successful wellness program.”
— Carri LaPlant, Health & Productivity Specialist
But for one allusion by CVS Caremark to non-specific “outcomes [that] were astounding,” I cannot find a single piece of evidence for success. (If the reference is to the 84% reporting that it was “their first time participating in a wellness program at the company,” that is not IMHO an “outcome.” For example, if my intention is to walk to the store, taking my first step is not an “outcome.”)
Now I get that my threshold for what is “evidence” may be different from yours. After all, I am unwilling to consider a bike ride in China, even if it was allegedly educational, as evidence for “a strong interest in public health issues.” But that is just me. Others may conclude differently.
Speaking of evidence, it appears as if what you claim is an “evidence-based online platform.”
In support you advertise the following:
Because your employees deserve only the best and most effective solutions, our wellness program is based on sound medical evidence.
Nationally-renowned researchers concluded that our team wellness competition helps employees achieve clinically significant weight loss.
Our program is also substantiated by other landmark research studies, including:
The Spread of Obesity in a Large Social Network over 32 Years
Christakis, Nicholas A., Fowler, James H.
The New England Journal of Medicine 2007 357: 370-379
Conclusion: “The spread of obesity in social networks appears to be a factor in the obesity epidemic. Yet the relevance of social influence also suggests that it may be possible to harness this same force to slow the spread of obesity. Network phenomena might be exploited to spread positive health behaviors, in part because people's perceptions of their own risk of illness may depend on the people around them. Smoking– and alcohol–cessation programs and weight-loss interventions that provide peer support — that is, that modify the person's social network - are more successful than those that do not. People are connected, and so their health is connected.”
Using Pedometers to Increase Physical Activity and Improve Health
Dena M. Bravata, MD, MS; Crystal Smith-Spangler, MD; Vandana Sundaram, MPH; Allison L. Gienger, BA; Nancy Lin, ScD; Robyn Lewis, MA; Christopher D. Stave, MLS; Ingram Olkin, PhD; John R. Sirard, PhD
JAMA. 2007;298(19):2296-2304.
Conclusion: The results suggest that the use of a pedometer is associated with significant increases in physical activity and significant decreases in body mass index and blood pressure.
Nowhere in those articles was I able to find “substantiation” for SUTN. In fact, as near as I can tell, your program is not even noted. (If I missed the mention, please accept my apologies.)
Substantiation is defined as “The act of validating; finding or testing the truth of something.” (From: http://www.thefreedictionary.com/substantiation, accessed January 31, 2010.).
Without even mentioning your program, which suggests that it was not put to the test, I find it unconvincing that your “program is also substantiated by [the] other landmark research studies…” you cited.
Again, frankly, to me this is another example of an IMHO con.
Which brings me to your article of May 2009.
Evidence-based medicine (EBM) has been considered “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." (Sackett D, 1996)
A component of EBM is an evaluation of the quality of a relied-upon study.
As near as I can tell from the SURI website, among other shortcomings, it was impossible to control for bias in subject selection and all data were self-reported. In the domain of studies, these factors relegate the data to the bottom-feeders.
Thus, I have to question the study. As I have to question the lastingness of the results.
When I see good data that the alleged (I could find no confirmation of the self-reported data) “modest” “weight losses” occurred, were maintained (at the very least) or improved upon and that health outcomes actually improved, then I will give your study more serious thought – especially if it is data generated independent of your company.
Lastly, and I hope you will forgive me for ending this comment early since there is much more to say, but I have commitments requiring my attention, I find Rajiv’s recognition by the Robert Wood Johnson Foundation (RWJF) support for my posture.
The RWJF, at least in the overweight/obesity department, is IMHO a net negative pursuing a garbage course of useless endeavors. Dealing as it does in the commerce of broad, sweeping generalities masquerading as “Recommendations,” government-based solutions and conventional sick care involvement, its support of Rajiv speaks to the inferior nature of your undertaking.
I hope I am wrong about my expected outcomes for your endeavor and that your social network of the blind leading the blind to successful weight loss will make the right differences.
Until such time as I am convinced otherwise, my conclusion remains that SUTN and SUTN-based wellness programs, as currently configured, are crap.
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