员工因肥胖而被老板罚款，真的吗？

    最近，美国CVS Caremark（CVS）公司登上了报纸头条，原因是该公司规定，那些在年度体检中未向公司汇报体重、体脂、血糖和胆固醇等健康数据的员工将被罚款600美元。这一备受争议的举措只是该公司实施新一轮职场健康计划的前奏，目的是通过定向激励措施来鼓励员工追求更加健康的生活方式。

    人力资源咨询公司怡安翰威特（Aon Hewitt）首席创新官吉姆•温科勒说，“人们将看到，在未来3至5年内，很多公司会奖励那些成功降低自身健康风险的员工。” 怡安翰威特通过对约800家公司的调查发现，58%的公司打算对那些不采取适当措施来改善自身健康状况的员工予以罚款。

    面对不断攀升的医疗保险成本，企业正扩大健康计划的外延。怡安翰威特的数据显示，2013年，人均医保成本预计将达到11,188美元（69813.12元人民币），而2007年为7,874美元（49133.76元人民币）。很多公司已将单一的奖励健康生活调整为奖励与处罚并举。在线健康咨询公司KEAs联合创始人、谷歌健康（Google Health）前任主管亚当•博斯沃思表示，美国公司每年要在医保上花费2.7万亿美元（16.848万亿元人民币），其中约50%-60%的资金都用在了那些可以通过饮食调整、运动和缓解压力来治疗的疾病上。

    最近通过的美国平价医保法（Affordable Care Act）明确指出，企业可以对员工的不健康生活方式进行经济处罚。该法案将罚款或奖金占医保费用的比例从20%上调至30%。联邦医保改革一揽子方案还对奖金或罚款能否有效影响员工的行为进行了探讨——不管企业更看重的是惩罚还是奖励。

    《唐尼肥胖报告》（The Downey Obesity Report）编辑、出版商摩根•唐尼说：“对于肥胖和体重管理来说，这些方案并不是很奏效。所有的研究都显示，员工在12个月内减掉的体重微乎其微。世界上最好的科学家和医学家都对控制这些问题感到头疼，我们为什么要指望人力资源部门能做到这一点呢？” 《唐尼肥胖报告》主要报道与肥胖有关的科学和公共政策。

    唐尼说，与抽烟、高血压和血糖控制（医师可以通过很多方法来治疗和控制这些症状）不同的是，目前没有有效的临床药物或治疗方案来解决肥胖问题。此外，医保改革中提到的联邦法规也探讨过是否实施此类措施，即公司要求所有员工的体质指数达到27，并对那些无法达到这一标准的员工或难以取得持续进步的员工处以罚款。

    大部分美国成年人都超重或患有肥胖症。研究发现，大部分人的减肥努力都以失败告终，而且大多数成功减肥的人也都在5年内恢复了基准体重。康乃尔大学（Cornell University）经济学家约翰•考利表示：“大多数美国女性随时随刻都在节食。人们其实也意识到了这个问题，他们也曾努力过。但是要改掉这些顽固的习惯谈何容易。”

    考利最近对奖励减肥的职场政策开展了一项研究，对象涉及2,635名员工。该研究发现，员工的减肥效果很一般，而且中途退出的比例很高。考利与德州大学阿灵顿分校（University of Texas at Arlington）的乔舒华•普莱斯共同发表了这篇研究报告。考利说：“我们试图找到设计这些激励方案的最佳方法，目前我们还处于起步阶段。”

    CVS Caremark (CVS) recently made headlines for rolling out a $600 penalty on workers who fail to report biometric data such as weight, body fat, blood sugar, and cholesterol in an annual screening. The controversial move is likely just the start of a new wave of workplace programs that aim to encourage healthier employee behavior through targeted incentives.

    "You're going to see over the next three to five years lots of employers rewarding employees for successfully improving their health risk," says Jim Winkler, chief innovation officer for HR consultancy AON Hewitt, which found that 58% of the nearly 800 employers it surveyed plan to penalize workers who fail to take appropriate actions to improve their health.

    Companies are expanding their wellness programs in the face of climbing health insurance costs, which in 2013 are expected to reach an average of $11,188 per employee, up from $7,874 in 2007, according to AON Hewitt. And many are switching from solely offering carrots -- rewards for making healthy choices -- to include sticks.

    Of the $2.7 trillion spent each year on health care, about 50% to 60% relates to conditions that could be improved through changes in diet, exercise, and stress management, says Adam Bosworth, co-founder of online wellness company Keas and former head of Google Health.

    The recently passed Affordable Care Act clarified employers' ability to financially penalize employees for unhealthy behavior. The act raised the allowed penalty, or reward, to 30% of health care premiums, from 20%. The federal health care reform package also cast a spotlight on the effectiveness of using payments and fines to influence employees' behavior -- regardless of whether they are weighted more on punishment or rewards.

    "These programs, when it comes to obesity and weight management, are simply not very effective. All the studies have shown a very marginal weight loss over 12 months," says Morgan Downey, editor and publisher of The Downey Obesity Report, which covers science and public policy on obesity. "The best scientists and clinicians in the world have trouble getting these conditions under control. Why do we think HR can do it?"

    Unlike smoking, high blood pressure, and glycemic control -- issues that physicians have a range of options to treat and control -- there are no clinically proven pharmaceutical or treatment protocols for obesity, says Downey. Moreover, the federal regulations proposed under health care reform contemplate such possibilities as an employer requiring its entire workforce to achieve a body mass index of 27, and fining those who cannot meet the standard or make consistent progress toward it.

    A majority of adult Americans are overweight or obese. Most fail in their attempts to lose weight, researchers find, but the majority of those who succeed return to baseline weights within five years. "The majority of American women are on a diet at a given time," says John Cawley, a Cornell University economist and public policy professor. "It's not that people don't know, and it's not that they aren't trying. It's that these are really hard behaviors to change."

    A recent study of a workplace program that offered financial incentives for losing weight to 2,635 workers found only modest weight loss and a high dropout rate, according to Cawley, who published this study with Joshua Price of the University of Texas at Arlington. "We're at an early stage with figuring out how to optimally design these incentive schemes," says Cawley.