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While studies show they have lost favor in recent years, biometric screenings are still a popular offering. According to the Kaiser Foundation, among large organizations that provide health benefits, 38% include biometric screenings.
Though widely utilized, some experts question whether biometric screenings can live up to the hype. As such, it’s worth taking a closer look at why employers include biometric screenings as a part of their wellness program and whether there is a better way to achieve the same goals.
But first, what is a biometric screening?
Biometric screenings are general health exams that measure a variety of physical characteristics to provide employers with a picture of employees’ overall health. Offering on-site biometric screenings within the office can increase accessibility and convenience. Alternatively, they can be done at the doctor's office, where employees schedule their own appointments. Sometimes, health coaching is offered to employees identified as high-risk to provide education and improve employee health.
Biometric screenings collect biometric data, while a physical exam is a more comprehensive evaluation of one’s health and well-being. It can include a detailed medical history, a thorough physical examination, and additional tests or procedures to address chronic conditions. Getting regular physicals with a healthcare provider has the added benefit of helping employees build a patient-physician relationship. Even so, physicals are not recommended annually.
The most common data collected from a biometric exam include:
Biometric health screenings may also include a blood test, which measures:
This data is used to assess an employee’s risk of various health conditions. For example, an elevated BMI is associated with various chronic diseases like type 2 diabetes, heart disease, and some certain type of cancer; high blood pressure or “bad” LDL cholesterol levels are major risks for heart disease and stroke; elevated blood sugar levels may indicate prediabetes or diabetes.
Biometric screenings are associated with several valuable outcomes that explain their widespread use. Unfortunately, there are ugly truths behind these benefits. Here are three common myths about biometric screenings:
Biometric screenings are often presented as a more accurate version of health risk assessments (HRA), which ask employees various questions about their health through a survey. Because employees may not have precise knowledge regarding their health status and feel reluctant to share their personal information, employers are often concerned that HRAs are inaccurate.
Since the tests used for biometric screenings rely on more "objective" measures, they are often thought to provide accurate and reliable pictures of employees' health risks.
Refutation: Many biometric screening results, especially those derived from weight and body size, can be inaccurate or misleading. For example, research from the Centers for Disease Control and Prevention (CDC) and the National Health and Nutrition Examination Survey indicates that BMI is a misleading measure for 18% of the country. The data shows that 12% of males and 3% of females identified as overweight according to BMI had normal body fat percentages.
The earlier a condition is caught, the better its prognosis is. Given that some individuals who undergo biometric screenings are unaware of any conditions they may have, the tests should help them learn about their risk factors early enough to make a significant difference in their long-term health. For example, through the screening process, a participant could learn they have high blood pressure and are at risk of developing heart disease. This might prompt them to work on improving their health before the health condition becomes a chronic disease.
Refutation: The ability of biometric screenings to produce a sizeable number of life-changing early detections depends largely on their accuracy and reliability. As was noted below the first claimed benefit, some of the more commonly used tests lack an appropriate level of objectivity or reliability. Moreover, many employees are likely already aware of their main risk factors. For example, individuals who are identified as "high risk" because of their weight or blood cholesterol levels probably had some idea of their health status. Confirming their suspicions through screening is therefore unlikely to have a significant impact on the trajectory of their conditions or save on healthcare costs.
Biometric screenings are often implemented under the assumption that once employees "know their numbers," this will motivate them to change their behaviors in ways that allow them to mitigate their health risks.
Refutation: Though it’s intuitive to think one would change their unhealthy habits after a biometric screening result indicating the presence of risk factors, experts argue that credible empirical evidence is hard to come by. In their editorial on the usefulness of employer-sponsored biometric screenings, Drs. Bruce Sherman and Carol Addy note, "efforts to find published evidence regarding the impact of biometric screening on individual behaviors have proved surprisingly fruitless." Thus, while biometric screenings may result in behavior change, there is currently insufficient scientific evidence to support this.
Getting employees to participate in biometric screenings is easier said than done. Skeptical of the benefits and concerned about their privacy, many employees are prone to opt out of this offering.
To offset this tendency, some employers offer incentives to those who participate. Though this practice may sound harmless, it raises legal and ethical red flags. In July 2019, a class-action lawsuit was filed against Yale University, with plaintiffs alleging the University violated the Americans with Disabilities Act (ADA) and Genetic Information Nondiscrimination Act (GINA) by offering incentives to those who underwent biometric screenings.
This case highlights the importance of adhering to ADA, GINA, and HIPAA regulations in biometric health screenings. Employers must ensure that their wellness initiatives, including screenings at the worksite, protect the privacy of the employee population and comply with legal standards.
Thus, even if biometric screenings were objective, reliable, resulted in early detection of conditions that changed their trajectory, and produced valuable behavior change, they may not be worth implementing given the legal risks associated with the use of incentives needed for sufficient participation.
Despite evidence, biometric screenings stay alive in the workplace and continue to fall short in achieving what employers hope for. The key thing to note is that the recommended behavior changes are similar for many of the health risks that biometric screenings are supposed to test for. Employers are better off directing their limited budgets towards implementing a workplace wellness program that encourages lifestyle change. Along with increasing access to a primary care physician, solutions include nutrition counseling, fitness programs, and health coaching.
Looking to build a program but don't know where to start? Take this quiz to get personalized recommendations on wellness initiatives most relevant to your population.