????最近，美國CVS Caremark（CVS）公司登上了報紙頭條，原因是該公司規定，那些在年度體檢中未向公司匯報體重、體脂、血糖和膽固醇等健康數據的員工將被罰款600美元。這一備受爭議的舉措只是該公司實施新一輪職場健康計劃的前奏，目的是通過定向激勵措施來鼓勵員工追求更加健康的生活方式。

????人力資源咨詢公司怡安翰威特（Aon Hewitt）首席創新官吉姆?溫科勒說，“人們將看到，在未來3至5年內，很多公司會獎勵那些成功降低自身健康風險的員工。” 怡安翰威特通過對約800家公司的調查發現，58%的公司打算對那些不采取適當措施來改善自身健康狀況的員工予以罰款。

????面對不斷攀升的醫療保險成本，企業正擴大健康計劃的外延。怡安翰威特的數據顯示，2013年，人均醫保成本預計將達到11,188美元（69813.12元人民幣），而2007年為7,874美元（49133.76元人民幣）。很多公司已將單一的獎勵健康生活調整為獎勵與處罰并舉。在線健康咨詢公司KEAs聯合創始人、谷歌健康（Google Health）前任主管亞當?博斯沃思表示，美國公司每年要在醫保上花費2.7萬億美元（16.848萬億元人民幣），其中約50%-60%的資金都用在了那些可以通過飲食調整、運動和緩解壓力來治療的疾病上。

????最近通過的美國平價醫保法（Affordable Care Act）明確指出，企業可以對員工的不健康生活方式進行經濟處罰。該法案將罰款或獎金占醫保費用的比例從20%上調至30%。聯邦醫保改革一攬子方案還對獎金或罰款能否有效影響員工的行為進行了探討——不管企業更看重的是懲罰還是獎勵。

????《唐尼肥胖報告》（The Downey Obesity Report）編輯、出版商摩根?唐尼說：“對于肥胖和體重管理來說，這些方案并不是很奏效。所有的研究都顯示，員工在12個月內減掉的體重微乎其微。世界上最好的科學家和醫學家都對控制這些問題感到頭疼，我們為什么要指望人力資源部門能做到這一點呢？” 《唐尼肥胖報告》主要報道與肥胖有關的科學和公共政策。

????唐尼說，與抽煙、高血壓和血糖控制（醫師可以通過很多方法來治療和控制這些癥狀）不同的是，目前沒有有效的臨床藥物或治療方案來解決肥胖問題。此外，醫保改革中提到的聯邦法規也探討過是否實施此類措施，即公司要求所有員工的體質指數達到27，并對那些無法達到這一標準的員工或難以取得持續進步的員工處以罰款。

????大部分美國成年人都超重或患有肥胖癥。研究發現，大部分人的減肥努力都以失敗告終，而且大多數成功減肥的人也都在5年內恢復了基準體重。康乃爾大學（Cornell University）經濟學家約翰?考利表示：“大多數美國女性隨時隨刻都在節食。人們其實也意識到了這個問題，他們也曾努力過。但是要改掉這些頑固的習慣談何容易。”

????考利最近對獎勵減肥的職場政策開展了一項研究，對象涉及2,635名員工。該研究發現，員工的減肥效果很一般，而且中途退出的比例很高。考利與德州大學阿靈頓分校（University of Texas at Arlington）的喬舒華?普萊斯共同發表了這篇研究報告。考利說：“我們試圖找到設計這些激勵方案的最佳方法，目前我們還處于起步階段。”

????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.