How far will the boss go to make you shape up?

Milwaukee’s recent designation as a “Well City” by the Wellness Council of America strikes the stereotype that Milwaukeeans are fat, cheddar-noshing, sausage-gobbling, beer-guzzling couch potatoes.

The designation recognizes cities for having a healthy work force. To qualify, a city has to get at least 20 companies to set up wellness programs that measure employees’ personal health risks and then do something to lower those risks. Typically, that means encouraging employees to quit smoking, lose weight, eat nutritious food instead of junk and get chronic health problems like high blood pressure and cholesterol under control.

In Milwaukee, 34 companies met the criteria to brand the city a healthy place to live and work, according to the Well City Milwaukee website.

Nationally, the “well workplace” movement has been gaining traction over the past decade as employers struggle to slow the pace of rising health costs. In theory, if a company’s workers commit to ending unhealthy habits, they’ll prevent more serious —and expensive — health problems down the road.

But how far are bosses going to convince their workers to shape up?

As it turns out, a growing number are penalizing workers who refuse to participate in wellness activities. According to a survey by global human resources consulting firm Hewitt Associates, 47 percent of large U.S. companies already use or plan to use financial penalties against workers who don’t enroll in health improvement programs.

Of those that currently penalize workers, 81 percent do so by charging higher insurance premiums; 17 percent charge higher insurance deductibles; and 17 percent apply higher out-of-pocket health expenses.

Behaviors on the no-no list include smoking, at 64 percent of companies surveyed; not enrolling in disease management or lifestyle behavior programs at 50 percent; and not getting biometric screenings for medical problems at 45 percent.

Local officials involved in the wellness movement say that, for the most part, Milwaukee employers tend to prefer positive incentives to encourage workers to enroll in wellness initiatives. A few, however, are applying some tough love.

Well City Milwaukee, the coalition of businesses behind the “Well City” campaign, found in a survey in late 2008 that 6 percent of coalition members required workers to participate in health risk assessments if they wanted company health benefits. Nine percent said they offered lower co-pays, deductibles or premiums to workers who participated in the assessments; and another 9 percent awarded cash, gift certificates or other merchandise for participation. Eight percent offered no incentives.

Corporate WORx, a Columbia St. Mary’s Inc. subsidiary that manages corporate wellness plans, recommends employers rely on positive incentives to convince workers to get in shape.

“We’ve not been involved in ‘blunt wellness,’ ” says Dr. Michael Lischak, medical director for Milwaukee-based Corporate WORx. “Some companies are using punitive approaches, but we’ve not recommended or employed negative incentives.”

Employees’ enthusiasm for health improvement can hang on how the wellness message is delivered, says Conrad Holling, program administrator at Corporate WORx. Businesses shouldn’t leave employees with the impression that they’re being punished for having bad health habits, he says. Rather, employers should communicate the message that they care about their employees’ well-being, and being well means having a better quality of life.

That may sound a little like a parent telling a child, “Do this because it’s good for you.” And yet, Mom was right.

So, if you work for a company that offers a financial incentive to change some bad health habits, consider it an investment – not a penalty —toward your good health and longer life.