Counterweight: a proactive approach to workplace obesity

Risks to the health of obese employees have implications for the workplace, but an awareness scheme aims to tackle issues at the early stages. Maria Dow outlines an evidence-based programme for weight management in the work environment.

Workers suffering from obesity (a body mass index (BMI) of 30kg/m2) suffer more ill health, have more absences and are less productive than colleagues who are considered to have a healthy weight. Obese people have higher levels of cardiovascular-related diseases (Hertz et al, 2005), joint and back pain, and may have difficulty getting around the office.

Even commuting to work can be more difficult as a result of their weight (Larsson et al, 2001; Hans et al, 1999). Respiratory problems, especially sleep apnoea, are more prevalent in employees with obesity resulting in poorer productivity and increased risk of tiredness, occupational and road traffic accidents (Lindberg et al, 1995) (see box 1).

Obesity is a significant predictor of both short- and long-term absenteeism in the workplace for both men and women (Ferrie et al, 2005).

CBI figures show that absence costs UK employers £12 billion per year with 168 million working days lost in 2004. Evidence shows that the average weight gain for the overweight or obese person is 1kg per year (Heitman et al, 1999). Further increases in sickness absences as a result of increasing weight are likely to occur over time. Any policy aimed at addressing sickness absence must deal with the issues of obesity in the workplace.

A survey of patients attending an NHS obesity clinic showed that: 50% had taken time off for health problems that could be attributed to their weight (Williams et al, 2005); 17% were unemployed or on incapacity benefits; 30% had difficulty wearing personal protective equipment; and 25% had difficulty wearing work uniforms.

This article looks at the Counterweight programme, which was recently evaluated across general practices. Counterweight trains and mentors primary care nurses to deliver a structured programme of weight management. Evidence shows that 70% of those who attend will lose weight and not put it back on after 12 months.

Recommendations

The National Institute for Health and Clinical Excellence (NICE) guidelines on overweight and obesity were published in 2006. Recommendations are that workplaces should endorse weight management programmes that aim for realistic weight losses of between 5% and 10% and focus on long-term lifestyle changes.

Practitioners delivering weight management should help employees to embrace these clinically beneficial weight loss targets of between 5% and 10%. For those who are not ready to make changes to their lifestyles, they should be encouraged to maintain their weight to avoid further weight gain.

The Scottish Intercollegiate Guidelines Network (SIGN) recommends weight loss targets of between 15% and 20% (15kg to 20kg) for patients with a BMI of 40kg/m2 or a BMI of 35kg/m2 with an associated disease in order to manage conditions relating to excess weight such as; diabetes, heart disease, osteoarthritis and sleep apnoea (Scottish Intercollegiate Guidelines Network, 2010).

Counterweight programme

The Counterweight programme is a prospective, evidence- and theory-based intervention for weight management, evaluated in 65 general practices from seven UK regions. Primary care nurses were trained and mentored to enable them to identify motivated patients, and deliver a structured programme of weight management (see Counterweight model below).

Counterweight model diagram

The mentoring ensured that practitioners were able to achieve a level of competency to deliver the weight management programme in their practice setting (Counterweight project team, 2008).

There were 1,906 eligible patients with a BMI of 30kg/m2, or a BMI of 28kg/m2 with an obesity-related disease who started the Counterweight programme. The mean weight loss in those who attended and had data at six, 12 and 24 months was 4.2kg, 3kg and 2.3kg respectively.

Among attendees, 30.7% and 31.9% maintained a clinically significant weight loss of 5% at 12 and 24 months respectively (see box 2). Counterweight programme evidence shows that 70% of those who attend will lose weight and keep it off after 12 months. Health economic analysis has demonstrated that Counterweight is cost effective compared with other interventions (Counterweight Project Team and Trueman, 2010).

Following the evaluation phase of the Counterweight weight management programme, it has been commissioned by the Scottish Government since 2006 and has been operational in 13 health board areas in Scotland and several primary care trusts in England.

The most recent published data showed that, as of October 2010, 6,715 patients from 184 general practices and 16 pharmacies were enrolled into the programme. Among attendees 35.2% maintained a weight loss of 5% at 12 months (Counterweight pro­ject team, 2012).

The Counterweight project team is piloting this programme of weight management in workplace settings including a Scottish local council and an oil refinery. The weight-change results as seen in primary care are being replicated in the workplace settings.

Box 1: Potential consequences of obesity

  • Increased risk of cardiovascular diseases.
  • Increased risk of joint and back pain.
  • Increased risk of respiratory illness and sleep apnoea.
  • Difficulty mobilising around desk and workplaces.
  • Difficulty fitting into uniforms and protective equipment.
  • Increased absenteeism.
  • Reduced productivity.
  • Increased risk of occupational and road traffic accidents.

Forty-eight patients started the Counterweight programme in the workplace setting with a mean weight change at six months of -4.2kg. If employers can show commitment to weight management, these are the results that can be expected to be replicated in their workplace.

The programme has a defined number of sessions and it only takes the employee away from their work for three to six hours over a 12-month period. This has minimum impact on working time but with obvious benefits as outlined earlier.

Counterweight Ltd has already secured two national contracts with occupational health companies – Corporate Health and Energy Fitness Professionals – and is in discussions with several others with a view to optimising programme availability in the workplace.

Nicola Blance, a nutritionist involved in delivering Counterweight to both the primary care and workplace settings, feels that the programme works well in the workplace setting. She says: “Weight management groups that are formed in workplaces seem to gel well and can become quite competitive. This competitiveness can be a spur for some participants to encourage them to lose weight, for others not doing quite so well they may be tempted to stop attending.”

Further research

People with a BMI of 40kg/m2 or a BMI of 35kg/m2 with an obesity-related disease may require a more intensive programme of weight management. The Counterweight project team has conducted a low-energy liquid diet (LELD) feasibility study between February 2010 and September 2011.

Ninety eligible patients began a nutritionally complete 832kcal/day LELD for 12 weeks, followed by a structured programme of food reintroduction and weight loss maintenance.

The mean weight loss for those remaining in the programme at 12 months was 12.4kg in a population with a mean BMI of 48kg/m2 (Lean et al, 2012). With one adult in four in the UK suffering from obesity, this programme offers a solution that provides both health and workplace benefits.

Conclusion

The NICE guidelines recommend that workplaces support weight management programmes for employees. The Counterweight programme is an evidence-based solution to the overweight/obesity problem. The programme has proven efficacy in both the primary care and workplace settings.

The programme is available to occupational health providers and their customers as Counterweight@Work. This is one solution to help organisations manage the rising problem of overweight people and obesity in their workforce.

For more information visit the Counterweight website or contact Louise McCombie. Tel: 07968 820081.

Box 2: Counterweight programme – facts and figures

  • It is an evidence-based, structured programme of weight management.
  • It is tested in primary care, peer reviewed and published.
  • It is eligible for people with a BMI ≥ 30kg/m2, or a BMI ≥ 28kg/m2 with obesity-related disease.
  • 1,906 eligible patients started Counterweight during original evaluation phase.
  • Mean weight change at six, 12, 24 months -4.2kg, -3kg, -2.3kg.
  • 70% of attendees lose weight and keep it off for 12 months.
  • More than 30% achieve and maintain ≥ 5% weight loss at 12 and 24 months.
  • 48 eligible employees recruited into the “workplace” pilot.
  • Low-energy liquid diet (LELD) available for those who require greater levels of weight loss.
  • In the LELD programme, mean weight loss is 12.4kg in people followed up at 12 months.

References

Campbell D, Ball J (2012). “Number of NHS patients missing waiting-time target soars”. The Guardian.

The Government Office for Science (2007). Foresight report. “Tackling obesities: future choices – summary of key messages”. (Accessed online Jan 2012.)

Ferrie JE, Kivimaki M, Head J (2005). “Weight and weight gain: implications for sickness absence in British civil servants over a five-year period form the late 1980s”. European Journal of Public Health.

Linehan C et al (2005). “Track 3: Work-related health problems and healthcare needs”. European Journal of Public Health.

Hans TS et al (1999). “Quality of life in relation to overweight and body fat distribution”. Am J Public Health 88: pp.1,814-1,820.

Heitman BL, Garby L (1999). “Patterns of long-term weight changes in overweight developing Danish men and women aged between 30 and 60 years”. Int J Obes Relat Metab Disord; 23: pp.1,074-1,078.

Hertz RP, Unger AN, McDonald M et al (2005). “The impact of obesity on work limitations and cardiovascular risk factors in the US workforce”. J Occup Environ Med. (12) pp.1,196-1,203.

National Institute of Clinical Excellence (2006). “Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children”. (Accessed online Nov 2010.)

Larsson UE, Mattesson E (2005). “Perceived disability and observed functional limitations in obese women”. Int J Obes Res; 25: pp.1,705-1,720.

Lean et al (2012). “12-month weight loss outcomes for the Counterweight low-energy liquid diet (LELD) and weight-loss maintenance programme delivered in primary care”. Obesity Facts; 5 (suppl.1): p.196.

Lindberg E, Carter N, Gislason T et al (1995). “Role of snoring and daytime sleepiness in occupational accidents”. Ann Intern Med; 122: pp.481-486.

Scottish Intercollegiate Guidelines Network (2010). “Management of obesity”. (Accessed Jan 2012.)

Counterweight project team. “Evaluation of the Counterweight programme for obesity management in primary care: a starting point for continuous improvement”.

Counterweight project team, Trueman P (2010). “Long-term cost effectiveness of weight management in primary care”. Int J Clin Pract; 64, pp.775-783.

Counterweight project team (2012). “The implementation of the Counterweight programme in Scotland, UK”. Family Practice; 29: pp.139-144.

Thomas D (2005). “Fattism is the last bastion of employee discrimination”. Personnel Today, 25 October 2005.

Williams NR, Malik N (2005). “Obesity and work: perceptions of a sample of patients attending an NHS obesity clinic”. Occupational Health. October 2005.

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