Solutions to a weighty problem

Growing
obesity figures mean that one-fifth of the population is now significantly
overweight . What can and should OH professionals do to help? By Eliza
O’Driscoll

A
new report from the National Audit Office shows that 20 per cent of British
adults are obese, defined as having a body mass index of more than 30. The NAO
estimates that the financial consequences of obesity include a cost of at least
half a billion a year to the NHS and more than £2bn a year to the wider
economy. 

The
evidence points to a combination of less active lifestyles and changes in
eating patterns being responsible for the rising prevalence of obesity which
has more than trebled in the past 20 years1.

The
human cost of obesity in terms of disease and premature death has been
calculated by the NAO at 30,000 deaths a year and obesity is estimated to shorten
life by an average of nine years. The impact on the workplace is substantial
with an average of 18 million days lost to sickness each year.

With
these statistics in mind, obesity is quite certainly something for the
occupational health department to be concerned about.

Can
obesity be tackled at work?

The
question that arises next is whether it is possible to tackle obesity
effectively in a workplace setting. A study of 1,053 employees in a Glasgow
factory suggests that it is. The study attempted to determine the overall level
of behaviour change after attending a workplace health check. Almost half the
participants responded by changing their behaviour in one of four ways
(stopping smoking, increasing exercise, reducing alcohol consumption or their improving
diet). The study also found that participants who perceived themselves to be at
risk were more likely to comply2.

A
review by the Health Education Authority of 15 workplace health promotion
initiatives found that workplace interventions aimed at weight control which
combined education and financial incentives were least effective.

"Sustained
weight loss appears particularly difficult and more effort is required to
develop and evaluate interventions aimed at long-term weight control," it
commented3.

However,
it pointed out some healthy eating measures had been found to be effective such
as point-of-purchase labelling of health food choices in workplace cafeterias
and computer-generated personalised nutrition advice.

The
study put forward a number of recommendations for developing and implementing
interventions, which are set out in the box below.

Another
study by the same agency,  looked this
time at healthy eating interventions in different settings4. Of the nine workplace
interventions that it examined, only four were considered of good quality. It
found that the most effective interventions focused on changing diet or blood
cholesterol rather than a diversity of other lifestyle factors. They also
involved individual screening and counselling sessions.

Although
effective large-scale interventions did not necessarily have to be intensive,
they did tend to require reorganisation of the workplace and substantial
resources.

As
an example of a successful intervention, it stated that one, which took place
over 15 months, featured workplace events, cholesterol screening, classes and
modification of cafeteria meals, which resulted in a reduction of fat intake of
1 per cent of energy.

Prevention

What
goals should a health promotion strategy have? The NAO itself suggests that
halting the upward trend by preventing people from becoming overweight or obese
is one important goal. Another vital goal is weight reduction in the already
overweight or obese. Recent research suggests that a reduction in total body
weight of an obese person of just 10 per cent is enough to deliver significant
health benefits5.

Multi-factorial
approach needed

How
is it possible to tackle obesity effectively in a workplace setting? It is
clear that a multi-factorial approach is necessary. Strategies that involve a
combination of diet, exercise and/or behavioural change, appear to be more
beneficial for weight loss than a change in diet alone6.

Weight
loss or weight management should be looked at in terms of lifestyle
improvements, and reducing the proportion of fat in the diet has been found to
be an effective method of weight loss in the obese7.

Another
study suggests that exercise is as effective as diet in inducing weight loss
among obese men8.

Yet
another study suggests that for adults aged over 45, exercise is even more
important than for younger people, avoiding health care costs of an average of
more than £30 per person per year9.

References

1
National Audit Office (2001) Tackling obesity in England, Report by the
Comptroller and Auditor General, HC220, 15 February.

2
Hanlon P et al. Behaviour change following a workplace health check: how much
change occurs and who changes? Health Promotion International, 13: 131-9.

3
Health Education Authority (1998) Effectiveness of health promotion
interventions in the workplace, Health promotion effectiveness reviews, Summary
bulletin 13, ISBN 0 7521 1416 6.

4
Health Education Authority (1997) Health promotion interventions to promote
healthy eating in the general population – a review, Health promotion
effectiveness reviews, Summary bulletin 6, ISBN 0 7521 0827 1.

5
Hankey C, Lean M (1995) The benefits of weight reduction and the maintenance of
weight loss, Royal College of Physicians of Edinburgh Working Group on Obesity.

6
Effective Health Care(1997) The prevention and treatment of obesity, 3 (2), p4.

7
Astrup A, et al. (2000) The role of dietary fat in body fatness: evidence from
a preliminary meta-analysis of ad libitum low-fat dietary intervention studies.
British Journal of Nutrition, 83(Suppl 1): S25-S32.

8
Ross R et al. (2000) Reduction in obesity and related comorbid conditions after
diet-induced weight loss or exercise-induced weight-loss in men, Annals of
Internal Medicine, 133(2): 92-103.

9
Nicholl JP et al. (1994) Health and healthcare costs and benefits of exercise,
Pharmacoeconomics, 5(2): 109-22.

Facts
and figures

The
four most common problems linked to obesity


Heart disease


Type 2 diabetes


High blood pressure


Osteoarthritis

The
estimated human cost


18 million sick days a year


30,000 deaths a year, resulting in 40,000 lost years of working life


Deaths linked to obesity shorten life by nine years on average

The
estimated financial cost


At least £1/2 billion a year in treatment costs to the NHS


Possible £2 billion a year impact on the economy

Source:
National Audit Office

Recommendations
for developing and implementing interventions

Interventions
should be targeted at specific groups at risk of particular health hazards and
tailor-made with the characteristics and needs of those groups in mind.


Workplace health promotion strategies should not isolate health-related
knowledge values and behaviours from the social and material context in which
the targeted employees live.


Organisations should employ both population-based policy initiatives and
intensive individual and group-oriented health promotion interventions to
create an integrated programme for change.


A sustained programme based on principles of empowerment and/or a
community-oriented model using multiple methods, visibly supported by top
management and engaging the involvement of all levels of worker in an
organisation is likely to produce the best results.


Ideally, interventions for healthy eating should address only one related risk
factor, such as exercise. Where multiple risk factor interventions are
necessary, it should be ensured that diet is assessed by a validated outcome
measure, and that this is central to the intervention.

Healthy
eating interventions in workplace settings should be conducted mainly with
individuals or in small groups. They should take into account personal
characteristics such as motivation and needs and would greatly benefit from
operating within an approach which incorporates a model of communications or
behaviour change such as social cognitive theory or the stages of change model.


These interventions should also include feedback on changes in behaviour and
risk factor level as central components.

Consideration
should also be given to long-term maintenance of behaviour change, and ideally
to addressing wider social and environmental factors which may impact on the
individual.

Source:
Health Development Agency

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