Employers dealing with obesity in the workplace have to contend with misunderstanding, stigma, lifestyles outside work and several other issues. Dr Nic Summerton looks at how to support employees.
We live in a world where there is one serious health condition that attracts more criticism than sympathy, where a level of stigma is considered acceptable – obesity.
In the workplace we need to be careful. It’s clearly not the job of employers to make judgements or pass comment on the size and weight of employees – especially when work can often play a major part in influencing eating and exercise habits.
In similar ways to stress, the relationship between obesity and work is complex. Routines and behaviours at work – particularly given the fact that much of modern work is sedentary – can have a substantial impact on lifestyle and wellbeing more generally.
Also, there is evidence suggesting that people can be technically obese but also physically healthy. Health and wellbeing can come in different shapes and sizes. A study by the US Centers for Disease Control and Prevention in 2015 showed that, in fact, people labelled “overweight” or “mildly obese” lived longest.
With these sensitivities in mind, we can consider the potentially negative effects of employees being overweight. Research has shown that obese employees take more short- and long-term periods of sickness absence, and according to Public Health England there are other significant costs associated with obesity: £126,000 a year in lost productivity due to a range of issues, including back problems and sleep apnoea, for an organisation employing 1,000 people.
There’s also the issue of how obese people are perceived – prejudice, discrimination and bullying – that impacts on their performance and all-round potential as an employee.
Latest thinking on obesity
In terms of how best to help, it is also important to understand the latest dietary thinking and the battle around sugar versus fat and what they both mean for our bodies. Sugar has been called the new smoking. Now widely agreed to be the main cause the global obesity epidemic, sugar is seen as a preventable cause of major forms of disease and death. Better to eat a fatty bag of crisps than fruit, say anti-sugar campaigners.
There is good scientific evidence that the traditional dietary advice – stick to a low-fat diet – was wrong. It was far too easy to believe that if you ate fat you’d get fat, and that fat in itself was the root cause of heart disease and strokes.
No-one ever said sugar was good for you, but under the cover of the idea that “fat is bad”, we’ve become used to relying on sugar-heavy products as a standard – products as innocuous looking as low-fat yoghurts, cereals and fruit juices – and lots of high-calorie, sugar-rich carbohydrates.
Refined carbohydrates are forms of sugars and starches that don’t exist in nature. They do come from natural whole foods, but they have been altered by processing to refine them. Examples include table sugar/white sugar (sucrose), corn syrup and high-fructose corn syrup.
Refined carbohydrates are rapidly absorbed into the bloodstream, causing risky spikes in blood sugar and insulin levels. This has fuelled obesity and changes in blood fats, also increasing the risks for heart disease, strokes and type 2 diabetes. The situation has become very confusing, and Government guidelines do not always help to clear the fog.
The problem is not to do with whether or not fat is bad for you, or sugar is really bad for you. It is the “bandwagon” nature of media stories and advice. We’re addicted to sugar, true – and we’re also addicted to novelty, the latest scare, or must-have food. Both sugars and fats are important for the normal functioning of our bodies. There’s nothing fundamentally wrong with either of them. It’s just an issue of excess. Too much exercise and losing too much weight are also harmful.
Another topical issue relating to obesity is how employees choose to relax in the evenings – particularly the popularity of alcohol-based relaxation. Some studies have shown that moderate drinking can have some health benefits, but the key here is the word moderate. It can be very difficult to keep track of drinking, especially given the knowledge of what constitutes a unit.
Despite several studies, many people do not know what actually constitutes moderate drinking – many bars now offer wine in 250ml measures. That’s the equivalent to one-third of a bottle of wine. Recent recommendations (see www.drinkaware.co.uk for the UK Chief Medical Officers’ low-risk guidelines) are that men and women should drink less than 14 units per week. However, 14 units is just six glasses of wine based on a 175ml glass of 13% alcohol.
What employers can do
Without turning into a finger-wagging irritant, occupational health and HR can help employees make better informed choices and move into sustainably healthy routines.
Most straightforwardly that means providing opportunities for staff to eat a healthy diet: actively and continuously promoting healthy choices in what’s offered through staff canteens, all events that involve catering (whether that’s a conference or just a weekly meeting), in vending machines, and any visiting food providers.
Healthy choices need to be made obvious and easy, not an alternative option – because if the bulk of the food normally available is chips, pizza and cheese sandwiches then that’s what we’ll eat. If the norm is sushi, salads and soups then suddenly the routine changes. As well as making healthier choices more normal and accessible, people should be incentivised by food being lower cost, with prominent promotions and advertising.
There’s a middle way between the sugar versus fat debate that reduces the risk of heart attacks, strokes and type 2 diabetes and should be kept in mind when reviewing available food at work.
It’s important to reduce total fat intake, but also our intake of refined sugars, especially sucrose and high-fructose corn syrup; to look more closely at the ingredients to see whether or not products include refined sugars such as fructose; and encourage the swapping of fatty and sugary snacks such as cereal bars, cakes and biscuits for fruit and vegetables. Menus should include low-fat milk and dairy products and include wholegrain bread and fish and less processed/fatty meat.
Drinks can be a problem. Juices, smoothies, canned and dried fruit are high in sugar; as far as possible, staff should be encouraged to eat unprocessed fruit and drink more water – a 150 ml glass of orange juice, 250ml smoothie, 30g raisins and 80g of canned peaches amounts to 69g of sugar (about 16 teaspoons). Five a day should be about “real fruit and vegetables”, which is where many guidelines have got it wrong and are out of date.
Employers need to think creatively about how and when people get exercise during their working day, in practical ways beyond the subsidised gym provision or activities that require time, money or motivation. HR and occupational health can start by:
- encouraging an active travel policy (offering employees expenses that incentivise walking and cycling;
- providing secure parking locations for bikes as well as shower and change facilities);
- fitting offices with standing desks; encouraging more standing meetings or even walking meetings in the open air; improving the look and environment around stairways, and introducing signage so more people choose the stairs over the lift – or limit access to lifts to necessary use; and
- developing links with local leisure and sports facilities and offering subsidised membership rates.
For those staff who actively want to lose weight, some employers offer a multi-component weight management programme (using an external agency) to those particularly overweight focusing on activity and eating behaviours.
The barriers to lifestyle changes can be as simple as a lack of knowledge and information on buying and preparing healthy foods, and the benefits involved.
Education on the gains involved is useful alongside visits from expert dieticians, with guidance on reducing cardiovascular and type 2 diabetes risk, improving existing conditions such as kidney problems, sleep apnoea, musculoskeletal problems and indigestion, and improving self-esteem and mood.
In its advice to employers, many national guidelines advocate health checks for employees that address weight, diet and activity, and provide ongoing support. BMI is used by most doctors as a quick and easy way to measure obesity.
However, because BMI is a relative measure of weight, it does not distinguish between fat and muscle mass. So, athletes with high levels of muscle mass can be classed as obese when this is inappropriate.
The best health screenings will include additional readings that can help people gain a better understanding of their overall health. For example, body composition analysers use bioelectrical impedance (a painless electrical signal is passed through the body via pressure-contact electrodes), to provide data that breaks down body composition into body fat measurements, visceral fat (the abdominal fat that surrounds the vital organs in the trunk/stomach of the body and which can increase the risk of high blood pressure, heart disease and type 2 diabetes), muscle mass, metabolic age and fat-free mass.
Gaining a full understanding of these measurements can be far more helpful than solely relying on the BMI.
Making health screenings an annual event is important in this context – a way for people not only to get a snapshot, but to track their own progress and set goals using the kind of app included in the Bluecrest offering, alongside a GP telephone consultation after each health check.
With both the alcohol and obesity issues in mind – and its link to issues of weight gain – it’s also useful for employees to be checked for liver fibrosis (the most common causes being damage due to alcohol or fatty deposits), getting a FIB4 liver fibrosis score based on liver blood tests and blood platelet count, as well as further advice on factors that impact your risks.
Also, the human body was not designed to sit for extended periods of time, yet both work and home lives are increasingly based around sitting in front of screens, at desks or in a car.
Backs are designed to move – and by moving less and less, your back can be under greater strain and at risk of strains. Given that back problems continue to be the most common reason for long-term absence, and are bound up with psychological attitudes to physical activity, it’s important to include advice on musculoskeletal health.
The Orebro back pain score is a good way to help people better understand and manage back problems and get them into more active routines.
Dr Nick Summerton is a GP and medical director at Bluecrest Wellness.