Obesity and other conditions such as smoking cause more deaths worldwide than occupational accidents and occupational cancers, but they are multifactorial in origin and owe a lot to behaviour learnt and practised outside work.
That said, the workplace offers an unrivalled opportunity to apply the principles of prevention of occupational ill health to these common public health issues.
Classically, risk reduction, as applied to agents such as chemicals, involves a hierarchy of measures:
Firstly, aim to eliminate the hazardous agent.
If it cannot be eliminated, then substitute it for something safer.
Put controls in place to prevent exposure.
Check that the controls are working.
Provide health surveillance to check for any residual risk.
Provide information, instruction and training for staff.
To manage obesity in the workplace, it is tempting just to look at putting in place better nutritional information and encouraging exercise, but a similar set of hierarchical measures could be applied:
Eliminate poor food and sedentary work design (see case studies 1, 2 and 3).
Substitute with low-fat, low-salt healthy foods and provide for physical activity (see case study 4).
Check these foods and drinks are attractive and accessed (checking controls, see case study 5).
Provide health promotion so people learn about food and activity and can make healthy choices for themselves (see case study 6).
Provide information, instruction and training in how to select food, portion size, and benefits of various types of physical activity (see case study 7).
CASE STUDY 1
The Radisson SAS Hotel, Edinburgh, is part of an international chain. On request, it produced healthy options menus and food for a conference of health specialists in December 2005. Menus were agreed in advance with the organisers and aimed to meet various dietary needs and food preferences with a varied choice of low-fat food options with lots of fruit and vegetables.
In addition to tea and coffee, the hotel provided still and sparkling water and strawberry and banana smoothies at break times in the morning and afternoon. The smoothies were popular as an alternative to caffeine-containing drinks. The high standard of appearance, quality and taste of the food was commented on by delegates at the conference.
(Reproduced with permission from the Radisson Hotel, Edinburgh.)
CASE STUDY 2
Reports about innovations in the Mayo Clinic in the US have described how walking on a treadmill at about 1mph while answering e-mails can burn up to 1,000 calories a day. The researchers have designed and developed a treadmill workstation that removes the sedentary nature of desk jobs. The computer is located at chest height on a small platform with a conventional keyboard. This is part of its ‘Office of the Future’ initiative, which includes setting up double-lane treadmills so that meetings can be held on the go. More information is available from its website (www.mayoclinic.com).
CASE STUDY 3
A large manufacturing company in the UK has abolished seated meetings. All meetings now take place standing up. Consequently, they tend to be shorter and more focused, with a higher level of physical activity recorded on pedometers during the working day.
CASE STUDY 4
San Pedro Disenos is a small textiles company in Guatemala, South America. Its workers are low-wage earners, many of whom are poorly educated. Wages are based on productivity but an occupational health and safety programme found that they often missed breakfast and many did not have a suitable lunch. There was little understanding about nutrition and what was known was learned from the media and television, and was often incorrect.
The company brought in an 60-minute lunch break and provided cooking facilities and a dining area. Free bread and coffee was provided during breaks.
The company subsidised the cost of breakfast and lunch by about US$2 (£1) per meal. Since the introduction of the programme, employees are more productive, morale is higher, and absenteeism has fallen, along with medical costs.
(Reproduced with permission from Food at Work by C Wanjek. ILO Geneva. Copyright 2005 International Labour Organisation.)
CASE STUDY 5
A Danish workplace initiative, Firmafrugt, aimed to increase fruit and vegetable consumption and had several components, including one focused on catering. Five demonstration canteens worked with increasing amounts of fruit and vegetables available to purchase. Personnel and management and the catering team worked closely with the project personnel. Intake was measured by weighing fruit and vegetables served minus baseline, during the intervention and one year later.
Significant increases in fruit and vegetable intake were shown at all five demonstration sites, on average 70g per day per customer, bringing the intake to an average of 95g per day per customer.
Other businesses have latched onto the health initiative and participation increased from 623 workplaces in 2001 to nearly 5,000 in 2003, and more than 9,200 in 2004. This latter figure represents 9% of the Danish workforce. The fruit is simple and is displayed in baskets with disposable towels available. There is usually one piece of fruit available per worker per shift. Staff consider Firmafrugt as a sign that the company cares about them.
(Reproduced with permission from Food at Work by C Wanjek ILO. Copyright 2005 International Labour Organisation.)
CASE STUDY 6
The General Electric Company (GEC) has a Health by Numbers programme that asks staff to achieve four personal numbers: 0 for smoking 5 for fruit and vegetable servings per day 10,000 for steps taken per day and 25 for their BMI target. Employees manage their personal health through web-based information sources and programmes to help them achieve each behavioural goal.
GEC’s programme won it a Best Employer for Healthy Lifestyles Award from the National Business Group on Health, a non-profit organisation devoted to representing large employers’ perspectives on national health policy issues and providing practical solutions to its members’ most important healthcare problems.
The Best Employer for Healthy Lifestyles Awards recognise and reward companies in the US that apply creative solutions to improving the health of employees.
(Reproduced with permission from the National Business Group on Health, 2006.)
CASE STUDY 7
Selecta is a UK catering company and provider of vending machine contents. It has started to educate users about the nutritional value of the machines’ contents by placing brightly coloured stickers and information about fat, sugar and calories on the machines, so employees can make healthier choices.
CASE STUDY 8
Having forced workers to give up smoking or give up their jobs, the owner of a US company employing 200 people has now adopted a hardline attitude towards excess weight. Staff are given $35 (£18) a month as an incentive to go to the gym, and another $65 (£33) if they meet fitness targets set for them. The results of the weight incentive are pending, but this approach to smoking led to 20 workers giving up. When interviewed in the Telegraph, the owner said: “I’m not controlling their lives. They have a choice if they want to work here.”
The workplace can be the setting for a range of initiatives to promote healthier eating and greater physical activity.
Budgets do not have to be large, but creative thinking can help develop interesting and innovative schemes.
One feature of health-based initiatives is their focus on employees – the schemes are often seen as a sign that the employer values its employees and cares about their wellbeing. Benefits, difficult to measure as they are, may therefore extend beyond improved health for the employees, to improved health of the business.
Litterick, D. Fat staff ordered to shape up or ship out, Telegraph. 28 January 2005
Key messages for workplace programmes
Initiatives need to:
Make it easy to make healthy choices
Make it harder to make unhealthy choices
Offer a range of options – one size does not fit all
Provide rewards (not necessarily financial) for participation and success
Celebrate success internally and externally
Ensure that evaluation is a fundamental part of any initiative.