Obesity in the workplace

Performance / 26 January 2012

Rising rates of obesity in the UK are affecting both businesses and employee wellbeing. But is it a manager’s place to step in? Sue Weekes asks how organisations can help their staff tackle weight issues

Medical conditions naturally invoke sympathy from bosses and work colleagues. There is one condition, however, that can’t always be guaranteed a warm and cuddly response: obesity.

It is classed as a medical disease, listed in the International Classification of Diseases with its own reference number (E66). But even in this enlightened and politically correct age, people with the condition are frequently subject to stereotyping and labelling in the workplace.

“One such label is that they are lazy,” says Dr Nerys Williams, a consultant occupational physician and former NHS honorary consultant in weight management. “[Managers] can have preconceived assumptions about obese people, which may affect the way they treat them as employees.”

Such prejudice is one reason why obesity remains a taboo subject in the workplace. Most managers would run a mile rather than discuss something as personal and potentially contentious as how an employee’s weight might be impacting their performance.

Much like smoking a few years ago, opinion is divided as to whether it is the employer’s business in the first place or even their responsibility to address it.

“I think obesity is largely ignored by individual managers,” says Dr Jenny Leeser, clinical director of occupational health at Bupa. “It’s seen as a private matter and not something that should be tackled in the workplace. I don’t think many managers feel confident enough to broach the issue.”

Ignoring the problem, though, will soon not be an option. Obesity, which is statistically measured using the Body Mass Index, is steadily on the rise in the UK. Data from the Organisation for Economic Co-operation and Development shows that adult obesity in the UK in 1990 stood at less than 15% of the population but had climbed to just over 20% by 2000.

According to the latest European Health Interview Survey, published by Eurostat (the statistical office of the European Union), 23.9% of women in the UK are obese, while the male statistic is not far behind at just over 22%.

And in a study published last year by Bupa, obesity was found to come with a hefty price tag for both individuals and employers.

It calculated that obese people could be reducing their earning power by as much as £500 a year because qualifications, skills and experience become outdated during long-term absences from work due to health problems caused by being overweight.

Bupa claims that if healthier lifestyles were adopted, UK employers could be saving close to £3bn a year by 2025, of which £490m could be saved annually on obesity-related conditions.

Last October, the Department of Health got involved in the issue, launching a call to action on obesity. It wants to change the UK’s eating habits in order to slash five billion calories off the nation’s daily diet.

Statistics show that the UK still trails behind the US in terms of obesity rates, but rather than rest on our laurels we should be learning from their mistakes, believes Dr Chris Tomkins, head of personal health risk management at AXA PPP healthcare insurance.

 

There is a strong correlation between being sedentary and poor cognitive performance, and a very strong relationship between an increase in blood pressure and a decrease in cognitive performance.

Dr Chris Tomkins, Head of personal health risk management, AXA PPP healthcare insurance

“In the UK, obesity is viewed as more of a problem of appearance and getting in shape,” he says. “Health, though important, is not necessarily top of people’s minds. In the US, it’s much more about health; the nation has been fatter for longer, so it has higher rates of cardiovascular problems and diabetes. But the UK is catching up.”

Heart of the matter

He adds a stark warning that employers as much as anyone should heed: “What people see at the moment as an obesity epidemic is going to become more like a cardiovascular crisis. Obesity is a symptom. We need to focus on what’s behind it: bad lifestyles leading to a gradual decline in health and performance.”

Most people recognise the potential impact on performance and productivity of conditions such as cardiovascular disease, diabetes and musculoskeletal problems, especially since they can lead to long-term absence, but obesity can affect performance in more subtle ways, too.

“There is a strong correlation between being sedentary and poor cognitive performance, and a very strong relationship between an increase in blood pressure and a decrease in cognitive performance,” explains Dr Tomkins.

Performance problems are easier to detect and deal with if there is a physical standard that an employee has to reach, or if the job has obvious physical demands.

“But in the white collar workforce the impact isn’t so acknowledged,” he says. “If you have a good diet and undertake physical exercise you will have higher energy levels and a sharper mind but this isn’t widely appreciated or understood.”

There are also specific conditions, potentially resulting from obesity, that can slow down a person’s mental capacity. Dr Leeser cites sleep apnoea as one example: “It causes interrupted breathing during sleep and can lead to drowsiness during the day. Obviously, this could have a knock-on effect on a person’s ability to work productively.”

In any discussion on obesity in the workplace, the subject of presenteeism will often be mentioned, meaning someone who is present at work but not necessarily performing as they should. “Ratios of presenteeism to absenteeism have been suggested to be as high as 10 to one,” says Tomkins.
 
Dr Leeser says Bupa’s corporate clients are increasingly beginning to recognise obesity as an issue that needs to be addressed. The healthcare group provides tailored overall health profile data for employers, detailing the lifestyle habits of their workforces, including weight.

“This data is anonymised, but we are beginning to see employers pick up on the weight issue in their business,” she says.

War against weight

However, Dr Leeser adds that there is still a long way to go: “We’re just waking up to the idea that public health issues can be tackled in the workplace. Employers are realising this because the obesity epidemic has had a great deal of publicity over the past decade.”

While some organisations have put wellbeing strategies in place and promote healthier lifestyles, Dr Williams, who is also author of the book Managing Obesity in the Workplace, says others are simply not investing in health promotion and the business argument is not being made.

She cites this as another instance where we are trailing the US. “Employers know that if they don’t do health promotion, the NHS will,” she says. “In the US they can’t rely on this backstop.”

There are different approaches employers can take to dealing with their employees’ weight management. Many believe that any plan is best packaged as part of a wider wellbeing strategy.

Within this, employers can introduce a range of initiatives including medical screening, healthy eating campaigns, cycle-to-work schemes, corporate gym membership, sponsored weight-loss events, on-site exercise classes and access to weight management programmes.

Adopting a company wellbeing approach may aim to be inclusive and therefore take the pressure off managers having to have difficult conversations with individuals. The big challenge, however, is encouraging those who have a problem to get involved in such activities.

“We generally find that the hard-to-reach people won’t engage in wellbeing activities because they feel it is rubbing their nose in it,” says Dr Tomkins. AXA PPP’s approach is to identify the risk groups and look at factors such as their health age score and then implement a solution that aims to change behaviour in terms of increasing physical activity.

AXA PPP’s Imperative programme allows employees to engage in a “digital dialogue”, which means managers do not need to have an awkward conversation with individuals.

“For us it’s about a much more permissions-based engagement process supported by some smart technology, followed by targeting of the right solution to the right person,” he says. “Ultimately, the individual has to take responsibility as you are talking about them changing their behaviour. What the employer can do is make sure there is an effective solution waiting when they decide to take action.”

Keeping it off

No matter how successful the programme, the next challenge is ensuring that it has lasting effects.

“Campaigns are great and ignite people’s enthusiasm, but the holy grail of weight loss is a healthy diet and physical activity, which keeps the weight off,” says Dr Williams, who adds that any wellbeing interventions need to take a holistic approach. “This may include help with smoking cessation while at the same time advising people on how not to gain weight when they stop smoking,” she says.

Tackling obesity in the workforce is never going to be easy, but even if an employer doesn’t have a problem currently, it’s likely that the issue will weigh heavily in the future.

“Obesity is not a problem that happens overnight,” says Dr Williams. “There has been a real lack of seeing it coming in the UK. Businesses have been much better at adapting to it in consumers than in visibly taking action to help staff reduce weight.”