Women moving a bike around many other bikes

Managing Obesity in the Workplace

Prevalence and Impact

Obesity is a global epidemic, impacting all countries, races, and genders. An estimated 650-million adults worldwide are obese based on body mass index (BMI >30 kg/m2), accounting for 13% of all adults.1

Since 1975, the rates of obesity have tripled, and they continue to rise.1 If tends follow the current trajectory, it is estimated that over 1-billion adults will be obese by the year 2030.1-2 The health consequences of obesity are innumerable. Obesity increases risk for chronic diseases including type 2 diabetes, heart disease, some cancers, sleep apnea, and chronic kidney disease.3-7 Due to the many associated co-morbidities, elevated BMI decreases quality of life and shortens life expectancy. Every 5 unit increase of BMI over 25 kg/m2 is associated with a 31% increased risk of premature death.8

Social stigmatism and bullying can also impact an obese individual’s psychological and emotional health. Obesity is associated with depression, which further contributes to unhealthy eating behaviors and low physical activity.9

In addition to the individual medical complications, obesity has profound economic consequences. Obesity contributes significantly to national medical costs, placing a heavy monetary burden on the government, insurance providers, and taxpayers. It is estimated that 21% of healthcare costs are a consequence of obesity-related medical care,and this number is trending upward.10 Between 2005 and 2010, medical care costs per obese adult increased by 14%.11

Increased medical care costs also place a burden on employers. Employers must pay higher life and health insurance premiums for employees that are obese.12 One study found that a single individual with class 1 obesity (BMI 30.0-34.9 kg/m2) costed their employer an additional $1775 per year in direct healthcare costs compared to an employee with a healthy BMI.13

Obesity in the workplace decreases productivity. Obese workers take more absences from work and are 25-68% more likely to have a work-related injury compared other employees.14-15 An employee with class 1 obesity incurs an additional burden of $617 per year in indirect costs compared to an employee with a healthy BMI.13 Additionally, employers are legally obligated to provide reasonable accommodations for obese employees, such as adjustable chairs and larger desks.

What Employers Can Do

Luckily, obesity is preventable and treatable. The first line of treatment for obesity is lifestyle change, including eating healthier and being physically active. Even moderate weight loss of 5-10% of body weight significantly decreases an individual’s risk for chronic disease.16

As working adults spend significant time at their job, an individual’s work environment may dictate their ability to achieve a desirable weight. Unfortunately, traditional working environments are catered to unhealthy behaviors.Many jobs are sedentary, and foods offered onsite often do not include healthy options.

Employers have the unique opportunity, and obligation, to influence the health of their employees in the place where they spend a significant proportion of their waking time. Companies that implement a comprehensive health program have fewer employee absences, sick leave and improved health.17 Although these programs can be costly initially, employers find that they obtain a return on their investment. The American Cast Iron Pipe Company estimates they receive a return of $1.70 for every dollar spent on their employee wellness program.18

Healthy behaviors must be encouraged without passing judgement or stigmatizing employees that are overweight and obese.During the hiring process, employees should be hired based on their qualifications, not their weight. Harassment and bullying among coworkers are not acceptable and should not be tolerated by management. Efforts to improve health at the workplace must avoid discrimination or harassment. Campaigns can emphasize the importance of making healthier choices rather than focusing on weight.

Employees cannot be forced to make healthy decisions; however,employers can raise awareness, enact policies, provide opportunities, and offer incentives.

Supporting employee wellness begins with creating a company culture that values the health of employees. Management is responsible for making wellness a priority and showing employees that they care about their health. Wellness challenges can incentivize healthy behaviors. Offering bonuses for tracking physical activity or healthy eating can promote employee cooperation and inspire them to make healthy changes.

Forming an employee-led task force that focuses on health and wellness can improve employee buy-in and participation. Employee-led wellness committees can organize events or lead email and newsletter campaigns to educate and encourage healthy behaviors.

Promoting Healthy Eating

Management can show their dedication to healthy eating by hosting free nutrition education classes, cooking classes, and providing access or reimbursement for counseling sessions with nutritionists or Registered Dietitians.

Company policies must promote healthy eating. Employees should be encouraged to take required meal breaks. Skipping meals and eating while working can lead to excess consumption of snacks, high in fat, sugar, and calories. Taking meal breaks encourages full meals that likely include more food groups, such as fruits and vegetables.

Requisite facilities should be provided where employees can eat meals away from work areas. Additionally, employee break rooms should be equipped with a refrigerator and microwave where employees can store and heat up meals.

Many employees eat meals and snacks provided for free or purchase onsite. At the very least, these facilities should have healthy options available. Employers can take additional steps to encourage healthy food choices by providing the nutritional value for cafeteria items.

Many workplaces, including Military dining facilities, utilize the “stoplight” color code system to indicate healthier choices. “Green” foods are lower in added fat and sugar verses “red” foods that are higher in added fat and sugar. These color-coding systems, or other methods of indicating nutritional value, can help employees that are trying to make better choices find food items that will improve their health.

Vending machines often contain foods that are high in calories with little nutritional value. Employers can take initiative to ensure that vending machines are stocked with healthy snack options.
Food provided at courtesy of management should promote healthy eating. Meals catered in the office or snacks provided in the break room should at least offer a healthy choice. For example, rather than ordering pizza for the office lunch, a sandwich and salad bar could be a healthy alternative.

Promoting Physical Activity

Although many jobs require employees to be sedentary, company policies can encourage physical activity throughout the day. Employees should be allowed and encouraged to take walking and stretching breaks. Mid-level management should foster a culture where this is socially acceptable and supported.

One barrier to being physically active for many workers is time constraints with job and family responsibilities. Allowing employees to exercise on paid time can reduce this barrier and offer incentive for being physically active at work. Onsite exercise facilities can be provided to allow employees convenient access to equipment. If it is not feasible to add a gym at the workplace, other resources can make exercising at work possible. Having clean walking paths and locking bike racks onsite can allow employees to spend break times being active outside. Changing and showering facilities can also be provided.

Allowing exercise at work may not be feasible for all companies. These companies can partner with community businesses and programs to reduce other barriers to physical activity. Offering subsidized rates or reimbursement for gym memberships and other leisure exercise activities can incentivize employees to exercise outside of work.

“Bike to work” and “walk at lunch” events can encourage employees to be active together, building moral and employee relationships.Organizing intramural sports teams can also urge employees to be active together. All employees must be allowed to participate in wellness events, regardless of weight or physical abilities.

Conclusion

Employers can significantly impact the quality of life and health of their employees by establishing a community that values wellness. Campaigns that focus of health, rather than weight, will improve employee buy-in and avoid discrimination.

Healthy eating and physical activity should become a part of the workplace as employers appreciate the importance of health for individual quality of life and company success. Improved health will increase productivity and decrease insurance, medical, and injury-related costs. As employers recognize the impact they can have on the health of their employees, companies can do their part to slow the spread of the worldwide obesity epidemic.

Featured Image Credit: Roman Boed / flickr

References

1. World Health Organization. Obesity and overweight. Published March 2020. Accessed March 2020. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
2. Kelly T, Yang W, Chen CS, et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008;32:1431-7.
3. Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis.BMC Public Health. 2009; 9:88.
4. Bogers RP, Bemelmans WJ, Hoogenveen RT, et al. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300,000 persons.Arch Intern Med. 2007; 167:17208.
5. American Institute for Cancer Research, World Cancer Research Fund. Food, nutrition, physical activity and the prevention of cancer. Washington, D.C.:American Institute for Cancer Research; 2007.
6. Beuther DA and Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies.Am J Respir Crit Care Med. 2007; 175:6616
7. Kopple JD. Obesity and chronic kidney disease.J Ren Nutr. 2010; 20:S2930.
8. Di Angelantonio ED, Bhupathiraju SN, Wormser D, et al. Body-mass index and all-cause mortality: Individual-participant-data meta-analysis of 239 prospective studies in four continents. The Lancet. 2016, doi: 10.1016/ S0140-6736(16)30175-1
9. de Wit L, Luppino F, van Straten A, et al. Depression and obesity: a meta-analysis of community-based studies.Psychiatry Res. 2010; 178:2305.
10. Cawley J andMeyerhoefer C. The medical care costs of obesity: an instrumental variables approach. J Health Econ. 2012; 31:219-30.
11. Biener A, Cawley J, and Meyerhoefer C. The High and Rising Costs of Obesity to the US Health Care System. J Gen Intern Med. 2017;32(Suppl 1):6–8. doi:10.1007/s11606-016-3968-8
12. Trogdon JG, Finkelstein EA, Hylands T, et al. Indirect costs of obesity: a review of the current literature. Obes Rev. 2008; 9:489-500.
13. Ramasamy A1, Laliberté F, Aktavoukian SA, et al. Direct and Indirect Cost of Obesity Among the Privately Insured in the United States: A Focus on the Impact by Type of Industry. J Occup Environ Med. 2019 Nov;61(11):877-886. doi: 10.1097/JOM.0000000000001693.
14. Tatiana Andreyeva, Joerg Luedicke, Y. Claire Wang. State-Level Estimates of Obesity-Attributable Costs of Absenteeism. JOccupEnviron Med. 2014;56 (11):1120.doi: 10.1097/JOM.0000000000000298
15. Gu JK, Charles LE, Andrew ME, et al. Prevalence of work-site injuries and relationship between obesity and injury among U.S. workers: NHIS 2004-2012. J Safety Res.2016;58:21–30. doi:10.1016/j.jsr.2016.06.001
16. Blackburn G.Effect of degree of weight loss on health benefits. Obesity Res. 1995;3:211S-216S.
17. Pronk, N. P. Physical activity promotion in business and industry: evidence, context, and recommendations for a national plan. J Phys Act Health. 2009;6:S220.
18. The Health Project. The Health Project Winning Programs: AMERICAN Cast Iron Pipe Company. 2016.