The workplace consequences of obesity

According to Simon Stevens, obesity has the potential to bankrupt the NHS. Charlotte Cross, director of the Better Health at Work Alliance, examines the obesity crisis facing the public sector workforce and what steps we should take to combat the growing trend

As evidence continues to mount that we are getting more obese as a society, there are clear implications for UK public health. While the government searches for broad scale strategies to avert the so-called ‘obesity crisis’, employers should also recognise it is very much in their interests to enter the debate.

Recent research by Imperial College, London, has predicted that by 2025 a fifth of the world’s population will be obese. The news added to the picture, painted by the UN in 2013, that showed Britain at the top of Europe’s obesity league with 25 per cent of adults classed as overweight. According to the Office for National Statistics, obesity is now estimated to affect around one in five adults in the UK.

Dr Mark Simpson, medical director at Medigold Health, believes that our changing working habits have played a part in the growing epidemic.

He said: “The gradual shift in the UK from a manufacturing to a service-based economy has been an unwitting and silent contributor to the obesity epidemic facing us. Many of us are now in essentially sedentary roles that leave us predisposed to weight gain and this is further compounded by poor diet and a lack of exercise opportunity or motivation.”

“The government recognised the role of the workplace in helping to tackle these challenges with the launch of the Public Health Responsibility Deal in 2011 by the Department for Work & Pensions and the Department of Health. This was intended to bring together a diverse range of organisations around four key pledges – food, alcohol, physical activity and health at work. This was well received and a large number of organisations both large and small signed up to it. But where is it now? Why has it apparently failed to have any significant impact?”

NHS Staff
It may surprise some that the Royal College of Physicians reckons half of the 1.3 million staff in the NHS are overweight or obese. At more than double the UK adult obesity rate, and with only 15 per cent of NHS trusts operating staff obesity policies, it is clear that more work is needed here.

However, because of working patterns, it has been recorded that 80 per cent of health practitioners regularly have to skip meals and snack on high-calorie junk food simply because they don’t have the time to sit down to a proper breakfast, lunch or dinner. Some staff claimed that they never have a break during the working day and around 50 per cent of hospital workers have admitted to ‘grabbing what we can, when we can’, with 20 per cent owning up to eating cakes or sweets on a regular basis.

Amazingly, in an environment where health is the number one priority, most NHS staff only average two portions of fruit and vegetables every day – less than half the recommended amount. The problem has become so bad within the NHS that having a poor diet is now reckoned to be far more detrimental to the health and well-being of staff than smoking.

Simon Stevens, chief executive of NHS England, said: “Obesity is the new smoking. It is a slow-motion car crash in terms of avoidable illness and rising health care costs.”

According to Stevens, one of the disadvantages of having a free health service is that employers do not have to worry about funding their employees’ health care treatment due to obesity. He has even said that it’s time to ‘get serious about obesity or bankrupt the NHS’. However, this doesn’t mean that the rest of the public sector, nor private sector businesses, are not affected by the growth in obesity-related health issues.

Issues associated with obesity
Latest figures show that 131 million working days are lost every year due to sickness absences, (with 31 million due to musculoskeletal conditions, themselves frequently worsened by weight complications), and the costs to employers and taxpayers work out at around £22 billion a year. Every 12 months, more than 300,000 people have to leave work and claim health-related benefits. Of course, not all of these claims are due to obesity, but it nonetheless has a dramatic impact upon the wellbeing of any workforce, of that we can be certain.

Issues associated with obesity – including increased risks of heart disease, cancer, type 2 diabetes, stress, depression, links to the onset of dementia and more - all have ramifications for employers. While proactive government initiatives certainly go some way in improving general public awareness, the Better Health at Work Alliance (BHWA) is calling upon employers to recognise the importance of their own influence. Of course, employees have a responsibility to manage their own wellbeing, but beyond that a very real power to fundamentally influence obesity and sedentary health risk lies in changes in workplace practices.

Links to mental health and stigma
The impact of obesity stretches beyond the physical health of individuals. According to the National Obesity Observatory, ‘obesity also has adverse social consequences through discrimination [and] social exclusion’ and this can also occur in the workplace. Indeed, cognitive-behavioural therapy (CBT) and counselling employee support service, Rightsteps, who work alongside departments across the public sector, report a steady increase in the number of employees being referred into their well-being support service by employers in relation to mental health as a direct result of issues relating to self-esteem and body image. 

Cliff Lee, head of the project, confirmed: “In many cases those employees who are struggling have become socially isolated and distanced from colleagues, family and friends.  This in turn has led to individuals self-harming and/or adopting poor lifestyle habits including sleep hygiene related issues, continued poor diet, reductions in mobility and physical activity.  These factors then further contribute to their symptoms and increase the depressive cycle increasing the likelihood of absence or presenteeism within the workplace due to their condition.”

Studies have shown that people who are obese are about 25 per cent more likely to experience a mood disorder, like depression, compared with those who are not obese. Sven Law, clinical lead at CBT Clinics Ltd., confirmed that obesity ‘can lead to common mental health problems and vice versa, yet the overlaps between the two are often overlooked. In my experience it’s rare for one to exist without the other’. Consequently he advises that interventions should look jointly at both the physical and mental causes if they are to succeed longer-term.

He claims: “Evidence-based approaches, such as cognitive-behavioural therapy and behavioural activation, can help by both tackling acute obesity and also working to avoid it in the first place. Employers wishing to support the health and wellbeing of their workforce need to recognise the importance of integrating such approaches into their well-being strategies.”

So, it’s not just employees who stand to profit from healthier lifestyles. Businesses both large and small and irrespective of sector, are known to make significant productivity and bottom-line gains when they take steps to improve health outcomes in their staff.

Put simply, healthier staff are more engaged in their work, especially those who feel their employer has a genuine interest in their well-being. As far back as 2002, the total impact of obesity on employment was estimated to be as high as £10 billion.

Steps to take
If the public sector can lead from the front and the wider population follow suit, then the cost saving per department and indeed for budgets overall could be immense. Countering obesity for the benefit of your staff and organisation starts with a simple philosophy – encourage the right behaviour and back it up with the right environment. For instance, enable staff to eat the right amount of, and right kind of foods, at the right time, and encourage more movement for those who are stuck behind desks all day.

These are all seemingly simple steps, yet the predominance of unhealthy meal options in vending machines and widespread franchising of fast food outlets such as Burger King and Greggs in NHS hospitals sends entirely the wrong message and forces staff into unhealthy choices. Tellingly, statistics have shown that 52 per cent of NHS staff believe there are not enough healthy eating options provided at the hospitals where they work.

Whether employers improve access to healthy food options, promote an active workplace (including providing a free gym on the premises), incentivise staff to follow health advice or, indeed, make adjustments to the work environment – such as standing desks, walking clubs or bike racks – the key is to facilitate and encourage behavioural change. Of course, informed thinking on the subject does vary and matching to the right environment is key, as is common sense; for instance a standing desk will offer little benefit to a nurse who has been on his/her feet all day but comparatively great benefit to a desk-bound office worker. Implementing an audit or advice from a trained occupational professional can make the difference when deciding your approach.

Engaging expert opinion to ensure you take the right steps can also help to avoid confusion on a subject area that has much conflicting information. The move towards active working itself has lately been contradicted by latest thinking that challenges the reported reduction in the number of calories consumed over the last 40 years, since obesity has increased significantly over that period.

The Behavioural Insights Team (BIT), a government agency working in partnership with the Cabinet Office, has asserted that the number of calories eaten in Britain is being undercounted by up to 50 per cent and claims that rather than looking to increase activity levels as the main way to tackle obesity we should be focusing far more on reducing calorie intake.

The BIT report said: “Reported calorie consumption is too low to sustain our current weight, even if we were only doing the minimum possible level of exercise. Also, we are burning much more energy than the statistics suggest (and we must be consuming at least this much energy, or we would be losing weight).

“The argument that a fall in physical activity has been the main driver of obesity is not a plausible explanation: the falls required to explain the rise in obesity are far too large. Falling levels of activity in the workplace do not provide the answer.

“Policies to reduce calorie consumption have an important part to play in an obesity strategy. Although attempts to increase physical activity should be part of the policy mix, they should not act as a distraction from the central importance of reducing calorie consumption.”

This means that while organisations should always encourage their staff to live active lives and to be as mobile as possible in the workplace, the problem of obesity is double-edged and employees should be supported in their efforts to eat healthily. One way that companies could do this would be to make lunch breaks longer so that people have time to eat a balanced meal. An hour would be a sufficient inventive since anything less can encourage people to eat at their desks or – worse still – snack along as they work.

Where to find help
BHWA is on a mission to make implementing workplace health practices an easy and obvious step for all employers by offering access to experts, guidance and solutions in a one-stop bespoke digital platform. With obesity a tricky subject to broach, it’s important that employees aren’t singled out.

As Mark Braithwaite, managing director of Gipping Occupational Health, said: “Providing access to impartial advice and guidance from a qualified health professional, such as an occupational health advisor, enables employees to talk openly, learn and improve management of their own health and ultimately take responsibility.”

By the same token, it also supports the employer in working towards a positive outcome. So, we should all work together, not only to halt the ‘obesity crisis’ for employees but to deliver productivity benefits to organisations.