According to a 2020 report, adults spend one-third of their lives (about 90,000 hours), at work. No doubt, since the outbreak of COVID-19, the workplace has changed. However, because employees often move about less while working from home, the urgency to address obesity in the workplace has arguably increased. 

It is extremely important for employers to understand that obesity must be treated as a disease because it has become: 1) much too common, 2) a serious threat for developing other comorbidities, and 3) very costly both in lost productivity and increased healthcare costs. (NOTE: It is equally important to understand that being underweight – having a BMI below 18.5 – is also a risk factor for serious complications of COVID-19 and other health issues.)

Addressing obesity solely to reduce healthcare costs and boost productivity will send the wrong message to employees. A successful obesity program must project a culture of acceptance and inclusivity, rather than stigmatize and dehumanize persons with obesity. Therefore, the more effective way to help employees living with obesity is to establish a culture that encourages healthfulness for all employees.

Dr. Kara Thompson, who specializes in weight loss/bariatric surgery and nutrition care at MercyOne Des Moines Bariatric Surgery in West Des Moines, provided her viewpoint for this blog about how employers can make their wellness programs more effective. She said employers having conversations with employees about their weight would not be well received. Instead, Dr. Thompson feels employers should focus on the general health of their workforce, as a much better approach to get employees engaged. “Successful programs are those backed by a culture that supports health.” 

Standard Lifestyle Modification Intervention Programs

Standard worksite wellness programs that address obesity interventions include financial incentives to employees for keeping their cholesterol and lipids within healthy range, attending health education classes, lunchtime walks, activity trackers and step counters and other opt-in health programs that primarily focus on behavior change. However, employers must be aware of the HIPAA nondiscrimination rules and the U.S. Equal Employment Opportunity Commission (EEOC) final rules when offering incentive plans for wellness programs. 

Science and research on physical activity continues to evolve. In fact, according to a New York Times article published in September 2021, there are two new large-scale studies of physical activity and longevity that suggest a ‘sweet spot’ of 7,000-8000 daily steps that will provide optimum benefits for those in middle adulthood.

Lifestyle modification workplace interventions have proven to produce modest weight loss and improvements to weight-related health problems. According to a 2018 review of workplace obesity programs by the American College of Occupational and Environmental Medicine (ACOEM), these modest improvements do not result in sustained employee engagement and long-term results. The authors suggest that lifestyle behavioral modification must be coupled with other approaches, including medical intervention. 

Other research on wellness programs, such as one from Harvard Medical School, suggests limited success in realizing large investment returns – at least in the short term. The authors concluded that wellness programs did not have, after 18 months, better clinical measures of health such as BMI, blood pressure or cholesterol. These programs did not exhibit lower absenteeism, better job performance or lower health care use or spending.

Unfortunately, studies have shown that yo-yo dieting can actually cause weight gain in the long run.  One theory, known as “set point,” says our bodies have a natural weight and will always fight to stay within a certain weight range (the patient’s “set point”) and that dieting will not change that weight permanently.  When asked about this, Dr. Thompson said this is a complicated question.

“We truly don’t have all of the answers to why some people lose more than others, or why weight loss can stall out. We do know that if someone drops calories really low, the body can fight that decrease by increasing hunger, decreasing calories used and even pulling more calories out of the food that was eaten, and that happens even if the body has lots of fat stores. My experience has shown that if one’s body thinks it is not getting adequate nutrition, fat or protein to support all of its demands, it does the same thing. I am frequently telling patients to eat more protein or more healthy fats, and that can often stimulate weight loss.

Dr. Thompson summarizes with this:

“It’s the types and quality of food eaten along with the individual’s genetics, age, activity, hormones, sleep, stress, muscle mass and even medications taken influencing all of this and you can see why it is so complicated.”

A 2020 Milken Institute report, “Obesity in the Workplace: What Employers Can Do Differently,” succinctly wrote the following about existing mainstream wellness programs:

To date, obesity programs in the workplace have failed to meet people where they are. They promote impersonal behavior change rather than provide employees with tailored support. The consensus among experts is clear: Interventions commonly characterized as targeting worksite wellness” have not adequately demonstrated improved health outcomes.

What Can Employers Do About Obesity?

First of all, there is no silver bullet for employers to eliminate employee obesity. There are, however, a number of strategies that employers can take that will hopefully result in a healthier workforce. 

To begin, employers must understand that obesity is a disease and address the stigmatization of obesity.

Dr. Thompson agrees that obesity is a disease. “Some people are genetically set up to carry more weight and some are in the situation where making better choices is difficult…like most diseases, outcomes for obesity can often be influenced by lifestyle and medical management.”

Coming from various resources, some recommended action steps employers can pursue include the following:

• Understand the Science

It is important to understand the science of obesity that impacts both appetite and energy, and why losing weight and keeping it off is so difficult. 

• Reduce/Eliminate Stigma 

Stigma begins with how obesity is perceived and communicated in the workplace. One primary example of this stems from the words we use when addressing obesity. Instead of inappropriately labeling people as “an obese person” or “an obese employee,” employers should approach obesity as a disease that affects individuals. People-first language, such as “a person with obesity” or “an employee living with obesity” may appear to be a subtle difference, but it more appropriately refers to the person first and their condition second. When carefully used, words can avert harmful stigma and stereotypes.

• Prevention

Having a culture of healthy eating at work, both in-person or remotely, is one important aspect of obesity prevention. Employers can help influence the choices of healthy food options in the workplace cafeteria and at the vending machines. Employers can pursue initiatives and education that encourage nutritious and healthier eating habits at home. The promotion of active lifestyles – both at the workplace and at home – are also critical components to any program promoting good health. Of course, monitoring employee uptake of these programs will help the employer understand patterns of employee engagement.  An improved culture of healthfulness will positively impact all employees.

• Treatment and Health Plan Coverage

Does your health plan view obesity as a lifestyle ‘choice’ or as a disease? The answer to this question reveals a big difference in treatment and whether coverage is included in the health plan. Obesity treatment covers a full range of healthcare options, including behavioral counseling, medical visits for obesity, dietician visits, anti-obesity medications, and bariatric surgery. Dr. Thompson states that it is very frustrating, from a physician’s perspective, to not be able to prescribe the medication best suited for a patient’s condition because the medication is not covered by insurance and is, therefore, cost prohibitive. Employers making this coverage a priority would go a long way in supporting their employees who seek obesity treatment.

Summary

Obesity is not a lifestyle choice, but rather, a disease. Employers should mindfully establish a company culture that encourages healthfulness.  This will benefit all employees, including those employees living with obesity. A culture that encourages healthfulness might include access to individual counseling, as well as dietary education and accessibility to healthy food in the workplace.  Also, education about other obesity risk factors such as physical activity vs sedentary time, stress and poor sleep can encourage changes that result in better health, especially when coupled with other employer sponsored work-life balance initiatives. Committed employers should also investigate coverage options available through their health plan that affect pharmacological and surgical treatments. When considering how to develop a comprehensive benefits package for outcomes-based obesity treatment, George Washington University provides a guide that identifies core components of a successful strategy – STOP Obesity Alliance.

The fifth and final installment of this series will address the treatment of obesity through healthcare interventions.

This post is the fourth in a five-part series. Click here to read “Obesity Requires Employer Attention and Focus – (Part 1),” “Is the Body Mass Index (BMI) Useful? (Part 2),” and “Obesity – a Disease or a Choice? (Part 3).”

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