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Making the business case for workplace health programmes

Lead author Dr Zofia Bajorek
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A new report from the Institute for Employment Studies (@EmploymtStudies) highlights a combination of legal, moral and business cases for employers to introduce workplace health programmes to improve employee health and wellbeing. The report also urgently calls for obesity to be a protected characteristic under the Equality Act, particularly pertinent considering the elevated risk of developing serious complications from Covid-19 for people living with obesity.

The findings come from Living and Working with Obesity: Are Employers Playing their Part?  The report looks at workplace health programmes and evidence of their effectiveness for people living with obesity. The research is the second output of the PURPOSE programme (Promoting Understanding and Research into Productivity, Obesity Stigma and Employment). The programme, funded by Novo Nordisk, focusses on improving national productivity levels via better employment and labour market outcomes for those living with overweight or obesity.

The UK government’s 2020 Obesity Strategy places considerable emphasis on public health measures to prevent obesity and to support people living with obesity to manage their weight more effectively.  Although the strategy refers to the role that employers might play in the delivery of the public health goals, there is little substantive discussion about the action which might be taken in modern workplaces to support people living with obesity.

IES researchers found compelling evidence for employers to embed workplace health programmes for staff living and working with obesity. However, there are differing views regarding the implementation of such programmes.  An area of concern is the risk that well-intentioned workplace health programmes with a nutrition, exercise or weight management element may inadvertently reinforce obesity stigma. It is also possible that some health promotion initiatives, especially if they encourage competition or use incentives, can produce negative outcomes for some workers living with obesity.  

The arguments for including workplace health programmes include:

The legal case:

Over recent years legislation has been enacted in the UK covering a range of protected characteristics, to ensure discrimination under these conditions does not occur at any stage in the labour market or the workplace.  The Disability Discrimination Act (1995), and more recently the Equality Act (2010) have explicitly protected the rights to equal treatment of employees on the grounds of age, gender, sexual orientation, race/ethnicity, disability and other health conditions such as cancer and multiple sclerosis. Central to this legislation is the requirement for organisations to implement workplace adjustments to provide suitable support for individuals with these protected characteristics in the workplace. However, for people living and working with obesity, weight-based discrimination from co-workers, supervisors, managers and colleagues remains common.  

Research findings from the maiden IES PURPOSE report, Obesity Stigma at Work: Improving Inclusion and Productivity, found that when women living with obesity are employed, many are subject to a wage penalty of up to 13 per cent, compared to other women. The study also found that in addition to getting paid less than other workers, women living with obesity also experience lower hiring success, fewer opportunities for promotion, reduced workplace wellbeing, increased stress and a higher likelihood of being dismissed. These findings have led some to question whether obesity remains the last acceptable form of discrimination, and whether more should be done by employers to help employees living with obesity.   

The moral case:

For many years there has been an increased focus and interest in the ‘good work’ agenda.  Arguments have been made that work is generally good for employee health and wellbeing, but for this to be the case, the nature, quality and social context of work needs to be taken into account, in addition to the requirement that an individual’s job should be safe and accommodating. Good quality work can also have implications for both health and productivity outcomes, which is why it is important to consider factors such as: job design; autonomy and ownership of tasks; fair workplaces; varied and interesting work and line management support.

However, evidence suggests that some aspects of the workplace may have an impact on obesity, and that employees living with overweight or obesity may not always experience good work. It could therefore be argued that employers have a moral duty to ensure that the workplace provides ‘good quality work’ and implement workplace health programmes to ensure that an employee’s physical and emotional health and wellbeing is not affected by their work or working conditions.

The business case:

Workplace ill health can be costly for organisations. Although obesity can be considered as a long-term health condition in its own right, it is also recognised as being a contributing factor to the development of a range of comorbid health conditions, including Type 2 diabetes, heart diseases, a range of cancers, osteoarthritis, respiratory conditions and mental health. The workplace can be a valuable setting in which workplace health promotion can be offered. Research suggests that the return on investment and overall health cost savings are high and employers are increasingly offering a wider range of workplace health programmes and interventions with the aim of improving employee health and wellbeing. Research suggests that implementing workplace health initiatives for those living with obesity can help optimise an employee’s productive capacity at work to the benefit of the organisation.

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Lead author Dr Zofia Bajorek said:

“The research highlights how the workplace can be a valuable setting to offer health promotion activities. However, for people living with obesity, workplace weight-management programmes can result in stigma, especially if they reinforce the erroneous belief regarding an individual’s controllability about their weight.  With the development of the Obesity Strategy, now is the time for obesity to be considered as a protected characteristic under the Equalities Act of 2010, providing employers with clarity about their duty to support employees working with obesity and avoid all forms of direct and indirect discrimination in employment settings.”

Angela Chesworth has been living with obesity for over 40 years and shares her lived experience as an employee:

“I have experienced stigma and bias within a number of my workplaces.  Whilst working for one employer who regularly held charity events, I was never asked to take part in any of the sporting activities. When I applied to take part in the 5km walk I was questioned if it was the right thing for me to do. The assumption that I was unable to take part was based purely on my appearance. Nobody knew I had a personal trainer and visited a gym three times a week. 

“Living with obesity meant that I needed extra support from medical professionals to deal with my comorbidities, sleep apnea, high blood pressure and anxiety. I couldn’t always arrange my appointments for my days off and asking for a shift change or unpaid time off was always an inconvenience for my employer. I would miss appointments because I was too nervous to ask for support, for fear I would lose my job.” 

The report delivers a number of recommendations for government, employers and individuals living with obesity:

For government:

  • Including a focus on the ‘good work’ agenda in the Obesity Strategy, ensuring that employers understand the rights all employees have to stay in, thrive in, and return to sustainable work. It may be time to clarify that obesity is considered as a ‘protected characteristic’ in its own right under the Equalities Act of 2010. This would make clear that employers have a duty to make reasonable adjustments for people living with obesity and to avoid all forms of direct and indirect discrimination in employment settings.
  • Funding more research, especially for those who may be considered in the more ‘at risk’ groups, especially post Covid-19, including considering both ethnicity and social inequalities in research samples.
  • Including health inequalities as part of the levelling up agenda post Covid-19 and understanding that work plays a fundamental role in shaping health. Reducing health inequalities could be an important factor in the UK’s economic recovery, and investment in workplace health and wellbeing could be beneficial within this.

For employers:

  • Language and framing is an important consideration. Employers should attempt to avoid ‘risk management’ language, when supporting employees living with obesity, and view all employees as an ‘asset’ rather than a ‘liability’ to an organisation. Emphasis should be placed on their workability and the contributions to the productive capacity and social capital of an organisation.
  • Any current workplace health and wellbeing practices or health promotion activities should be reviewed to ensure that they are supportive and not stigmatising to employees living with obesity. When designing, implementing and evaluating employer-sponsored weight management programmes or other related initiatives, it is important that this occurs in conjunction with employees, so that they are able to input ideas that may not have been considered important by employers, and thus could also eliminate any risks of the interventions perpetuating any further weight-based stigma.
  • Any work-based programmes should be offered and advertised in non-stigmatising ways (including avoiding the use of stigmatising imagery and language), focusing on overall benefits to health and wellbeing and not just weight per se.  Programmes should not be obligatory for employees to attend, and they should not fear discrimination if they do not join the programme.

For individuals:

  • It is important to recognise that support is available if you are experiencing stigmatising behaviour or discrimination at work. Depending on the source of this stigma or discrimination, your immediate line manager might be the best first option or, alternatively, an HR manager or union representative. Often these concerns can be dealt with informally and amicably, especially if they give you the opportunity to explain how the behaviour of others affects you. However, sometimes you may need support to raise your concerns more formally.
  • If you would like to get the support of a range of weight management services but have not found this easy or accessible via your GP, you employer’s Occupational Health (OH) service is likely to be in a position to help you. You and your manager can then use this to decide how to make changes to your health and work in ways that help you do your job well so that you can continue to enjoy working. If your employer offers health benefits or health promotion campaigns which you find difficult to access or which do not meet your needs, again an OH professional will be able to give you advice and support if you feel you need it.
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