Well-designed weight management programmes can help employees living with obesity to manage their weight more effectively and continue to make a vital contribution at work, but it’s crucial they do not stigmatise and alienate the very people they are designed to support.
Obesity is a complex, challenging and controversial public health issue that is facing many modern, developed economies, but it is also a condition that most people have an (often negative) opinion on.
Much of this stigma towards people living with obesity arises from the popular (but misinformed) perception that those living with obesity can control their weight by eating less and doing more. However, the causes of obesity are far more complex, multi-factorial and interrelated than this.
Indeed, research has identified a range of factors that can contribute to causing obesity including: an individual’s biology, social and economic inequalities, an individual’s environment (both in terms of access to physical activity infrastructure and their food environment), stress and/or mental health and employment.
Rising rates of obesity
However, there is rightly some concern regarding the increasing prevalence of overweight and obesity worldwide, and the implications this can have for both health and economic outcomes.
In the UK, levels of obesity have increased over the past decade. For example, data published by Public Health England in 2020 reported that 63 per cent of adults in England have a body mass index (BMI) of 25kg/m², with 36 per cent and 28 per cent of adults living with overweight and obesity respectively. One out of four men and almost one out of three women are currently living with obesity, with forecast data suggesting that without intervention, obesity rates will continue to rise among the UK adult population.
Projections have estimated that if current trends continue, in 2050, 60 per cent of males and 50 per cent of females in the UK will be living with obesity. These statistics provide a compelling case for action to prevent this worsening in the future, but also, and of particular interest for the Institute for Employment Studies (IES), it is important to understand the implications of obesity and its associated stigma in employment.
If more individuals of working age will be living and working with obesity in the future, it could be argued that this in itself should be a catalyst for organisations to provide open, fair and inclusive workplaces for those working with obesity. However, discrimination and stigma against those living and working with obesity occurs at every stage of the employment cycle despite the growth in equalities legislation.
This suggests that more does need to be done at an employer and policy level to help and encourage employers to protect and promote the health and wellbeing of those living with obesity at work.
The current Covid-19 pandemic has propelled obesity back as a priority in the policy agenda, as data suggests that those living with obesity are more likely to experience more severe symptoms if they contract the virus.
The UK government’s 2020 Obesity Strategy announced a range of policies to help those living with obesity, with a distinct shift in focus from healthcare to placing a considerable emphasis on public health measures to prevent obesity and to support people living with obesity to manage their weight more effectively.
The strategy did recognise that there are individuals for whom current weight management initiatives and interventions are insufficient, and there was a call to expand weight management clinical support and treatment and make that more accessible.
Within the strategy, although there was a call for a public discussion to begin with employers about how to better understand what can be done to support people to be healthier at work, I would argue that now is the time to have a more substantive discussion about the action that could be taken in modern workplaces to better support people living and working with obesity.
Support for workers living with obesity
Workplaces, especially those that are already engaged in health promotion, could be ideal environments in which people living with obesity could find support and access advice. Many employers are increasingly offering wider workplace interventions which aim to improve employee health and wellbeing.
Although it is now understood that improved health and wellbeing can be positive for both the individual employee and the organisation, some workplaces are still having to justify why investments should be made in the workplace for people living with obesity. This could be based around three main arguments:
The moral case
Employers have a moral duty to ensure that all employees have access to good quality work, and that their physical and emotional health and wellbeing is not affected by their work or working conditions. However, some aspects of the workplace may have an impact on obesity (for example, shift work, long working hours and the psychosocial environment).
Also, employees living with overweight and obesity may not always experience good work (for example, they may get fewer opportunities for promotion and progression, face stigma and receive a wage penalty).
The legal case
Employers have a legal obligation to ensure that employees living with obesity have access to employment and interventions that could help improve their health and wellbeing at work. They must also ensure that risk assessments and workplace adjustments are made so that employees living with obesity are not discriminated against at work.
However, for people living and working with obesity, weight-based discrimination from co-workers, managers and supervisors remains common, leading some to question whether obesity remains the last acceptable form of discrimination. Although obesity is not yet a protected characteristic under the UK’s Equality Act 2010, the Kaltoft case in the European Court of Justice has set a precedent under which obesity could be regarded as a disability, especially if an individual’s obesity hinders their full participation on an equal basis with other employees at work.
The business case
Implementing workplace health initiatives for those living with obesity can help to optimise an employee’s productive capacity at work, to the benefit of the whole organisation. Recent research has highlighted the annual costs of mental ill health in the workplace, which has led to arguments that it is in the interests of employers to prioritise investment into improving the mental health at work agenda.
There is also evidence to suggest that costs could be associated with employees living with obesity (as a result of sickness absence, presenteeism and potentially as a result of being unable to complete physical tasks in the workplace having an impact on the role they may be able to undertake).
Therefore, as with mental health and other long-term chronic health conditions, implementing workplace health initiatives that can help people living with obesity can optimise their productive capacity. The difference here is that mental health is a protected characteristic and employers have a legal obligation to support employees. Obesity is not (yet) of the same status, and (some) employers may not see it as important to support employees living with obesity.
Evidence shows that weight management programmes in the workplace fall into two main categories: those with an ‘organisational focus’ (such as on-site exercise programmes, healthy on-site catering and workplace adaptations to improve the physical space); and those that are more ‘individual focused’ (programmes focusing on nutrition, physical activity, counselling and behaviour modification). Within this, some programmes could be tailored to individuals, and some individuals could be offered incentives to encourage them to join and remain in the programme.
Although much of this comes from well-intentioned workplaces, there is a concern that programmes with an exercise or weight focus could inadvertently reinforce obesity stigma, by promoting the common rhetoric that overweight and obesity can be easily resolved by eating less and doing more, and this can be achieved by the greater application of willpower on the part of the individual.
The consequence of this could be for some people living with obesity to internalise the stigma they experience from wider society. It may also result in people living with obesity being reluctant to participate in workplace health programmes that could help them, and/or failing to access any other weight management advice or psychosocial help that could be of benefit to them in the future.
There are ways for employers to get around this of course – including employee consultation and involvement about what their preferred health programmes are, how stigma can be removed from the programmes and how they could best be implemented to encourage uptake without discriminating against individuals.
Obesity stigma is also evident in the wider discourse around employee health and wellbeing and employee productivity, and the ‘harm’ or ‘cost’ that employees with obesity can have for businesses and the wider economy – for example, through potentially higher healthcare costs. If obesity stigma is to be challenged in the workplace, then now is the time to reframe this debate, and focus on an asset-based view of workplace health and wellbeing, emphasising the full contribution that employees living with obesity can make if relevant support and workplace adjustments are made.
Recommendations for government, employers and individuals
As such, in a recent IES report discussing how employers can play their part in addressing weight-based stigma and discrimination in employment (see link at end of article), a range of recommendations for key stakeholders in this field were developed, to recognise that more can be done to help develop fair participation for employees working with obesity. These are:
For the UK government:
- ‘Good work’ should be included in the Obesity Strategy, so employers understand the rights that all employees have to stay in, thrive in and return to sustainable work. It may be time to clarify obesity as a protected characteristic under the Equality Act 2010, making it 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 into workplace health and wellbeing programmes, especially for those who may be considered more ‘at risk’, especially post Covid-19
- Health inequalities should be included as part of the levelling-up agenda post Covid-19, with the understanding that work plays a fundamental role in shaping health and could be an important factor in the economic recovery.
- Any current workplace health and wellbeing practices and activities should be reviewed to ensure they are supportive and not stigmatising for those living with obesity
- Co-production (i.e. working in partnership with employees), should be considered when designing, implementing and evaluating employer-sponsored weight-management programmes, to eliminate any risks of interventions perpetuating weight-based stigma
- Language and framing needs to be considered – an emphasis should be placed on workability and the positive contribution and productive capacity that people living with obesity can bring to an organisation
- Weight-management programmes should be offered and advertised in non-stigmatising ways. There must be careful use of imagery relating to healthy eating, personal weight management, etc and people-first language must be used
- Weight-management programmes should not be obligatory and no one should fear discrimination if they do not join.
- Recognise that support is available if you experience stigmatising behaviour and discrimination at work, linked to overweight and obesity
- If you would like to access support from weight-management services and have not found this easily accessible from your GP, your employer’s occupational health service (OH) could be in a position to help. The employer’s OH service could also help your line manager make changes at work to support you, so you can continue to enjoy and experience good work.
Overweight and obesity are conditions where barriers and stigma to full participation in the workplace still exist. However, if these stereotypes are tackled and key stakeholders remove some of the barriers that are currently seen in the workplace (and provide the relevant support), it will provide employees living with obesity the opportunity to make a full contribution at work. This will benefit both the individual and the organisation.
The IES report, Living and working with obesity: Are employers playing their part?, is at: bit.ly/3FwG4Nn
The views expressed in this article are those of the author and not necessarily those of the IES as a whole.
Dr Zofia Bajorek is Senior research fellow at The Institute for Employment Studies (IES)
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