A weighty burden: Can we reduce workforce obesity without discriminating?

Describing obesity as a problem doesn’t really do it justice. It’s more a crisis.

As our economies expand, so do our waistlines. As a consequence, weight gain has developed into a well-recognised global problem. Worldwide, one in three of us are overweight or obese according to the latest data from the World Health Organisation (WHO). In the UAE, meanwhile (one of the world’s fastest growing economies), The National newspaper recently reported this figure to be 60% – so about double the global average.

The question is, where does this leave employers? If obesity is hitting profits, how can we address it without appearing to discriminate? Or is addressing it in fact not discriminating at all?

Because a recent report by McKinsey found the obesity epidemic is up there with smoking and armed conflict as the human activities having the greatest negative impact on our economies. This is startling. Two of those three – overeating and smoking cigarettes – are associated with our lifestyles.

And a Willis Towers Watson study titled “Employee Health & Business Success” published in 2016 found that three of the top five workforce health risk factors relate to sedentary lifestyles, with overweight and obesity listed as one of the most serious problems (at 45%).

Essentially, we are addressing issues here that many of us have at least some control and choice over. And so we must ask: How much control? And where does the employer fit in the equation?

Expanding costs for your company

In the US, a recent study published in the American Journal of Health Promotion found that those with a BMI of between 30 and 35 had average medical expenditures of USD 1,071 greater than those of a healthy weight. These statistics will be of concern for many employers, especially those providing health insurance, an offering that is becoming increasingly common (even mandatory) for many companies around the world. In the Gulf, Dubai recently joining Saudi Arabia and Abu Dhabi in forcing the hand of employers to offer health coverage to all employees.

In the US, a recent study published in the American Journal of Health Promotion found that those with a BMI of between 30 and 35 had average medical expenditures of USD 1,071 greater than those of a healthy weight.

Being overweight means losing out elsewhere, too – with indirect costs that impact the office but are hard to quantify. Lost days at work, reduced productivity while at work, and increased compensation claims to name a few. A 2011 study by Gallup and Healthways found that, on average, overweight employees will take 18 days off per year, while those in the healthy range take just one-and-a-half days. Another study of 30,000 employees, again published in the American Journal of Health Promotion, found that when taking into account direct healthcare as well as loss of productivity due to sick days, being overweight doubled yearly employer costs from nearly USD 4,000 to over USD 8,000.

This is then a growing problem for employers.

Many are rapidly realising that they will not be able to control medical claim costs if they do not begin to reduce the demand placed on healthcare by heart disease, diabetes, depression and many other chronic health conditions. So tackling obesity is an obvious place to start.

Approaches: The fine line between discrimination and accountability

If we ask ourselves why obesity is on the rise, things become complex.

In the West and much of the Gulf, the culture has shifted to one of low exercise, plus high calorie intake of processed food and unhealthy beverages. Work is frequently office-based, adding to increasingly sedentary lifestyles. In the UAE there can even be a perception that being overweight is a sign of high social status and prosperity. These all undoubtedly combine to account for much of the obesity epidemic.

But there are other factors that determine a person’s health – genetics being one of them.

Whereas people have a choice of how much to eat, whether to take the car or walk to the shops, we have no control over what genes life has handed us. If someone is pre-disposed to a condition that directly or indirectly increases their risk of obesity and all that comes with it, then it may be argued that things are beyond their control.

This opens up a minefield for employers: One neatly summarised by the words ‘discrimination’ and ‘accountability’.

These two words go hand-in-hand, so let’s deal with discrimination first. The waters are pretty murky here because things are different around the world and are constantly changing. In 2015, the EU courts ruled if obesity ‘hinders the full and effective participation of that person in professional life on an equal basis with other workers’ then it can be classified as a disability. In the US, the Americans with Disabilities Act does not qualify obesity as an impairment, and only the state of Michigan expressly prohibits discriminating against employees based upon their weight.

In 2015, the EU courts ruled if obesity ‘hinders the full and effective participation of that person in professional life on an equal basis with other workers’ then it can be classified as a disability.

So overall, employers should tread carefully when approaching staff about their weight. In most cultures things could soon become messy if a person is paid less or fired because of their weight.

But what about attempting to reduce workplace obesity overall? This is where accountability comes in.

Because it is certainly the case that we are all accountable for our own health and the bad choices we make that affect it. Yet, how does this relate to our job? In some professions accountability is higher than others. Soldiers, lifeguards, catwalk models are prime examples. Such roles put demands on a person’s fitness or image. But while it appears fair enough to tell a lifeguard to ‘get in shape’, you may struggle to make similar demands of those who spend their days behind a desk. In fact, if the role demands that an employee spends hours of their life sitting, then some may argue that the employer becomes at least partly responsible for that person’s health and should provide provisions to improve it.

It goes both ways, though: If a person’s weight is putting unnecessary strain on their colleagues and employer, whether because of reduced ability to actually do the job or increased healthcare cost, then that person also needs to put their hands up and take some responsibility.

Using the case of smoking to examine obesity

The case of smoking offers particular parallels. Here again our prime example comes from the US. The Patient Protection and Affordable Care Act allows employers and insurers to give incentives to workers who are non-smokers, particularly when it comes to insurance premiums. This is shaped as an incentive rather than a punishment, with lower premiums for employees who complete certain activities, such as smoking cessation clubs. Those who don’t pay the normal premium.

So the argument for smoking is very similar to the one we’ve already made for obesity. Smokers cost employers more – to the tune of USD 6,000 per year according to an Ohio State University study – but it is a lifestyle choice even if some genetic factors do play a role. So workers have no right to expect that this unhealthy lifestyle choice won’t end up costing them more. In fact, in many countries employers are beginning to make the same insurance premium distinction based on overall health.

A case for intervention

Is it possible to reduce workforce obesity without discriminating? That’s an incredibly complex question with an equally complex answer. Not only are matters of weight extremely sensitive, but with so many stakeholders involved – governments, medical professionals, the food and drink industry, health insurers, employers and employees – there is no one right way to tackle the issue. Whatever approach is taken, it needs to reflect the fact that no one is being punished or singled out for their weight.

It is a case of balanced accountability between both employer and employee. It is possible to take action to reduce the impact of obesity and improve the effectiveness of the business. And the best way of doing this is through health and wellness programmes that promote physical activity and healthy eating, while also addressing habits.

It is possible to take action to reduce the impact of obesity and improve the effectiveness of the business.

Let’s look at some key points to consider.

1. Incentives to encourage healthy behaviour: Reduced premiums for those undertaking certain weight loss and fitness-improving activities.

2. Environmental support: Healthy on-site catering and vending machines, open stairwells, work-based gyms.

3. Healthy work cultures: Communication programmes about health and wellness, competitions to promote healthy living.

4. Community and family connections: Employee education, corporate support for physical education in schools and parks.

Do these kind of interventions work? Results are encouraging. US company General Mills has implemented a policy based on building a supportive environment, which offered many of the benefits above. The result was a drop in the percentage of employees with a BMI greater than 30 from 23% to 6% in three years.

The obesity crisis isn’t going away anytime soon, but as individuals and as employers we can and should tackle it. Especially if the outcome has positive physical and economic benefits for everyone.

Please visit the Al Futtaim Willis website at www.willis.ae.