O as in Obesity: Implications for the Worksite Setting.
Nico Pronk, Ph.D., FACSM, FAWHP, is executive director of the Health Behavior Group and vice president of Health and Disease Management at Health Partners health system, which provides health promotion, disease prevention, and disease management services for worksites and health plans around the country. Dr. Pronk has published extensively in the health-related scientific literature and is currently an associate editor for ACSM's Health & Fitness Journal® and an Editorial Board member of the U.S. Center for Disease Control and Prevention's Preventing Chronic Disease e-journal. Among other public services activities, he currently serves on the Task Force on Community Preventive Services supported by the U.S. Center for Disease Control and Prevention and the Interest Group on Worksite Health Promotion at ACSM. Dr. Pronk received Fellow status from ACSM and the former Association for Worksite Health Promotion.
Obesity is clearly recognized as a major health concern in the U. S. today. On a regular basis, new evidence is presented in the scientific literature and in the lay press that describes the impact it has on disease risk, work-related productivity, and overall quality of life. Furthermore, childhood obesity is of increasing concern as obese children and adolescents are developing diseases formerly only associated with adults, such as type 2 diabetes and prediabetes.
Despite its association with serious health problems, obesity rates are soaring. Adult obesity prevalence has doubled since 1980 and now stands at 30%. Two thirds of all adults in the U.S. are now either overweight or obese. Childhood obesity rates have nearly tripled since 1980, increasing from 6.5% to 16.3%. Obese children are more likely to become obese adults, which put them at risk for poor health outcomes throughout adulthood. In fact, this generation of U. S. children could be the first to live shorter less healthy lives than their parents.
The U.S. health care system is frantically trying to deal with an ever-increasing demand for services related to chronic disease care, much of it contributed by obesity. This has a direct effect on overall health care expenditures; more than a quarter of the nation's health care costs are associated with obesity and physical inactivity (1,6). Whereas a major portion of this cost is paid for by employers, American businesses also incur the expense associated with obesity-related productivity losses. Table 1 presents an overview of obesity-related issues and concerns in several domains that affect employers. As a result, obesity and obesity-related lifestyle factors should be high on the list of action items for employers.
WORKSITE-RELATED OBESITY DRIVERS
Currently, 66% of the U.S. workforce is overweight (3). Whereas employers are concerned about this, they also are partly to blame. The workplace itself is one of the factors that drive excess weight to begin with. Many of today's workplaces are not conducive to health. Consider today's sedentary job types that limit movement for hours on end. Often, activity, in general, is highly discouraged because it may take workers away from their stations or desks, assuming this will lower productivity. In general, workplaces may provide very little opportunity for physical activity during the work day. Many employees are discouraged from using active transportation to and from work because of lack of bicycle racks or shower facilities at the worksite. In addition, on-site cafeterias offer few healthy food options, and the available options are relatively more expensive than the less healthy options. Historically, corporate cafeterias were created to ensure that workers would have ready access to a sufficient number of calories throughout the day, so they would be able to do the work (and be productive). Today, on the other hand, managing calorie intake through healthy food options has become paramount. Furthermore, employees need access to resources and facilities to ensure they are able to burn a sufficient number of calories throughout the course of the day to ensure prevention of metabolic health issues and allow themselves to stay focused (and be productive). Finally, health insurance benefits may not be available to support obesity prevention or treatment options such as dietetic counseling, pharmaceutical interventions, or bariatric surgery.
TOWARD SOLUTIONS-PUBLIC-PRIVATE PARTNERSHIPS
Attempts to address obesity in both the worksite setting and in the broader community should involve public-private partnerships. Government and the private sector should create an environment conducive to implementation of worksite health and wellness programs. It is obvious that it is in the best interest of both the private sector and the government, as well as the employees and their families, to put greater emphasis on employee health.
Solutions at the worksite ought to be focused on the root causes of chronic disease and excess weight-poor nutrition and physical inactivity. In addition, providing the supportive context needed to implement programs, such as benefit designs, leadership commitment, incentives, communications, and a culture at the worksite conducive to health, is critical to stimulate participation, good experiences, and strong outcomes. Solutions should be heavily informed by what we know works based on research evidence so it increases confidence that the investments will prove worthy. As part of an update on obesity policy in the United States (2), employers and health insurance companies should consider the actions outlined in Table 2.
THE VALUE OF OBESITY PROGRAMS
To ensure that the value of these programs is captured, evaluation and research should be promoted and supported by employers and other community stakeholders. In particular, practice-based participatory research, action research, program evaluations, and case study projects should be encouraged and results distributed broadly at meetings and publications. More distribution channels need to be created and used that support the practitioner in learning from field experiences and sharing of ideas. Publications and journals that will not accept project descriptions that lack scientific methodology that will not necessarily drive innovations into the field. Yet at the same time, we can not lose sight of the need for more formal research on what works and what doesn't.
1. Anderson LH, Martinson BC, Crain AL, et al
. Health care charges associated with physical inactivity, overweight, and obesity. Prev Chronic Dis
2. F as in Fat: How Obesity Policies are Failing in America. Trust for America's Health [cited 2008 Aug 23]. Available from: http://www.healthyamericans.org
3. Hertz RP, Unger AN, McDonald M, Lustik MB, Biddulph-Jrentar J. The impact of obesity on work limitations and cardiovascular risk factors in the U.S. workforce. J Occup Environ Med
4. Pronk SJ, Pronk NP, Sisco A, Ingalls DS, Ochoa C. Impact of daily 10-minute strength and flexibility program in a manufacturing plant. Am J Health Promot
5. Taylor WC. Transforming work breaks to promote health. Am J Prev Med
7. Yancey AK, Pronk NP, Cole BL. Workplace approaches to obesity prevention. In: Kumanyika S, Brownson RC, editors. Handbook of Obesity Prevention
. New York (NY): Springer; 2007. p. 317-47.