Obesity and its Cost on the Workforce

• Introduction
• What is obesity?
• The obesity epidemic
• Healthcare costs of obesity
• Job specific obesity
• Unhealthy workplaces
• Obesity and absenteeism
• Obesity and presenteeism
• Obesity and workplace injuries
• Obesity and workplace discrimination
• Promoting healthy workplaces

Introduction

Obesity is costing the Australian economy $637 million dollars each year due to indirect costs associated with increased sick leave, lower productivity, unemployment, disability, early retirement and workplace injuries. This is in addition to the $1.08 billion obesity related healthcare costs. Hidden costs to employers also include the costs of hiring and training replacement staff and administration costs. Given the high cost of obesity to individual employers, there is growing support for workplace interventions used to promote healthy eating and physical activity.

What is obesity?

Obesity is usually the result of sustained energy imbalance, where energy intake far exceeds energy expenditure through physical activity and metabolic processes. Unused energy is stored by the body as fat. Obesity is where a high percentage of the body’s total composition is accounted for by fat. Clinically, a person is classified as Class I obese if their BMI is within the range of 30 – 34.9. Class II obese is a BMI between 35 and 39.9, and Class III obese includes all those with a BMI of 40 or more.

Obesity is associated with a long and varied list of complications. A review of the literature by the Australian Institute of Health and Welfare (AIHW) shows that there is strong evidence for an association between obesity and risk factors for heart disease, such as clogged arteries, high blood pressure, high cholesterol and diabetes. There also appears to be moderate evidence to support an association between obesity and heart failure and stroke. The link between obesity and heart disease is particularly concerning because it is responsible for the highest number of deaths each year in Australia. Obesity has many negative effects beyond the circulatory system. The excess weight involved in obesity can place pressure on the joints and the spinal column, increasing the risk of osteoarthritis. Obesity can also lead to lung disorders and sleeping disorders. It has also been linked to many cancers and gall bladder disease.

The obesity epidemic

In 2006, 62% of men and 45% of women in Australia were estimated to be overweight or obese. The AIHW estimated in 2004 that one in five Australian adults was obese, and 2 in 5 were overweight. To put this into perspective, in 2005 there were approximately 3.1 million obese Australian adults. There appears to be an ageing trend in relation to obesity and overweight in Australia. In 2004 the AIHW reported that obesity is becoming more prevalent among older Australians (55 or over) because of the ageing population. It was estimated that there were one million obese older Australians (23%), with the age category 50 to 59 having the highest percentage of obese adults. The prevalence of obesity in Australia reflects a global trend, which is most pronounced in developed Western countries. The World Health Organisation (WHO) estimated that in 2005 there were 1.6 billion obese adults worldwide, and 400 million overweight people. By 2015, this is predicted to reach a staggering 2.3 billion. The US has the highest rate of obesity, but it is now becoming more common in countries that are undergoing rapid economic development. This includes countries in the Asia-Pacific region such as China, India, the Pacific Islands and Indonesia.

Over the past few decades, there has been a significant change in the average Australian lifestyle. This is thought to account for the trends and patterns in obesity. Factors that contribute to increased obesity include a preference for fatty foods, the low cost of unhealthy foods, labour saving devices, increase in the use of electronic media, more sedentary occupations using a computer, stress and fewer opportunities for sport and recreation. It is also possible that recreation has decreased due to safety fears. This may discourage people from walking to workplaces, the shops, school or university. The National Health Survey of Australia in 2001 identified several risk factors for becoming overweight or obese. These include being socioeconomically disadvantaged, poorly educated, older, single, Australian born and physically inactive.

Healthcare costs of obesity

Obesity represents a significant drain on healthcare resources. This is due to its co-morbidities and the fact that obesity often worsens previously existing conditions. The National Health Survey of Australia in 2001 showed that obese people were 28% more likely than their healthy weight counterparts to have seen a doctor in the previous two weeks. They are also twice as likely to rate their health as ‘fair’ or ‘poor’. Direct healthcare costs include the cost of being in hospital, outpatient visits and doctor and specialist visits. These direct costs on the healthcare system reached approximately $1.08 billion dollars in 2005. There is strong evidence for a link between BMI and healthcare costs. This is most evident in the US, where direct spending on healthcare for obese individuals per year is 5.5 – 7% of the national health expenditure.

Job-specific obesity

Studies show that there is a negative association between socioeconomic status and obesity. Socioeconomic status is usually measured by a person’s occupation and their level of education. It appears that low levels of education predispose a person to obesity more than low status occupations. A study in 2000 showed that salespersons, personal service workers, plant-machine operators, drivers, and labourers have higher rates of obesity than men and women in managerial, administrative, clerking or professional positions. In one study, there was a two fold increase in the rate of obesity for female equipment and transportation officers compared to other occupations.

Unhealthy workplaces

There is now widespread recognition of the role of the environment in predisposing people to becoming obese. Although obesity is usually a behavioural/lifestyle issue, a person’s environment may not enable them to make healthy eating choices and do sufficient physical activity. Obesity is seen to be the interaction between a person’s behaviour, their environment and their own physiology/biology. The term ‘obesogenic‘ is now used to refer to all external factors which promote obesity. Studies have shown that a person’s workplace may contribute to their obesity. For example, men and women who are in low income and low status jobs may be more likely to be obese. In one study, this was associated with a lack of control and decision making power, combined with increased stress levels. Shift work may also contribute to obesity if it disrupts normal sleeping and eating patterns. Occupations that are sedentary in nature, for example office jobs and truck/taxi driving, may promote obesity if employees do not have opportunities to exercise. Occupations which involve meeting deadlines and working under time pressure may also encourage weight gain if employees do not have time to prepare healthy food.

Obesity and absenteeism

The probability of being absent from work increases with increasing body weight. For example, overweight people are 32% more likely to miss work, with obese people 62% more likely and the morbidly obese more than 118% more likely to miss work than their healthy weight counterparts. In 2001, obese Australians were 21% more likely to have been absent from work for at least one day in the pervious two weeks due to illness or injury. Furthermore, the average duration of absence was longer for obese individuals. This translated into approximately 4.25 million working days lost per year. This trend is also seen in mature age workers (45 – 64), who make up one third of the total workforce. Indirect costs of obesity such as absenteeism, lower productivity and unemployment cost the Australian economy $637 million in 2005. Since obesity is associated with absenteeism, it is no surprise that it is also associated with higher rates of unemployment. Obese Australians are 8% more likely to be unemployed. This figure increases with age, because older obese Australians (55+) are 20% more likely to be unemployed full time. It is thought that this is due to obese employees taking early retirement or being unable to participate in the workforce due to disability. Alternatively, unemployment could be a cause of obesity.

This association between obesity and absenteeism may be stronger or weaker amongst different occupations. For men in professional employment and sales workers, the probability of missing work increases with increased body mass. However, this same pattern is not seen amongst male managers, office workers and equipment operators. Among sales workers, obesity and overweight is consistently associated with increased absenteeism. This leads to significant costs per employee who is overweight or obese. For males, the per-employee costs are greatest for managers whereas for females it is in the category of professionals. Overall, the costs of obesity related absenteeism are higher for females than for males.

Obesity and presenteeism

Presenteeism is a term used to refer to lower productivity whilst present at work. Studies suggest that there is an association between obesity and lower productivity at work. One study estimated that lost productivity time (LPT) costs the US economy $42.29 billion annually. This was thought to be a conservative figure because studies which use BMI data rely on self-reported weight, which is often understated. The estimate also does not include the costs of recruiting and training new staff and the impact on co-workers’ productivity. The obese participants in the study were more likely to report poor work ability or a limitation in the amount, type or quality of work they could perform. In a study of randomly selected manufacturing employees, productivity was measured using a work limitations questionnaire. Moderately or severely obese employees had the greatest number of work limitations and needed more time to complete tasks. There was a threshold effect, whereby the association was stronger with increasing weight. This resulted in an additional $506 cost annually per obese worker.

Obesity and workplace injuries

There is evidence to suggest that obese employees are more likely to have workplace injuries. A US study examined the rate of occupational injury at several manufacturing plants. Approximately 29% of the participants had an injury during the study period. Of those who were injured, they were more likely to be overweight or obese. Injuries to the knees or legs were especially common for obese employees. Amongst obese employees, there was a higher rate of injury to the hands, wrist or fingers. The study also found a larger percentage of overweight and obese employees were affected by a back injury. To explain the associated between weight and traumatic non-fatal workplace injury, some studies have cited fatigue, physical limitations or poor health as possible factors. Medication used to treat the co-morbidities of obesity could also increase the rate of injury. Obese employees may also be less likely to wear protective equipment such as gloves and goggles if it is uncomfortable. This research has implications for employers, because the higher rate of injury in obese employees has an economic as well as a human cost. Costs would include hiring and training replacement staff and the administration costs associated with claims for compensation.

Obesity and workplace discrimination

Employers should be aware of the social implications of obesity. In particular, there is a need to combat the prejudice and discrimination that obese employees are known to suffer in the workplace. Some employers also contribute to the problem by discriminating against obese people during the recruitment process. One study showed that when resumes were accompanied with a photo of an obese person, the applicant was rated as lacking self discipline, having low supervisory potential and having poor hygiene and appearance. The study also found that obese people were more likely to be recommended for a job which did not involve client contact, such as systems analyst. Obese people may also face inequalities in wage and promotions opportunities. Discrimination in the workplace is a cause of low job satisfaction, which may in turn lead to higher rates of absenteeism.

Promoting healthy workplaces

Given the high workplace costs of obesity, it is in employers’ best interests to actively encourage healthy weights among staff. Barriers to effective health promotion in the workplace include a lack of resources, the financial cost, time constraints, lack of interest from employees and a lack of suitable onsite facilities. A UK study suggests that managers can strategically engage, advise and educate workers about obesity prevention. Workplaces can be designed to allow for exercise and physical activity. For example, providing bike sheds and car parks away from the entrance so that employees get some exercise through walking. Employees can also be given more time to use for physical activity or recreation away from the place of work. Canteens can include healthier options, or employees can be encouraged to bring a healthy lunch from home. The most important intervention is to create a supportive environment, where individuals feel motivated to take responsibility for their health. Rewards programs can supplement this by providing extra motivation.

Top ten ways to promote a healthy workplace

• Encourage staff to bring healthy food from home or provide healthy options at the canteen
• Provide microwaves to reheat food and fridges to store packed lunches
• Offer incentives for staff who have a healthy diet
• Give staff extra time to use for exercise
• Encourage staff to leave the workplace during breaks and go for a walk
• Educate staff about the effects of obesity and obesity prevention
• Facilitate a supportive environment and tell obese staff to discuss treatment options with their doctor: see meal replacement program for more information
• Reward and acknowledge staff for their good work
• Eliminate any discrimination and bullying in the workplace
• Ask staff to write down their health goals

More information

For more information on workplace health including office ergonomics series, useful tips on avoiding injuries in the workplace and costs on the workforce, see Workplace Health.

For more information on obesity, health and social issues, and methods of weight loss, as well as some useful tools, see Obesity and Weight Loss.

For more information on living with obesity, including discussing obesity with friends or loved ones, bullying and obesity in children and links between obesity and pain, sexuality, fertility and depression, see Living with Obesity.

References

1. Australian Institute of Health and Welfare (AIHW) and National Heart Foundation of Australia (2004) The relationship between overweight, obesity and cardiovascular disease. AIHW Cat. No. CVD 29. Canberra: AIHW (Cardiovascular Disease Series No. 23)
2. AIHW (2005) Obesity and workplace absenteeism among older Australians. Bulletin. 31: 1-16
3. Finkelstein, EA. Rhum CJ & Kosa KM. 2005. Economic Causes and Consequences of Obesity. Annual Review of Public Health. 26: 239-257
4. Kouris-Blazos, A. & Wahlqvist, ML. 2007. Health economics of weight management: evidence and cost. Asia Pacific Journal of Clinical Nutrition. 16(1): 329-338
5. AIHW; Bennett SA, Magnus P & Gibson D (2004) Obesity trends in older Australians. Bulletin no. 12. AIHW cat. no. AUS 42. Canberra: AIHW.
6. World Health Organisation (WHO) Obesity and Overweight [online] Available at URL: http://www.who.int/mediacentre/factsheets/fs311/en/index.html (accessed February 19 2008)
7. The International Association for the Study of Obesity 2006. The burden of overweight and obesity in the Asia Pacific region. Obesity reviews. 8: 191-196
8. Brown, A. & Siahpush, M. 2007. Risk factors for overweight and obesity: results of the 2001 National Health Survey. Public Health 121: 603-613
9. Thompson, D. & Wolf, AM. 2001. The medical care cost burden of obesity. Obesity Reviews. 2: 189-197
10. AIHW. 2003. Are all Australians gaining weight? Differentials in overweight and obesity among adults 1989-90 to 2001. Bulletin. 11: 1-17
11. Ball, K., Mishra, G. and Crawford, D. 2002. Which aspects of socioeconomic status are related to obesity among men and women? International Journal of Obesity & Related Metabolic Disorders: Journal of the International Association for the Study of Obesity. 26(4): 559-565
12. Galobardes, B., Morabia, A., and Bernstein, M.S. 2000. The differential effect of education and occupation and body mass and overweight in a sample of working people of the general population. Annals of Epidemiology. 10: 532-537
13. Moodie, M. 2007. Living in an Obesogenic Environment. Nutridate; 18(4):1
14. Laaksonen, M., Sarlio-Lähteenkorva, S., Leino-Arjas, P., Martikainen, P. and Lahelma, E. 2005. Body Weight and Health Status: Importance of Socioeconomic Position and Working Conditions. Obesity. 13:2169-2177.
15. Cawley J, Rizzo J, Haas K. Occupation-specific absenteeism costs associated with obesity and morbid obesity. JOEM 2007; 49(12): 1317-1324
16. Ricci, JA. & Chee, E. 2005. Lost Productive Time Associated with Excess Weight in the US Workforce. JOEM; 47(12): 1227-1234
17. Gates, DM. et al. 2008. Obesity and Presenteeism: The Impact of Body Mass on Workplace Productivity. Journal of Occupational and Environmental Medicine; 50(1): 39-45
18. Pollack, KM. et al. 2007. Association between Body Mass Index and Acute Traumatic Workplace Injury in Hourly Manufacturing Employees. American Journal of Epidemiology; 166(2): 204-211
19. Klarenbach, S., Padwal, R., Chuck, A. and Jacobs, P. 2006. Population-Based Analysis of Obesity and Workplace Participation. Obesity. 14:920-927.
20. Tunceli, K., Li, K. and Williams, K.L. 2006. Long-Term Effects of Obesity on Employment and Work Limitations Among U.S. Adults, 1986 to 1999. Obesity. 14:1637-1646.
21. Puhl, R., and Brownell, K.D. 2001. Bias, Discrimination, and Obesity. Obesity Research. 9:788-805.
22. Williams, N. 2004. On the scale of it. Occupational Health; 56(10): 25-30
23. Knowledge @ Warton. Human Resources 2007 [online] available at: http://beyond.knowledgeatwharton.com/index.cfm?fa=viewArticle&ID=1876 (cited 20 Feb 2008).