Workplace weight-loss programs: More harm than good?
Workplace weight-loss programs: More harm than good?
Experts debate value of encouraging employees to shed pounds
Employee health departments routinely offer diet and exercise programs to help overweight employees slim down, but many experts now decry such practices, claiming that weight loss interventions actually increase health risks and reinforce the social stigma against obesity. Better to support size acceptance, they say, than to encourage weight loss.
Those who advocate this new approach say being overweight does not necessarily equal unhealthiness. In their view, society places too much value on thinness instead of respecting differences in size and shape. Attaining a stable weight contributes to better health, even if that weight is higher than the "ideal," they state.
They criticize workplace weight-loss programs with names such as Choose to Lose, Dump Your Plump, Weight No More, The Leaner Weigh, and even Weight Watchers as reflecting society's obsessive preoccupation with weight and the need to be thin to be accepted. Armed with data from recent studies, they argue that urging obese employees to diet and exercise has little long-term success and is often counterproductive because it discourages adoption of healthier lifestyles. (See recommendations for new health and weight practices for EHPs, pp. 27, 28, 30, and insert.)
On the other hand, weight loss advocates have gathered data to support their conviction that weight management produces healthier, more productive employees.
The Bureau of Business Practice (BBP) Center for Health Programs, an affiliate of the National Center for Health Promotion in Southfield, MI, operates The Leaner Weigh program. Billed as "a cancer and heart disease risk reduction program," The Leaner Weigh emphasizes a low-fat, high-fiber diet. The course consists of five one-hour sessions focusing on the link between nutrition and cancer and heart disease.
Kathy Walters, RN, a BBP Center trainer, says statistics show the economic impact of poor health practices, "and that certainly includes the employee in the work setting." Information compiled from sources such as actuarial studies and academic journals by the BBP Center includes the following:
* Poor employee health habits cost employers up to $300 per employee per year in excess direct medical costs, with indirect costs estimated as high as $1,200.
* Overweight employees have 45% more hospital days, and 48% more annual claims over $5,000.
* Employees with high blood pressure are 15% more likely to have annual claims over $5,000 and have 25% more hospital days than employees with normal blood pressure.
* Employees with high blood cholesterol levels have 16% more hospital days and 24% more annual claims over $5,000.
* Cancer of the colon, breast, and prostate are the three forms of cancer most closely associated with nutritional risk factors and together cause more than 130,000 deaths annually.
* Sedentary employees have 15% higher health care costs than exercisers, and obese employees have 11% higher costs than those of normal weight.
* Poor diet and sedentary activity patterns account for at least 300,000 deaths per year.
* At least 40% of the U.S. population is sedentary.
* Physically inactive people are twice as likely to develop coronary artery disease as people who are regularly physically active.
* About 32 million U.S. adults aged 25 to 74 are obese (defined as 20% or more above desirable body weight).
* Diabetes and hypertension are three times more prevalent in overweight people than in those who are not. Obesity also is a risk factor for heart disease and cancer. (Editor's note: For complete references and statistics, contact BBP at the number listed at the end of this article.)
Stress, long shifts inhibit exercise
Walters, who presents courses in hospitals as well as other work settings, says hospital employees are among those least likely to exercise.
"People who work in hospitals are very stressed out and work long shifts at times, so exercise is the last thing on their minds. [Due to stress and long hours] they are probably also eating poorly, so there is a problem with being overweight," she says.
Workplace weight-loss programs are an important benefit for employees, says Ron Goor, PhD, MPH, president of Choice Diets in Rockville, MD, which operates the Choose to Lose Weight Loss/Healthy Eating Program.
Even if all or most of the cost is borne by the participants, just providing a place for lunchtime meetings helps busy workers who may not be able to attend evening community classes.
Choose to Lose is or has been offered in about 300 hospital workplaces. Over the past four and a half years, more than 24,000 people have signed up for it at those and other sites. Goor says the program incorporates three strategies essential for any successful weight loss program: eat a low-fat diet, eat nutrient-dense, fiber-rich foods to keep up the metabolic rate, and exercise aerobically for at least 20 to 30 minutes every day.
"Many people really do want to lose weight," says Goor. The name of his program reflects that fact, and is not meant to be derogatory. "If we just called it the healthy eating program, we wouldn't have a program. Nobody would sign up. If Weight Watchers all of a sudden decided they weren't interested in weight loss any more, that they just wanted people to eat healthfully, they would be bankrupt in two weeks. You can't market something as something else. Some people may not be ready for it, but other people are."
Focus on risk factors alone unsuccessful
Goor, who coordinated the National Cholesterol Education Program for the National Institutes of Health's National Heart, Lung, and Blood Institute, claims programs that focus on reducing other recognized health risk factors, such as high cholesterol, usually are unsuccessful.
"People don't see or feel their cholesterol," Goor states. "It's easy to get upset for one or two weeks when you discover your cholesterol is 250, and then you forget about it. But you never forget about the fact that you weigh 270 pounds. Also, you don't feel well."
As for the contention that many overweight people actually are healthy and feel well, Goor simply disagrees.
"I don't believe that," he says. "It defies belief. They may feel well at the moment, but there are real health effects [of being overweight]. It's not a cosmetic issue. Take a sack of salt that weighs 100 pounds. Put it on your back and carry it all day, day after day, and tell me how your knees feel. These people get diabetes, they get strokes, they get high blood pressure and high cholesterol. There is no way they can be healthy in the long run."
Even a small weight loss of eight to 10 pounds can reduce high blood pressure and other risk factors, says Pat Lyons, RN, MA, regional health education consultant for the Oakland-based Northern California region of Kaiser Permanente, the largest health maintenance organization in the United States.
While acknowledging that fact, Lyons works with nutritionists and physicians, "trying to shift the focus of care to health rather than weight loss," she explains.
The difference between blame and motivation
Information about the cost of obesity for employers may not be completely accurate and serves mainly to increase the "shame and blame" that overweight employees already feel, says Lyons, author of Great Shape: The First Fitness Guide for Large Women (Palo Alto, CA: Bull Publishing, 1990).
"There is a fine line between blaming people for increasing health care costs and motivating people to take care of themselves," she says. "Blaming does not help motivate. It pushes [employees] into what are generally completely unsuccessful attempts to lose weight. This does not improve long-term outcomes."
Workplace weight loss "contests" are not only ineffective in terms of long-term outcomes, but also put employees through "public humiliation," she maintains.
Lyons also is opposed to programs with names referring to plumpness or being overweight because they are "unhelpful" and they, too, increase shame and blame.
Diets don't work
Even when large people lose a small amount of weight, "the traditional weight-loss paradigm says they should continue to try to lose weight, and they are doing something wrong if they don't. If you look at the straight science, people's ability to lose a large amount of weight and keep it off is basically nil," she says.
Diets don't work, so health professionals should help people stop dieting and instead encourage them to live a healthy lifestyle, "focusing on making behavior changes to support that rather than losing X number of pounds. Any weight loss that occurs is a by-product," Lyons states.
"Health and fitness come in all shapes and sizes," she says, and workplace programs must get that message out to employees.
Jonathan I. Robison, PhD, MS, executive co-director of the Michigan Center for Preventive Medicine in Lansing, says large people can be healthy, and the focus of any workplace weight-related classes should be health improvement, not weight loss.
"It is a mistake to run weight-loss programs," says Robison, a nutritionist and exercise physiologist who also is an adjunct assistant professor in the department of physical education and exercise science at Michigan State University in East Lansing.
"I suggest to people in the health profession that at some point you have to take a stand, and when you have a treatment that has a 95%-plus failure rate, and when you have a population that is becoming heavier and heavier despite $60 billion a year being spent on weight-loss programs, and when you have an explosion of eating disorders partially caused by getting people to diet all the time, you have to say, 'This isn't working. We have to do something else.' For health professionals, the primary directive is to do no harm, and we are doing inconceivable harm to people by having them diet over and over again. If the ultimate goal is to get people healthier, this is not going to do it," he states.
Do we need to look like Twiggy?
Robison is at the forefront of what he calls the "size acceptance and nondieting movement." In answer to the question of how to help employees lose weight, the movement's philosophy is to encourage them to stop trying. Obesity and overweight are society's problem, not the individual's.
"We need to look at our culture's preoccupation with slimness and discrimination against anybody who doesn't look like Kate Moss or Twiggy," Robison suggests. "Take the focus off weight and put it on health."
No effective ways of losing weight have been proven, he says. The theory that large people are starved for nutrition advice also is a myth. Most have been through so many weight-loss programs that "they've been educated to the max and can tell you the number of fat grams in every food there is. Yet they don't lose weight and keep it off. Research shows very clearly that most large people are not eating more, or any more poorly, than most thin people. It's important to educate people about food, but the worst thing you can do to someone who is obsessed with eating and counting calories and fat grams is to give them nutritional information because all they do is get more obsessed," he explains.
The more people focus on their weight, the bigger they get, and weight issues are too complicated to be handled in the usual 10-week weight-loss class, Robison says.
Because most dieters regain the weight they've lost, they wind up depressed and ashamed, which does not lead to healthy lifestyle changes, he adds. Instead of traditional weight loss programs, employee health professionals can organize workplace groups with a new three-pronged approach to health and weight that focuses on self-acceptance, physical activity (not "exercise" or "fitness"), and "normal" eating.
Self-acceptance involves encouraging employees to see that their worth as a human being is not dependent on their size. Most large people have had issues about weight since childhood, "so their problem is more with self-esteem than with food," he says. Reversing their negative thought processes takes time; there is no quick fix.
While employees work on self-acceptance, they should be encouraged to explore ways of becoming healthier. One component of that is physical activity or movement.
"It's not called exercise, because exercise and physical activity are not the same thing," Robison says. "Physical activity is movement, while exercise is movement for the purpose of being fit. The problem in our culture is that only very recently has it been necessary to do exercise. Fifty years ago people had all this physical activity; now, we don't have any left in our daily lives so we invented gyms and aerobics classes. There are not many large people in those places because there is shame around them appearing in the same place as people with hard bodies in skinny leotards."
EHPs can help workers find "safe" places with special classes for large people, such as at some YMCAs and YWCAs. The focus should not be to lose weight or burn calories, but to have fun, feel safe, and enjoy moving, "and the outcome of that is you will get fitter," he says.
The other component is "normal eating," which he describes as eating that is internally regulated by feelings of hunger and fullness. Calorie-restricted diets rely upon external regulation because dieters are forced to stop eating when they have reached a calorie limit, not when they feel satisfied. In support groups, Robison defines normal eating as "being able to choose food you like and eat it and truly get enough of it -- not just stop eating because you think you should."
Because dieting doesn't work, helping people feel better about their size, move more, and remove anxiety about food is better for their health. "Many times, their body will then settle at a weight that is healthy for them, although it may not be based on height and weight charts," Robison says.
Only one way to lose weight
Others disagree with this approach. Controlling calories is necessary for weight loss, says Elaine Frank, MEd, RD, vice president of the American Institute for Preventive Medicine in Farmington Hills, MI. Her organization offers two weight-loss programs: Weight No More and HealthyLife Weigh, which both emphasize low-calorie diets and exercise.
She says there is only one way to lose weight: Decrease calories in and increase calories out.
Weight No More is an eight-to-12-week program begun in 1983 and used at about 100 hospital workplaces. HealthyLife Weigh was designed two years ago as an ongoing program that participants can join at any time. It is operating at about 35 hospitals. More than 100,000 people are or have been enrolled in the programs.
"A diet has to be calorie-focused for weight loss," says Frank, "but we have always encouraged people to recognize that their thought process related to [weight issues] is a very big portion of their ability to be successful. We discourage people from kicking themselves for being bad because they're overweight."
Frank says the nonweight-focused approach is "playing with words. The issue is weight. Why? Because the real issue is health, and we are trying to help people establish changes in their lifestyle that will help them to be healthier. To make this particular health change, weight must change."
Many overweight people are healthier than other people who are at a "normal" weight, she acknowledges, "but it's burying your head in the sand to say that obesity does not contribute to ill health. Many people who are overweight would like to lose weight, and not just because someone else out there thinks they should. Just because society has a negative view of obese people does not mean that is the only reason why obese people want to lose weight."
Fitness program is disguised as weight loss
About 100,000 people have participated in the Dump Your Plump team aerobic weight loss program developed by Don Alsbro, EdD, CHES. The South Haven, MI-based program has been used by 83 U.S. hospitals and a variety of other worksites. Alsbro says between 30% and 60% of employees typically sign up.
Although the 10-week program uses a contest approach, Alsbro says participants set individual goals that may or may not include a specific weight loss. People will lose weight if they continue to exercise, he says.
"I don't care what weight-loss goal they put down," Alsbro states. "What I'm concerned about is [participants] doing the 30 minutes of exercise five days a week. That is the most healthy thing they can do. This is a fitness program disguised as a weight-loss program."
Conditions such as heart disease and diabetes are attributable to overweight, he says. "One out of three people in this country is obese. In 1980, it was one out of five. We're not winning the battle. Sooner or later [overweight] people have to step forward and admit they made the choice to get where they are and say, 'Now I'm going to make the choice to get back where I want to be.' And they can do it."
Alsbro notes that most people are not offended by the name of his program, which he came up with 10 years ago. His logo depicts a cartoon-like character with a huge belly standing on a scale. Only about 1% of the people he talks to are "touchy" about the name, he says, and "they really aren't ready to do something like this anyway. If I used a name like 'Healthy You,' no one would remember it."
A program by any other name . . .
Judging a program by its name "without investigating who and what we are doesn't say much" for the critics, says Karen Miller-Kovach, MS, RD, general manager of health program development for Weight Watchers International in Woodbury, NY. Begun in 1963, Weight Watchers is the oldest commercial weight-loss program in existence, with about 25 million current and former members. The Weight Watchers at Work program brings the traditional support-group format into the workplace.
It may be "politically correct" to downplay the importance of weight, "but we have an epidemic of obesity in the United States that is costing us billions of dollars," Miller-Kovach says. "Weight should not be the end-all and be-all of an organization, but to say it shouldn't be mentioned is incorrect."
Although Weight Watchers uses government tables to determine an individual's healthy body weight, the notion of an "ideal weight for anyone and everyone based on their gender and their height" is outdated, she adds.
"Perhaps not everyone can be or should be at a healthy weight, but everyone can be at a healthier weight. If you are eating appropriate foods in appropriate amounts and being physically active, the likelihood of being morbidly obese is very small. But to tell somebody who is 275 or 300 pounds that they can be perfectly healthy at that weight is doing them a disservice, and the facts don't support that," she states.
Miller-Kovach says the program does not rely on calorie-counting, nor does it focus on weight at the expense of health.
Weight Watchers is like a "three-legged stool," she says. "One leg is food, one leg is activity, and the third leg is cognitive behavior -- what you think about eating, your life, and yourself. The seat of the stool is group support."
Thought processes are central to weight loss, she explains.
"We work on eliminating all-or-nothing thinking: Either I'm on a diet or off a diet. Either I'm perfect or I'm terrible. We're about living a healthy lifestyle, not about being perfect."
Workplace provides group support
Keith Ayoob, EdD, RD, a spokesman for the American Dietetic Association (ADA) in Chicago, says the workplace is conducive to weight-loss programs because of the group support it can offer.
"The advantage of the workplace is you have comrades; you don't have to do it by yourself. If people come together in the workplace environment, they will have the same goals without necessarily having the same immediate objectives," he says.
Although weight loss may not be everyone's focus, "most [overweight] people are interested primarily in losing weight." Ayoob says to ask people to think about how willing they are to change their lifestyle -- including diet and physical activity -- permanently.
"Ultimately, that is what is required. Some people don't want to attempt that. Sometimes we discover things about ourselves that we don't necessarily like but that are keeping us from achieving our goals," he says.
Workplace weight-loss programs are most successful when management is supportive, he adds. "Many administrators are, because they realize that taking care of our health results in fewer sick days and fewer injuries, so it's to their best advantage."
Ayoob suggests using programs that take a more "holistic" approach (see related story, p. 32), addressing not only weight loss "but rather a healthy change in eating style and healthy activity." Good programs also should take stress into account "because we do a lot of eating out of stress." In addition, programs should take a positive approach rather than a punitive one.
Hospital settings are ideal for good programs because occupational health professionals can combine their own expertise with that of registered dietitians and physical therapists.
"The more people we get involved and the more of an in-house approach we take, the more likely we are to have good compliance," Ayoob says. "It's also important in a hospital setting to acknowledge that even though this is a hospital, we don't have to be perfect. Physicians and other medical personnel don't have to feel embarrassed about having an issue with weight because these are human things that are independent of one's occupation."
Ayoob also recommends the following:
* Encourage each person to keep a food diary to discover exactly what they eat. Having to keep track can draw attention to what we eat and how much, "and also makes you ask yourself if you really need to eat those kinds of foods." This usually helps reduce food intake.
* Encourage workers to get involved in activities other than eating after work. Social events can distract one from eating and focus gratification on something other than food.
'Don't think of it as exercise'
* Encourage workers to start increasing their physical activity. "Gradually do something more than you used to do. That's what lunch hours are made for," he says. Walking five or 10 minutes alone or with a co-worker can start a healthy habit even if it doesn't produce massive weight loss immediately.
"Don't think of it as exercise. Think of it as fun, as your down time, a chance to get away from the workplace for a while," he explains. "Good eating and activity habits are more important than losing weight."
* Initiate inexpensive means of stress reduction, such as a stretch class or "gripe sessions" where people can "moan and groan and get tension out."
* Elicit the cooperation of food-service staff in displaying the calorie and fat content of entrees, which gives workers support in making better food choices.
[Editor's note: To get more information on any of the programs mentioned in this article for possible use in your hospital, Hospital Employee Health provides you with the following addresses and phone numbers:
The Leaner Weigh, BBP Center for Health Programs, National Center for Health Promotion, 26925 W. 11 Mile Road, Suite A, Southfield, MI 48034. Telephone: (800) 843-6247. A free 30-day program preview is available for Hospital Employee Health subscribers.
Choose to Lose Weight Loss/Healthy Eating Program, P.O. Box 2053, Rockville, MD 20847-2053. Telephone: (301) 897-9360. No-obligation preview available.
Pat Lyons, RN, MA, regional health education consultant, Kaiser Permanente. Telephone: (510) 987-3107. She recommends calling Krames Communications at (800) 333-3032 for a free sample of a 16-page booklet titled Living in a Healthy Body: A New Look at Health and Weight.
Michigan Center for Preventive Medicine (offers workshops, seminars, consulting), 405 West Greenlawn, Suite 300, Lansing, MI 48910. Telephone: (517) 482-7400.
Weight No More and HealthyLife Weigh, American Institute for Preventive Medicine, 30445 Northwestern Highway, Suite 350, Farmington Hills, MI 48334. Telephone: (810) 539-1800.
Dump Your Plump, Rainbow Wellness Inc., P.O. Box 30, South Haven, MI 49090. Telephone: (800) 67PLUMP.
Weight Watchers at Work program and membership information. Telephone: (800) 651-6000, or check your local telephone directory.
American Dietetic Association consumer nutrition hotline, staffed by registered dietitians to answer questions and provide printed information. Telephone: (800) 366-1655.] *
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.