BDA Work Ready Programme: Workplace health nutrition interventions aimed at improving individuals working lives

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1 BDA Work Ready Programme: Workplace health nutrition interventions aimed at improving individuals working lives

2 Interim findings from the BDA review Responding to recent policy drivers such as the NHS Five Year Forward View 1 and the NICE public health guidance for the workplace 2, which recognise that businesses benefit from investing in the wellbeing of their employees, the BDA is conducting a review of published peer-reviewed evidence of workplace health studies in order to present findings on effective nutrition interventions. This paper summarises our interim findings, with a full white paper due for publication in the summer. Dietitians, other healthcare professionals and those commissioning employee benefits will be able to use the white paper to make the case for funding and implementing evidencebased nutrition in the workplace programmes, alongside existing services which empower employees. The BDA study is looking at interventions published within the last five years designed to support adults who are in regular office-type and frontline work rather than the population group who are unable to work due to health problems. Background One in six working people have a long-term condition (such as diabetes, cardiovascular disease, chronic obstructive pulmonary disease, depression) or a disability, but eating well can help support all workers to maintain health. Later this year, designed from the final review findings, the BDA will offer its members an accredited programme and framework. This programme will focus on the positive benefits for workers and employers which are associated with healthier eating and drinking habits. To understand more about the components of a successful health promotion intervention in a work-based setting, the review is focussing on two outcomes: 1. Positive health outcomes for the worker are defined as weight maintenance. Healthcare professionals agree that maintaining healthy weight is the single most important modifiable diet and lifestyle related factor in preventing a range of noncommunicable diseases such as diabetes, cardiovascular disease 3, some types of cancer and mental health problems. 4 Whilst the BDA has selected weight as a proxy for health, the focus of any programme designed will be wellness. BMI is one measure which is often seen as a sign of health in studies, along with other factors such as fruit and vegetable intake, whether weight loss is required or not. 2. Positive outcomes for the employer were defined as increased productivity (1-2% 5 ). One survey showed that poor eating habits, such as skipping breakfast or lunch, are believed to cost employers billion a year, equivalent to a loss in productivity of almost 97 million working days. 6 Eating well during working life will support workers to maintain a healthy weight 7 and stay healthy so that businesses have a reliable, resilient workforce who are well enough to do their jobs. Businesses in the UK lose 15 million working days with regards to depression, stress and anxiety 8, and one study showed that drivers for productivity in four large employers ranked fatigue, depression, arthritis, hypertension, back and neck pain and other pain higher than obesity. 9 1

3 Interim Findings There is a relationship between the individual and their environment, so while workers are responsible for their own lifestyle, certain behaviours are largely influenced by their workplace. 10 The most effective approach to promote healthy behaviour is a combination of efforts at more than one level to target different levels of influence individual, organisational, interpersonal, community, policy/national. 11 This will be key in successfully positioning any nutrition interventions in a workplace health programme. The initial finding for weight management workplace health interventions is that they are most effective when a combination of dietary and physical activity advice is used. The interventions studied so far all report some benefits (either weight loss or reduced risk factors for long term health problems). One systematic review of 47 studies showed modest improvements in employee weight status at 6-12 month follow up with 2.8lbs (1.3kg) weight loss and a decrease in BMI of 0.5kg/m There is evidence that programmes aimed at improving nutrition behaviour to decrease weight are effective in promoting behaviour change but there is limited evidence on work outcome 13 and a lack of long-term follow up. There is evidence that nutrition interventions that cover other areas of eating behaviours such as fruit and vegetable intake or cardiovascular disease risk prevention can be modestly successful 14-15, but the focus has been limited to environmental change (i.e. through food service provision) and any impact on food intakes outside the workplace or on health generally is less available. Dietitians are in a position to influence all levels, and those where they can be most effective are individual behaviour change (via one to one counselling or group sessions) and also organisational change (through interventions that target food and drink provision in a workplace). In 2012, half of employers surveyed in the UK were offering employee benefits which included advice on healthy eating, 15% offered free fresh fruit and 38% offered healthy canteen options. 13 Dietitians are well placed to support employers in the provision of healthy food at a reasonable cost 10,15,16, and awareness can be promoted by health promotion methods such as tasting sessions, point of sale nutritional labelling and certification schemes that promote healthy eating and drinking support as well as positive behaviour change using leaflets, posters, websites, apps. Both the workforce and management need to be directly involved for any successful public health initiative in the workplace. Enablers include effective leadership, creating a culture of wellness and good communication 17. Key Conclusions 1. Multi-component (i.e. nutrition and physical activity), multi-level (i.e. the worker and the workplace) interventions are required to have sufficient influence on dietary behaviour. 2. Weight loss or maintaining a healthy weight is the current proxy measure for health in the majority of studies looking at workplace health interventions. 3. Dietitians have the skills to deliver a programme aimed at creating individual and organisational change to improve eating and drinking habits in a variety of work 2

4 settings. These programmes should aim to be dietitian-led and developed in conjunction with the workforce and management. 4. The NHS is the fifth largest employer in the world and should access its dietetic workforce to better lead initiatives which support staff to maintain a healthy weight (1/3 of Trusts currently offer no support 1 ). 5. In review of current programmes offered by employers, no distinction is made between nutrition interventions and any other type of wellbeing programmes, but it is clear that the drivers for all programmes are the same, suggesting that multifunctional programmes can work hand-in-hand. Limitations Studies reviewed tend to be short, commonly 6-12 months, and no relationship between outcomes of longer-term studies and disease prevention are examined. Future Directions The next phase of the study will look at whether small change nudge behaviour is a useful strategy, focus further on hydration and quality of life studies, and review the barriers to implementing a nutrition intervention in the workplace. This review has been supported by belvita Breakfast Biscuits. 3

5 References 1. NHS Five Year Forward View, October NICE Workplace policy and management practices to improve the health and wellbeing of employees, Expected June Eckel, RH et al. Preventing Cardiovascular Disease and Diabetes: A call to action from the American Diabetes Association and the American Heart Association. Diabetes Care July 2006 vol. 29 no Obesity and Mental Health, National Obesity Observatory, March FINAL_070311_MG.pdf 5. Jensen JD. Can worksite nutritional interventions improve productivity and firm profitability? A literature review. Perspect Public Health Jul;131(4): Baxter Storey Workplace Productivity Survey (conducted by Ipsos Mori) Schröer S, Haupt J, Pieper C. Evidence-based lifestyle interventions in the workplace an overview. Occup Med (Lond) Jan;64(1): Office of National Statistics, Sickness Absence in the Labour Market, February Ronald Loeppke et al., Health and Productivity as a Business Strategy Journal of Occupational & Environmental Medicine, July Geaney F et al. The effectiveness of workplace dietary modification interventions: a systematic review. Prev Med Nov;57(5): Goldgruber J and Ahrens D. Effectiveness of workplace health promotion and primary prevention interventions: a review, J Public Health 2010, 18: xt.pdf 12. Anderson L et al. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: A systematic review. American Journal of Preventive Medicine 2009, 37(4): London s Business Case for Employee Health and Wellbeing, GLA Economics, May 2012, ness%20case%20for%20workplace%20health% pdf 14. Aneni et al. A systematic review of internet-based worksite wellness approaches for cardiovascular disease risk management: outcomes, challenges & opportunities. PloS One Jan 8;9(1):e Maryuama. Effect of a worksite-based intervention program on metabolic parameters in middle-aged male white-collar workers: a randomized controlled trial. Prev Med Jul;51(1): Andres et al. Evaluation of a cardiovascular Risk Reduction Program at a workplace medical clinic. Workplace Health Saf Oct;61(10): Building the Case for Wellness, hwwb-dwp-wellness-report-public.pdf 4

6 Published: June 2015 Review Date: June The British Dietetic Association 5th Floor, Charles House, 148/9 Great Charles Street Queensway, Birmingham B3 3HT Tel: Fax: Commercial copying, hiring or lending without the written permission of the BDA is prohibited. bda.uk.com

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