January 09, 2020
Weight bias in the workplace - negative attitudes toward employees with overweight and obesity – has the potential to undermine the success of comprehensive weight management strategies. Persistent weight bias can lead to weight stigma and weight-based discrimination, a pervasive trend in the U.S. with serious consequences for the health and well-being of employees.82
Weight bias can exacerbate behaviors that impede weight loss or contribute to weight gain; studies show that people who experience weight stigma turn to food as a coping mechanism and also avoid physical activity.83-87 Evidence also shows that higher levels of weight bias internalization are associated with increased risk for cardiovascular and metabolic disease.88 People with obesity also report delaying preventive care due to disrespect from or negative attitudes of providers related to their weight.89
On average, 10.3% of women reported daily or lifetime discrimination due to weight, while men were half as likely to report such experiences (4.9%). Women with a BMI of 30–35 were three times more likely than men in the same weight group to report weight/height discrimination (20.6% vs 6.1%).82
Nutritious Food and Movement
Nutritious food choices and movement at work can help increase the likelihood that employees with obesity are successful with behavioral, pharmacological and/or surgical treatments. In promoting these things, employers can also protect their investment in weight management programs and benefits.
The office foodscape can undermine employees’ weight management efforts
According to a recent study, almost a quarter of employees (23%) obtain food and beverages from work each week and most of this food is high in empty calories, sodium and refined grains. Top items obtained at work included regular soft drinks, cookies or brownies, fries, tortilla and potato chips, candy containing chocolate and crackers.91
There are a number of evidence-based ways to promote a healthy diet at work, including serving appropriate portions, reducing the cost of healthy foods, and providing visuals or nudges. However, surveys indicate that evidence based strategies are currently underutilized by employers: In 2018, 55% of employers had nutritional labeling in place, 52% had healthy food options in the café or vending machine and 25% had subsidies or price differentials for healthy food in on-site café.43
Research indicates that the use of stairwell signs and prompts, access to places for exercise like walking trails and fitness centers, and flexible work time for exercise, can all promote physical activity throughout the day. Surveys show that many employers have these offerings (and more) in place: In 2018, 72% offered on-site fitness classes, 70% offered subsidies or discounts for off-site gym memberships, 67% provided treadmill or sit-to-stand desks, and 39% offered stretch breaks.43
Workplace Culture & Design Checklist
- Determine if weight bias and stigma are a problem in your workplace. Ask employees about their experiences with weight bias or stigma in focus groups or through employee surveys.
- Incorporate weight bias training in workplace trainings. Evaluate practical ways training can be incorporated into the employee lifecycle (e.g. onboarding, leadership development, etc.). When asked for their perspective on the best way to reduce weight-based stigma, individuals with obesity rated inclusion of education about weight bias in existing anti-harassment workplace trainings as one of the top three most impactful and feasible strategies worth pursuing.92
- Evaluate how you communication about overweight and obesity. Examine current and future communication materials for stigmatizing content (e.g. headless images of people with obesity, language or images that suggests a person’s body weight is a reflection on their character or intelligence, use of pejorative language or inappropriate humor). Research shows that even well-intentioned public health campaigns promote stigma and shame. Instead, employers should communicate in a way that is respectful, actionable and promotes health.
- Make nutritious food choices easy. Assess your café, vending and catering offerings to determine whether you are providing appropriately healthful options to employees. Use this information to fuel the implementation of policies that reduce exposure to unhealthy foods (e.g. creating healthy checkouts in cafes to avoid impulse food purchases), and support smarter food choices (e.g. serve appropriate portions, subsidize healthy items).
- Enable movement throughout the work day. Look for opportunities to reduce sitting (e.g. stretch breaks, standing desks) and promote movement (e.g. walking meetings, easily accessible stairwells, on-site fitness centers) in the “daily life” of employees.
- 1 | Snook KR, Hansen AR, Duke CH, et al. Change in percentages of adults with overweight or obesity trying to lose weight, 1988-2014. JAMA. 2017;317(9):971-3.
- 2 | Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS data brief, no 288. Hyattsville, MD: National Center for Health Statistics. 2017.
- 3 | Waters H, DeVol R. Weighing down America: The health and economic impact of obesity. Milken Institute. 2016. https://assets1b.milkeninstitute.org/assets/Publication/ResearchReport/PDF/Weighing-Down-America-WEB.pdf. Accessed December 2018.
- 4 | Agency for Healthcare Research & Quality. Total expenses and percent distribution for selected conditions by type of service for persons aged 20-64 years with private insurance: United States, 2014. Medical Expenditure Panel Survey Household Component Data: generated interactively on June 30, 2018.
- 5 | Oster G, Edelsberg J, O’Sullivan AK, Thompson D. The clinical and economic burden of obesity in a managed care setting. Am J Manag Care. 2000;6(6):681-9.
- 6 | Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. New Eng J Med. 2003; 348(17):1625-38.
- 7 | Wolin KY, Carson K, Colditz GA. Obesity and cancer. Oncologist. 2010;15(6):556-565.
- 8 | Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K. Body fatness and cancer—viewpoint of the IARC Working Group. New Eng J Med. 2016;375(8):794-8.
- 9 | Arnold M, Pandeya N, Byrnes G, Renehan AG, Stevens GA, Ezzati M. Global burden of cancer attributable to high body mass index in 2012: a population based study. Lancet Oncol. 2014.
- 10 | GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. New Eng J Med. 2017; 377(1):13-27.
- 11 | Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta- analysis. BMC PublicHealth. 2009;9(1):88.
- 12 | Coggon D, Reading I, Croft P, McLaren M, Barrett D, Cooper C. Knee osteoarthritis and obesity. Int J Obes Relat Metab Disord. 2001;25:622–627.
- 13 | Moriarty JP, Branda ME, Olsen KD, et al. The effects of incremental costs of smoking and obesity on health care costs among adults: a 7-year longitudinal study. J Occup Environ Med. 2012;54(3):286-91.
- 14 | Arena VC, Padiyar KR, Burton WN, Schwerha JJ. The impact of body mass index on short-term disability in the workplace. J Occup Environ Med. 2006;48(11):1118- 1124.
- 15 | Cawley J, Meyerhoefer C. The medical care costs of obesity: an instrumental variables approach. J Health Econ. 2012;31:219-230.
- 16 | Andreyeva T, Luedicke J, Wang YC. State-level estimates of obesity attributable costs of absenteeism. J Occup Environ Med. 2014;56(11):1120-1127.
- 17 | Van Nuys K, Globe D, Ng-Mak D, Cheung H, Sullivan J, Goldman D. The association between employee obesity and employer costs: evidence from a panel of U.S. employers. Am J Health Promot. 2014;28(5):277-85.
- 18 | Bray MS, Loos RJ, McCaffery JM, et al. NIH working group report-using genomic information to guide weight management: from universal to precision treatment. Obesity. 2016;24:14-22.
- 19 | Pigeyre M, Yazdi FT, Kaur Y, Meyre D. Recent progress in genetics, epigenetics and metagenomics unveils the pathophysiology of human obesity. Clin Sci (Lond). 2016;130:943-86.
- 20 | van der Klaauw AA, Farooqi IS. The hunger genes: pathways to obesity. Cell. 2015;161:119-32.
- 21 | van Dijk SJ, Tellam RL, Morrison JL, Muhlhausler BS, Molloy PL. Recent developments on the role of epigenetics in obesity and metabolic disease. Clin Epigenetics. 2015;7:66.
- 22 | Domecq JP, Prutsky G, Leppin A, et al. Clinical review: Drugs commonly associated with weight change: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2015;100:363-70.
- 23 | Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100:342-62.
- 24 | Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017; 376:254-266
- 25 | McAllister EJ, Dhurandhar NV, Keith SW, et al. Ten putative contributors to the obesity epidemic. Crit Rev Food Sci Nutr. 2009;49:868-913.
- 26 | Levi J, Vinter S, St. Laurent R, Segal LM. F as in Fat: How Obesity Policies are Failing in America 2008: Trust for America’s Health; 2008.
- 27 | Williamson DF. Descriptive epidemiology of body weight and weight change in U.S. adults. Ann Intern Med. 1993;119(7 Pt 2):646–9.
- 28 | Woods SC. Body weight “set point”. What we know and what we don’t know. https://4617c1smqldcqsat27z78x17-wpengine.netdna-ssl.com/wp- content/uploads/Body_Weight_Set_Point_online.pdf Accessed December 2018.
- 29 | Polidori D, Sanghvi A, Seeley RJ, Hall KD. How strongly does appetite counter weight loss? Quantification of the feedback control of human energy intake. Obesity. 2016;24(11):2289-95.
- 30 | Kaplan LM, Golden A, Jinnett K, et al. Perceptions of barriers to effective obesity care: Results from the national ACTION study. Obesity. 2018;26(1):61-9.
- 31 | Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and The Obesity Society. J Am Coll Cardiol. 2013;online
- 32 | LeBlanc EL, Patnode CD, Webber EM, Redmond N, Rushkin M, O’Connor EA. Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: An updated systematic review for the US Preventive Services Task Force: Evidence synthesis No. 168. Rockville, MD: Agency for Healthcare Research and Quality; 2018. AHRQ publication 18-05239-EF-1.
- 33 | Virginia A. Moyer, on behalf of the U.S. Preventive Services Task Force. Screening for and management of obesity in Adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(5):373-378.
- 34 | Smith AW, Borowski LA, Liu B, et al. U.S. primary care physicians' diet-, physical activity-, and weight-related care of adult patients. Am J Prev Med. 2011;41(1):33-42.
- 35 | Ma J, Xiao L, Yank V. Variations between obese Latinos and whites in weight-related counseling during preventive clinical visits in the United States. Obesity. 2013;21(8):1734-41.
- 36 | Ma J, Xiao L, Stafford RS. Underdiagnosis of obesity in adults in US outpatient settings. Arch Intern Med. 2009;169(3):313-4.
- 37 | Simkin-Silverman LR, Gleason KA, King WC, et al. Predictors of weight control advice in primary care practices: patient health and psychosocial characteristics. Prev Med. 2005;40(1):71-82.
- 38 | Stafford RS, Farhat JH, Misra B, et al. National patterns of physician activities related to obesity management. Arch Fam Med. 2000;9(7):631-8. PMID: 10910311.
- 39 | Steeves JA, Liu B, Willis G, et al. Physicians' personal beliefs about weight-related care and their associations with care delivery: The U.S. National Survey of Energy Balance Related Care among Primary Care Physicians. Obes Res Clin Pract. 2015;9(3):243-55.
- 40 | Federal Register. Health insurance Issuer standards under the Affordable Care Act, including standards related to exchanges. 45 C.F.R. § 156.125
- 41 | The New York Times. A.M.A. recognizes obesity as a disease. 2013. https://www.nytimes.com/2013/06/19/business/ama-recognizes-obesity-as-a-disease.html. Accessed December 2018.
- 42 | Business Group on Health. Quick survey findings: Weight management programs & benefits. 2018. https://www.businessgrouphealth.org/resources/quick-survey-findings-weight-management-programs-and-benefits. Accessed December 2018.
- 43 | Business Group on Health/Fidelity Investments' Annual Employer-Sponsored Health & Well-being. Making well-being work. Ninth Annual Employer-Sponsored Health and Well- Being Survey. 2018. Accessed December 2018.
- 44 | The Business Group on Health/Fidelity Investments' Annual Employer-Sponsored Health & Well-being. Moving from wellness to well-being: Seventh annual employer-sponsored health and well-being survey. 2016.
- 45 | National Institute of Diabetes and Digestive and Kidney Diseases. Prescription medications to treat overweight and obesity. https://www.niddk.nih.gov/health- information/weight-management/prescription-medications-treat-overweight-obesity. Accessed December 2018.
- 46 | Colman E. Food and Drug Administration’s obesity drug guidance document: A short history. Circulation. 2012;125:2156.2164. Accessed December 2018.
- 47 | Colman E, Golden J, Roberts M, et al. The FDA’s assessment of two drugs for chronic weight management. New Eng J Med. 2012;367(17):1577-1579.
- 48 | Sherman M, Ungureanu S, Rey JA. Naltrexone/Bupropion ER (Contrave): Newly approved treatment option for chronic weight management in obese adults. Pharmacy and Therapeutics. 2016:41(3);164–172.
- 49 | Personal communication with Novo Nordisk. December 1, 2017.
- 50 | Kahan S. Quick takes: What you need to know about the 5 FDA-approved obesity drugs. https://www.medscape.com/viewarticle/876411. Accessed December 2018.
- 51 | Bohula EA, Wiviott SD, McGuire DK, et al. Cardiovascular safety of lorcaserin in overweight or obese patients. New Eng J Med. 2018; 379(12):1107-1117.
- 52 | Caffrey M. Obesity therapy Saxenda gets cardiovascular safety indication. https://www.ajmc.com/newsroom/obesity-therapy-saxenda-gets-cardiovascular- safety-indication. Accessed December 2018.
- 53 | Thomas CE, Mauer EA, Shukla AP, Rathi S, Aronne LJ. Low adoption of weight loss medications: A comparison of prescribing patterns of antiobesity pharmacotherapies and SGLT2s. Obesity. 2016:24(9); 1955-1961
- 54 | Personal communication with RX Connection.
- 55 | Personal Communication with Express Scripts.
- 56 | Personal communication with CVS Caremark.
- 57 | Personal communication with OptumRx.
- 58 | Glauser TA, Roepke N, Stevenin B, et al. Physician knowledge about and perceptions of obesity management. Obes Res Clin Pract. 2015.
- 59 | U.S. Department of Health and Human Services. National Institute of Diabetes and Digestive and Kidney Diseases. Prescription Medications for the Treatment 82. Andreyeva, T, Puhl RM, Brownell KD. Changes in perceived weight discrimination among Americans, 1995–1996 through 2004–2006. Obesity. 2008;16:1129- of Obesity. 2016. https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity. Accessed December 2018.
- 60 | Briggs G, Reid TJ. Medical Directors Guide on Obesity. JMCM. 2013;16(4):4-29.
- 61 | Hendricks, EJ. Off-label drugs for weight management. Dove Press. 2017; 2017(10):223-234. https://www. dovepress.com/off-label-drugs-for-weight- management-peer-reviewed-fulltext-article-DMSO. Accessed December 2018.
- 62 | American Society for Metabolic and Bariatric Surgery. Who is a candidate for bariatric surgery? https://asmbs.org/patients/who-is-a-candidate-for-bariatric-surgery. Accessed December 2018.
- 63 | Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity. Cochrane Database of Systematic Reviews. 2009;2:CD003641
- 64 | Blue Cross Blue Shield Association. Bariatric Surgery Evidence Review. March 2018.
- 65 | Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741-752.
- 66 | Scopinaro N, Papadia F, Marinari G, et al. Long-term control of type 2 diabetes mellitus and the other major components of the metabolic syndrome after biliopancreatic diversion in patients with BMI < 35="" kg/m2.="" obes="" surg.="" 2007;17(2):185-192.="" />
- 67 | Sjostrom CD, Lissner L, Wedel H, et al. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric90. Puhl RM, Andreyeva T, Brownell KD. Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J surgery: the SOS Intervention Study. Obes Res. 1999;7(5):477-484.
- 68 | Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683-91. Onufrak S, Zaganjor H, Pan L, et al. Foods and beverages obtained at worksites in the United States. J Acad Nutr Diet. 2019. 2693.
- 69 | Torgerson JS, Sjostrom L. The Swedish Obese Subjects (SOS) study--rationale and results. Int J Obes Relat Metab Disord. 2001;25 Suppl 1:S2-4.
- 70 | Arterburn D, Wellman R, Emiliano A, Smith SR, Odegaard AO, Murali S, et al. Comparative effectiveness and safety of bariatric procedures for weight loss: A PCORnet cohort study. Ann Intern Med. 2018;169(11):741-750.
- 71 | Zhang L, Scott J, Shi L, Truong K, Hu Q, Ewing JA, et al. Changes in utilization and peri-operative outcomes of bariatric surgery in large U.S. hospital database, 2011-2014. PLoS ONE 2017:12(10); e0186306.
- 72 | Weiner JP, Goodwin SM, Chang H, et al. A 6-year follow-up of surgical and comparison cohorts using health plan data. JAMA Surg. 2013;148(6):555-562.
- 73 | Salem L, Jensen CC, Flum DR. Are bariatric surgical outcomes worth their cost? A systematic review. J Am Coll Surg. 2005;200(2):270-278.
- 74 | American Society for Metabolic and Bariatric Surgery. Estimate of bariatric surgery numbers, 2011-2017. https://asmbs.org/resources/estimate-of-bariatric- surgery-numbers. Accessed December 2018.
- 75 | Alalwan A. National trends in utilization of bariatric surgery. Value in Health. 2018: 21(S248).
- 76 | Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310(22):2416-2425.
- 77 | Business Group on Health. 2019 Large Employers' Health Care Strategy and Plan Design Survey. 2018. https://www.businessgrouphealth.org/resources/2019-large-employers-health-care-strategy-and-plan-design-survey. Accessed December 2018.
- 78 | Azagury D, Morton JM. Bariatric Surgery Outcomes in US Accredited vs Non-Accredited Centers: A Systematic Review. Journal of the American College of Surgeons. 2016;223(3):469-77.
- 79 | Business Group on Health. Impact of bariatric surgery on health care costs and utilization: Towers Watson National Data Cooperative Study. August 2010.
- 80 | American Society for Metabolic and Bariatric Surgery. Preoperative supervised weight loss requirements. https://asmbs.org/resources/preoperative- supervised-weight-loss-requirements. Accessed December 2018.
- 81 | Krimpuri RD, Yokley JM, Seeholzer EL, Horwath EL, Thomas CL, Bardaro SJ. Qualifying for bariatric surgery: is preoperative weight loss a reliable predictor of postoperative weight loss? Surg Obes Relat Dis. 2018;14(1):60-64.
- 82 | Andreyeva, T, Puhl RM, Brownell KD. Changes in perceived weight discrimination among Americans, 1995–1996 through 2004–2006. Obesity. 2008;16:1129-1134
- 83 | Durso LE, Latner JD, White MA, Masheb RM, Blomquist KK, Morgan PT, Grilo CM. Internalized weight bias in obese patients with binge eating disorder: associations with eating disturbances and psychological functioning. Int J Eat Disord. 2012;45(3):423-7.
- 84 | Eisenberg ME, Berge JM, Fulkerson JA, Neumark-Sztainer D. Associations between hurtful weight-related comments by family and significant other and the development of disordered eating behaviors in young adults. J Behav Med. 2011;35(5):500-8.
- 85 | Puhl RM, Moss-Racusin CA, Schwartz MB. Internalization of weight bias: Implications for binge eating and emotional well-being. Obesity. 2007;15(1):19-23.
- 86 | Schvey NA, Puhl RM, Brownell KD. The impact of weight stigma on caloric consumption. Obesity. 2011;19(10):1957-62.
- 87 | Wott CB, Carels RA. Overt weight stigma, psychological distress and weight loss treatment outcomes. J Health Psychol. 2010;15(4):608-14.
- 88 | Pearl RL, Wadden TA, Hopkins CM, et al. Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity. Obesity. 2017;25(2):317-322.
- 89 | Amy NK, Aalborg A, Lyons P, Keranen L. Barriers to routine gynecological cancer screening for white and African-American obese women. Int J Obes. 2006;30(1):147-55.
- 90 | Puhl RM, Andreyeva T, Brownell KD. Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J surgery: the SOS Intervention Study. Obes Res. 1999;7(5):477-484. Obes. 2008;32(6):992-1000.
- 91 | Onufrak S, Zaganjor H, Pan L, et al. Foods and beverages obtained at worksites in the United States. J Acad Nutr Diet. 2019. https://jandonline.org/article/S2212-2672(18)30369-1/pdf. Accessed January 2019.
- 92 | Puhl RM, Himmelstein MS, Gorin AA, Suh YJ. Missing the target: Including perspectives of women with overweight and obesity to inform stigma‐reduction strategies. Obes Sci Pract. 2017;3(1):25–35.
More TopicsArticles & Guides Culture and Strategy Physical Health
IntroPractical Playbook: Managing Overweight & Obesity
Part 1Managing Overweight and Obesity: Behavior-based Interventions
Part 2Managing Overweight and Obesity: Weight Management Drugs
Part 3Managing Overweight and Obesity: Bariatric Surgery
Part 4Managing Overweight and Obesity: Workplace Culture & Design