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After completing my training, I’m now officially a Public Health Collaboration ambassador. This is an exciting honour and a great opportunity to help a great group of people make a difference to public health… although I know the work won’t provide an easy ride. 

The Public Health Collaboration (PHC) is a charity dedicated to improving public health through diet (its hashtag is #RealFoodRocks). It is tackling the root cause of the UK’s health problems by working to improve the UK’s healthy eating and weight loss guidelines. It also works with GPs, diabetes nurses and other healthcare practitioners to offer more choice to type 2 diabetes sufferers in their treatment, highlighting the NHS-approved availability of a low-carb approach to put diabetes into remission. 

The PHC works closely with diabetes organisation www.diabetes.co.uk to introduce healthcare practitioners to a dietary approach to type 2 diabetes treatment and to provide support with this new protocol. For years, type 2 diabetes has been considered a progressive, irreversible ie terminal condition. But in recent years, thousands have used a low carb/’real food’ approach in combination with other lifestyle changes to put their diabetes into remission or even reverse it completely. Diabetes.co.uk has developed a 10-week low carb eating programme for patients which is approved by the NHS for GPs to prescribe.   It has also received CE Mark approval. At £30 this represents good value compared to the £300 – £375 the NHS currently spends per person on diabetes treatments (and that does not include spend on complications of diabetes which take up around 80% of the total annual diabetes costs of £14bn – 16bn). But this approach is new to the NHS and it will take time for health care providers to be confident to try something different. Recognising this, diabetes.co.uk developed a 30-minute learning module for GPs and other healthcare practitioners which has been approved by the Royal College of GPs.

More alternatives to drug therapy… and more hope
Another dietary lifestyle approach to type 2 diabetes reversal includes the very low calorie diet featured on recent BBC and ITV programmes, based on the DiRECT study. Therefore, alternatives to drug therapy exist for patients, once healthcare practitioners are aware of this. Patients value being given a choice in treatment protocol and, importantly, being given hope that their condition can be either better managed or reversed. 

Type 2 diabetes affects around 6% of the UK population but takes 10% of the NHS budget. With a third of the UK population estimated to have prediabetes, it is obvious that our struggling NHS could not cope if people’s prediabetes progressed to full diabetes. And the issues that lead to prediabetes and type 2 diabetes, also predispose people to other conditions such as obesity, cardio vascular issues, fatty liver disease, kidney problems and some cancers. Increasing evidence suggests that our carbohydrate-heavy diet, particularly in terms of sugars and starchy carbs such as flour, rice, pasta and starchy bread, is a major contributor to the obesity and diabetes crisis which is why the PHC is working to revise lthe UK dietary guidelines.

Exciting times ahead!
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What has workplace health and wellbeing got to do with reversing type 2 diabetes? A huge amount and it’s a very exciting opportunity. The problem is, employers are finding it hard to start a much-needed conversation with employees that would help. But there are simple (cheap) solutions.

Last night I sat in Committee Room 11 in the Houses of Parliament and listened to three doctors, a nurse plus two formerly-diabetic patients speak about how type 2 diabetes can be reversed with lifestyle change. The most important lifestyle change revolved around diet. But something they all mentioned was how our obesogenic (obesity-generating) environment makes it difficult to prevent and treat the disease.

Professor Roy Taylor told the All Party Parliamentary Group for Diabetes how patients could get into remission, but struggled to maintain it in our food-obsessed society. He said we must challenge society to change our attitudes to snacking (we are constantly told we must “close the energy gap”), the food environment and the hidden sugar in food. Dr David Unwin said we must do something urgently, and not accept diabetes as inevitable and that changing our food environment would help. Dr Campbell Murdoch, Geoff Whitington and Mark Hancock talked about the need to support patients in a challenging food environment. Geoff, Mark and nurse Catherine Cassell spoke of the hope patients feel when they’re given a chance to come off medication and reverse a disease that is traditionally seen as progressive and terminal.  (It’s not either of those things.)

How can employers help?

Increasingly there are calls for a societal ‘whole systems’ approach to tackle obesity and obesity-related non-communicable diseases (1, 2) such as type 2 diabetes, cancers, non-alcoholic fatty liver disease, cardiovascular disease and chronic respiratory complaints. These are largely preventable and cause the majority of deaths (3). Diabetes costs the NHS is over £1.5m an hour or 10% of the NHS budget for England and Wales which equates to over £25,000 being spent on diabetes every minute (4).

That employers have a role to play, alongside the NHS and politicians, has already been pointed out (5, 6). After all, we spend between half and two thirds of our waking hours at work (7) so the workplace is an important setting for encouraging healthy lifestyles (8-10). Employer organisations, including the Chartered Institute for Personnel & Development (CIPD) and Business in the Community recognise this (11,12) and NICE has guidelines for workplace health provision and leadership and line management responsibility. Professor Cary Cooper, president of the CIPD, said, “It’s the employer’s job to create an environment where employees can make healthy lifestyle choices” (12).

But office cake culture is getting in the way. My research into office cake culture found office cake changes employee eating habits and therefore is likely to undermine health and wellbeing programmes. Many employers invest in health and wellbeing initiatives such as standing desks, healthy canteen offerings, cycle to work schemes and employee assistance programmes. But failing to stem the tide of sugar flooding our workplaces undermines that investment. Having the best wellbeing initiatives but not reducing office cake availability is like going to sea in a ship loaded with all the best safety equipment… but without fixing the leak in the hull.

Last week I discussed this with two groups of employers – a group of doctors and a group of HR and wellbeing professionals. They all helped me realise there is a glitch in my ideas for reducing office cake consumption.

My idea, informed by my research, is that if you start a conversation among employees about office cake, you begin an empowering, employee-led process that would reduce cake consumption, maximise its social benefits and minimise its unhealthy consequences. You would also make it easier for employees to make healthy choices at work and therefore help prevent non-communicable disease.

This idea is based on a key finding from my survey of nearly 1000 UK office workers: 95% thought the ideal frequency for office cake was once a week or less – much less than it is typically available. Therefore, I’ve been reasoning that if people realise they actually agree on how often cake should be available, they would, with support and encouragement, figure out among themselves how to make that happen. The result: healthier, less sugary workplaces without mandated cake bans. Empowered, bought-in employees with agency to influence their workplaces for the good. More awareness of how small changes to an office environment or culture could have a positive impact on our health.

The glitch is that employers are reluctant to start the conversation, even if they recognise the benefits of a less sugary workplace. One senior health and wellbeing executive at a large organisation (a household name) told me the cake table at their office was known as ‘the trough’. Yet with squeezed resources and, until now, little awareness that office cake changes employee eating behaviours, tackling office cake is well down the wellbeing priority list.

Birthdays, meetings, holidays, feeling fed up – there’s always a reason to have cake

Our obesogenic world makes it harder to make healthy food choices at home, when out and about, and at work. The research found it’s becoming the norm to have cake and other treats in the office almost daily for many. Birthdays and other celebrations are the main reason, followed by leftovers from meetings and events. But people also bring goodies back from business trips and holidays (“it’s traditional”) and it’s used to reward (or ‘encourage’ people to do unpopular tasks), and it’s the obvious choice when kind-hearted colleagues fancy a treat and want to share it, or when they’re having a bad day and don’t want to be the only one having a sugary pick-me-up.

Add to this national workplace cake stall our natural propensity to seek out pleasure-giving, dopamine-secreting sugary rewards and we have one explanation for our obesity and diabetes crisis. One of the doctors I talked to said one of the teams in their workplace was staffed by about 16 people all wanting to lose weight. But they had a ‘treat table’. Talk about making it hard for themselves …

Office cake is the now the norm

One reason there is so much office cake around despite 95% thinking once a week is enough, is possibly because we are herd animals and it would take a brave person to risk being ostracised by their herd for suggesting cutting down on cake. So office cake becomes the norm because no one feels comfortable speaking up to challenge it. This is a crying shame if, as the evidence showed, there is consensus around how often to have cake. We are too polite for our own good. Offices are full of people on diets yet survey respondents said cake made it harder to stick to a diet (59%), harder to eat healthily at work (38%) and harder to control bodyweight (35%).

Shouldn’t we be making it easier?

Here’s an example of how a cake conversation does work. Melanie said she’d seen my TEDx talk on the subject and, after outlining the research results to her team, asked whether she should continue to bring a cake to weekly team meetings. They said they’d prefer it if she didn’t because if it was there they would eat it and they were all trying to watch their weight. The TEDx talk triggered a bit of openness by all parties potentially leading to a healthier team. And they could use that new openness to explore other health-related aspects of their workplace environment. A good result coming from a conversation about cake.

There are precedents for starting successful conversations around obesity

Perhaps it is not surprising that HR and wellbeing professionals and even medics feel uncomfortable starting the conversation. No one likes to risk conflict or to upsetting anyone. Overweight and obesity is a taboo subject, and office cake discussions are often emotive. Some managers fear losing a cheap, convenient way to boost morale or say thank you (although there are other ways to do this that don’t involve unhealthy food). Others fear a backlash, should triggering the conversation be misinterpreted as accusing people of being overweight or interfering in matters of personal choice.

Employers are not alone in feeling apprehensive about tackling the obesity taboo. A trial to investigate the effectiveness of brief, opportunistic weight loss conversations by GPs with obese patients reported that GPs were “nervous” about bringing up the subject of obesity. However, 81% of patients found the intervention “both appropriate and helpful” while less than 1% felt it was inappropriate to do so (13).

Similarly, plans to conduct an exploratory survey of obesity in nurses in England (14) were initially met with hesitation by senior personal across the health sector despite their acknowledgement that obesity among nurses was a problem. Fortunately their concerns were overcome and nurses were pleased that someone was trying to help. The Weight Initiative in Nurses (WIN) interim report said: “Almost without exception, the hundreds of nurses who visited our stand at RCN Congress thanked us for taking on this challenge and working with them to help them achieve and maintain a healthy weight” and “The enthusiasm with which WIN has been greeted by obese nurses as well as senior personnel and key stakeholders, and the interest expressed in expanding it beyond England, reaffirms the importance and value of the initiative and is helping to allay concerns about the sensitivities of tackling the problem.” (15).

These are great indications that people want to be helped to tackle their obesity and those in a position to help should not shy away from the challenge.

Time to grasp the nettle

OK, so starting a conversation is challenging, but does that mean it should be avoided? When nearly two thirds of the UK population is overweight or obese (16) and in the UK we spend more on obesity-related illness and diabetes treatment than on the police, judicial system and fire service combined (17), surely we need to grasp the nettle?

As well as societal and moral reasons for employers to engage in making workplaces healthier, employee health impacts the bottom line. Studies found employees who perceive their employers to genuinely care about their health are generally healthier (18.19) and healthy employees are more likely to be happier, more engaged and more productive (20-22).

UK overweight and obesity levels have almost doubled in the last 25 years (23). Type 2 diabetes prevalence has doubled in the last 20 years (4) and this is just the tip of the iceberg with a third of the UK population having pre-diabetes. Why? What has changed in the last few decades to predispose us to such illness? The food environment is one of the culprits, but at least we have a chance to influence the food environment in our workplaces. Tackling office cake really could help us all be healthier and help provide that support and hope everyone spoke about at the Houses of Parliament last night.

Let’s do it!

Eight ideas to make it easier for employers to start a conversation about office cake

  • Create a setting where discussing workplace food is appropriate, even expected eg a health and wellbeing event. Not got one planned? Plan one! Employees who perceive their employer genuinely cares about their health is more likely to be healthy (18,19)
  • Ask your workplace wellbeing champions to watch the TEDx talk then introduce the topic with colleagues. Alternatively, consult them about how best to broach the topic. They have the networks and local knowledge and could suggest appropriate ways to start the conversation. If you don’t have wellbeing champions, consider it. The Royal Society of Public Health runs Workplace Health Champions training plus other relevant qualifications.
  • Start a competition for the most creative, healthy cake alternative. Many people love a bit of team rivalry. Create a gallery of photos of healthy creations in a break out room or kitchen. Why not feature creative cake of the month on your intranet or employee magazine?
  • Ask leaders and managers to identify individuals and teams who might be amenable to/interested in a conversation. Trialling it in one group would provide evidence and generate confidence that a cake conversation has merit.
  • Be confident that initiatives around caring about employee health are appropriate and relevant for employers, and onsite food provision is part of that. Employers should feel confident consulting employees to discuss, survey and learn about employee food needs and preferences in the context of health and safety, improved productivity and wellbeing. All aspects of onsite food provision, cake culture, meeting refreshments, vending and catering for shift workers are relevant topics. The British Dietetic Association’s Work Ready initiative and NICE Workplace Health guidelines both recommend consulting employees and involving them in new initiatives. You could start by consulting on general food provision to start a general food conversation, then introduce a cake conversation at a later date. 
  • When situations have been identified or created where a conversation could be appropriate, share the TEDx talk (11 mins) and ask for reactions. Download the It’s time to rethink office cake research report for background, information and suggestions for ways to reduce cake consumption while retaining opportunities to get together socially at work.
  • If a the water’s been tested and people seem amenable to finding out more, consider conducting a short, anonymous questionnaire among employees to a) get people thinking and talking about it and b) get objective data on the prevailing opinion. Then that data can be shared and form the basis of a conversation.
  • It can start small. It might take months to get a conversation going across the whole company. Don’t be afraid to start small, test the water and work with enthusiasts at first.

Lou Walker is a workplace health and wellbeing consultant, specialising in obesity and office cake culture. She uses talks, training workshops and surveys to help improve workplace environments so that healthy choices become the easy choices. Visit www.louwalker.com to find out about how she can help your workplace become healthier and more productive.


References

  1. House of Commons Health Committee (2018). Childhood obesity: Time for action.
  2. A whole systems approach – Leeds Beckett University
  3. World Health Organisation (2018). Noncommunicable diseases fact sheet. Retrieved 26 June 2018.
  4. Diabetes.co.uk.
  5. Crisp, N. et al (2016). Manifesto for a healthy and health-creating society. The Lancet (388) No 10062, e24-e27
  6. Tackling obesity seriousy: the time has come. The Lancet Public Health (3)
  7. World Health Organisation (2013). Global action plan for the prevention and control of noncommunicable disease 2013-2020.
  8. Black, C (2008). Working for a healthier tomorrow.
  9. Heinen, L., & Darling, H (2009). Addressing obesity in the workplace: The role of employers. The Millbank Quarterly, 87(1).
  10. NiMhurchu, C., Aston, L., Jebb, S. (2010). Effects of worksite health promotion interventions on employee diets: A systematic review. BMC Public Health, 10(1).
  11. Chartered Institute of Personnel & Development (2018). Health and Well-being at Work, 2018
  12. Business in the Community. Workwell Model. Accessed 26 June 2018
  13. Aveyard, P. et al. (2016). Screening and brief intervention for obesity in primary care: a parallel, two-armed, randomised trial.
  14. C3 Collaborating for Health/The Healthy Weight Initiative for Nurses. (WIN.) (2018). Final report.
  15. C3 Collaborating for Health/The Healthy Weight Initiative for Nurses. (WIN.) (2016). Interim report November 2015 – November 2016.
  16. Health Survey for England (2017). Health Survey for England, 2016.
  17. Public Health England (2017). Health matters: obesity and the food environment.
  18. Tabak, R., Hipp, J. A., Marx, C., & Brownson, R. (2015). Workplace social and organizational environments and healthy-weight behaviors. PLoS One, 10(4).
  19. Lemon, S. et al. (2010). Step Ahead: A worksite obesity prevention trial among hospital employees. American Journal of Preventative Medicine, 38(1).
  20. Department for Business Innovation & Skills (2014). Does worker wellbeing affect workplace performance?
  21. National Institute for Health and Care Excellence (2015). Workplace health: management practices.
  22. Millar, M. (2005). Vielife-IHPM health and performance research study
  23. National Statistics/NHS England (2018). Statistics on obesity, physical activity and diet.
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Blog

 

When I was planning my office cake research, cake-related discussions with friends and colleagues often led to the same full and frank discussion.


Some argued that if you eat too much cake or other snacks (at work or elsewhere), you risk weight gain. This carries health risks for individuals and productivity-related consequences for employers. The counter-argument was that office cake provides a valuable chance for colleagues to take a break to catch up with colleagues and cross-fertilise ideas. Obviously, I had no idea what the research would tell us.


Well, the results suggest there’s merit in both positions and, more importantly,  both provide insights that could help improve workplace health and wellbeing, physical and mental.


The research surveyed almost 1000 UK office workers about their attitudes, habits and opinions around workplace cake culture. Cake was available to most respondents (86%) at least ‘once or twice a week’.  31% said office cake had contributed to weight gain, 38% said it made it harder to eat healthily in the workplace and 59% said it made it harder to stick to a weight loss diet. Round one to the ‘office cake is bad’ camp.


But. 61% thought office cake was a good thing, 81% said it brings people together and 83% said it cheers people up. Round two to the ‘office cake is good’ camp.


So how often did the respondents think would be ideal for office cake? This is the ‘wow!’ piece of data that could make some real difference to workplace health. Almost all  respondents (95%) said the ideal frequency for office cake was once a week or less.  41% said once a month.


Make workplace cake special again


So, the evidence is telling us that workplace cake affects many people’s efforts to eat healthily at work and control their weight, yet it also provides a popular way to boost morale and build relationships. But however they felt about workplace cake, almost all respondents considered cake once a week or less to be often enough.


Add all this together and what have we got?


The evidence suggests we could reduce workplace health risk and enhance social benefits while having office cake just once a week.  And it seems this would be acceptable to the vast majority of employees.  


To make this work we’d need small changes to the way office cake happens at most workplaces. For example, displaying cakes all day on a table in the main working area (as happens for nearly three quarters of respondents) encourages mindless grazing and doesn’t provide the social benefits people enjoy. Instead, choose a day and time for cake every week/month/whatever people agree. Until cake time, keep the cakes out of sight (and out of mind) in opaque cake tins, in cupboards.  When cake o’clock has passed, pack the cakes away. This would make cake special again, a treat to look forward to and encourage social interaction.  More ideas can be found in the research report It’s time to rethink office cake.


Employers can have confidence


This research investigated the opinions of office workers so might not translate to other working environments. Even so, I hope it gives organisations the confidence to at least start a conversation among colleagues so they can explore their own cake culture. There is a strong chance they will realise they are all in the “office cake is great, but once a week is enough” camp. Then they might feel able to discuss ways to make this happen. Supportive management can encourage and endorse but won’t need to regulate.


Develop a culture of health in the workplace


In 2013, the World Health Organisation calculated we spend two thirds of our waking hours at work.  So a healthy working environment makes a significant contribution to overall public health. And starting a conversation about office cake culture is a giant step in a healthier direction.



Find out more about the research, how to start a conversation and what small changes can help organisations rethink office cake culture harmoniously at www.louwalker.com.
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Blog, Press releases
New research has found office cake culture influences employee eating behaviour and could therefore undermine the effectiveness of workplace health promotion programmes. 

However, 95% of the 940 respondents said the ideal frequency for office cake was once a week, which is less than it is currently available. Therefore there is a mandate for office cake consumption to be reduced.

‘Office cake culture’ refers to the popular phenomenon where work colleagues and managers provide cake and other sweet treats for colleagues to share.

The research was conducted by leadership development consultant Lou Walker as part of an MSc in Obesity & Weight Management at the University of Chester.  UK office workers were surveyed about their own office cake habits and attitudes, and their opinions on office cake in general. Believed to be the first academic study to explore office cake culture, the research is summarised in a report, It’s time to rethink office cake.

As well as providing extra sugar and calories which typically were not compensated for, the research found cake consumption was promoted by cake’s accessibility and availability, and the influence of work colleagues.  These factors could counteract measures taken by employers to enhance employees’ physical and emotional health.

Respondents identified negative consequences of office cake culture such as weight gain (31% of respondents), difficulty eating healthily at work (38% of respondents) and difficulty sticking to a weight loss diet (59% of respondents).  People reported eating office cake “if it’s there” and consumption was also influenced by work colleagues.  Almost all respondents (92%) reported they ate office cake at least sometimes if it was available, with 41% saying they often or always ate it if it was available.  Over a third (36%) said they never refused office cake if it was offered to them. Almost a quarter (23%) often or always found it hard to refuse cake if others were eating it and over half (52%) said they were persuaded to change their minds at least sometimes if they had initially refused it. Over a quarter (28%) said they often or always found cake hard to resist even if they were not hungry or had just eaten a meal.

A majority of respondents said office cake was ‘a good thing’ (61%), brought people together (81%) and cheered everyone up (83%).  Despite this, almost all (95%) respondents said the ideal frequency for office cake was once a week or less; 41% said once a month. This is less frequent than the current availability of at least once a week for the majority (86%) of respondents.   

Researcher Lou Walker said: “I hope this new evidence provides enough of an opportunity to start a conversation about cake culture in as many workplaces as possible. If we now know that work colleagues enjoy getting together for cake but think once a week or once a month is enough, it will be easier for them to encourage each other to keep cake for weekly or monthly occasions. This would make office cake a treat again and reduce sugar consumption without anyone feeling deprived.

“Rethinking office cake culture could contribute to a culture of health in the workplace which research shows has benefits for both employers and employees.  Creating a culture of health in the workplace also has implications for public health.”

Lou Walker’s website, www.louwalker.com, provides free access to a short version of the research questionnaire to allow workgroups to explore their own cake culture. The resulting data could provide the basis for a conversation on rethinking office cake.

The It’s time to rethink office cake report makes practical recommendations.  These focus on small changes to the workplace environment following the principles of nudge theory. Using colleague collaboration rather than policy decisions from management, the changes do not rely on individuals’ willpower to resist cake. Instead they aim to make healthier options the easy options.  For example:

·         Encourage work groups to discuss how often they actually want office cake. It may not be as often as it is currently available.

·         Make cake special again. Propose that work groups have a weekly ‘cake day’ (or less often if they prefer). Birthdays and special occasions could all be celebrated on that day.

·         Encourage a conversation about whether edible treats from holidays and business trips abroad could also be saved for ‘cake day’.

·         Stop having cakes openly displayed all day – research shows this encourages people to eat whether or not they are hungry. Instead, agree a ‘cake time’. Until cake time, store cakes out of sight, ideally in opaque containers in a cupboard. This would prevent mindless grazing and enhance the benefits of coming together for a sociable break at the agreed day and time.

·         Use the out of sight, out of mind approach to workplace kitchens. Keep surfaces clear of unhealthy food. Make healthy alternatives more prominent, convenient and accessible.

·         Encourage cake providers to offer a healthier alternative as well as cake. Depending on the preferences of the people involved, this could be something savoury, fruit, nuts or vegetables and dips. In the survey, 52% of respondents said fruit would be a good alternative.

·         To get the social benefits of eating and talking together, suggest a team picnic lunch. This way the food is instead of, rather than as well as, a meal.

·         Over half the survey respondents thought meeting refreshments in their workplace did not offer enough healthy options. Consult employees (and clients) on healthier alternatives. Are food refreshments always needed?

According to the OECD (Organisation for Economic Co-operation and Development), the UK has the highest obesity rates in Western Europe, with over two thirds of the population either overweight or obese. Obesity is one of the most common workplace health problems and is strongly linked to sickness absence. Workers spend two thirds of their waking hours at work so the workplace provides an important opportunity to improve health across socioeconomic groups, ages, ethnicities, education levels, geographies and industrial sectors.

 

Ends

Notes to editors

·         For further information please contact:
Lou Walker on 07764 189516 or lou@louwalker.com

·         Click here to access the It’s time to rethink office cake report.

·         A short version of the survey questionnaire and access to a version that can be shared by workgroups can be found at www.louwalker.com

·         The research study was approved by the University of Chester Faculty of Medicine, Dentistry and Life Sciences Research Ethics Committee, reference 1241/17/LW/CSN
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