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