For the first time ever, overweight and obese people outnumber their underweight counterparts – a phenomenon that occurs in every region except parts of sub-Saharan Africa and Asia. According to the WHO, in 2016, more than 1.9 billion (almost 40%) adults were overweight. Of these, 650 million (13%) were obese, resulting in a heightened risk of death, costly health complications, loss of productivity through absenteeism or injury, and the inability to live life to its fullest.

In 2017, WHO identified workplace wellness programmes as a best-buy option for preventing and controlling non-communicable diseases, including mental health, an approach that has been vindicated by a recent Lancet study published in 2021. In a first-of-its-kind study, the Lancet team looked at the effects of workplace wellness programmes over a 30-year period on dietary factors, body anthropometrics, and cardiometabolic risk and concluded that workplace programmes can improve fruit and vegetable consumption, body weight, and body-mass index, and, potentially, cardiometabolic risk factors. The best results were achieved by a combination of education (promoting a healthy diet), increasing physical activity, and accompanying improvements in the food environment of the workplace.

But it’s not as simple as instituting lunchtime walks and removing the vending machines. A 2018 literature review of obesity in the workplace conducted by the American College of Occupational and Environmental Medicine (ACOEM) found that while these lifestyle modification interventions in the workplace can produce modest weight losses and improvements in weight-related health problems, sustained engagement and long-term results were uncommon. The Internet is also littered with anecdotal evidence suggesting that far too many programmes are still based on an outdated view that obesity is a personal choice. This is counter-productive as the one thing we do know about the complex issue of obesity is that fat shaming – whether overt or covert – is cruel and, as a weight loss technique, utterly without merit. It can, in fact, exacerbate the issue.

The Milken Institute Center for Public Health, a nonprofit, nonpartisan think tank, rings the changes for employers wishing to offer a comprehensive approach to prevention and treatment and get maximum employee buy-in in the process:

1. Change the conversation. Obesity is not a lifestyle failure but a disease that can be prevented and treated.

2. Use people-first language, such as “a person with obesity” or “employees living with obesity” rather than “an obese person” or “obese employees.”

3. Do the work to understand the total cost of obesity to your business. Employers who understand the impact on their financial bottom line are more motivated to find long-term solutions and support tailored programmes to meet individual needs.

4. Engage with affected employees. A 2015 study by Awareness, Care, and Treatment In Obesity MaNagement (ACTION) found that a major barrier to engagement is misaligned perceptions of the company’s wellness offerings: 72% of employers perceived their wellness programmes as helpful, compared to only 17% of employees with obesity.

5. Lead with compassion and acceptance. Workplace programmes can be stigmatising and isolating to employees with obesity. Be hyper-alert for interventions that glorify thinness. Call out fat jokes for the bullying and harassment that they are.

6. Apply an inclusive lens. Ensure that all team members are considered when it comes to corporate apparel. Choose furniture that can accommodate heavier bodies and team-building activities that allow everyone to participate.

7. Address work-related factors contributing to obesity, such as stress, poor sleep, and other wellness measures as part of work-life balance initiatives.

8. Acknowledge that there are no quick wins or silver bullets to addressing obesity, only recommended steps within a comprehensive approach.

9. Approach incentives with care. Workplace programmes can be stigmatising and isolating to employees with obesity. Financial weight-loss incentives can be perceived as dehumanising the struggle against obesity while shaming people who cannot reach their weight-loss goals without additional support.

10. Choose health care plans that cover the full range of obesity treatments, i.e. nutritional and behavioural counselling, pharmacotherapy, and bariatric surgery, including the expectation of long-term disease treatment that is typically covered for other similar serious chronic progressive diseases like diabetes. When healthcare coverage is not comprehensive, employee utilisation is low or virtually zero.

11. Evaluate interventions on employee weight loss and improved health outcomes over the long term. The Centers for Disease Control and Prevention also offers a Worksite Health ScoreCard, to help employers assess whether they have implemented evidence-based health promotion interventions. This is especially relevant as it is still too early to predict what effect remote work and the hybridisation of the workplace following Covid-19 will have on future outcomes.

12. Collaborate with other companies in your industry and sector to share evidence-based strategies to address obesity in specific workforce environments.

The Milken report also notes that an employer’s commitment to reducing obesity stigma among their current employees will also reduce weight bias in their hiring process – a phenomenon supported by a vast body of research. Addressing obesity in the workplace is, therefore, a key component to promoting an overall culture of inclusion and is critical to ensuring that applicants with obesity are less likely to face discrimination and can receive fair and equitable consideration.

Ultimately, “we need to stop treating obesity as a personal problem and acknowledge it for the social issue it is,” says James Bloodworth, writing in The New Statesman, echoing a common sentiment among plus-sized workers having to deal with well-meaning colleagues and badly-thought-out HR wellness programmes.