Healthy eating and work: an unhealthy mix?

The role that work can play in tackling one of the UK's biggest public health challenges - obesity - is rising up political, academic and employment agendas.

Official efforts to defuse the growing problem of obesity are focusing on the activities of food and drinks firms. These companies have responded by introducing fitness and healthy eating initiatives among their own workforces that they hope will act as good practice for others to follow.

The government's public health white paper published last autumn and the chief medical officer's latest annual report identifying an "obesity time-bomb" have both drawn attention to the role that the food and drinks industry plays in the nation's diet and fitness.

Political pressure on the industry is likely to heat up with the imminent publication of a report on improving food information, including labelling, from a subcommittee of the Select Committee on Environment, Food and Rural Affairs.

Meanwhile, latest estimates of food consumption and nutrition from the Expenditure and Food Survey show that biscuit consumption increased by almost 5% in the single year 2001/02 to 2002/03.

The industry is responding to this growing pressure on its activities by launching a series of voluntary initiatives. Its trade association, the Food and Drinks Federation (FDF), produced a "manifesto" of commitments last autumn. This includes initiatives among the industry's own employees in the areas of health and wellbeing.

Manifesto for food and health

The FDF's manifesto for food and health sets out seven areas where food manufacturers, working with the rest of the food chain, will coordinate efforts to take their responsibilities for food and health seriously. The FDF expects that individual companies will honour the commitments in a variety of ways, according to their product ranges and consumer demand.

In addition to commitments in areas such as advertising to children and more informative labelling, the manifesto also commits FDF members to "establish and promote healthy workplace schemes on diet and lifestyle on premises belonging to companies in the food chain and within their communities".

This "industry as exemplar for healthy lifestyle" commitment is intended to champion food and drinks manufacturers as sources of best practice in promoting employees' wellbeing. Action taken by firms might include making sure that healthy eating options are available in staff restaurants and encouraging physical activity among workers.

Why a manifesto?

Christine Fisk of the FDF explains the thinking behind the manifesto for food and health: "The issue of food and health has been around for many years, and the industry has undertaken various initiatives in the area, including a FDF healthy lifestyle campaign, which dates back to 1996. But member organisations, including most of the big brand names, decided they needed to pull together initiatives in the area of food and health into a series of clear commitments. These are designed to demonstrate that FDF members take their responsibilities seriously in the food and health debate."

Discussion among FDF members culminated in the production of the manifesto and its seven key areas for action, including "industry as exemplar". The seven areas form a blueprint for individual food and drinks companies to use in putting their own actions in place.

The idea for including an "industry as exemplar" commitment emerged from the view that food and drinks workplaces are a good place to start in providing examples of how healthy lifestyles can be built into everyday life. Some of the company-level initiatives outlined on the FDF's website (see table 1) are well-established employee health and wellbeing ones, while others, including that at United Biscuits are new and emerging.

There will be no formal evaluation or monitoring of how FDF member companies are using the manifesto. However, Fisk believes that the commitment to take responsibilities seriously, and the fact that the manifesto "comes from the industry itself", will result in company-level initiatives being launched over the coming year.

But is the FDF initiative primarily a way of heading off more regulatory action in areas like advertising and labelling? Fisk responds that the manifesto has not "happened overnight out of nothing", adding that the industry has been involved in the food and health debate since at least 1996. She believes that the manifesto has been well thought through, and that the industry recognises that it needs to be part of the solution but that, at the same time, it cannot solve the problems of obesity on its own.

Case study: United Biscuits

United Biscuits (UB) is one FDF member company taking up the "industry as exemplar" commitment in the manifesto. UB launched a six-month internal communications campaign on fitness and wellbeing at the end of October 2004, covering 12,000 employees in 23 factories and office sites across Europe.

"As a food manufacturer, we should be committed to fitness and wellbeing, and how this can be achieved in the workplace," UB's Alexandra Chilvers explains.

The campaign has two elements. First, UB is displaying a series of healthy eating and physical activity posters. A different poster is displayed every six months, starting with one on the theme of obesity, and moving on to tackle exercise, salt, sugar, fat and "healthy messaging". The latter is UB's description of the nutritional information and guidelines that appear on its products.

Each poster features an image, for example, a "food wheel" was used on the obesity one, some text, for example, dealing with calories in and out, and information on what UB is doing in terms of its own products and commercial activities. For instance, the poster on salt covered how UB has cut the salt content in its leading biscuit line, and gives details of the company's commitment to reduce levels of sodium used in the manufacture of all its products by almost 20% over the next five years. Its policy on sodium is reiterated, including the UB commitment to label the amount of sodium on packaging and "challenging the sodium content in new product development".

The posters were placed in canteens, corridors and other places where people congregate.

The second element of UB's campaign involved issuing a free pedometer to each member of staff at the start of the campaign last autumn, with the challenge to do 10,000 steps a day.

Everyone had a go, and "there was a bit of competition in some sites", Chilvers says. Some 50 employees in four sites were monitored for two weeks after receiving the pedometer. The results showed that factory workers walked the most.

One UB site in Halifax is taking the initiative further, working with the primary care NHS trust in Calderdale to encourage staff to make a health pledge, perhaps to get fit or lose weight. The occupational health team at UB in Halifax has run a series of sessions on fitness.

The UB campaign was planned concurrently with the FDF manifesto, driven by the company's belief that, as it was increasingly putting health messages on products, it ought to do something in terms of staff education.

Feedback from employees on the initial initiative was good, and UB plans to develop it further in the coming months. Chilvers believes that the industry is already making a difference to diet and health without the need for regulation, for example in its healthy messaging on products.

Dieticians speak up

Workplace is the theme of this year's annual Food First campaign in June, which is being run by the professional association for dieticians, the British Dietetic Association (BDA).

The choice of the workplace setting reflects a growing awareness in the profession of the role that work can play in influencing people's dietary choices. The aim of the BDA campaign is to empower and encourage people at work to make changes to their eating and physical activity habits to achieve and/or maintain a healthier weight.

The focus of the BDA's workplace campaign will be "healthy lunch break days" on Wednesdays in June, although its members are being encouraged to organise other events in their own workplaces and those with which they have contact.

Ideas for events include competitions using pedometers to see who walks the most, encouraging people to eat healthily in canteens by working with catering teams, putting fruit and vegetables at canteen tills and working with employers' IT departments to produce a screensaver promoting "weight-wise at work".

Dieticians will also undertake mini-studies comparing the lunches of six people at work - for example, a chief executive, lorry driver, mayor, store worker and office worker - and publicising the results in local media. In addition, workplaces will be asked by BDA members to devise a healthy lunchtime recipe for long-term use in canteens beyond the June 2005 campaign.

As the FDF initiative shows, employers in all sectors are waking up to the fact that they have responsibilities in this area, according to Dr Amelia Lake, a dietician working at the Human Nutrition Research Centre, University of Newcastle. However, she adds that most have some way to go, citing a student on her MSc course who works in an NHS trust, where there are three chocolate dispensers but only one small basket of fruit on offer in the restaurant.

Dr Lake believes that employers should adopt common-sense approaches, and make imaginative, healthy choices available at a price that is not more expensive than other less healthy options.

Also, the speed and ease of obtaining and eating more healthy food at work needs consideration. Dr Lake points out that sometimes it is quicker and more convenient for time-pressed workers to obtain and eat a less healthy diet.

Healthy options also need to be targeted at the groups least likely to take them up. Changes in workplace eating options need to be "small but acceptable, and certainly not radical", Dr Lake argues, suggesting that presenting workers with a stark choice between a pie or a salad will not make dietary change easy.

Work hampers diet change

These various initiatives on healthy eating face significant challenges inherent in the nature of employment: work, and the kind of job that an individual performs.

Dr Lake has conducted a study¹ of the ways in which people change dietary habits, for better or worse, and the influence that work - particularly, shift work - plays in inhibiting dietary change.

She and her colleagues analysed the food intakes of 200 people as children and then again 20 years later, with the general conclusion that diet does get healthier over time, and that adults eat twice as much fruit and vegetables and less fat and sugar than they did as children.

However, work makes it more difficult to eat healthily, and can undermine the beneficial influence of health-conscious partners, or a desire to improve children's health outcomes by eating healthily at home.

The research suggests that all initiatives designed to encourage healthy eating options at work need to take account of work organisation and environment factors, such as working patterns, breaks and the make-up of the workforce.

One-third of workers in the study said that their employment influenced their ability to change diet, including one man who noted "shift work for the past 14 years has played a big part in my eating habit", and a second who commented "working away doing long hours, grabbing food when available" had not helped.

Individuals citing work as a factor in their eating habits increased their fruit and vegetable intake less over time than those not citing it as important. Work typically reduced the time available to cook and prepare foods, which appears to have an impact on the ability to change diet, Dr Lake's study concludes.

This article was written by Sarah Silcox, a freelance writer and trainer on employee health issues, sarahsilcox@waitrose.com.

¹Lake, A A et al (2004) "Longitudinal dietary change from adolescence to adulthood: perceptions, attributions and evidence", Appetite, vol. 42, pp.255-263.

Source: Food and Drink Federation, www.fdf.org.uk.