Obesity, Pain, and Presenteeism

Pain is an obesity issue, because “musculoskeletal or joint-related pain in the feet, knees, ankles, and back” can make certain maneuvers difficult or impossible. Obese people often cannot move very well because of arthritis, and, of course, the relative lack of mobility leads to increased obesity. Carpal tunnel syndrome also shows up more often among heavier workers.

It might seem that a very obese person would be more difficult to knock over, but other factors are involved. The authors suggest that, in heavy individuals, balance and coordination are compromised. Obesity is also connected with sleep apnea and heart disease, both of which cause shortness of breath and general weakness, two definite drawbacks in a work situation.

According to an Australian study of long-term health conditions and obesity released in 2020, the mechanisms of the phenomenon are still obscure to the point where “little is known.” That paper’s conclusion “implies that interventions to improve workers’ health and well-being will reduce the risk of presenteeism at work,” an observation that one reviewer with an attitude dryly states “does not actually qualify as helpful.”

A 2018 study, using data compiled around 10 years earlier, compared various occupations in terms of how, and how much, productivity is affected by weight. Not surprisingly, obesity had the most profound impact in the physically demanding field of construction. Arts and hospitality was the next most affected category, which seems like an odd pairing since the arts can include extremely strenuous physical activity like performative dance, while hospitality could encompass standing behind a counter giving out room keys in a hotel.

Perhaps in this context, hospitality only includes the personnel who clean the premises, change the bedsheets, and so forth. A surprising number of jobs might turn out to include repetitive motions, awkward body positioning, and other challenging requirements.

At any rate, the conclusion there was that “Obesity differentially impacted productivity and costs, depending upon occupation,” which could not have come as much of a surprise to anyone. Between 2004 and 2011, all American industries saw weight increases in their average workers. This much was definitely stated:

When examined by occupational group, the highest age-standardized obesity prevalence was found for US adults working in the Motor Vehicle Operator occupational category (39.2%), with the lowest prevalence for those working in the Health Diagnosing and Treating Practitioner (15.4%) category.

These facts should also not be startling, because the drivers of trucks and buses are perpetually seated, while employees in the health field have a relatively high awareness level of the dangers of obesity. An interesting insight emerged from a large study in the Netherlands, which…

[…] reported that obesity was predictive of developing musculoskeletal symptoms, especially among workers whose jobs had low (vs high) physical workloads… Yet, the researchers acknowledged that their findings could alternatively be explained by individuals with musculoskeletal symptoms tending to self-select into occupations with fewer physical job demands.

In the field of manufacturing, when physically demanding tasks are involved, excess weight definitely impairs productivity, especially in terms of needing “additional time to complete physically demanding tasks.” In the realm of office workers, management and professional occupations tended to see higher costs “attributable to obesity-related absenteeism across a number of primarily office-based positions.”

Impairments in productivity and higher medical expenditures tend to characterize obese individuals with cardiometabolic risk factors like hyperlipidemia, diabetes, and hypertension. During the time period encompassed by that study, it was found that almost two-thirds of the expenses incurred by businesses were attributable to morbidly obese employees.

The authors noted that such studies tend to focus on only one or perhaps a few occupations, so…

[T]here exists a dearth of empirical research investigating the impact of obesity across varying occupational groups. Such research is critical, as excess weight may be associated with differing degrees of burden depending on profession and job responsibilities.

Your responses and feedback are welcome!

Source: “Obesity and Presenteeism: The Impact of Body Mass Index on Workplace Productivity,” Academia.edu, 2008
Source: “A longitudinal exploration of the relationship between obesity, and long term health condition with presenteeism in Australian workplaces, 2006-2018,” PLOS.org, 08/26/20
Source: “Impact of Obesity on Work Productivity in Different US Occupations: Analysis of the National Health and Wellness Survey 2014 to 2015,” NIH.gov, 2018
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More About Absenteeism, Presenteeism, and Obesity

The authors of a 2008 meta-study described the obesity-related costs (that take such a toll on society as a whole) as “astounding.” “Obesity and Presenteeism: The Impact of Body Mass Index on Workplace Productivity” found that “the annual presenteeism cost for moderately or extremely obese workers was $1783.81, which is $506 higher than the cost for other workers.”

The study’s subject groups categorized as moderately and extremely obese experienced the highest absenteeism, averaging 91.08 absentee hours “for personal health reasons.” Financially, presenteeism is dreaded because…

[…] absences do not necessarily cost the employer the full value of the worker’s time to the extent that these are unpaid absences and that other workers are able to cover the missing shifts. Meanwhile, presenteeism is always a cost to employers because the worker is receiving a full paycheck despite reductions in productivity.

All in all, this accounts for a sizable chunk of the annual $900 billion that American employers pay for medical expenditures.

As numerous other studies have confirmed, the price paid by businesses for employee obesity is up there in the mega-bucks range. Unfortunately, much more work is needed on the minutiae of “Why?” When the cost derives from absenteeism and/or medical services rendered, this is easily understood.

What seems elusive is the exact process by which, when obese employees are involved, presenteeism (showing up for work but underperforming) is so wasteful. Is it just that they move more slowly when picking up a phone or straightening a stack of papers? Do they take longer lunch breaks, or spend more on-duty time moving back and forth to the snack machines? Do they fall asleep at their desks? What, exactly, is the issue?

Employees are on the job, but not functioning effectively because of medical or psychological conditions. But how does this manifest? We are told that the moderately and extremely obese workers experience the most limitations, as measured by the time needed to complete some tasks, and sheer inability to perform others.

In a broad sense, that tracks. If employed as a ballet dancer, a person with a BMI of over 35 would obviously fail. But how does the extra poundage inhibit or prohibit, for instance, a journalist? Presumably, the fingers on the keyboard would still be just as fast and accurate.

The particular questionnaire utilized in this study comprised 25 items falling into four categories:

The time scale addresses difficulties with meeting job expectations and scheduling demands. The physical scale focuses on workers’ ability to perform their normal job tasks as influenced by bodily strength, movement, endurance, coordination, and flexibility. The mental-interpersonal scale examines cognitive tasks, sensory input, and interactions with others. The output scale focuses on the quantity, quality, and timeliness of meeting job demands.

But the details involved in particular office tasks are not described. We know what the workers in a warehouse do. They move heavy physical objects from one location to another, which presumably requires an energy expenditure that helps prevent them from putting on weight. (Although, don’t count on it.) Still, a job in a plant or warehouse environment usually implies the ability to bend, stretch, squat, push, and walk.

But in an office setting, how heavy is a pencil or a file folder? Someone in the Information Technology department might need to lift a computer once in a while, but in general, what physical task is so daunting that a worker in the top obesity classification would be slowed down, stopped, or injured by its performance?

Okay, the IT person probably has to get under a desk now and then, to check on or reorganize some wiring. For a morbidly obese employee, this would be a struggle, costing time and possibly medical expenses.

It is easy to see why fitting beneath a desk, in the category of physical demands, could be problematic. However, seemingly, it would also qualify as a time issue, because the other employee who should be using that machine to complete work is unable to. Adding insult to injury, hashing out these procedural details adds to the time it takes to finish such studies.

Your responses and feedback are welcome!

Source: “Obesity and Presenteeism: The Impact of Body Mass Index on Workplace Productivity,” Academia.edu, 2008
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Presenteeism and Obesity

A prominent and ever-growing cause of financial loss to businesses is obesity, as described in the previous post. That post included as a subheading “The big but…” which is indicative of the problem in general: Obesity is such an easy target for mockery.

One difficulty with this topic is the temptation to succumb to flippancy and make jokes about the ruinous cost to widen the doorways in workplaces, and replace collapsed chairs… which would be wrong. The humor temptation might be why obesity, as a contributing factor to presenteeism, does not cause as much concern as it should.

But for some very dedicated scholars and business experts, the problem is (to reference another corny old joke) “serious as a heart attack.” They and their colleagues have discovered that in the world of work, presenteeism (reporting for duty but performing less than optimally) is actually more expensive than absenteeism, or not showing up at all. Now, why, in the business realm, is obesity seen as exceptionally harmful to the bottom line?

A worker with a broken wrist will eventually have the cast removed and, after a period of readjustment, will probably return to their original state of productivity. A pregnant worker may need some extra leeway, but will eventually become, instead, the parent of a child who is elsewhere during working hours. That situation offers its own challenges to an employed woman, but most are able to return to their pre-motherhood level of usefulness on the job.

Another big but…

However, in most cases, obesity does not go away. Usually, it increases. Over time, whatever negative effect an employee’s obesity has on the situation will probably not change for the better, and will probably change for the worse.

But how, exactly, does obesity contribute to presenteeism, and how does it do that in an especially impactful and intractable way? Exactly how do our collective tons of excess body fat add to the price of doing business, and thus increase the amount that consumers pay for every product, service, and commodity?

Not surprisingly, it is possible to find a raft of academic papers exploring the relationship between excess weight and presenteeism. The connections may not be immediately obvious to the casual eye, but they certainly exist. There are many reasons why a person’s Body Mass Index might affect their ability to do top-notch work. Also, there is said to be a “threshold effect,” meaning that the workers with a BMI of 35 or higher are significantly less productive than their slimmer counterparts.

Moderately or extremely obese workers… experienced the greatest health-related work limitations, specifically regarding time needed to complete tasks and ability to perform physical job demands. These workers experienced a 4.2% health-related loss in productivity, 1.18% more than all other employees, which equates to an additional $506 annually in lost productivity per worker.

In 2010, journalist Alyssa Zamora described the work done by Eric Finkelstein and many others at Duke-National University of Singapore. Researchers took into consideration “three factors: employee medical expenditures, lost productivity on the job due to health problems (presenteeism), and absence from work (absenteeism).” Furthermore, health problems cost more than medical expenditures.

Zamora wrote,

Collectively, the per capita costs of obesity are as high as $16,900 for obese women with a body mass index (BMI) over 40 (roughly 100 pounds overweight) and $15,500 for obese men in the same BMI class. Presenteeism makes up the largest share of those costs.

Bottom line: “The cost of obesity among U.S. full-time employees is estimated to be $73.1 billion.”

Your responses and feedback are welcome!

Source: “Obesity and presenteeism: the impact of body mass index on workplace productivity,” NIH.gov, January 2008
Source: “Obese Workers Cost More Than Healthcare, Absenteeism,” Duke.edu, 2010
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Is Obesity Everyone’s Business?

Here is one final look at an archived piece of health journalism from Dr. Bruce Y. Lee, which featured seven myths about obesity under the punning title, “Obesity is Everyone’s Business.” The general topic of this sequence of posts is the overall cost to society of treating and/or preventing obesity, and especially the way in which it has increasingly affected the cost of doing business.

In a very pragmatic demonstration of cause and effect, the author enumerated some of the
“immediate and long term physical, psychological, and social ailments” caused by obesity, which in turn affect a person’s effectiveness on the job. It should be mentioned that upper-level executives are just as prone to debilitating illness as the most humble new hire in the shipping department. The difference is that the folks in the higher ranks are more advantageously positioned to hide the deficiencies in their work output.

The check makes a difference

Also, executives can much more easily afford health-producing commodities like high-quality food, vacation time to recover from stress, membership in fitness establishments, and so on. However, in recent years, there has been some improvement in the equality with which corporations try to affect the basic health of their people.

Many physical ailments may be detrimental to an employee’s productivity. Depending on what field of commerce they are in, the damage from workplace machines, noise, and substances in the air can be quite serious. Even psychological issues (depression, anxiety, etc.) are perfectly capable of minimizing the usefulness of a worker at any level. A conscientious manager never wants to see conditions deteriorate to where workers experience sickness, pain, lack of energy, and the consequent lowering of morale.

Hopefully, that consideration results at least partly from generous human considerations. It is possible, after all, to operate simultaneously on two different planes of consciousness. Management can care and, at the same time, remain conscious that any and all physical and mental dysfunction in the workplace leads directly to lowered productivity, increased healthcare expenses, and shrinking profits.

This quoted paragraph illustrates some of the trends that motivated the business world to take a hard look at the consequences of obesity in the workplace. As previously mentioned,

A study by researchers at Duke University tabulated that obesity-related absenteeism and presenteeism cost U.S. employers $73 billion annually. [W]hile normal-weight employees cost on average $3,838 per year in healthcare costs, overweight to morbidly obese employees cost between $4,252 and $8,067.

Once researchers have wrapped their heads around some numbers, they enjoy expressing the significance of those figures in various ways. In this case, the authors also calculated the dollar amount of Body Mass Index points above the normal range. Once the border of obesity territory has been broached, statically speaking, each BMI point was said to represent an additional amount of around $200 per year that the company would pay out in healthcare costs for that employee.

The broad overview matters

Getting back to Dr. Lee, he formatted his Forbes.com article as a series of propositions which turn out not to be true; or myths. As Myth #5, he specified: “Obesity has little to do with overall business strategy, management, operations and finance.”

On the contrary, this author emphasized the big picture and maintained that “Employee weight and health can be a bellwether or ‘canary in a coal mine’ of how the overall business is functioning overall.” Why? Because a person’s normal weight can say a lot about their dedication, discipline, and work ethic, as well as function as an indicator of “the social, cultural, and financial situation and environment.”

In various industries, many members of the workforce have learned (the hard way) to keep the majority of their job-related opinions to themselves. Surveys and requests for feedback about company policy are often thinly-disguised traps designed to identify underlings who might be inclined to cause trouble. If “management” really cared about the average worker (the thinking goes), that collective noun would have caught on a long time ago, and realized that the whole outfit, from top to bottom, needed refurbishment.

Instead of initiating feedback requests that could be viewed with suspicion, the wise executive might be well advised to consult a psychologist familiar with the health manifestations of discontent — because obesity can definitely be interpreted as one of them.

Your responses and feedback are welcome!

Source: “Obesity Is Everyone’s Business,” Forbes.com, 09/01/15
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More About Offices, Desks, and Obesity

Note: This post will definitely make more sense if considered in context with its predecessor.

Journalist Rodney Wagner poses other pertinent questions and makes several points about desk dining. It can certainly get a person fed “without sacrificing productivity,” because the diner is still able to concentrate on the work being accomplished at the desk, while chewing and swallowing.

On the other hand, we might add, many authorities believe that a person’s full attention and conscious participation ought to be directed toward eating. Otherwise, they have not fully experienced the intake of nutrition, and are apt to overeat in compensation for that lack, and become obese.

At any rate, according to this authority, snacking at work can allegedly help to maintain mental energy and improve alertness (though it seems the same might be said of periodic exercise breaks, or inhaling a hit of oxygen). However, admittedly, there are also “numerous downsides to eating at your desk.”

The person’s attention may be distracted from the work at hand (especially, we presume, if eating involves consulting a menu and placing an order.) Worse yet, the average worker’s meal often tends to involve items purchased from snack vending machines, the contents of which are universally acknowledged to be unhealthful and fat-promoting.

At any rate, the availability of food and water to those who need them is a factor that a manager can affect. While many people do not care for the nanny-state implications, it is probably on the whole a good thing, when those in charge bear some degree of responsibility for the well-being of the workers.

Strength in motion

For the well-being of employees who like to burn calories by walking between the floors of a building, the security of stairwells should be assured. Overall, the important thing is to cultivate an awareness of how extensively employee health affects productivity, morale, and healthcare costs. Basic amenities like breathable air count for a lot. So really, the biggest error an executive can make is to assume that she or he might not be able to affect the situation positively.

Understandably, one of the myths that Dr. Lee identified is the fallacy of ineffectualness. An employer should never buy into the idea that little can be done to shrink obesity in the workplace. There is a cliche that fits the case very neatly: “If you’re not part of the solution, you’re part of the problem.”

The boss can make a difference

Often, there is a belief that not even the most well-intentioned business can do much to prevent obesity, which by extension implies there is nothing they can do to stem the rising costs of obesity that adversely affect the company’s bottom line. Dr. Lee resists this defeatist notion because the reach of the job may in fact be extensive:

Your workplace can affect your commuting, sleep patterns, relationships with family and friends, available food at home, energy to exercise, overall stress levels and many other aspects of your life… No matter how you prioritize work-life balance, your workplace does have an impact on the rest of your life […] and in turn obesity.

Of course, obviously, the job affects the weight class of the worker’s entire family, because if the pay is not sufficient to feed them well, the consequences will show up. Which brings the topic back to the cost of a health plan, if indeed such an amenity exists at all. A company with common sense ought to recognize that it is cheaper to pay for obesity prevention than for bariatric surgery.

At the same time, corporate leadership must have the sensitivity to prevent its caring approach from coming across as criticism or worse yet, as a threat. In some times and places, rules are in effect to shield workers from various types of discrimination — even from what might appear as fat-shaming.

Dr. Lee’s last word to the bosses is,

In the end, the heart of a business is its employees. Having employees who are overweight and unhealthy is akin to a football team trying to compete with chronically injured players. If you view obesity as a completely separate issue from your business, you do so at your peril. To make a real difference, you need to have real substantial change in the culture and operations of a workplace.

Your responses and feedback are welcome!

Source: “Source: “Is It Good to Eat While Working? Uncovering the Truth,” MeatChefTools.com, 02/03/25
Source: “Obesity Is Everyone’s Business,” Forbes.com, 09/01/15
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Offices, Desks, and Obesity

We are in the midst of examining a very detailed, decade-old Forbes.com article. Authored by Bruce Y. Lee, M.D., it explored some myths about the extent to which companies are able to influence the amount of obesity experienced within the ranks of their employees. At the time, contemporary Duke University research showed that obesity-related issues cost American businesses, overall, just short of $75 billion each year.

More specificity was found in this quotation:

Another study measured that while normal-weight employees cost on average $3,838 per year in healthcare costs, overweight to morbidly obese employees cost between $4,252 and $8,067. Each additional body mass index (BMI) point above normal weight costs $194-$222 per year per employee.

Significantly, bosses at every level were reminded that weight-related issues tend to sneak up and may not become obvious until after some real damage has already been done. Consequently, it is always wise to have a finger on the pulse of industry-wide trends and interventions.

High employee turnover is never a good sign, and obesity-related issues can influence employee behavior to a very great extent, so the smart executive keeps an eye on that area. Advice in this area can be just as true today as when businesses began to track such matters. Overall, the author urges bosses to remember that substantial change might be needed, and that…

[…] in the end, the heart of a business is its employees. Having employees who are overweight and unhealthy is akin to a football team trying to compete with chronically injured players. If you view obesity as a completely separate issue from your business, you do so at your peril.

But once the people in charge become aware of the potential undesirable impacts of obesity, relative to the big picture, they should not be discouraged by all the possible negative outcomes. As always, “fore-warned is fore-armed,” and it would be a mistake, according to Dr. Lee, for employers to think there was not much they could do.

In some work environments, for instance, it might help to offer the alternative of a standing desk. A slogan that was heard in this context was, “Sitting is the new smoking” — in other words, a harmful yet totally avoidable habit. Of course, many job descriptions preclude sitting and require constant standing. But in circumstances where sitting has always been considered the normal state for workers, to forbid it might be construed as gratuitous cruelty, and the basis for a legal challenge. Still, in many situations and workplaces, leeway could be built in.

While some things are simply not done — like a bank teller eating while taking care of customers at the window — in many situations company policy allows leeway for habits and preferences. Choosing a couple of articles at random brings to light some of the current thinking in this area. A website for professional chefs asks, “Is it good to eat while working?“:

A survey found that over 60% of employees regularly eat at their desks, indicating that this trend is not just common but almost normalized.

Amongst people who work seated at desks, perhaps. What about lifeguards? Firefighters? Heart surgeons? Okay, the author probably meant that, among the sub-population of office-bound, sedentary workers, more than half are accustomed to eating at their desks. (Leaving aside matters related to obesity, their habits might directly impact the company’s pest control budget.)

(To be continued…)

Your responses and feedback are welcome!

Source: “Obesity Is Everyone’s Business,” Forbes.com, 09/01/15
Source: “Is It Good to Eat While Working? Uncovering the Truth.,” MeatChefTools.com, 02/03/25
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