Opinion

Beating the stigma of obesity: Time for a three-step programme

It is time for the hand-wringing to stop and some serious effort be put into the system-level barriers to inclusivity which too many people living with obesity face, says Stephen Bevan from the Institute for Employment Studies.

Image credit: Institute for Employment Studies

Image credit: Institute for Employment Studies

This blog is a comment piece from the PURPOSE programme (Promoting Understanding and Research into Productivity, Obesity Stigma and Employment). The programme, funded by Novo Nordisk, focusses on improving national productivity levels via better employment and labour market outcomes for those living with overweight or obesity. Novo Nordisk has had no influence over the content of this blog or this programme. IES retains full and final editorial control over all aspects of the PURPOSE programme.

There will be quite a bit of discussion today – World Obesity Day – about the importance of tackling the UK’s rising levels of obesity. Several viewpoints will be reflected, from the clinical (diabetologists, endocrinologists, dieticians and nutritionists, for example) to public health specialists and a clutch of public figures and columnists among whom the absence of any scientific credibility has never been a barrier to sharing their views about both the causes of and cures for obesity.

However, amid the very worthwhile and evidence-based discussions about the sugar content of food, the impact of inequality on childhood obesity, the genetic component of obesity, the so-called ‘obesogenic’ environment and, of course, the link between living with obesity and the elevated risks of Covid-19, it’s very unlikely that you will see much of a discussion about the impact of obesity on poor outcomes at work or in the wider labour market.

Yet research that IES published last November as part of our PURPOSE programme shows that stigma and discriminatory employment practices relating to obesity remain widespread and largely unchallenged, often because of stereotypical attitudes and beliefs, even among some GPs.

These stereotypes have translated to disadvantages for employees living with obesity, with evidence that they have lower starting pay, less hiring success and lower co-worker ratings. Workers living with obesity also report being targets of derogatory comments, denied promotions or even fired because of their weight.

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Forty-five per cent of employers say they are less inclined to recruit candidates living with obesity. People living with obesity themselves are less likely to be regarded as able leaders or to have career potential and are more likely to experience bullying and harassment, with women living with obesity in particular less likely to get customer-facing jobs.

We also found that women living with obesity can experience a ‘wage penalty’ of 9 to 13 per cent per year, representing a UK total of over £10bn each year. As we have written elsewhere, weight stigma in the labour market feels like it is the last ‘acceptable’ form of discrimination and we need an urgent debate about what can be done to correct this.

Our research so far, together with interviews with a range of academic, clinical and patient experts, has led us to focus on changes to three parts of the ‘system’ which might help to improve both clinical and work outcomes for people of working age who are living with obesity.

The first is to make explicit that, in the UK, obesity is a disease in its own right. Of course we are not clinicians, so cannot pronounce on this from a medical perspective (although the WHO first classified obesity as a disease in 1936, as did the American Medical Association in 2013 and the German Parliament in 2020).

However, our work with working age people with a range of chronic conditions (for example, rheumatoid arthritis, schizophrenia, multiple sclerosis and cancer) shows that designation as a disease makes it much easier for the NHS to develop a National Service Framework, clinical guidelines, care pathways, clinical audits, data registries and commissioning protocols which attract resources, have clinical priority and reduce the risk of a ‘postcode lottery’ in provision.

For an employment perspective, this step might also make it easier to get ‘work as a clinical outcome’ embedded into the way healthcare professionals think about the importance of employment to patients living with obesity. In addition, while the cost-effectiveness of medical interventions such as bariatric surgery have been assessed and confirmed by NICE, these do not explicitly take into account their further potential benefits to work participation and labour productivity.

Second, the UK could include obesity within the scope of the Equality Act (2010) as a ‘protected characteristic’ for the purpose of employment law. At present obesity is not covered by this legislation, although if a person has a medical condition that is linked to their obesity, then they may qualify as having a disability in accordance with the definition set out by the Act.

If an employer treats an employee differently due to a disability related to obesity or fails to make reasonable adjustments in line with the requirements made of them under the Act, then this may give rise to a claim for discrimination. Our experience is that this complexity makes it hard for employers to understand their obligations and for employees living with obesity to bring an action against an employer.

A simple amendment to the Equality Act would resolve this ambiguity, it would strengthen the rights of employees and would – over time – make discrimination on the grounds of obesity far less common and acceptable.

Third, UK employers could be far more thoughtful about the inclusion of weight loss and ‘healthy eating’ elements in their workplace health promotion programmes – especially when they risk increasing weight stigma. One problem here may be the somewhat evangelical though well-meaning tone of some workplace interventions which focus on ‘lifestyle’ change. Several studies have shown that many employees are reluctant to participate in these programmes, including those in lower status work and those with pre-existing health conditions.

Another challenge is that, among employees living with obesity, health promotion initiatives which focus on weight loss can reinforce the view that being overweight or obese is predominantly in the control of individuals (despite the majority of recent clinical studies suggesting the opposite) and, as a result, inadvertently strengthen the perception that obesity is the fault of the individual and only a little more willpower or self-control is needed to lose weight.

Just before Christmas last year IES broadcast a webinar looking at the employment impact of obesity. We concluded that obesity stigma negatively affects decisions and judgements about employees living with obesity at every stage in the employment cycle, from recruitment to job loss.

Indeed, our colleagues at the Centre for Musculoskeletal Health and Work published data last year which showed that women over 50 living with severe obesity were also the most likely to cut down, avoid, or change what they did at work because of a health problems and were almost three times as likely to lose their job because of their health.

As the data on the extent of weight-based discrimination accumulates, we think it is time that the hand-wringing should stop and that some serious effort should be put into the system-level barriers to inclusivity which too many people living with obesity face when they are seeking full and fulfilling employment in increasingly difficult labour market conditions.

Stephen Bevan is head of research and development at the Institute for Employment Studies

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