The secret ingredient for real corporate wellness

Companies who care about their employees’ health are often seen as being responsible and forward thinking. But could these good intentions be paving the way to harm? 

A few books have come out this year debating this question "do corporate wellness programs help or harm employees?" There have been numerous articles talking about the subject, as well as debates such as the one on the CBC radio show Q. 

One of the books in question is called The Wellness Syndrome and it was written by Dr. Andre Spicer and Carl Cederström. They state that some company's extensive wellness efforts caused employees stress. You can read a print interview of this book here.

Another book along the sames lines is Surviving Workplace Wellness…with Your Dignity, Finances, and (Major) Organs Intact. You can read a summary of it here.

At first glance, it may seem that the obvious answer is that corporate wellness programs do help employee health. However, if you delve deeper into both sides of the debate, the answer is far less clear.

On the one hand, you have the idea that healthy employees work more efficiently, are sick less often and help to add to a culture of healthiness and happiness. Also, most people feel that if your employer cares about your health and gives you time to take care of it, it is an added benefit. However, implementing a corporate wellness program and having this program actually work are two separate things. The assumption is that the wellness programs really do help people be healthier and improve their lifestyles. But this may not always be the case.
 

Labelling people who don't participate in the program as lazy or singling out people to participate can do more harm than good. People who are perceived as being unhealthy by their peers (this is usually based on their physical appearance) may be bullied or coerced into needing to participate. This backfires on the whole point of corporate wellness since stigmatizing people due to their weight or size has been linked to lower levels of healthiness. Although weight and body size is an easy thing to see (and thus judge) it really does not indicate one's health status. The factors that do matter most are the ones you cannot see, like cholesterol levels, blood pressure and stress.

Assuming that the "unhealthy looking" employees need help improving can alienate them from the corporation and their peers and assumes they are either doing nothing to improve their well-being or are too stupid to know what to do. When these initiatives come down from the top, they can persist weight biases and encourage continued ignorance on the subject of global health. In The Wellness Syndrome, the authors succinctly summarize their proposed “syndrome”. They state "that because employees had every opportunity to stay healthy, those who didn't meet extreme health standards sometimes felt like failures".

The people that these programs "would be good for" often end up feeling like they have to prove their worth in society by participating in a never-ending cycle to self-improve (in most cases, this is about losing weight). If weight loss and dieting usually leads to weight regain and weight cycling is linked to low mood and low quality of life, then the ethics of having such weight loss based programs must be reconsidered. If you want to learn more about the ethics of health professionals recommending dieting, you can read a past blog here.

Furthermore, the people who feel they must participate or risk being judged, may be already doing something to improve their health that they have not publically announced (ie. seeing a therapist for stress management or a dietitian for weight management). If these programs are poorly designed, participating can actually set them back.

It is amazing that even today, in 2015, well-meaning people want to focus on the same diet stuff that was being talked about in 1990! No, losing weight is not a guarantee that your employees will be less sick. No, it does not mean that your employees will work more efficiently. And no, it does not mean they are better people. How well do you work with the burden

when you are hungry, exhausted from dieting and feel like your company expects you to lose weight? 

The danger lies in the foundation of the wellness program. One that is designed by an actual health professional that has experience in overall well-being, not just weight loss competitions and fat shaming, is optimal. Ideally, this program would include all aspects of health as well as the proper health professionals such as registered dietitians, kinisiologists and psychologists. Including both spheres of health – the mind and the body- is key.

Another big problem is that these programs are being delivered by professionals (or pseudo-health professionals) who are emphasizing the wrong aspects of health. Focusing on the number of pounds lost or following food rules at the office (i.e. going gluten free) are just a few of the nutrition related mistakes that happen all the time. Focusing on weight lost is simple to quantify to the company who is funding the wellness program, but it is a terrible predictor of overall health.

Most people know what to do to be healthy. The question is why can't they make the changes. Focusing on ways to overcome barriers to healthy living is much more useful than reiterating the reasons why you should change. Learning (again) how to read a food label for fat content or stating the reasons why you have to aim for 10000 steps per day is fine if your participants lack knowledge. However, a more motivating discussion around why choosing high fat foods is easy or why they aren't getting 10000 steps in every day can be a lot more useful. 

The authors suggest alternatives to weight loss competitions and exercise tracking such as keeping working hours under control, letting people disconnect in the evenings and weekends, and understanding what actually causes a sense of well-being. 

For real health changes, we have to get back to the science of wellbeing and stop focusing on old school theories because the dangers in promoting a poorly designed wellness program can do much more harm than good. 

When "do no harm" can mean NOT talking about dieting

There has been much controversy in the nutrition and weight management world about the sometimes harmful role professionals can play when trying to help a client lose weight. Since doctors carry so much weight (so to speak) with their advice, it is extremely important that they give useful, easy to understand and sympathetic advice. By sympathetic I mean advice that takes into consideration their clients as people (not just bodies) who have limitations, feelings and are probably doing more for their health than they see. Obviously, it is also important to that doctors know their limitations in knowledge and make referrals. Knowing your limits can be harder than you think especially if you come from a background of an "all knowing" profession like medical doctors. This is where a lot of my frustration stems from- the "all important god" that is better known as your doctor who gives harmful and often wrong advice on weight loss. One big argument is the fact that the hippocratic oath may suggests that bad weight loss advice is unethical by actually doing harm to their clients.
Before I go further, I must state that not all doctors frustrate dietitians or give harmful advice to their clients. Unfortunately, I only hear the sad stories from my clients.

Recently I had a few clients who were (and I quote) "traumatized by what my doctor told me about the need to lose weight". I can only guess that the doc's goal was to motivate the client to lose weight (little did he know that she is already doing many things to try to lose weight...did he even ask her?). However, I wonder the usefulness of stating that "[she] would be better off as a drug addict than addicted to food". Yes- that is a direct quote from the client quoting her doc.

Firstly, being obese is vastly different than being addicted to food (which is not a well supported theory amongst eating disorder professionals) so he first assumed she was addicted to food (again, not a diagnosis as popular as say, binge eating) and secondly that being skinny while doing drugs is better. Is that really based on science? Will that advice really help her lose weight? All that encounter did was make that day the "worst day of [her] life" (another actual quote). Was that advice ethical considering she may turn to unhealthy ways to lose weight such as diet pills, fasting, or very low calorie diets? All of which may lead to binge eating, skewed relationship with food and body hate.

Not only do my clients already feel ashamed and hateful of their bodies, but they have to return to see their doctor for a follow up. It's no wonder that they are scared, anxious, preoccupied about the upcoming visit. I wonder if these feelings will help or get in the way of communication at their next appointment?? It was certainly something that got in the way in talking about nutrition at our session. I was more than happy to discuss the encounter since issues that influence eating is something we discuss (not just diet advice) at appointments. However, I can only imagine how frustrated my paying client felt after leaving our session with little spoken about the topics for which she sought advice.

Weight shaming and weight bias as well as misunderstanding the complexity of weight loss is something that is expected from the masses. NOT from educated health professionals.

My advice to my clients who bring these stories to our session is easier to give than to take- find another doctor. Not an easy task in this city or in Canada. If that's not possible, perhap a firm but polite acknowledgement that things are being taken care of in the weight loss area with the help of another professional, then asking the doctor to get back to what they specialize in practicing.

Judging those who already judge themselves

Some people believe that judging people who "should" lose weight will help them to make the changes necessary to lose weight. Of course, those people are dead wrong but that is not the point of this post. The point is that judging others is useless since they often judge themselves more than can be imagined. 

This is especially true of people who suffer from binge eating disorder. Having a greater than normal concern for ones weight and shape as well as an over-evaluation of their weight and shape (meaning they feel they have more control than they actually have over their weight and shape) leads to much pain. These negative views of ones body and weight can be quite destructive as well as self-perpetuating. Having what is called a disturbed body image maintains an eating disorder and can actually predict success with therapy in resolving an eating disorder. 

As a dietitian, I rarely work directly with clients to treat a body image disturbance but I do work closely with many amazing psychologist who do just that. However, body image often comes up in nutrition sessions when clients insist they "should" or "must" lose weight. Losing weight before resolving an eating disorder (for those people who have a high BMI) is never recommended but many clients are convinced that losing weight will help increase their self-esteem. The basis for many people with an eating disorder is low self esteem or basing ones self worth on their weight, so does losing weight actually increase self-esteem? No. Surprisingly, despite the many protests from clients, losing weight does not miraculously increase their mood or self-esteem. Instead, dealing with what perpetuates negative thoughts, how to come to terms with ones body and how to enhance positive body image is what helps people feel better. 

Guess what else it helps with? You got it- weight management. Weight shaming, guilt-tripping, judging and all those other negative abuses DO NOT HELP. Loving and accepting ones body and shape helps people eat healthier, move more and just live healthier lifestyles. It may be hard to accept or change the way you think at first, but change is possible! Professional help from a registered dietitian and psychologist speed up recovery from an eating disorder and help you feel happier.

Are my eating habits normal? Use this tool to know when to reach out for help

There are a few ways to screen for an eating disorder. One short and easy questionnaire is called the SCOFF. SCOFF is an acronym that is used to help people & professionals remember the specific questions. It is touted as being simple, memorable, easy to apply and score. It is designed to raise suspicion of the presence of disordered eating rather than to diagnose. It is mostly used by health professionals but since it is easy to understand, it can be used by anyone. 

The SCOFF questions

Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone in a 3 month period? (or about 6kg or 15lbs)
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?

To score the questionnaire, give one point for every “yes”. A score of 2 or more indicates that there are symptoms present similar to those in anorexia nervosa or bulimia. In other words, if you (or who ever took the test) scored 2 or higher, you may need help in re-establishing a healthy relationship with food and your body. 

There are other more in-depth questionnaires for helping to determine whether you have symptoms commonly associated with an eating disorder. One very popular one is called the Eating Attitudes Test-26 (or the EAT-26). You can take the test anonymously here.

Thinking that your disordered eating is not "bad enough" to seek help or the idea that you aren't sick enough to merit the help of a professional is one of the main reasons people suffer from eating disorders. Getting help sooner rather than later helps to speed recovery and lift the burden off your shoulders. 

2013 No diet day campaign!

http://equilibre.ca/journee-internationale-sans-diete/