Improving the Nutrition Environment in Manufacturing Practical Strategies for a Healthy Workforce by Innovations2Solutions

Improving the Nutrition Environment in Manufacturing: Practical Strategies for a Healthy Workforce Becky C. Williamson, M.S. Nutrition and Wellness, ACSM - CPT

American manufacturers continue to shoulder much of the healthcare burden and productivity costs associated with obesity-related chronic diseases and disability in the United States. Forward-thinking companies, however, are focusing on providing good nutrition and fostering positive eating behaviors as part of their riskmanagement strategy, to improve the overall well-being of workers.

THE COST OF OBESITY CONSEQUENCES OF POOR DIETARY HABITS Millions of working Americans battle obesity and chronic obesity-related diseases on a daily basis. According to the Centers of Disease Control and Prevention (CDC), 34.9% of U.S. adults were classified as obese between 2011 and 2012. Chronic obesity-related diseases, such as Type 2 diabetes, hypertension, heart disease, stroke, and some cancers, are the most prevalent conditions, and some of the most preventable causes of death. Obesity-related conditions are very costly; in fact, overweight and obese Americans spend an average of $1,429 more per year on healthcare, when compared with their normal weight counterparts.1 In 2012, Sears, Yuyan, Coberley, and Pope determined that U.S. employers spent a staggering $534 billion on health care and an additional $226 billion on absence and performance loss due to health issues.2

We spend 54% of our waking hours at work.

Although genetics and socioeconomic status play a role in obesity, behavior and environment contribute significantly to the problem. Statistics from the U.S. Department of Labor indicate that Americans between the ages of 24-54 years old spend approximately 54% of their waking hours at work, with little more than an hour dedicated to eating or drinking.3 The workplace environment is therefore uniquely situated to influence workers’ dietary choices, lifestyle behaviors, and wellbeing—all of which can have a significant impact on productivity, healthcare costs and retention. Other indirect costs of overweight and obesity point to “presenteeism.” Presenteeism is defined as being at work, but not fully able to function due to diminished mental clarity, illness, or other health conditions. Presenteeism is a serious productivity issue that results in hidden costs from lost innovation, job-related errors, lower output, and potential accidents.4

THE COST OF OBESITY IN THE MANUFACTURING SECTOR Employees in specific industries, including the manufacturing sector, have higher rates of overweight and obesity as compared with other industries. A 2013 Gallup Poll indicated that 82% of workers in manufacturing or production were above normal weight or had more than one chronic condition. These workers missed 0.24 more work-days each month as a result of their sub-par health, costing companies an estimated $2.8 billion in productivity losses per year due to absenteeism.5

missed 82% 0.24 overweight or have 2+ chronic conditions

more work days each month

$2.8B

productivity losses per year due to absenteeism

Overweight and obese workers are also more likely to sustain an injury while at work, and unfortunately the manufacturing sector is known to have one of the highest rates of injury and illness. A 2007 study examined data from 7,690 hourly workers at eight U.S. aluminum manufacturing plants and found that 85% of injured workers were either overweight or obese, with leg or knee injuries especially prevalent among The information and concepts contained in this document are the proprietary property of Sodexo. As such, they cannot be reproduced or utilized without permission. ©2015

Overweight workers are more likely to sustain an injury while at work. workers in the very obese group. In addition, the odds of injury were 2.21 times higher in the highest obesity group as compared with the ideal body mass index group, even after adjusting for sex, age, education, smoking, physical demands of the job, plant process and location.6 Availability and/or effectiveness of personal protective equipment may also be an issue for obese workers, raising the risk for job-related injuries.7 According to the 2013 Workplace Safety Index study, the most disabling workplace injuries and illnesses in 2011 amounted to $55.4 billion in direct U.S. workers compensation costs.8 Time losses and other indirect costs incurred by injured employees also pose a sizeable hidden impactâ&#x20AC;&#x201D;the National Safety Council estimates that the lost time associated with the average injury costs nearly $30,000. With this in mind, many manufacturers are asking: What are some of the causes behind the costly, high rates of overweight and obesity in this industry? World-class manufacturers have turned internally to study potential barriers faced by their workers.

BARRIERS TO GOOD HEALTH IN MANUFACTURING Evidence-based research suggests a link connecting nutrition to brain and body function, with a direct association to work performance.9 Factors negatively impacting food choices and eating behaviors in manufacturing environments seem directly related to time pressures, job stress, and psychosocial and environmental cues.9,10,11,12

Recent studies indicate shift workers experience a higher prevalence of overweight and obesity as irregular work hours disrupt their daily routine, impair biological rhythms, and result in higher frequency of meal intake and/or poor nutrition quality.10,11 A 2008 study examined the energy intake of 2,254 male manual workers in a Japanese metal products factory. Higher total caloric intakes were shown among factory workers who worked the midnight shifts versus those working the daytime shifts. In this study, a correlation between shift work and obesity was determined to be statistically significant even after controlling for physical activity at work and/or during leisure time.11

Physical and Psychological Job Stress Many production occupations require manual labor and physical strength for lifting, loading, and unloading of heavy objects. Bending, stooping, reaching, and long hours of standing while tending to machines or managing production processes are common. Assembly and fabrication occupations may require long periods of standing, sitting, and repetitive motion, along with high levels of mental focus to operate high-powered machinery. In certain manufacturing environments, for instance food processing or metals production, workers may be exposed to temperature extremes. Optimal nutrition to fuel and hydrate body and mind are therefore essential in workplaces that can be both physically and mentally demanding. Stressful work environments, whether resulting from time pressures or the demanding nature of job tasks, may also result in poor eating behaviors. Such behaviors include skipping meals, eating at workstations, a preference for high-calorie foods, or overeating during meals after work. Stressed and fatigued workers may use food as a means to cope with work-related stress, contributing to the development of obesity.12

Time Pressures Time pressures that serve as barriers to good health include working evening or night shifts, working a schedule that interferes with family mealtime, or having an inflexible job schedule. A typical 30-minute lunch break may not provide sufficient time for a worker to take a restroom break, walk to the cafeteria, select and purchase a healthful meal, and eat mindfully.9 Increasingly, meeting production demands and optimizing for business competitiveness require U.S. manufacturers to adopt the practice of shift working, a pattern of working twenty-four hours per day. Shift workers represent an estimated 24% of the working population, including manufacturing employees. The information and concepts contained in this document are the proprietary property of Sodexo. As such, they cannot be reproduced or utilized without permission. ÂŠ2015

Workplace Factors Company factory sites are often located away from the main business buildings where the cafeterias are typically situated. Depending upon the type of manufacturing—some factories emit unpleasant odors—the sites may also be purposefully located away from neighborhoods or cities where healthy food options are more readily available. This makes it difficult for workers to purchase nutritious meals and eat in a relaxing environment. In addition, factory break rooms often consist of little more than a few vending machines, which more often than not offer highly processed, fat and salt-laden food options, or sugary beverages with low nutritional value. If a refrigerator is available, workers are dependent upon their personal nutrition knowledge and ability to bring healthful meals from home.

Manufacturing worksites may be located away from neighborhoods where healthy food options are readily available.

A supportive workplace that focuses on access to healthful food, education, and lifestyle behaviors can improve worker well-being and reduce employer costs. The following strategies and tactics can help manufacturing companies achieve these goals for their workforce and the organization as a whole.

Obtain Organizational Commitment Successful cultures of health and wellness requires passion, persistence and persuasiveness from leadership at all levels, including collaborative support from union leaders. A worksite wellness program should be wellaligned with company identity, the workplace culture, and long-term organizational aspirations.16 Business leaders realize that time, financial investment, and policy support are needed to make lasting changes in workplace culture. A recent survey showed that 75% of high-performing companies consider heath status as a factor in their risk management strategy. In addition, a healthful work environment fueled by engaged work teams serves as a competitive advantage, enhancing employee recruitment and retention.4,17

Establish a Wellness Committee Psychosocial Factors Finally, it is crucial that manufacturing companies not overlook the social aspect of meals and the effect that social cues can have on individual dietary choices. Most people enjoy eating food with others, as it creates a sense of belonging and adds enjoyment to the dining experience. Individual eating behaviors, however, are strongly influenced by social cues and the values of fellow diners, whether co-workers, family members, or friends. Studies show overconsumption during mealtime is likely to occur when eating companions consume more. Work-related events involving food, such as celebrations, fundraisers, and social events, may also result in excess caloric intake.12,13

PRACTICAL STRATEGIES FOR A HEALTHY WORKFORCE The manufacturing industry faces many challenges in addressing the health of its workforce; however, these barriers present organizations with strategic opportunities for intervention. Evidence exists that healthier employees have lower rates of chronic disease and work-related injuries. Research suggests that companies see nearly $3.27 reduction in medical costs for every dollar invested in workplace wellness programs, along with a reduction of $2.73 in absenteeism costs.14

One way to improve the manufacturing nutrition environment is by creating an employee advisory team to identify and provide suggestions for issues contributing to poor employee health and habits. A “wellness committee” can introduce new ideas, develop nutrition and lifestyle-based policies, and determine program outcome objectives shared amongst employees, management, wellness staff and service providers.18 Wellness committee-driven nutrition policies developed in partnership with foodservice vendors can also provide access to healthier food options, and promotes continual health-awareness through positive food marketing messages.

Define, Measure, and Evaluate Success Health promotion program effectiveness must have outcomes in sight and metrics put in place prior to implementation. Evaluation of worker productivity, healthcare costs, health outcomes and organizational change allow for measurement from the beginning of the program. They also provide important feedback for course correction and insight on effectiveness and improvement at the end of the campaign.19 Worker health needs and interests should be assessed for building and developing supportive environmental intervention campaigns. Ongoing awareness raising, education and skill-building activities, along with program monitoring and evaluation are also critical

components for successful worksite wellness programs.20 Some evidence exists that workers respond positively to workplace health promotions when both workplace and personal objectives are addressed, rather than just personal risk factors.7

Create a Supportive Eating Environment Wellness committees cite strategic policy changes, such as adjusting scheduled shift work and work breaks, as supporting both the workplace and personal needs of the worker. For example, management can collaborate with company unions to design worker shift schedules that allow for more rest time between night and day shift rotations. Shift rotation forward from day to afternoon to night, are considered to help with circadian rhythm adjustment. Longer breaks during each shift are scheduled providing ample time for workers to obtain and enjoy a well-balanced meal or snack, and relax before returning to work.

Improve On-site Dining Facilities An attractive, well-lit and comfortable cafeteria where healthy food options are available to accommodate nutritional needs for all workers, including specific nutritional differences between day and night shift workers due to circadian rhythms, is well- received and demonstrates company commitment toward wellness.21 Conveniently located break rooms with ample appliances, amenities for food preparation, and healthful vending machine offerings are also supportive.

Offer Nutritious Food Options According to the CDC, availability of healthy foods in the workplace can positively affect employee nutrition.22 Since manufacturing work can be both physically and mentally demanding, providing nutritious food and beverages to meet energy needs and maintain mental focus should be a priority. Convenient access to nutrient-dense foods in cafeterias and healthy vending machines can fuel a workforce toward optimal productivity. Food policies for social events can also help achieve better worker health; these can include promoting healthy employee celebrations or fundraising events in which healthy foods are offered as rewards or incentives. Meals and snacks should be rich in long-digesting carbohydrates to meet energy demands and to prevent blood sugar crashes, which lead to fatigue. Lean proteins should be balanced with healthful fats to promote satiety and enhance mental acuity.9 A variety of beverages, including high-quality coffee offerings, can also promote worker satisfaction, while boosting mental and physical endurance, especially during late-night or early-morning shift work.

The information and concepts contained in this document are the proprietary property of Sodexo. As such, they cannot be reproduced or utilized without permission. ÂŠ2015

Employ Communication & Marketing Techniques Overarching wellness objectives can be communicated by leveraging food marketing techniques and branding materials provided by foodservice partners in cafeterias and dining areas. For example, providing seasonal, healthful options with appropriate portions on cafeteria menus, while highlighting the healthiest choices, can help motivate workers to make more nutritious selections and support company wellness initiatives. Conveniently placed, reasonably priced nutritious options, along with nutrition fact sheets at point of sales locations, including vending machines, can help promote employee participation and potentially increase sales. A U.S. study conducted in 2010 demonstrated that increased sales were realized when availability of healthy food options (beverages, snacks and entrees) were offered in vending machines with a 10% reduction in price as compared with the unhealthier options.23

Offer Ongoing Awareness Raising, Education and Skill-Building Activities As supportive eating environment elements are put in place, nutrition and lifestyle behavioral intervention campaigns should be implemented to create ongoing awareness, provide education, and help workers build skills leading toward healthy eating and lifestyle habits. Healthy worksite promotions require effective communication strategies ranging from individual to mass presence.24 Company intranet and signage, such as posters and flyers around production areas are effective communication vehicles. Discussion by work area supervisors and managers clarifies wellness program specifics and employee incentives during staff meetings.25 Educational and skill-building programs offered at work, including seminars on the connection between health and safety or â&#x20AC;&#x153;Lunch and Learnâ&#x20AC;? sessions on healthful food and lifestyle behavior modification, can positively affect worker dietary habits. Company-sponsored skill-building activities involving the entire family, such nutrition label reading, menu planning, food safety and cooking classes with Registered Dietitians can promote long-term, lifestyle behaviors. One-on-one, low or nocost counseling interventions with a Registered Dietitian can increase access to company-provided services and help individuals develop additional skills needed to positively affect food preparation and eating habits. Self-monitoring techniques and overcoming barriers to selecting healthful foods can serve as motivation and support for individual workers to make healthy behavior changes.26

The information and concepts contained in this document are the proprietary property of Sodexo. As such, they cannot be reproduced or utilized without permission. ÂŠ2015

CASE STUDY Lincoln Industries, a metals manufacturing company in Nebraska, has incorporated health-related goals into workers’ performance objectives for more than 20 years. Its wellness programs, which include nutrition-based weight management initiatives and the promotion of healthy behaviors, have helped the company save more than $1 million. The company also boasts healthcare costs per person of less than a half to two-thirds of the industry average.15

Motivate Employees to Take Action A supportive environment, along with individual knowledge and autonomy, have been shown to positively motivate and engage employee and are positively related to safe working practices.27 However, fully engaging workers after initial participation can be challenging. Ongoing awareness campaigns providing constant communication and motivation for workers are necessary.28 Healthy behavior role modeling by management, union leaders and supervisors can demonstrate leadership commitment, continuing the momentum of successful wellness-based programs. Finally, company social committees can lend ongoing peer group support to encourage employees toward meeting personal eating goals.

Extrinsic incentives are external motivators, usually a tangible reward, which may be used to engage participants in activities. Examples include reduced copays or insurance premiums for demonstrated healthy behaviors, or financial incentives for participating in company wellness activities (e.g., gift cards or cash prizes). Employer- sponsored offerings, such as supermarket tours, health screenings, Lunch and Learn sessions, and walking clubs are also effective extrinsic incentives used to promote employee engagement in wellness programs.

CONCLUSION The manufacturing setting is seemingly a challenging environment for workers who wish to make positive food and nutrition changes. However, companies today recognize that worker health and wellness are major contributors to an organization’s prosperity and longterm success. Evidence shows that workers actively participating in wellness programs are absent less often and perform better at work as compared with their non-participant counterparts.2,6,12,13 As a result of such programs, worker self-efficacy, self-esteem and commitment increase, resulting in higher employee morale, a thriving organization, and reduced health care costs.14 As more forward-thinking manufacturers implement wellness programs focused on healthful food options and positive eating habits, workers will become healthier, happier, and more productive—and company profitability will soar. It’s a winning strategy for everyone.

Utilize Incentives Incentives provide another means to increase motivation toward continual participation, and have long been used to drive worker engagement in wellness programs. Two commonly used strategies include intrinsic and extrinsic incentives. Intrinsic incentives increase personal satisfaction and motivate people from within themselves. Intrinsic motivators can include feelings of personal pride for progress toward reaching a specific goal. For example, a visual scale depicting number of steps achieved toward 10,000 steps per day in one month can be personally rewarding and motivating toward additional physical activity the following month.

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