Preventing diabetes and obesity

The first in C3′s series of workshops on workplace health (following a successful initial workshop on ‘Next steps for workplace health’, click here >>) was held on 15 June 2012 on the subject of ‘Preventing diabetes and obesity.

• This record of the meeting is available as a pdf for download here >>

Presentation by Iain Frame, director of research at Diabetes UK

The slides from this presentation are available here >>

What is diabetes?

• Diabetes is a collection of health conditions in which the amount of glucose in the blood is too high – either because the pancreas does not produce enough insulin, or because the insulin does not work properly. Type 2 diabetes (for which obesity is a major risk factor) accounts for 90 per cent of cases.
• 2.9 million people in the UK have diabetes; 850,000 are not aware that they have the disease. Many more are at high risk of developing the disease.
• On average, in the UK, people have the condition for nine years before it is diagnosed: symptoms include increased urination, thirst, blurred vision, tiredness and slow healing.
• Complications include heart attack (often the first indication of type 2 diabetes), stroke, retinopathy, kidney disease and neuropathy (potentially leading to foot ulcers and amputation).
• The projected cost of diabetes is £39.8 billion a year by 2035 (17% of the NHS budget), up from £23.7 billion today.

Prevention of type 2 diabetes

• At least 80% of type 2 diabetes could be prevented by lifestyle changes.
• Lifestyle intervention studies have reduced the risk of diabetes by 40–60%, but these studies tend to be very resource-intensive, so they are not generally suitable for translation into programmes that can be widely used. But there is much that can be done to reduce risk – for example, weight management.
• Research has indicated that 78% of people are aware that being overweight is a risk factor for diabetes, and that they understand the risks, but still do not act on this knowledge.

The Diabetes UK Healthy Lifestyle Roadshow

• Iain described the Roadshow, which began in 2005, and aims to reach the undiagnosed and to raise awareness in high-risk communities. The key message is that you can do something about it, and there is a focus on healthy lifestyles and prevention. Risk assessments are carried out, and anyone at high or moderate risk is referred to their GP (and given a letter to take with them to explain that they have completed the risk assessment).
• In 2011, the Roadshow visited 52 locations, undertook 11,000 risk assessments, and referred over 5,000 people (although it is not possible to know how many people followed through on their referral).
• The Roadshow generally visits public spaces, but the model could be adapted to a wide range of places (e.g. workplace car-parks).

Main themes of discussion

The workplace is a crucial arena in which to act on diabetes:

• The workplace is a good place to promote health, because it is convenient and free – employees are not going to disappear; we know where they are and we can engage with them. Employers will have to act to keep people well for longer because of the ageing demographic.
• Employers need to do something with the workforce or engagement just will not happen: knowledge alone is not enough (we all know about the problems obesity can cause, but it is still increasing). The culture of the company, and how health is communicated within the company, is very important – for example, addressing privacy concerns as to who will see the results of health risk assessments.
• A barrier to workplace health can be that many health professionals do not speak to companies in language that engages senior leadership. Advocates need to keep messages really straightforward and change the way we talk. Local health and wellbeing coordinators have been helping to translate these health issues into business language.

Occupational health could play a greater role:

• Ideally, occupational health providers will be engaged with prevention; but they tend to be reactive rather than proactive, and OH providers often do not see health promotion as part of their remit. Training people new to the field is not enough: we also need to update the knowledge of those currently working in occupational health. Lifestyle nurses are few and far between!
• In addition, the majority of businesses are SMEs, and are too small to have an OH person in the team; big corporates can embrace new ways of working, but it is harder to filter this down to SMEs.

Delivery of information by non-specialists is important:

• The most powerful advocates of behaviour change can be the employees themselves – even when OH personnel are very engaged with prevention, they do not have the level of influence wielded by peers, and getting messages using peer influencers could lead to a ready-made army of health advocates.

Tools can help to get the word out:

• Videos can be useful, such as the Diabetes UK animation, which one participant has found really helps people with diabetes to understand their disease: http://www.youtube.com/watch?v=jHRfDTqPzj4&feature=youtube_gdata_player
• One company is producing short health videos for line managers to show to their teams – and line managers find them very valuable because they do not have to give a presentation themselves.
• Expert patients’ blogging can also be valuable.
• Capturing stories on diabetes success can be valuable (although may be inadvertently off-putting – for example, highlighting major weight loss can feel unattainable to many).

Data are needed to prove the benefits of workplace health:

• There are tools that allow companies to estimate the costs of ill health, and the potential impact of workplace health programmes – helping to make the case.
• Data need not be exact to make people take notice – for example, companies make basic calculations on the number of people with diabetes by extrapolating from the statistic that (say) about 6% of the working population has the disease.
• Simple statistics on deaths among individuals at a workplace can be very powerful: many business leaders are motivated by this sort of very personal, non-business case.

Health risk assessments:

• Take-up of HRAs is much higher in companies in the US where an HRA is needed before health insurance is given. Where they are voluntary, take-up is much lower – although one company’s success in offering its employees a health check (300 people a year on a rolling basis) was noted, with take-up of over 90% in the UK.

Example: the Olympic Park

• An excellent example of holistic OH is the new Olympic site in East London. Most people working on the site were not directly employed, and will have been worried they would lose their job if they had been identified as having an illness – so it is particularly impressive that so many engaged with the programme.
• 75% said that they would change their behaviour in future because they had received such good support from the programme.
• The contracts with the agencies had ‘designed in’ engagement from the start.
• A video, ‘Raising the bar for health’, is available at http://www.youtube.com/watch?v=zJYP38aGkK4

Example: National Grid

• National Grid is focusing parts of its resources on reaching identified ‘high-risk’ populations and providing support for them to make sustained change. The rest of its working population is encouraged to make small changes (i.e. moderation) – and it is also important to have fun!
• The company is taking ideas from many different areas and packaging and delivering them in new ways.
• The company is investigating nutrition among its shift workers, mental health issues (especially in its call centres), etc., and there is a suite of service providers to deliver the wellbeing programme, including in the near future a mental wellbeing adviser and a health coach. In addition, the role of occupational health has changed its approach and is now looking to ‘make every contact count’ by retraining the occupational health advisers to have motivational behaviour-change discussions with employees that present for illness or injury, but have underlying wellbeing issues. Over the next few years, line managers are being encouraged to engage with these employees and encourage them to address their lifestyle issues through entry into the work-based or external health-improvement programmes.
• National Grid has been collecting data over a couple of years, helping the company to identify the groups that most need support. For example, external analysis of this data has enabled the link to be made between excessive weight and absence, and that absence and reduced personal performance. Following on from that, National Grid is sponsoring a range of weight-management programmes for employees with BMIs over 35, and Kingston University is validating the outcomes (the results of the weight-management programme will be published in the future). Involvement in National Grid programme is voluntary for the most part, although some employees do have mandatory health checks based on their workplace risks.
• Senior leadership is very important in National Grid, and the CEO now wants to know the impact of workplace health programmes on employees’ lives – i.e. going beyond the basic return-on-investment argument. Individual stories can be very powerful in motivating the board to take action.