The poor diet of shift workers should be considered a new occupational health hazard, according to an editorial in the online journal PLoS Medicine, published by the Public Library of Science in San Francisco.
While some of the effects of shift work are probably unavoidable, such as the disruption of circadian rhythms, others, such as eating patterns, are obvious targets for intervention, said the editorial.
“It would, however, require a change in thinking and an acceptance that occupational health needs to move into territory more personal than before: The diet of workers,” said the journal’s editors. “But such a change would not be unthinkable.”
The editorial, published Dec. 27, draws on a study published in the journal earlier that month that showed a strong correlation between shift work in nurses and the risk of developing Type 2 diabetes. The study used data from the long-running United States Nurses’ Health Study, which has followed 238,000 nurses since 1976.
“The relationship now between shift work and Type 2 diabetes is much clearer, the evidence is much stronger and, therefore, we need to start looking at ways to intervene and the workplace is an obvious place for that to start,” said Jocalyn Clark, a Toronto-based senior editor at PLoS Medicine.
Shift workers are also at greater risk for obesity. This is likely because shift work disrupts circadian rhythms, interferes with the quality and quantity of sleep and has a negative effect on diet and exercise, said the PLoS editors.
“Because shift work disrupts circadian rhythm and, therefore, metabolism, it disrupts people’s ability to eat healthily because it disrupts the normal routine of preparing meals and things,” said Clark.
And shift workers who eat poorly and don’t exercise enough are at greater risk of developing heart disease, angina, stroke, high blood pressure, insomnia and digestive problems, said Rachael Goodmurphy, a public health dietitian at KFL&A Public Health in Kingston, Ont.
More than four million Canadian workers aged 19 to 64 worked something other than a regular day shift in 2005, according to Statistics Canada.
“Shift work does occur across almost every industry,” said Clark. “About one-fifth of people have some kind of irregular working pattern… We can probably speculate that as the economy regresses, and as companies and industries are looking for ways to maximize their efficiency, we may see the growth of shift work.”
Employers have a lot of influence on employees and they have a responsibility to promote the health and safety of workers, which should include support for healthy eating, she said.
OMNI Health Care relies on shift work to provide a 24-7 health-care environment at its 19 nursing homes and long-term care homes across Ontario. To encourage staff to eat better, it provides healthy vending machines stocked with reduced-sodium soups, healthy hot meals and fruit, said Candace Chartier, COO of the 2,000-employee company based in Peterborough, Ont.
“It prompts your staff to buy the fruit and snacks there as opposed to running out to McDonald’s,” she said. “And some staff will do potluck meals and you always get the veggie trays, the spinach dip with pumpernickel — what it does is it prevents the staff from bringing in junk.”
If a workplace has a cafeteria, it should be open and available, no matter what time, to accommodate shift workers, said Clark. The food being offered should follow Canada’s Food Guide and focus on whole foods while limiting processed foods high in calories, fat and sodium, said Goodmurphy.
But it might be challenging for employers to access certain healthy food items since it depends on what their food service supplier offers, she said.
“It’s also a challenge in the perceptions of what employees are expecting in terms of food variety,” said Goodmurphy. “There are perceptions that some employees want unhealthier items so that can be a barrier if there are those misconceptions that get construed.”
Employers can also create a healthy eating culture where management spearheads healthy eating initiatives, puts a healthy eating committee in place and creates policies that require healthy food options at work, said Goodmurphy.
“It could be in their values as an organization, they could support healthy food initiatives such as having a community garden, providing access to dietetic services such as a registered dietitian, providing nutrition education and skills building,” she said.
OMNI employees receive regular healthy eating tips through a wellness newsletter, pay stub attachments and healthy eating in-services once per month, said Chartier.
While providing access to these services and revamping a company culture may be costly at first, the investment will be offset by having a healthier workforce, said Clark.
“It’s always less expensive to prevent disease than to treat it, so any costs associated with implementing interventions in workplace health and safety that include healthy eating should offset the enormous costs associated with treating diabetes and other diseases.”
Employers should not only be concerned about the negative health effects of poor eating, but also about the impact it has on work performance. If employees are eating unhealthy foods, they will experience fluctuations in blood sugars, which cause periods of extreme tiredness, irritability and light-headedness, said Chartier.
“If they’re tired and sluggish, they’re not going to want to do (their) job,” she said. “And, especially in our industry, the personal support workers, it’s a heavy, heavy job — you’re lifting residents, doing a lot of on-your-feet work and you also have to have the clarity to realize what’s going on in the environment around you.”
Offering healthier food options to employees, especially shift workers, can decrease burnout, sick time, overtime hours and benefits usage, which can get out of control with an unhealthy staff, said Chartier.
“We have a lot of older staff and we found we’re getting an increase… of staff who are suffering from insomnia, suffering from heart disease — they’re on really expensive medications for a lot of chronic conditions,” she said. “We wanted to help them because it will help (us) in the end.”
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