Health promotion programs can lead to stigma, discrimination: Study

Looks at issue of individual responsibility versus organizational responsibility

Health promotion programs can lead to stigma, discrimination: Study
Team events help create greater camaraderie and inclusion, especially for employees who are not proactively taking care of their health and wellness and may feel intimidated, says Tammy Brazier of GoodLife Fitness. Sharomka/Shutterstock

As yet another holiday season approaches, many employees will be striving to maintain a healthy lifestyle despite many sugary, fatty temptations.

Increasingly, employers have stepped in, offering different kinds of workplace programs to help workers combat the bulge or improve their overall wellness.

But too much of a focus on individual responsibility for health — versus organizational responsibility — could be having a negative effect, in inadvertently facilitating stigmatization and discrimination against overweight people, according to a study out of the Netherlands and the United Kingdom.

“These workplace health promotion programs (WHPPs), even though they are implemented with the best of intentions, can actually have substantial backlashes that nobody really anticipated,” said Susanne Täuber, associate professor and Rosalind Franklin fellow at the Faculty of Economics and Business at the University of Groningen.

The research is based on the results of three studies — one surveying 255 people, another involving 96 undergraduate students, and a third surveying 250 people — looking at WHPPs and issues around weight, controllability and stigma.

Controllability, stigma

In the end, the researchers found the mere presence of a WHPP in the workplace is associated with perceptions that being overweight is more controllable.

“Ultimately, we know that there are myriads of different factors that contribute to people’s health, and while there is for certain an element of personal responsibility, there is a much wider responsibility that’s ultimately impacting people’s health,” said Stuart Flint, a senior research fellow at the Carnegie School of Sport at Leeds Beckett University.

“People aren’t informed enough about the uncontrollable factors, and we focus on placing the blame on individuals.”

There are many other factors that are also related, such as income, genetics or marketing, he said.

“It’s not just simply how much you eat and how much exercise you do. And… that’s why we have continuous simplified messages about ‘You can lose weight easily by eating less and moving more.’”

The study also found there is greater stigma around weight when an WHPP emphasizes individual responsibility compared to organizational responsibility for health.

There are basically two sides of the coin, said Täuber, co-author of the study.

“Employees who are normal weight and pursuing a healthy lifestyle… the more they think that, for instance, weight is something in the responsibility of employees, the more they find colleagues with obesity not very nice anymore, and not very competent, and you see outright discrimination.”

On the other hand, if people with obesity are exposed to a program that emphasizes individual responsibility, they feel responsible for their weight, but they also find it uncontrollable, she said.

“This is a horrible situation for people, so that you feel responsible for something but, at the same time, you feel you have no control about it in motivational terms — it’s quite a doomsday scenario. It basically leads to learned helplessness, so I think that the consequences of emphasizing employees’ responsibility too much are quite negative, just for how people relate to each other in the workplace, and also for their motivation and how they think about themselves.”

Employees with a higher BMI might actually self-stigmatize, leading to physical and mental health issues, found the study.

“Morality is invoked when controllability is invoked,” said Täuber. “By saying employees are responsible for their health, organizations also imply that employees (who are) overweight, or who smoke, are immoral. This, of course, leads to very unpleasant relationships between employees.”

Making it better

To reduce weight-based stigmatization and discrimination, WHPPs should be designed and communicated in ways that emphasize the responsibility of the organization rather than just the individual employee, said the researchers. This can be done, for instance, by offering healthy food at work, providing standing desks or encouraging people to use the stairs.

“If you’re taking away individual responsibility, controllability, totally, then people of course have no incentive whatsoever to actually change their behaviour; so we’re not saying you can take it away entirely, we’re trying to say be careful with the way you phrase your workplace health promotion programs, and try to emphasize that you, as the employer, feel responsible for employees’ health,” she said.

“Of course, it is important that employees have the feeling they have control about their health, because otherwise changing behaviour is really useless — so this is really about a balance.”

Employers should definitely take a more active role in providing spaces that are conducive to the messaging, said Tammy Brazier, senior director of corporate and business development at GoodLife in Toronto, citing as examples the provision of regular breaks, stretch-and-breathe programs or nutrition information.

“It’s not enough to provide lip service, so to speak… You can talk about it but if you’re not actually taking actions to implement and support the messaging, then absolutely that can be conflicting for an employee.”

The most successful wellness programs are joint efforts, said Brazier.

“All employee wellness programs should be employee-driven. And what I mean by that is… the employer has an obligation to be invested in how that employee is feeling, what the work environment is allowing them to do, be it from a productivity standpoint, from just an overall wellness position,” she said.

“The employee is absolutely responsible in driving that business, if you will, and organizations are really just providing tools and programs in response to what employees are asking for.”

Team events also help create more camaraderie and inclusion, said Brazier.

“You don’t have to stand out on your own and take this step towards something that, in many cases, you’re unfamiliar with, you’ve got unknowns. Most people are intimidated, who are not proactively taking care of their health and wellness… by what they don’t know, so sometimes that whole team inclusion and challenge type of environment is what allows them to take a step in without being in the spotlight.”

Ultimately, the focus on personal responsibility can have a very negative impact on people, said Flint, co-author of the study.

“But also, from a structural perspective, it also reduces the incentive or the need for organizations or even government… who might be controlling a system to act themselves because it’s reducing their responsibility or their accountability for the health within that system.”

Reinforcing the message that weight loss, for example, is simple and can be changed rapidly is not only incorrect, but can be demoralizing, he said.

“(It) can reduce people’s motivation to engage in health-related behaviours because, ultimately, we know that that’s not going to happen,” said Flint.

There needs to be a greater focus on behaviours rather than outcomes, he said.

“A lot of the interventions currently are every much (about) reducing a health concern, whether that’s cardiovascular disease, diabetes, obesity, rather than actually the behaviours… because they’re the things that people can have more control over... And, therefore, when you don’t meet a target or an outcome that is supposedly your goal, it’s less likely to demotivate.”

Wellness is not a destination, said Brazier.

“It’s not a number on a scale with respect to weight, it’s not a place that you’re actually getting to, it really is about the journey,” she said.

“Everybody is at a different point, and that’s completely OK. The intention of wellness programs should not be to get an employee to a certain point but to have them feeling great about what they’re doing on that journey — and that’s different for everyone.”

Latest stories