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Undernourished and Obesity

Problems in Workplace
Siti R. Nadhiroh
Nearly a billion people are undernourished and
one billion are overweight or obese; a stark
contrast of the haves and have-nots (WHO,

Workplace meal programmes can prevent

micronutrient deficiencies and chronic diseases,
including obesity

Investments in nutrition are repaid in a reduction

of sick days and accidents and an increase in
productivity and morale.
• Access to healthy food (and protection from unsafe and
unhealthy food and eating arrangements) is as essential
as protection from workplace chemicals or noise.

• Adequate nourishment can raise national productivity

levels by 20 per cent (WHO, 2003).

• a 1 percent kilocalorie (kcal) increase results in a 2.27

per cent increase in general labour productivity
(Galenson and Pyatt, 1964).

• Increasing the average daily energy supply to 2,770

kcal per person per day with adequate nutrients in a
sample of countries could have increased the average
annual GDP growth rate by nearly 1 % each year
between 1960 - 1990 (Arcand, 2001).
• Hypoglycaemia, or low blood sugar, which can
occur when one skips a meal, can shorten attention
span and slow the speed at which humans process
information (McAulay et al., 2001).
• Obesity accounts for 2–7 per cent of total health
costs in industrialized countries (Kumanyika et al.,
• In the United States, the total cost attributable to
obesity calculated for 1995 amounted to US$ 99.2
billion (Wolf and Colditz, 1998).
• Studies : obese workers are twice as likely as
fit workers to miss work (Wolf and Colditz,

• In 2001, NCDs contributed to about 46 % of

the global disease burden and 60 % of all
deaths worldwide, with cardiovascular

• The global disease burden from NCDs is

expected to climb to 57 % by 2020 (WHO,
The price of poor nutrition

• Nearly a billion people are undernourished while

over one billion are obese or overweight.

• The cost of cardiovascular disease for the United

States in 2002 was US$329.2 billion

• In India, the cost of lost productivity, illness and

death due to malnutrition is US$10–28 billion, or 3–
9 % of GDP

• Iron deficiency accounts for up to a 30 per cent

impairment of physical work capacity and
The rationale for government
• Governments gain revenue from increased work
productivity and reductions in health costs for adults
and, by feeding children, through securing future
generations of healthy workers.
• In 2001, NCDs contributed to about 46 % of the global
disease burden and 60 % of all deaths worldwide, with
cardiovascular disease alone amounting to 30 % of
• The global burden from NCDs is expected to climb to 57
% by 2020.
• Obesity accounts for 2–7 % of total health costs in
industrialized countries.
The rationale for employers
• Obesity and iron deficiency both result in
fatigue and loss in dexterity (kecekatan)
• A 1 % kcal increase results in a 2.27 %
increase in general labour productivity.
• In the US the annual economic costs of obesity
to business for insurance, paid sick leave and
other payments are US$ 12.7 billion.
• In Canada, the cost-effectiveness of workplace
health promotion programmes is estimated to
be CAN$1.75–6.85 (US$1.50–5.75) for every
corporate dollar invested.

Nutritionists have established the energy

expenditure for men and women for a variety of
activities. Sedentary office work requires 1.8 kcal
per minute; sitting requires 1.39 kcal per minute;
farming, mining, forestry and construction can
require 5 to 10 kcal per minute worked.

Poorer nations are more likely to rely on manual

labour; and workers in poorer nations are more
likely to consume inadequate calories for these
labour-intensive tasks.
For example,

Among males, sedentary office work requires 1.8 kcal/mnt;

sitting requires 1.39 kcal/mnt; and sleeping requires
1.08 kcal/mnt.

Over the course of a day, eight hours of each activity amounts

to a 2,050-kcal expenditure. In this scenario, consuming
more than 2,050 kcal will lead to weight gain.

Farming,mining, forestry and construction can require 5 to 10

kcal per minute energy. Substituting this for office work in
the above scenario, the energy requirement for the day rises
to over 3,500 kcal. Consuming fewer calories than this will
result not only in weight loss over time but also an inability
to perform the work.
Inadequate intake of food to meet energy requirements will
result in weight loss and often the breakdown of body
tissue. In both scenarios – obesity or undernourishment –
the result is a decreased ability to work and to resist

Poorer nations are most likely to rely on manual labour,

and workers there are mostly likely to be underfed. One
study has shown that some cutters in South African sugar-
cane fields lose 3 % of their body mass
• Merely providing enough calories to workers to
perform their tasks will not guarantee good health.
Some workers in poorer nations :
 mostly carbohydrates – such as corn porridge or
bread – and little protein, fat or micronutrients.
 cannot sustain their health on this kind of diet for
• in wealthier nations, office workers could consume
most of the daily requirement of 2,050 kcal in one
meal of a cheeseburger, fried potatoes and a
milkshake, yet receive few micronutrients, such as
vitamins A and C.
• Food choice is clearly crucial for maintaining good
• WHO suggests that 8–15 % of the total energy consumption
should come from protein, with the range depending on
whether one is eating high- or low-quality protein or in
convalescence (WHO, 1998, p. 59).

• Of this, 10–25 per cent of dietary protein should be of

animal origin (WHO, 1998, p. 58). Virtually all unprocessed
foods contain protein, even foods thought of as
carbohydrates, such as rice and wheat.

• Animal products are considered to provide the highest-

quality protein. This includes beef, lamb, game (buruan),
fowl (ayam), fish, some insects, dairy products and eggs.
• Legumes – particularly soya and other beans, –
are considered very good sources of vegetable
protein, as are nuts and some seeds.
• Potatoes are high in protein quality but low in
• cereals and leafy vegetables are low in protein
quality but complement legumes.
• Whey protein (commercially available in
powder form) is a high quality, relatively
inexpensive protein source with suitable for
warm climates and remote work locations
• Fats provide essential fatty acids, which are
not made by the body and must be obtained
from food. These fatty acids are the raw
materials that help regulate blood pressure,
blood clotting, and other body functions.
• necessary for healthy skin and hair and for
the transport of the fat-soluble vitamins.
• Fats serve as energy reserves, stored in the
adipose tissue (fat cells) that helps cushion
and insulate the body.
Healthier fats
• Polyunsaturated, omega-3 – flaxseed and
flaxseed oil, oily fish such as salmon, mackerel,
herring, dst
• Polyunsaturated, omega-6 – most liquid
vegetable oils such as sunflower, corn and soya
bean, sesame oil and most nuts.
• Monounsaturated – olives and olive oil, avocado,
Fats to use in moderation
• Saturated fats – found in most animal
products, such as butter, cheese, ice cream,
organ meats and lard and beef
• also in tropical oils such as coconut, palm
Fats to avoid
• Trans fats – found in fried foods, processed
foods and commercial baked goods such as
crackers, biscuits and doughnuts.
Food solutions
Cost and place
• The company can ensure that workers have healthy foods
at a reasonable price.
• Canteens are clearly an expensive option, and require
• Vouchers allow the employer to avoid some of these
costs. Workers use vouchers to choose from local
• Mess rooms can be less expensive than vouchers,
although these too require space. In their simplest form,
mess rooms are merely rooms in which food is served.
An outside company could provide the daily food
Time, timeliness and rest
• Employers have to ask whether, for example,
30 minutes is enough time for employees to
walk to the food service, choose a meal, pay,
find a seat, eat and return to work.
• The type of work must be considered too.
Workers performing hot, exhausting labour
need more time to rest. Industrial workers
need extra time to change from their
protective clothing and wash.
Comfort and accessibility
• Canteens and mess rooms can offer workers a
place to relax and bond; they should be
within safe walking distance from the work
area, offer affordable food, and be sheltered
from the weather
Dole Food Company, Inc.
Westlake Village, California,
United States

A typical weekly menu at the Dole canteen. Main courses are low-fat. Vegetarian dishes are
available daily and healthy food is subsidized.
San Pedro Diseños, S. A. revamped meal programme to address workers’
Guatemala City, Guatemala lack of calories and nutrients.
The basics of the new meal programme include: cooking facilities; a dining
area; subsidized meals; an hour-long meal break; free sweet bread and coffee
during the breaks; and a healthy, varied menu

since the creation of the new meal programme, Workers are more productive and more
satisfied; morale is higher; absenteeism and the need for rotation due to illness have
fallen; and medical costs are down. Since 2001, production has increased by around
70 % and annual earnings have increased approximately 20 %.
• provided by the employer to employees, or sometimes their families,
for food and meals at select shops and restaurants.

• Employers contribute 50-100 % of the face value of the voucher.

• Laws specify maximum tax exemption and employee contribution,

as well as the types of shops and restaurants that can participate, the
types of items that can be purchased (no alcohol or tobacco, for
example) and the daily use (number of vouchers accepted, no change
given, etc.). Laws vary from country to country.

• Vouchers are usually in paper form with rigorous anti-counterfeit

elements; electronic “smart cards” are gaining popularity.
A mess room is a place where employees eat food
prepared elsewhere. There is minimal food storage.
Local vendors or caterers bring food for daily
Employees can reheat their own food. Vending
machines might be available.
A kitchenette is a small kitchen, often with an adjoining
dining area where employees can store, cook or
reheat food brought from home.
Typical appliances include a small refrigerator, a
microwave, a hotplate or a small stove.
employee-operated kitchen areas
• encourage home cooking, which is usually
healthier than nearby street food in terms of
nutritional content and food safety. Cooking
facilities, may include a steam cooker, an
oven, a food warmer, a refrigerator, a sink,
pots and, a coffee maker.
• employees often bring warm, home-cooked
meals to work, which they place in a food
warmer to keep warm
• inexpensive ideas for providing safe and healthy food.
• Employers can support local vendors to improve food
• Employers can provide infrastructure to make
food safer: ice, ice buckets, stainless steel trolleys or stalls,
clean water, etc.
• Employers can persuade food van operators or shop
owners to serve healthier food through financial incentives
or the promise of regular customers.
• Refreshments, particularly during meetings, are often
sweet and fatty foods, yet healthy alternatives abound. One
healthy trend is free workplace fruit; another is healthy
vending machines.
on-site farmers’ markets, along with
healthier meeting foods

Kaiser Permanente of Northern California

The End – Thank You
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