Reducing Absenteeism: Obesity-Related Stress in Healthcare

This report investigates the perceptions of obesity-related stress among healthcare workers and its correlation with absenteeism. The study, conducted through qualitative research using semi-structured interviews with five healthcare workers in a New Zealand healthcare institute, explores the participants' understanding of obesity, its workplace impact, and its relation to absenteeism. The findings reveal that fatigue and laziness are perceived as major factors contributing to absenteeism among obese individuals. The study also highlights the impact of understaffing and the need for task compensation, ultimately affecting colleagues. Furthermore, the research aims to identify strategies to reduce obesity-related stress and its impact on absenteeism, offering valuable insights for the New Zealand healthcare sector and contributing to the reduction of lost productivity costs.

0
Running Head: HEALTHCARE
Health care
Name of the student:
Name of the University:
Author’s note

1
HEALTH CARE
Table of Contents
Literature review..............................................................................................................................1
Methodology:...................................................................................................................................6
Results and analysis:........................................................................................................................7
Conclusion:....................................................................................................................................12
References:....................................................................................................................................13
Appendices:...................................................................................................................................18

2
HEALTH CARE
Title: Perception of Obesity related stress at workplace among health care workers to reduce
absenteeism
Literature review
The main purpose of literature review is to present background information on the topic
and increase understanding regarding the correlation between obesity, stress and absenteeism.
Prevalence of obesity related stress at workplace
Obesity is a medical condition associated with accumulation of body fat and any
individual with a body mass index (BMI) of 30 or more are termed as obese. The current global
standard for diagnosing obesity is BMI over 30 kg/m2 (American Diabetes Association, 2018).
Obesity is linked to high risk of many chronic diseases like diabetes, cancer and heart disease. In
New Zealand, BMI is measured using height and weight compared to some other countries
which rely on self-reported values (Stats NZ, 2015). According to the Ministry of Health survey
in 2017, about 34% of the adults are obese in the country. As per the most recent statistics for the
year 2018/2019, around 1 in 3 adults were obese and adults living socioeconomically deprived
areas where most likely to be obese compared to those living i n least deprived areas (Ministry of
Health NZ, 2019). Obesity has become a major public health burden in New Zealand as it has
increased health care and lost productivity cost. According to a study by Lal, Moodie, Ashton,
Siahpush and Swinburn (2012) done to estimate the cost of health care productivity and lost
productivity due to obesity in New Zealand, it was found that obesity resulted in expenditure of
NZ$686 million in the year 2006. A systematic review by Goettler, Grosse and Sonntag (2017)
suggested substantial cost due to lost productivity among workers with obesity. This indirect cost
increased due to losses from decreased productivity due to inability to work. The severity of the

3
HEALTH CARE
issue in New Zealand is evidenced by obesity rate of 65% among minority groups like Pacific,
47% in Maori and 32% in rest of New Zealand citizens. These evidences clearly suggest the need
for policies and interventions to reduce the rate of obesity and decrease the productivity losses at
workplace.
Correlation between obesity related stress and absenteeism
Development of obesity related stress has become a common phenomenon in workplace
which is linked to increase in incidence of body shaming and discrimination at workplace.
Various research studies have examined the incidence of discrimination in the workplace and
these studies mainly explain how stereotypes about obese employees contribute to discriminatory
behaviours. Flint et al. (2016) gave the evidence regarding high stress in obese workers because
of discrimination at the hiring stage. Managers were less likely to call obese people for an
interview as they held negative automatic stereotypes. However, obesity alone was not the cause
of discrimination. It occurred because of gender as well as requirement of the job. The results
from a longitudinal study by Reber, König and Hajek (2018) revealed that overweight and obese
women are often subjected to weight stigmatization and prejudice which leads to increased
feelings of stress and increased job strain. Such situation leads to poor coping strategies which
results in withdrawal behaviours such as sick leave. Thus, the relation between excess weight,
absenteeism and stress has been established from past research evidences too.
Apart from discrimination and obesity related stereotypes, obesity is one of the cause
behind high absenteeism rate at workplace too. Fitzgerald, Kirby, Murphy and Geaney (2016)
gave evidence regarding central obesity to be a strong predictor of sick leave. The researcher
argues regarding paying attention to the workplace for obesity prevention as employees spend

4
HEALTH CARE
longer time in their work environment and workplace culture can create a balance between
organizational targets and workers health. There are various evidence of high rate of absenteeism
due to obesity. VanWormer, Linde, Harnack, Stovitz & Jeffery (2012) reported that obese
employees are more prone to high workplace absenteeism rate as employees with BMI ≥ 30
kg/m2 had 25% higher odds of falling sick. Similarly, the study by Asay, Roy, Lang, Payne &
Howard (2016) revealed absenteeism rate of 30% for obesity. The study also showed high rate of
employee absenteeism due to other factors like smoking, physical activity, hypertension and
diabetes. However, the major gap found in all the studies were that it did not explored about the
issues from the perspective of workers. Evaluating their opinion is important to understand their
expectation at workplace and implement policy changes in workplace so that obese individual
gets equal rights and recognition at work.
Prevalence of obesity related absenteeism in health care setting:
There are many reasons to investigate about the prevalence of obesity related absenteeism
in health care settings. According to Amani and Gill (2013), accurate assessment among health
care professional is important because obesity increased the incidence of muscular disorders and
mental health conditions which is the leading cause of work-related illness. In addition, obesity
increased risk of chronic disease and the associated sickness absence rates which affect the
capacity of healthcare workforce and lead to patient safety issues. Hence, evaluating obesity rate
in health care professional group is important to identify possible contribution of adverse
workplace factors on obesity and consider health promotion efforts of health care professionals
to make positive changes to behaviour of workers in health setting. The study by Kyle et al.
(2017) reported about the prevalence of obesity among health care professionals in England.
Obesity rate was found to be high in all groups and the odds of being obese were high for nurses

5
HEALTH CARE
compared to other groups. However, as the reason for high rate of obesity among nurses was
missing, this study suggested the need to better understand the reason for the same through future
research work.
The study by Sharma, Anand, Kishore, Dey and Infgle, (2013) investigating about
obesity and stress among health professionals in a rural hospital of Delhi confirmed that three-
fourth of the overweight and obese workers had stress at their job compared to professionals who
were underweight or with normal weight. The findings related to coping strategies used by each
workers revealed that majority of workers adapted positive strategies to deal with stress. 47% of
them reported talking to family members to deal with stress. However, one limitation of the
study was that it did not gave objective definition of stress. Despite this, the study points out to
the need health promotion programs at workplace so that the problem of obesity related among
this cadre of workers are effectively managed. Averett (2014) also argues regarding the need to
pay attention to the issues of obese individuals considering evidences of discriminatory hiring for
obese people and low wages for obese people. The above discussion clearly shows the effect of
obesity on labour market outcomes. Hence, evaluating perceptions of health workers could open
the possibility of considering programs that could enhance the motivation of people affected by
obesity and improve attitude towards obesity among co-workers at workplace. Such initiative in
New Zealand would lead to savings in the health cost expenditure and as well as a productivity
concerns due to high absenteeism rates.
Discussion from the review of literature:
From the review of literature, it has been found that being overweight or obese is
associated with discrimination at workplace and this eventually leads to stress and poor coping

6
HEALTH CARE
styles among workers. One of the harmful consequence of such form of obesity related stress is
that it has significantly influenced absenteeism rate and affected productivity of companies. The
review also highlights the severity of the issue if obesity increased absenteeism rates in health
care setting. Such trend would have an impact on patient safety, care delivery and patient
outcome. Hence, reviewing the issue of obesity and its relation with absenteeism from the
perspective of health care professionals is very important This would pave the way for increasing
health promotion initiatives at work place so that employees are more active physically and their
performance is not hampered due to obesity related stress. There is lack of evidence on how
fellow health care workers can provide support to obese colleagues in dealing with obesity. Thus,
analyzing the role of fellow works in providing support to obese colleague is crucial too. This
research findings is likely to be significant in encouraging workers to have a positive attitude
towards workers and intervene positively to reduce their obesity related stress and its impact on
absenteeism rates.
Therefore, to narrow the research gap found in previous research, the main purpose of
this research is to determine the perception of obesity related stress at workplace among health
care workers to reduce absenteeism. The key objectives of the research is to get clear idea about
the perception of health care workers regarding obesity, determine the impact of obesity related
stress on workplace and identify strategies to reduce the problem as perceived by the health care
workers. As New Zealand is a country with high obesity rates, the research will benefit New
Zealand heath sector, institutions and student. It is likely to provide new directions to curb down
lost productivity cost occurring due to high rates of absenteeism linked to obesity. The research
question that will guide the search process are as follows:

7
HEALTH CARE
What is the impact of obesity on absenteeism of healthcare staff and how does it affects their
stress level?
Methodology:
Study design:
Based on the review of research design, qualitative research using semi-structured
interview method has been chosen as a research design for this study. The main rationale for
selecting this research design is that the main objective of the study is to explore perceptions
related to the topic from the health care workers and qualitative research design is a research
method that studies human behavior and opinions related to a phenomenon. As this research
design helps in gaining in-depth information about a research topic, use of qualitative approach
is considered most suitable for this research (Silverman, 2016). Health care workers were taken
as research participants and the research was done in a health care institute of New Zealand.
Total samples for the study include five health care workers. The participants were recruited
after completing the informed consent process and the study mainly
Data collection:
Data collection will be done using interview method. The interview will be based on 13
questions related to obesity, stress and absenteeism. The list of questions has been attached in
appendix 1. The interview was done in the meeting hall of the institute and the duration of the
interview was 20 minutes. The interview response was audio recorded along with transcripts.
The data analysis was done using thematic analysis method. The interview transcripts were
reviewed, and certain phrases were colour coded. After this, the findings were categorized into

8
HEALTH CARE
different themes based on combining codes with similar meanings together. According to
Nowell, Norris, White and Moules (2017), thematic analysis is beneficial in producing
trustworthy and insightful findings. In addition, triangulation method was used to analyse the
data by comparing the data with research literatures and other secondary sources. Total three
themes were identified and different colours were given while coding data under one theme (See
appendix 7). The coding process has been demonstrated in the interview transcripts of each
participant by means of different colour codes (Appendix 2-6).
Results and analysis:
Theme 1: Fatigue and laziness is the main cause behind absenteeism rates in obese person
Participant 2: ‘’They have a big impact as some obese just prefer to sit during work.’’
Participant 3: ‘’Understaffed will lead to reduced work completion……. Other colleagues
will also be affected because of task compensation’’
Participant 5: ‘’I think obese person get tired easily’’
Based on the review of interview transcripts, the health care workers opinion
suggested fatigue to be a major problem among obese person and this being the reason for
stress and absenteeism. The text that implies the term fatigue and laziness includes ‘prefer to
sit’ and ‘get tired easily. Thus, based on the finding of the interview, it can be said that
obesity and lack of opportunities for physical activity could be one factor leading to high
obesity in health care setting and high rate of absenteeism due to fatigue.
The study by Cavuoto and Nussbaum (2014) reported similar findings. The
researcher linked obesity to increased fatigue in the workplace and shorter endurance level.

9
HEALTH CARE
Obese people had greater decline in task performance compared to other groups. These
findings should be seriously taken by New Zealand health care recruiters and clinical
managers because fatigue can be the first sign of deteriorating workplace performance and
absenteeism rates. Cavuoto and Nussbaum (2014) reported difficulty for people with high
BMI in reaching and pain during picking up objects and task involved regular motions.
According to the clinical guidelines for weight management in New Zealand, one action that
can be taken is to improve health literacy in the context of weight management and
implement programs to ensure regular clinical examination for workers with BMI of greater
than 30 kg/m2 (Ministry of Health, 2017). Thus, comparison of finding with research
literature clearly explains how obesity could be one of the contributing factor behind fatigue
and poor work performance. However, as the interview presents perception of workers with
respect to one center only, the working conditions and environment of other health care
settings should be reviewed first before transferring the research findings to local settings.
Theme 2: Demand of respect and to change attitude towards obese people
Participant 2: ‘’They should respect obese people....... no some of the workmates are
bullying obese people
Participant 3: ‘’I would encourage them to more understanding and respectful’’
Participant 4: “Yes, I have seen mostly new comers to look arrogantly at obese people”
Participant 1: ‘’I think acceptance and support. They could help motivate our employee to
reduce weight’’

10
HEALTH CARE
This theme echoes the health worker’s expectation of attitudinal change. This is
relevant because of increased prevalence of discrimination or stigmatization towards obese
individuals. Stigmatization is defines as any act of identifying and denoting an undesirable
characteristic of any person in a way that narrows their social identity and leads to feelings of
disrespect (Chen & Courtwright, 2016). Obesity related stigma is an important subject in
public health as stigma and discrimination have pervasive consequences for psychological
health. Such stigmatized nature of any disease greatly influences public efforts to prevent the
disease. Tomiyama et al. (2018) opines too that weight stigma drives obesity epidemic and
this problem is particularly prevalent in health care settings. The study identified changing
the behaviours and attitudes of those who stigmatized to be most important in preventing
obesity epidemics. Thus, for this reason, the theme related to attitude towards obese people is
important.
From the review of statements of participant, changing attitude towards obese people
was identified as a dominant theme. Demand of respect was understood by terms like
‘respect, respectful and acceptance’ in the transcripts. Very few participants pointed the
need to understand the struggles or experience of people with obesity. They wanted to be
respectful, however they lacked the sensitivity to know about challenges of these people.
Hence, the attitude to be respectful is a positive aspects of health care worker’s opinion and
this should be strengthened by changing the clinical environment in a way to make obese
clients or workers feel less threatened and inculcating the notion among colleagues that they
should empower their obese colleagues to positively cope with obesity. Reducing weight
stigma is a shared responsibility of all clinical staffs and increasing empathy is the key to
reduce explicit bias against obese people (Phelan et al., 2015). Elimination of discrimination

11
HEALTH CARE
against people on the basis of disease and health status is one of the objectives of the New
Zealand Health Strategy too (The New Zealand Health Strategy, 2015).
Theme 3: Lack of actions to handle obesity related stress and absenteeism
Participant 1: ‘’I am not aware of any specific policy that caters to stress related to obesity in
my work place…’’
Participant 3: ‘’ I don’t see much about it…’’
Participant 4:’’ I am not aware about any bullying related policy’’
Participant 5: ‘’no strict actions have been taken and there are many incidence of
bullying…’
During the interview, many participants were asked to rate give ratings to
organizations based on actions taken to address obesity related stress in workplace. Apart
from one participant, all participants gave rating ranging from 3-5. This clearly revealed that
the organization has not been active in responding to the issue of obesity related stress
though it is present in the organization. Some response that helped to come to this theme
include ‘I am not aware’, ‘I don’t see much’ and ‘no strict actions’. Hence, in response to
this evidence, it can be concluded that if New Zealand government aims to eliminate obesity
related impact among health care professionals, the government will have to focus on efforts
to change stigmatized attitudes towards obese in workplace too by means of stricter anti-
discriminator policy (Puhl & Heuer, 2010).
The above findings suggest the need for better strategies to address obesity related
absenteeism and organization policy changes was a common expectation among health care

12
HEALTH CARE
workers. VanWormer, Linde, Harnack, Stovitz & Jeffery (2012) argues that weight
maintenance program alone cannot reduce the high absenteeism trend. Instead, longer term
view is needed by taking into account all those factors that lead to physical inactivity and
weight gain in workplace. To prevent productivity related losses due to obesity and
absenteeism, Goettler, Grosse and Sonntag (2017) suggests an increase in public health
initiative along with weight loss to minimize absenteeism and improve productivity of
workers. Health workers expectation of policy indicates lack of policies against
discriminatory practice in health care setting so far. As stigma influences the type of care
provided and humiliation of staffs, zero-tolerance policy for comments that degrade any
worker should be imposed (Phelan et al., 2015).
Conclusion:
To summarize, based on the review of transcripts related to health workers opinion about
obesity and its effect on absenteeism and productivity, three themes were found which are as
follows: 1) Fatigue and laziness is the main cause behind absenteeism rates in obese person 2)
Demand of respect and to change attitude towards obese people and 3) Lack of actions to handle
obesity related stress and absenteeism
The findings indicate positive relation between obesity and absenteeism. Based on the
review of gaps related to implementation of appropriate policy related change to address obesity
related stress and stigma, the paper suggest many recommendations to health care organizations
of New Zealand to promote well-being of their workforce. It is recommended to educate health
workers about the social contributors to weight gain and loss and using positive coping strategies
to deal with obesity related stress. As the research suggests lack of organizational steps to change

13
HEALTH CARE
attitude to workers, it is recommended that educational reform and zero tolerance policy on
obesity related discrimination be imposed in health care settings.
References:
Amani, R., & Gill, T. (2013). Shiftworking, nutrition and obesity: implications for workforce
health-a systematic review. Asia Pacific journal of clinical nutrition, 22(4), 698. doi:
10.6133/apjcn.2013.22.4.11. https://www.ncbi.nlm.nih.gov/pubmed/24231009
American Diabetes Association. (2018). 7. Obesity Management for the Treatment of Type 2
Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes care, 41(Suppl 1),
S65.doi: 10.2337/dc18- S007.
https://care.diabetesjournals.org/content/41/Supplement_1/S65
Asay, G. R. B., Roy, K., Lang, J. E., Payne, R. L., and Howard, D. H. (2016). Peer reviewed:
absenteeism and employer costs associated with chronic diseases and health risk factors

14
HEALTH CARE
in the US workforce. Preventing chronic disease, 13.doi: 10.5888/pcd13.150503.
https://www.cdc.gov/pcd/issues/2016/15_0503.htm
Averett, S. (2014). Obesity and labor market outcomes: The hidden private cost of obesity:
Lower earnings and a lower probability of employment.
https://wol.iza.org/articles/obesity-and-labor-market-outcomes/long
Cavuoto, L. A., & Nussbaum, M. A. (2014). Influences of obesity on job demands and worker
capacity. Current obesity reports, 3(3), 341-347. doi: 10.1007/s13679-014-0105-z.
https://www.tandfonline.com/doi/abs/10.1080/15459624.2014.887848
Cavuoto, L. A., & Nussbaum, M. A. (2014). The influences of obesity and age on functional
performance during intermittent upper extremity tasks. Journal of Occupational and
Environmental Hygiene, 11(9), 583-590. doi:
10.1080/15459624.2014.887848.https://www.ncbi.nlm.nih.gov/pubmed/24484265
Chen J., Courtwright A. (2016). Stigmatization. In: ten Have H. (eds) Encyclopedia of Global
Bioethics. Springer, Cham.
https://link.springer.com/referenceworkentry/10.1007%2F978-3-319-09483-0_404
Fitzgerald, S., Kirby, A., Murphy, A., & Geaney, F. (2016). Obesity, diet quality and
absenteeism in a working population. Public health nutrition, 19(18), 3287-3295. Doi:
Doi: https://doi.org/10.1017/S1368980016001269.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5197930/
Flint, S. W., Čadek, M., Codreanu, S. C., Ivić, V., Zomer, C., & Gomoiu, A. (2016). Obesity
discrimination in the recruitment process:“You’re not Hired!”. Frontiers in

15
HEALTH CARE
psychology, 7, 647. doi: 10.3389/fpsyg.2016.00647
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853419/
Goettler, A., Grosse, A., & Sonntag, D. (2017). Productivity loss due to overweight and obesity:
a systematic review of indirect costs. BMJ open, 7(10). Doi:
http://dx.doi.org/10.1136/bmjopen-2016-014632.
https://www.researchgate.net/publication/319503738_Productivity_loss_due_to_overwei
ght_and_obesity_A_systematic_review_of_indirect_costs
Kyle, R. G., Wills, J., Mahoney, C., Hoyle, L., Kelly, M., & Atherton, I. M. (2017). Obesity
prevalence among healthcare professionals in England: a cross-sectional study using the
Health Survey for England. BMJ open, 7(12), e018498. Doi:
https://bmjopen.bmj.com/content/7/12/e018498
Lal, A., Moodie, M., Ashton, T., Siahpush, M., & Swinburn, B. (2012). Health care and lost
productivity costs of overweight and obesity in New Zealand. Australian and New
Zealand journal of public health, 36(6), 550-556. .Doi: 10.1111/j.1753-
6405.2012.00931.x.https://www.ncbi.nlm.nih.gov/pubmed/23216496
Ministry of Health 2017. Clinical Guidelines for Weight Management in New Zealand Adults.
Retrieved from: https://www.health.govt.nz/system/files/documents/publications/clinical-
guidelines-for-weight-management-in-new-zealand-adultsv2.pdf
Ministry of Health NZ.(2019). Obesity statistics. [online] Available at:
https://www.health.govt.nz/nz-health-statistics/health-statistics-and-datasets/obesity-
statistics

16
HEALTH CARE
Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to
meet the trustworthiness criteria. International Journal of Qualitative Methods, 16(1),
1609406917733847. DOI: 10.1177/1609406917733847
https://journals.sagepub.com/doi/full/10.1177/1609406917733847
Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M.
(2015). Impact of weight bias and stigma on quality of care and outcomes for patients
with obesity. Obesity Reviews, 16(4), 319-326. doi: 10.1111/obr.12266.
https://www.ncbi.nlm.nih.gov/pubmed/25752756
Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: important considerations for public
health. American journal of public health, 100(6), 1019-1028.
doi: 10.2105/AJPH.2009.159491.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866597/
Reber, K. C., König, H. H., & Hajek, A. (2018). Obesity and sickness absence: results from a
longitudinal nationally representative sample from Germany. BMJ open, 8(6), e019839.
doi: http://dx.doi.org/10.1136/bmjopen-2017-019839
https://www.ncbi.nlm.nih.gov/pubmed/29880564
Sharma, S., Anand, T., Kishore, J., Dey, B. K., & Ingle, G. K. (2013). Obesity and Stress among
Health Professionals of a Rural Hospital of Delhi. Research and Reviews: A Journal of
Medicine, 46-53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089075/
Silverman, D. (Ed.). (2016). Qualitative research. Sage. https://books.google.co.in/books?
hl=en&lr=&id=9FALDAAAQBAJ&oi=fnd&pg=PP1&dq=Silverman,+D.+(Ed.).
+(2016).+Qualitative+research.+Sage.&ots=9nfylt0w5J&sig=63lPv8z-

17
HEALTH CARE
Rk1mayKqQg5VZojR_-M&redir_esc=y#v=onepage&q=Silverman%2C%20D.
%20(Ed.).%20(2016).%20Qualitative%20research.%20Sage.&f=false
Stats NZ (2015). Obesity. Retrieved from:
http://archive.stats.govt.nz/browse_for_stats/snapshots-of-nz/nz-social-indicators/
Home/Health/obesity.aspx
The New Zealand Health Strategy. (2015). The New Zealand Health Strategy. Retrieved from:
https://www.health.govt.nz/system/files/documents/publications/newzealandhealthstrateg
y.pdf
Tomiyama, A. J., Carr, D., Granberg, E. M., Major, B., Robinson, E., Sutin, A. R., & Brewis, A.
(2018). How and why weight stigma drives the obesity ‘epidemic’and harms health. BMC
medicine, 16(1), 123. Doi: https://doi.org/10.1186/s12916-018-1116-5.
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1116-5
VanWormer, J. J., Linde, J. A., Harnack, L. J., Stovitz, S. D., & Jeffery, R. W. (2012). Weight
change and workplace absenteeism in the HealthWorks study. Obesity facts, 5(5), 745-
752. doi: 10.1159/000345119. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032064/

18
HEALTH CARE
Appendices:
1.List of interview questions:
1. What is your current position in the health care institution?
2. Have you ever suffered from extreme levels of workplace related stress that led to
absenteeism?
3. Does your institution have any screening process for physical health while accepting
admission of health workers?
4. What is your understanding of obesity?
5. Do any obese people worker in your institution?
6. What is the impact of obesity in workplace?
7. What do you think about obesity and its correlation with absenteeism?
8. How would you correlate obesity, stress and absenteeism to conclude their impact on the
overall productivity in the workplace?
9. Do you feel your fellow members are acceptable in their treatment and attitude towards
obese people in the workplace?
10. What changes would you like to inculcate in your fellow workers in their treatment and
attitude towards obese people?

19
HEALTH CARE
11. If you ever encounter an obese worker suffering from workplace stress, how will you
intend to help him/her?
12. On a scale of 1 to 10 (10 being the severe), how much would you rate your institution in
efficacy of handling obese related workplace stress?
13. What are the recommendations to solve this problem?
2. Interview transcripts and coding process for participant 1:
1. What is your current position in the health care institution?
I am currently employed as a healthcare assistant in an aged rest home facility.
2. Have you ever suffered from extreme levels of workplace related stress
that led to absenteeism?
Yes, I have.
3. Does your institution have any screening process for physical health while
accepting admission of health workers?
Not that I am aware of, but when I applied at my current job asked me if I have any
medical conditions.
4. What is your understanding of obesity?
Obesity for me is the excess weight from what is normal for a person’s height. BMI
5. Do any obese people worker in your institution?
Yes, I have notice a few.
6. What is the impact of obesity in workplace?
For me, obesity can hinder your mobility resulting to more time being consumed in a
single task.

20
HEALTH CARE
7. What do you think about obesity and its correlation with absenteeism?
I think obese people are prone to injury due to the extra weight they are carrying
which can lead to absences
8. How would you correlate obesity, stress and absenteeism to conclude
their impact on the overall productivity in the workplace?
Extra time is consumed in doing task lowering the productivity.
9. Do you feel your fellow members are acceptable in their treatment and
attitude towards obese people in the workplace?
I haven’t notice any discrimination from my workmate towards obese people.
10. What changes would you like to inculcate in your fellow workers in their
treatment and attitude towards obese people?
I think acceptance and support. I think this could help motivate our obese employees
to reduce weight.
11. If you ever encounter an obese worker suffering from workplace stress,
how will you intend to help him/her?
I will try to comfort them and motivate to lose some weight.
12. On a scale of 1 to 10 (10 being the severe), how much would you rate your
institution in efficacy of handling obese related workplace stress?
I think 5. Because I am not aware of any specific policy that cater to stress related to
obesity in my work place. However, our unit coordinator and managers
always encourage us to open up about our feelings.
13. What are the recommendations to solve this problem?
Provide information on health eating and exercise in areas visible to employees. This
is to encourage them to lose some weight.

21
HEALTH CARE
3. Interview transcripts and coding process for participant 2:
1. What is your current position in the health care institution?
I am a care support.
2. Have you ever suffered from extreme levels of workplace related stress
that led to absenteeism?
Yes, because of heavy workloads I became stress.
3. Does your institution have any screening process for physical health while
accepting admission of health workers?
None, they just check my credentials and experience.
4. What is your understanding of obesity?
It is about gaining excessive weight that can lead to easy fatiguability.
5. Do any obese people worker in your institution?
Yes. Some of them while other are overweight.
6. What is the impact of obesity in workplace?
Some of my obese senior co-workers becomes lazy during work.
7. What do you think about obesity and its correlation with absenteeism?
Obesity can lead to absenteeism due to laziness and easy fatiguability. Obese people
prefer to sit, lie down and eat.

22
HEALTH CARE
8. How would you correlate obesity, stress and absenteeism to conclude
their impact on the overall productivity in the workplace?
They have a big impact as some obese just prefer to sit during work.
9. Do you feel your fellow members are acceptable in their treatment and
attitude towards obese people in the workplace?
No, some of my workmates are bullying obese people.
10. What changes would you like to inculcate in your fellow workers in their
treatment and attitude towards obese people?
They should respect obese people. More strict anti-bullying policy must be
implemented.
11. If you ever encounter an obese worker suffering from workplace stress,
how will you intend to help him/her?
Where promoting equality of work in our workplace so these obese people must do
the work. It is good also for them to exercise their body.
12. On a scale of 1 to 10 (10 being the severe), how much would you rate your
institution in efficacy of handling obese related workplace stress?
8, they are allowing people to take their leave to promote rest.
13. What are the recommendations to solve this problem?
Nothing, just equality and respect for obese people. We all need to work to bring food
on our table.
4. Interview transcripts and coding process for participant 3:
1. What is your current position in the health care institution?

23
HEALTH CARE
Health care assistant
2. Have you ever suffered from extreme levels of workplace related stress
that led to absenteeism?
Not yet
3. Does your institution have any screening process for physical health while
accepting admission of health workers?
They have asked us a set of questions to have a self assessment regarding our self
health status
.
4. What is your understanding of obesity?
Certain level of BMI, no sure of the value. It is unhealthy body mass index which
may lead to other disease
5. Do any obese people worker in your institution?
Not sure, because I don’t know their BMI. But basing it physically, I don’t think I
have an obese colleague
6. What is the impact of obesity in workplace?
It limits the ease of movement for the worker that leads to increased tiredness and
reduce completion of work
7. What do you think about obesity and its correlation with absenteeism?

24
HEALTH CARE
Maybe because of obesity and the risk of getting tired easily, It lead to absenteeism.
In addition, the stress of getting teased by colleague could also be possible
8. How would you correlate obesity, stress and absenteeism to conclude
their impact on the overall productivity in the workplace?
Understaffed will lead to reduced work completion, therefore leads to lower
consumer satisfaction. Other colleagues will also be affected because of task
compensation
9. Do you feel your fellow members are acceptable in their treatment and
attitude towards obese people in the workplace?
I believe my colleagues are respectful enough not to offend others regarding their
weight
10. What changes would you like to inculcate in your fellow workers in their
treatment and attitude towards obese people?
If so, I would encourage them to more understanding and respectful;
11. If you ever encounter an obese worker suffering from workplace stress,
how will you intend to help him/her?
I would try to ask how he or she is. And try to listen. I am not an expert, so I wouldn’t
be fit to advise him. Supporting through active listening would be of much
help.
12. On a scale of 1 to 10 (10 being the severe), how much would you rate your
institution in efficacy of handling obese related workplace stress?
I don’t see much about it, may be because we don’t have any obese colleagues, I
would rate at 3.
13. What are the recommendations to solve this problem?
Increase awareness of the intention to help and provide activities that
encourage health living and diet for the health care workforce

25
HEALTH CARE
5. Interview transcripts and coding process for participant 4:
Interview Questions
1. What is your current position in the health care institution?
I am employed as a senor nurse
2. Have you ever suffered from extreme levels of workplace related stress
that led to absenteeism?
Yes, many times I have taken breaks to deal with stress
3. Does your institution have any screening process for physical health while
accepting admission of health workers?
Yes, a preliminary medical check was done.
4. What is your understanding of obesity?
It is a condition leading to accumulation of body fat and a BMI of greater than 30
5. Do any obese people worker in your institution?
Yes, we have at least 10-20 obese people
6. What is the impact of obesity in workplace?
Yes, I have found obese workers to be less active and bit tired
7. What do you think about obesity and its correlation with absenteeism?
I don’t think obesity is the sole reason for absenteeism. There might be many
organization reasons for it.

26
HEALTH CARE
8. How would you correlate obesity, stress and absenteeism to conclude
their impact on the overall productivity in the workplace?
Obesity may lead to delayed completion of work which would lead to stress and
eventually absenteeism. This could affect productivity
9. Do you feel your fellow members are acceptable in their treatment and
attitude towards obese people in the workplace?
Yes, I have seen mostly new comers to look arrogantly at obese people
10. What changes would you like to inculcate in your fellow workers in their
treatment and attitude towards obese people?
Yes, I have always trained my nurses to be respectful and never judge them on their
appearance
11. If you ever encounter an obese worker suffering from workplace stress,
how will you intend to help him/her?
I would motivate them to take time out from work for at least half an hour walk and
some exercise after work. I would also give advice on diet changes.
12. On a scale of 1 to 10 (10 being the severe), how much would you rate your
institution in efficacy of handling obese related workplace stress?
I am not aware about any bullying related policy. I would give score of 5
13. What are the recommendations to solve this problem?
I recommend implementing an obesity prevention program annually or during times when
workload is low. This will lead to indulgence in some education as well as engagement in other
recreational activities
6. Interview transcripts and coding process for participant 5:
1. What is your current position in the health care institution?
I am a front desk worker
2. Have you ever suffered from extreme levels of workplace related stress
that led to absenteeism?
Yes, many times

27
HEALTH CARE
3. Does your institution have any screening process for physical health while
accepting admission of health workers?
No, we don’t have such process
4. What is your understanding of obesity?
Anybody with excess weight gain issues
5. Do any obese people worker in your institution?
Yes, we have at least 10-15% obese workers
6. What is the impact of obesity in workplace?
I found those workers to be mostly sleepy and they don’t wish to run in case of
emergencies
7. What do you think about obesity and its correlation with absenteeism?
I think obese person get tired easily and this might increase absenteeism rate
8. How would you correlate obesity, stress and absenteeism to conclude
their impact on the overall productivity in the workplace?
Yes, they are interlinked as obese staffs are more stressed not just because of work
but also because of their body image. They find being absent as a way to
escape this
9. Do you feel your fellow members are acceptable in their treatment and
attitude towards obese people in the workplace?
No, I have seen many colleagues shaming fat persons
10. What changes would you like to inculcate in your fellow workers in their
treatment and attitude towards obese people?
They should display some respect and they must be aware about professional
obligations

28
HEALTH CARE
11. If you ever encounter an obese worker suffering from workplace stress,
how will you intend to help him/her?
I would ask if they have ever taken any professional help for this. I would suggest
them to talk to their managers regarding it
12. On a scale of 1 to 10 (10 being the severe), how much would you rate your
institution in efficacy of handling obese related workplace stress?
I would rate my organization at 1 as no strict actions have been taken and there are
many incidence of bullying
13. What are the recommendations to solve this problem?
The institute should take measures to pass on the message of healthy living
and maintaining ideal weight
7. Colour coding and assigning of themes
Colour codes Themes
Yellow Theme 1
Pink Theme 2
Green Theme 3