The Triple Threat: Workload, Stress, and Shift Work

Imagine a job where chronic pressure, constant stress, and erratic schedules are the norm. This combination forms a potent triad of risk factors for NHS staff, creating a detrimental cycle for their health.

Chronic Excessive Workload

"Chronic excessive workload" isn't just a buzzword; it's identified as the number one predictor of staff stress and a primary reason people leave the health and social care sectors. This relentless pressure isn't just tough mentally; it has direct physical consequences. Sustained stress is directly linked to an increased risk of conditions like cardiovascular disease and diabetes. When under pressure, staff often gravitate towards convenient, high-calorie foods, lacking the mental energy to make healthier choices. In fact, a study found that workplace stress negatively impacted the dietary choices of 60% of nurses, midwives, and healthcare assistants.

Shift Work and Sleep Disruption

The NHS operates 24/7, meaning a large part of its workforce is on shifts, including nights and rotating schedules. This is a well-established risk factor for metabolic disease. Studies, including the long-running Nurses' Health Study, show a significant link between extended periods of rotating night shifts and a higher risk of developing type 2 diabetes. Why? Because shift work fundamentally disrupts our body's natural circadian rhythms, which control not just sleep but also vital metabolic processes. This misalignment directly increases the risk of obesity and type 2 diabetes.

Lack of Breaks and Time Pressure

A recurring theme for NHS staff is the sheer lack of time for basic self-care. Many report that eating a healthy meal at work is difficult due to missed breaks. Some even regularly skip meals entirely. This intense time pressure, driven by high patient loads and often inadequate staffing, forces staff into a pattern of "grabbing what we can, when we can." This inevitably leads to reliance on unhealthy snacks, vending machine options, and other quick-but-nutritionally-poor choices. It's not a lack of willpower; it's a lack of opportunity.

The Obesogenic Workplace Environment

Beyond the demands of the job itself, the physical environment within many NHS facilities often makes healthy living incredibly difficult. Public health experts call this an "obesogenic environment."

Unhealthy Food Choices at Work

Despite being leaders in health, the food options available within NHS premises can be surprisingly unhealthy. Over half of NHS staff feel there aren't enough healthy eating options at their workplaces. The prevalence of vending machines packed with sugary snacks and drinks, and even fast-food outlets within hospital buildings, sends a contradictory message. While there have been initiatives to improve this, staff perception suggests there's still a long way to go. The environment often defaults to unhealthy convenience, reinforcing poor dietary habits.

Sedentary Roles and Lack of Activity

While some NHS roles are physically demanding, many within the vast NHS structure have become increasingly sedentary. Even for active staff, the workplace often offers few opportunities for recreational exercise. Many hospital employees don't meet recommended physical activity guidelines, citing lack of time, feeling too tired, and lacking motivation as key barriers. These aren't personal failings; they're direct consequences of a high-stress, high-workload environment that leaves employees physically and mentally depleted.

The COM-B Deficit: Why Health Interventions Struggle

To understand why NHS staff struggle with health, consider the COM-B model of behaviour change: for a behaviour to occur, an individual needs Capability, Opportunity, and Motivation.

NHS staff generally have high Capability (they know what a healthy lifestyle entails). However, the workplace systematically strips them of the Opportunity to act on this knowledge – through limited healthy food choices and a chronic lack of time for breaks or exercise. Simultaneously, their Motivation is severely depleted by constant stress, emotional exhaustion, and physical fatigue, eroding the energy needed for self-regulation and making difficult healthy choices.

The NHS work environment, therefore, creates a profound "Capability-Opportunity-Motivation" deficit. Any truly successful health intervention cannot just provide more information; it must offer practical, accessible solutions that fit into a time-poor, high-stress reality and use sophisticated behavioural science to bolster and sustain motivation when individual reserves are low.

‍

The High Price of Preventable Disease: Economic Costs to the NHS

We've delved into the deep-seated health challenges facing our NHS workforce – the stress, the prevalence of obesity, and the hidden burden of type 2 diabetes. But these aren't just personal health battles; they have profound, quantifiable consequences for the NHS as an organisation and for the entire UK economy. Let's examine the direct impact of this disease burden on sickness absence and the staggering economic costs involved.

The Direct Link: Obesity, Diabetes, and Lost Days

It's a clear equation: healthier staff means more productive staff. Research consistently shows that employees with obesity take significantly more time off work due to illness. This isn't just a coincidence; it's a causal relationship.

For instance, a study of London Underground staff found that obesity led to an extra four days of sick leave per year on average for affected individuals. The more severe the obesity, the higher the absenteeism risk. Those with severe obesity were 2.5 times more likely to have taken at least a week off work in a year compared to healthy-weight colleagues.

Why the increase in sick days? It's largely due to the chronic health conditions that obesity causes or worsens, like type 2 diabetes, high blood pressure, heart disease, and critically for the NHS, musculoskeletal disorders (MSDs). Remember from our earlier discussion that MSDs are the leading cause of sickness absence in the NHS, and obesity is a major risk factor for conditions like back pain and osteoarthritis.

This directly translates to a massive financial hit for the NHS. With roughly 350,000 obese employees (based on nurse prevalence), an estimated 1.4 million extra sick days annually are directly attributable to obesity alone. Reducing obesity would therefore yield substantial and direct cost savings from reduced sickness absence, making a compelling business case for investment in prevention.

The Staggering Financial Burden

The economic impact of obesity and diabetes extends far beyond sick days. These conditions impose a staggering burden on the UK, affecting direct healthcare spending, social care, and wider societal productivity.

The Cost of Obesity

An updated economic analysis from 2021 estimates that the total annual cost of overweight and obesity to the UK has spiralled to an astronomical £98 billion! This figure represents almost 4% of the UK's GDP.

• Direct NHS Costs: The cost to the NHS for treating obesity and related illnesses is estimated at a colossal £19 billion per year.
• Wider Societal Costs: The impact on the broader economy, including lost productivity from absenteeism, presenteeism (working while ill), and premature mortality, is estimated at £16 billion annually.

The Cost of Diabetes

The financial burden of diabetes is similarly vast. A 2024 study commissioned by Diabetes UK provides the most current estimates:

• Total Annual Cost: Diabetes costs the UK almost £14 billion annually.
• Direct NHS Costs: The direct cost to the NHS is £10.7 billion. Crucially, nearly 60% of this expenditure (over £6 billion) is spent on treating the largely preventable complications of diabetes, such as stroke, amputation, kidney failure, and heart disease.
• Indirect Costs: Lost productivity due to diabetes (from absenteeism and premature mortality) is estimated at £3.3 billion annually.

Taken together, these two preventable conditions represent one of the single greatest financial challenges facing the health service and the UK economy.

Diabetes care alone is estimated to consume around 10% of the entire NHS budget! The fact that the vast majority of these costs are driven by treating preventable complications, rather than by preventative care, highlights a fundamental misalignment of resources. This makes the financial case for preventative health interventions not just strong, but a clear fiscal imperative.

‍

Works cited

1.    NHSStaff Survey 2024: health and wellbeing overview | NHS ..., accessed on June28, 2025, https://www.nhsemployers.org/articles/nhs-staff-survey-2024-health-and-wellbeing-overview

2.    TheNHS Crisis Of Caring For Staff: What Do We Need To Do? | The ..., accessed onJune 28, 2025, https://www.kingsfund.org.uk/insight-and-analysis/blogs/nhs-crisis-caring-staff

3.    Whatdoes the NHS staff survey tell us about the changing behaviours and motivationof health care staff? | Nuffield Trust, accessed on June 28, 2025, https://www.nuffieldtrust.org.uk/news-item/what-does-the-nhs-staff-survey-tell-us-about-the-changing-behaviours-and-motivation-of-health-care-staff

4.    NHSStaff Survey 2023: health and wellbeing overview, accessed on June 28, 2025, https://www.nhsemployers.org/articles/nhs-staff-survey-2023-health-and-wellbeing-overview

5.    Workand wellbeing in the NHS: why staff health matters to patient care - RCP,accessed on June 28, 2025, https://www.rcp.ac.uk/media/tijhbs1d/work-and-wellbeing-in-the-nhs.pdf

6.    Namingthe issue: chronic excessive workload in the NHS | The King's Fund, accessed onJune 28, 2025, https://www.kingsfund.org.uk/insight-and-analysis/blogs/naming-issue-chronic-excessive-workload-nhs

7.    Background- Workplace-based interventions to promote healthy lifestyles in the NHSworkforce: a rapid scoping and evidence map - NCBI, accessed on June 28, 2025, https://www.ncbi.nlm.nih.gov/books/NBK555615/

8.    Workplace-basedinterventions to promote healthy lifestyles in the ..., accessed on June 28,2025, https://www.journalslibrary.nihr.ac.uk/hsdr/HSDR08180

9.    NHSEngland » NHS health and wellbeing framework, accessed on June 28, 2025, https://www.england.nhs.uk/publication/nhs-health-and-wellbeing-framework/

10. Developingour Staff Health and Wellbeing Strategic Action Plan 2022-2023, accessed onJune 28, 2025, https://elht.nhs.uk/application/files/9116/7302/2518/Staff_Health_and_Wellbeing_Strategic_Action_Plan_2022-2023.pdf

11. Healthand Wellbeing Strategy P150, accessed on June 28, 2025, https://swsenate.nhs.uk/wp-content/uploads/2018/10/Health-and-Wellbeing-Strategy-P150-3-1.docx

12. Obesityprevalence among healthcare professionals in England: a cross-sectional studyusing the Health Survey for England, accessed on June 28, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC5719305/

13. Obesityprevalence among healthcare professionals in England: a cross-sectional studyusing the Health Survey for England | BMJ Open, accessed on June 28, 2025, https://bmjopen.bmj.com/content/7/12/e018498

14. Adultoverweight and obesity - NHS England Digital, accessed on June 28, 2025, https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2022-part-2/adult-overweight-and-obesity

15. Arehalf of NHS workers obese? - Full Fact, accessed on June 28, 2025, https://fullfact.org/health/are-half-nhs-workers-obese/

16. Onein four NHS nurses are obese, study reveals | The Independent, accessed on June28, 2025, https://www.independent.co.uk/news/health/nhs-nurses-obese-stats-figures-survey-results-a8091781.html

17. Healthmatters: preventing Type 2 Diabetes - GOV.UK, accessed on June 28, 2025, https://www.gov.uk/government/publications/health-matters-preventing-type-2-diabetes/health-matters-preventing-type-2-diabetes

18. Adultobesity and type 2 diabetes - GOV.UK, accessed on June 28, 2025, https://assets.publishing.service.gov.uk/media/5a7f069140f0b6230268d059/Adult_obesity_and_type_2_diabetes_.pdf

19. Healthmatters: obesity and the food environment - GOV.UK, accessed on June 28, 2025, https://www.gov.uk/government/publications/health-matters-obesity-and-the-food-environment/health-matters-obesity-and-the-food-environment--2

20. Theworkplace consequences of obesity | Government Business, accessed on June 28,2025, https://governmentbusiness.co.uk/features/obesity-%E2%80%93-what-are-consequences-your-department

21. Obesityprevalence among healthcare professionals in England: a cross - LSBU OpenResearch - London South Bank University, accessed on June 28, 2025, https://openresearch.lsbu.ac.uk/download/690c265926642aa29e363ba985e0bc6bb00ebf8e89d56634bcc6363ca7cbf178/357831/e018498.full.pdf

22. Obesityprevalence among healthcare professionals in England: A cross-sectional studyusing the Health Survey for England - ResearchGate, accessed on June 28, 2025, https://www.researchgate.net/publication/321537654_Obesity_prevalence_among_healthcare_professionals_in_England_A_cross-sectional_study_using_the_Health_Survey_for_England

23. NHSEngland » NHS scheme reduces chances of Type 2 diabetes ..., accessed on June28, 2025, https://www.england.nhs.uk/2023/02/nhs-scheme-reduces-chances-of-type-2-diabetes-for-at-risk-adults/

24. Howmany people in the UK have diabetes?, accessed on June 28, 2025, https://www.diabetes.org.uk/about-us/about-the-charity/our-strategy/statistics

25. Themanagement of adult diabetes services in the NHS progress ..., accessed on June28, 2025, https://www.nao.org.uk/wp-content/uploads/2015/10/The-management-of-adult-diabetes-services-in-the-NHS-progress-review.pdf

26. Thedescriptive epidemiology of type 2 diabetes in the United Kingdom from 2004 to2021, accessed on June 28, 2025, https://www.medrxiv.org/content/10.1101/2024.03.04.24303693v1.full-text

27. NWO0101- Evidence on Nursing workforce - UK Parliament Committees, accessed on June28, 2025, https://committees.parliament.uk/writtenevidence/81471/pdf/

28. Diabetesprofile: statistical commentary, March 2025 - GOV.UK, accessed on June 28,2025, https://www.gov.uk/government/statistics/diabetes-profile-update-march-2025/diabetes-profile-statistical-commentary-march-2025

29. Trendsin incidence, prevalence and prescribing in type 2 diabetes mellitus between2000 and 2013 in primary care: a retrospective cohort study - PMC, accessed onJune 28, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC4735176/

30. Costof Diabetes, accessed on June 28, 2025, https://www.diabetes.co.uk/cost-of-diabetes.html

31. NHSidentifies over half a million more people at risk of type 2 diabetes in aYear, accessed on June 28, 2025, https://www.england.nhs.uk/2024/06/nhs-identifies-over-half-a-million-more-people-at-risk-of-type-2-diabetes-in-a-year/

32. Riskfactors for pre-diabetes and undiagnosed type 2 diabetes in England: 2013 to2019 - Office for National Statistics, accessed on June 28, 2025, https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthinequalities/bulletins/riskfactorsforprediabetesandundiagnosedtype2diabetesinengland/2013to2019

33. WeightManagement Services for preventing and managing type 2 diabetes, accessed onJune 28, 2025, https://www.diabetes.org.uk/about-us/about-the-charity/our-strategy/position-statements/treatment-of-obesity

34. Type2 diabetes: an update for community nurses, accessed on June 28, 2025, https://www.britishjournalofcommunitynursing.com/content/professional/type-2-diabetes-an-update-for-community-nurses/

35. Symptomsof type 2 diabetes and how it's diagnosed - NHS, accessed on June 28, 2025, https://www.nhs.uk/conditions/type-2-diabetes/symptoms/

36. Contributionof the Nurses' Health Studies to Uncovering Risk Factors for Type 2 Diabetes:Diet, Lifestyle, Biomarkers, and Genetics - PMC - PubMed Central, accessed onJune 28, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC4981796/

37. Health... - Scandinavian Journal of Work, Environment & Health, accessed on June28, 2025, https://www.sjweh.fi/show_abstract.php?abstract_id=3445&fullText=1

38. Health-relatedinterventions among night shift workers: A critical review of the literature,accessed on June 28, 2025, https://www.researchgate.net/publication/263584568_Health-related_interventions_among_night_shift_workers_A_critical_review_of_the_literature

39. Obesity- NHS Long Term Plan, accessed on June 28, 2025, https://www.longtermplan.nhs.uk/online-version/chapter-2-more-nhs-action-on-prevention-and-health-inequalities/obesity/

40. (PDF)Health in the NHS: Lifestyle behaviours of hospital employees, accessed on June28, 2025, https://www.researchgate.net/publication/236208554_Health_in_the_NHS_Lifestyle_behaviours_of_hospital_employees

41. Co-Design,Delivery, and Evaluation of Wellbeing Initiatives for NHS Staff: The HOW(Healthier Outcomes at Work) NHS Project - ResearchGate, accessed on June 28,2025, https://www.researchgate.net/publication/359927538_Co-Design_Delivery_and_Evaluation_of_Wellbeing_Initiatives_for_NHS_Staff_The_HOW_Healthier_Outcomes_at_Work_NHS_Project

42. Obesityand sickness absence: results from the CHAP study | Occupational Medicine |Oxford Academic, accessed on June 28, 2025, https://academic.oup.com/occmed/article/60/5/362/1382790

43. Obesityand sickness absence: results from the CHAP study - Oxford Academic, accessedon June 28, 2025, https://academic.oup.com/occmed/article-pdf/60/5/362/4189210/kqq031.pdf

44. Sicknessleave is more common among overweight adults - Diabetes UK, accessed on June28, 2025, https://www.diabetes.co.uk/news/2024/may/sickness-leave-is-more-common-among-overweight-adults.html

45. Obesepeople twice as likely to be off work as 'sick-note culture' costing UK £98bn ayear, accessed on June 28, 2025, https://www.gbnews.com/news/obese-people-sick-note-culture

46. UnhealthyNumbers: The Rising Cost of Obesity in the UK - Tony Blair Institute, accessedon June 28, 2025, https://institute.global/insights/public-services/unhealthy-numbers-the-rising-cost-of-obesity-in-the-uk

47. Estimatingthe full costs of obesity - Frontier Economics, accessed on June 28, 2025, https://www.frontier-economics.com/media/hgwd4e4a/the-full-cost-of-obesity-in-the-uk.pdf

48. Costof diabetes to UK estimated at £14 billion, research shows - University ofYork, accessed on June 28, 2025, https://www.york.ac.uk/news-and-events/news/2024/research/diabetes-cost-to-uk/

49. Costof diabetes to UK estimated at £14 billion, research shows | Nursing inPractice, accessed on June 28, 2025, https://www.nursinginpractice.com/clinical/diabetes-and-endocrinology/cost-of-diabetes-to-uk-estimated-at-14-billion-research-shows/

50. Estimationof the direct health and indirect societal costs of diabetes in the UK using acost of illness model - PubMed, accessed on June 28, 2025, https://pubmed.ncbi.nlm.nih.gov/38890775/

51. Usingthe NHS Health and Wellbeing Framework successfully, accessed on June 28, 2025,https://www.england.nhs.uk/long-read/using-the-nhs-health-and-wellbeing-framework-successfully/

52. Physicalhealth and wellbeing - NHS England, accessed on June 28, 2025, https://www.england.nhs.uk/supporting-our-nhs-people/support-now/physical-health-and-wellbeing/

53. NHSEngland » NHS online weight loss programme highlighted as a ..., accessed onJune 28, 2025, https://www.england.nhs.uk/2024/04/nhs-online-weight-loss-programme-highlighted-as-a-success-in-new-study/

54. Studyreveals promising early outcomes of NHS Digital Weight Management Programme,accessed on June 28, 2025, https://www.midlandsandlancashirecsu.nhs.uk/study-reveals-promising-early-outcomes-of-nhs-digital-weight-management-programme/

55. Preventingillness and improving health for all: a review of the NHS Health Checkprogramme and recommendations - GOV.UK, accessed on June 28, 2025, https://www.gov.uk/government/publications/nhs-health-check-programme-review/preventing-illness-and-improving-health-for-all-a-review-of-the-nhs-health-check-programme-and-recommendations

56. Evidence-basedapproaches to workforce wellbeing - NHS Employers, accessed on June 28, 2025, https://www.nhsemployers.org/articles/evidence-based-approaches-workforce-wellbeing

57. Effectivenessof workplace wellness programmes for dietary habits, overweight, andcardiometabolic health: a systematic review and meta-analysis, accessed on June28, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC8627548/

58. Five-yearWorkplace Wellness Intervention in the NHS - PubMed, accessed on June 28, 2025,https://pubmed.ncbi.nlm.nih.gov/23771680/

59. Non-PharmacologicalInterventions to Improve Chronic Disease ..., accessed on June 28, 2025, https://www.mdpi.com/2624-5175/3/1/9

60. ASystematic Review of Workplace-Based Employee Health ..., accessed on June 28,2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9204576/

61. ASystematic Review of Workplace-Based Employee Health Interventions and TheirImpact on Sleep Duration Among Shift Workers - PubMed, accessed on June 28,2025, https://pubmed.ncbi.nlm.nih.gov/34284682/

62. Effectivenessof Workplace Interventions to Improve Health and Well ..., accessed on June 28,2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10298158/

63. (PDF)Effectiveness of Workplace Interventions to Improve Health and Well-Being ofHealth and Social Service Workers: A Narrative Review of Randomised ControlledTrials - ResearchGate, accessed on June 28, 2025, https://www.researchgate.net/publication/371717702_Effectiveness_of_Workplace_Interventions_to_Improve_Health_and_Well-Being_of_Health_and_Social_Service_Workers_A_Narrative_Review_of_Randomised_Controlled_Trials

‍

‍