Original article published in Harvard Business Review, May 31st, 2018
Checking into a hotel for a conference several years ago, I asked the receptionist where I could get some dinner. There was no restaurant in the hotel, I was told; my only options were ordering delivery from a fast-casual chain or a pizza joint. I went with the pizza, but my lack of choices was annoying — so much so that, when I got home, I started looking into the data on health and travel for work.
My experience is far from unique. According to the Global Business Travel Association and American Express, Americans took more than 500 million domestic business trips in 2016. And while many workplace health programs for business travel provide immunizations, information about avoiding food-borne illness, and alerts about civil or political unrest, few focus on a more a common threat to health: the stress, sleep interruption, unhealthy eating and drinking, and lack of exercise that are common side effects of being on the road. Over the long-term, these issues can add up to chronic disease risks.
To investigate the link between business travel and chronic disease conditions, my colleagues and I turned to de-identified electronic medical record data from EHE, Inc., which provides preventive medicine exams, health screenings, and wellness program services nationally to tens of thousands of employees a year working at companies in the U.S. In addition to preventive medicine exams, the full patient encounter also includes a comprehensive online health assessment that asks about the frequency of business travel.
When we analyzed these data, we found a strong correlation between the frequency of business travel and a wide range of physical and behavioral health risks. Compared to those who spent one to six nights a month away from home for business travel, those who spent 14 or more nights away from home per month had significantly higher body mass index scores and were significantly more likely to report the following: poor self-rated health; clinical symptoms of anxiety, depression and alcohol dependence; no physical activity or exercise; smoking; and trouble sleeping. The odds of being obese were 92% higher for those who traveled 21 or more nights per month compared to those who traveled only one to six nights per month, and this ultra-traveling group also had higher diastolic blood pressure and lower high density lipoprotein (the good cholesterol).
Although only about 12% of employees in the data we looked at traveled for business 14 or more nights per month, the clustering of all these health conditions among extensive business travelers is worrying, both for their own health and the health of the organizations they work for. Physical, behavioral and mental health issues such as obesity, hypertension, smoking, depression, anxiety, poor sleep, and alcohol dependence can create costs for employers through higher medical claims, reduced employee productivity and performance, absenteeism, presenteeism, and short-term disability. The effects of these issues have the potential to strain or sever relationships with clients and suppliers.
Our results are backed up by several other pieces of research. A study of health insurance claims among World Bank staff and consultants found that travelers had significantly higher claims than their non-traveling peers for all conditions considered, including chronic diseases such as asthma and back disorders. The highest increase in health related claims was for the stress-related disorders. A second World Bank study found that almost 75% of the staff reported high or very high stress related to business travel. And an analyses of health risk appraisal surveys conducted at a large multinational corporation found that international business travel was associated with higher alcohol consumption, lower confidence in keeping up with the pace of work, and lower perceived flexibility in fulfilling commitments.
So what can companies do to help their employees develop healthy habits while traveling? We suggest a combination of employee education and improvements in employer policies around travel. First, employees simply need to be aware that business travel can predispose them to making poorer health decisions. The steak with fries and a late-night cocktail at the hotel bar might seem easily justifiable as a reward for acing a long day of client meetings. But research finds that restaurant food contains more calories per serving, is higher in total fat and saturated fat per calorie, and contains less dietary fiber than meals prepared at home. Research also suggests that the higher calorie content of restaurant food is compounded by chronic stress, like that caused by frequent business travel, which is linked to preferences for even more high calorie foods. Given this, employers should help employees learn to identify and select the healthiest options available — and to help them prepare in advance if they wind up at a hotel like the one I visited, with few good choices nearby.
It’s often harder to maintain an exercise regimen when you are on the road, too. Over the long term, many high-calorie rewards for a job well done can add up to weight gain and associated cardiovascular disease risks. Supporting exercise and physical activity among employees can help prevent weight gain — and the physical activity can help reduce stress. One fairly simple thing employers can do is to ensure that their preferred accommodations have well-equipped gyms. Employers can also use hotels that provide complementary workout clothes or in-room exercise equipment such as mats, weights, or workout videos. In general, hotel gyms can be minimalist and a bit depressing, but an alliance of sorts between employers and business hotel chains could work together to improve the hotel gym experience. If hotel gyms aren’t an option, employers could also provide employees with memberships to gym and health club chains with a national presence.
Employers can also provide their business travelers training in a variety of stress management approaches and sleep hygiene techniques. Cognitive behavioral therapy and mindfulness-based stress reduction training are therapeutic options that provide personal coping strategies and have been shown to be effective for managing depression, anxiety, and workplace stress. These techniques may also be useful for employers to integrate into prevention and treatment programs for employees who engage in frequent travel and who may be more vulnerable to stress and negative emotions.
Even with the increasing sophistication of conference calls and video chat, business travel is a prominent feature of many occupations and is likely to remain so. It will continue to be an avenue of professional advancement, and the opportunity to travel is often touted by companies as a benefit in their recruitment of talent. But the accumulating evidence linking extensive business travel to chronic disease health risks needs to be factored into the cost-benefit analysis of the practice. Business travel can surely be educational, and even fun, not to mention necessary for many people; but the wear and tear resulting from constant trips may not be altogether worth it.
If you travel for work regularly, it’s worth pausing to examine whether you actually need to be on the road frequently — and if you do, how you can mitigate the effects of stress and be mindful about your dietary choices. And if you have employees who are often between cities, you owe it to them to provide the education, tools and resources so they can maintain healthy lifestyles while on the road.