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Sandwiched between office meetings and sales calls, Usana Health Sciences employees blow off steam at the West Valley City nutritional company's gym, shoot hoops on the basketball court, work with a yoga coach or relax in the cafeteria by eating a healthy salad and a bowl of soup.

Over at Brainstorm, people manage stress with impromptu dance contests, foosball games and dodgeball matches.

"We like to take those spontaneous breaks throughout the day, where everyone can get up out of their desks and take a few minutes to get a little exercise," said Chandler Milne, part of the American Fork-based software training company's marketing team. "It's just one of those little things that help employees reset."

Neither company has ever bothered to do a productivity study or a cost-benefit analysis to prove that these and other office diversions help their bottom lines. They just know. Productivity is high, turnover is low and health insurance for employees is cheaper than the norm, they say. Their companies are growing while their employees' waistlines are shrinking.

"My personal opinion is the health and the happiness of your employees is definitely a reflection of the productivity of the company, that it's the wisest investment that any company could make," Usana spokesman Dan Macuga said. "The bottom line is you want to make a place where people want to work."

Without realizing it, Usana and Brainstorm have internalized many of the lessons arising from a new study to be published in the journal Population Health Management by several researchers led by Ray Merrill, a health science professor at Brigham Young University.

The study of close to 20,000 employees who work at three large U.S. companies found that "presenteeism" — showing up for work but performing at subpar levels because of physical or emotional health reasons — takes an enormous toll on worker productivity. Citing other research, Merrill said presenteeism accounts for about 63 percent of wasted worker productivity, and absenteeism explains the rest.

According to the study, productivity problems show up more often in women and in people who are separated, divorced or widowed. High school graduates and people with some college experience also show lower levels of productivity. Service, clerical and other office occupations seem to give rise to presenteeism, he said.

"Given the trends that we see in health and the economy, my guess is that presenteeism is getting worse and will continue [to worsen] unless employers are sensitive to the issue and are making some of the changes that are suggested in this [study]," Merrill said.

Employees with an unhealthy diet were 66 percent more likely to show a loss in productivity than healthy eaters. People who exercised only occasionally were 50 percent more likely to be less efficient on the job. Smokers were 28 percent more likely to report a productivity loss, the study said.

The biggest cause of presenteeism was having too much to do and not enough time to do it. Next in line were personal problems, technology issues and financial stress, which was a revelation, Merrill said.

"It didn't surprise me that health plays an important part. I guess the ranking that surprised me was that financial stresses seemed to play a bigger role. And I was also surprised that the main thing that leads to subpar performance is being asked to do too much and then not having the technical support to do what's asked," Merrill said.

"I was thinking that it would be health issues and personal stresses versus the demands that an employer has on an employee. If they are not realistic, that can lead to a lack of productivity," he said.

Presenteeism isn't an issue at Brainstorm, where life hardly could be better, Milne said. The 32-employee company occupies an office building on American Fork's Main Street in the shadow of Mount Timpanogos, the second-highest peak in the Wasatch Range. Employees are allowed to manage their work hours as they see fit, as long as they get their work done on time and are in the office when someone needs to see them.

"I can't say we've invested time and money in formal studies, but we have seen just in the bottom line, in the culture and in the revenue how much more effective it is to give the responsibility [of time management] back to the employees and trust them, and make sure we provide the tools they need to be successful," Milne said.

"I can tell you that certainly it makes sense, seeing how successful the company has been."

For every success story, health issues persist in the workplace and beyond. Two-thirds of U.S. adults are overweight or obese, exposing them to an increased risk of heart disease, diabetes, high blood pressure and other food-related conditions.

At the same time, the recession and underwhelming recovery have put many Americans on a downward economic spiral. The takeaway, Merrill said of his study, is that increasing numbers of people are coming to work unable to be fully productive.

"Presenteeism is costing employers a lot, and studies have shown the cost to employers is much greater than absenteeism. People are showing up for work, but they are performing at subpar levels, and there are a number of factors ... that contribute to presenteeism," he said.

At Usana, more than 600 employees have access to the company's basketball court, 6,000-square-foot gym, personal trainers, climbing walls and yoga instructors any time during the day.

Cafeteria food is gluten-free and made from organic ingredients. Fresh fruit is free for the taking. The fare is so good and plentiful that members of the U.S. speed-­skating team eat there at least once a week, Macuga said.

"Job satisfaction at the company is at its highest. In regard to health-care costs, we do see on average a lower cost to the company as a result of all these things. We do believe it's because we walk the walk and talk the talk," he said.

"We promote good health, good eating and fitness, and our employees embrace it fully, as does the whole company."

pbeebe@sltrib.comTwitter: @sltribpaul —

Unhealthy trends in the workplace

• Employees with an unhealthy diet were 66 percent more likely to show a loss in productivity than healthy eaters.

• People who exercised only occasionally were 50 percent more likely to be less efficient on the job.

• Smokers were 28 percent more likely to report a productivity loss.

Source: Research study led by Ray Merrill, professor at Brigham Young University