Research ArticlePrevalence of Obesity Among U.S. Workers and Associations with Occupational Factors
Introduction
The CDC recognizes obesity as a national epidemic.1, 2 At the same time, the CDC has identified obesity, along with nutrition and physical activity, as a “winnable battle” because measurable progress can be quickly made by developing policy, systems, and environmental initiatives that help make healthy choices available, affordable, and easy (http://www.cdc.gov/WinnableBattles/Obesity/index.html). Along with public health and clinical professionals, employers are taking note of rising obesity rates among their employees, as obesity is strongly related to chronic health problems and concomitant increased healthcare costs.3
Contributors to the obesity epidemic are complex and numerous, and may include several work characteristics.4, 5, 6 These range from work organization factors such as long workweeks6, 7 and shiftwork8, 9, 10, 11, 12 to psychosocial factors such as job stress.6, 13 All of these factors may contribute to obesity, at least partially, by influencing health behaviors. For example, total caloric intake and unhealthy eating behaviors are positively associated with stress,14, 15, 16, 17 and long workweeks may decrease the opportunity for physical activity.18 On the other hand, shift work may also increase the risk of obesity through physiologic maladaptation,19 and chronic stress from any of these work factors may contribute directly to obesity by promoting deposition of intra-abdominal fat.20 These factors may help explain why the prevalence of obesity has been shown to vary considerably across U.S. occupational groups.21
Job stress can be defined as the harmful physical and emotional responses that occur when job requirements do not match the capabilities, resources, or needs of the worker.22 Much of the previous research regarding job stress and obesity has focused on the demand-control model6, 23, 24, 25 or effort–reward imbalance model,6, 26, 27, 28 with mixed results.4, 6 Specific individual work-related psychosocial stressors recently linked to physiological and psychological stress responses and poor health behaviors include a hostile work environment (i.e., exposure to threats, bullying, or harassment on the job),29, 30 job insecurity,6, 31, 32, 33 and work–family imbalance34; however, associations between these stressors and obesity have not been well described.
In 2010, the National Institute for Occupational Safety and Health (NIOSH) sponsored an Occupational Health Supplement to the National Health Interview Survey (NHIS-OHS) to collect nationally respresentative data on working conditions, potentially hazardous exposures, and work-related health outcomes among U.S. workers. The present study utilized the NHIS-OHS data regarding work organization characteristics (workweek length, work shift, and work arrangement)35 and work-related psychosocial stressors (hostile work environment, job insecurity, and work–family imbalance)36 to investigate whether these factors represent stressful work conditions that may be associated with obesity among a large, nationally representative sample that includes U.S. workers from all industry and occupation (I and O) categories. The findings may help explain differences in the prevalence of obesity by I and O.
Section snippets
Study Sample
The National Center for Health Statistics (NCHS) within the CDC has conducted the NHIS, a cross-sectional in-person household survey used to monitor the health of the nation, since 1957.37 With the exclusion of individuals in long-term care facilities, correctional facilities, active-duty Armed Forces personnel, and U.S. nationals within foreign countries, the data are considered to be representative of the U.S. population. The survey employs a multistage clustered sample design with
Prevalence of Obesity by Demographic Characteristics and Health Behaviors
Data were available for 15,121 working adults representing approximately 135 million people. The overall prevalence of obesity among workers was 27.7%. Workers aged 18−29 years, non-Hispanic Asians, and workers with college degrees had the lowest prevalence of obesity in their respective categories (Table 1).
Former smokers had a higher prevalence of obesity compared to current smokers and those who never smoked. As expected, a lower obesity prevalence was found among respondents meeting
Discussion
This study found significant, albeit modest, associations between long work hours, hostile work environments, and obesity among a nationally representative sample inclusive of U.S. workers from all I and O categories. These associations persisted after adjustment for demographic characteristics and health behaviors. There were also a few I and O categories that were associated with increased prevalence of obesity, even after adjustment for demographic characteristics, health behaviors, long
Acknowledgments
The authors express their appreciation to the many other persons, both within and outside of NIOSH and NCHS, who contributed to study planning, questionnaire development, and/or review of previous drafts of this paper. These include, but are not limited to, Marie Haring Sweeney, Toni Alterman, John Sestito, Aaron Sussell, Jim Dahlhamer, Brian Ward, Aleck Ostry, and Alberto Cabán-Martinez.
No financial disclosures were reported by the authors of this paper. The findings and conclusions in this
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