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American waistlines are expanding, with the adult obesity rate estimated by some to be as high as 40%. The obesity rate in the workforce has historically been lower than that of the general population, but this too is on the increase. Obese workers reportedly have more occupational limitations, more workplace absences and more workplace injuries. This leads, of course, to increased healthcare and workers’ compensation costs. Given the resultant public health and fiscal implications, it is important to know and understand the scale and scope of the problem. A recent study, Prevalence of Obesity by Occupation Among US Workers, based on the National Health Interview Survey 2004 – 2011, and published in the Journal of Occupational and Environmental Medicine, comes to the sobering conclusion that not only are over a quarter of all US workers obese (using a BMI index of 30 or higher), but that the overall prevalence of obesity increased “significantly” between 2004 and 2011.
A Snapshot of the American Obesity Problem
These conclusions are based on information collected from approximately 126,000 working adults in connection with the 2004-2011 National Health Interview Surveys (“NHIS”). The study went a step further than previous research, in that it also analyzed the prevalence of obesity by occupational group and along gender and race/ethnicity lines. In so doing, some patterns began to emerge. For example, while the overall prevalence of obesity increased 4.1% from 2004-2011, there were noticeable differences among gender, race/ethnicity and occupation subgroups. The data revealed that of the three main race/ethnicity groups looked at by the study (black, white, Hispanic), whites had the lowest rate of obesity (male 27%, female 23.1%), followed by Hispanics (male 28.2%, female 28.5%) and then blacks (male 31.7%, females 40%). As for occupations, the highest rates of obesity were found in traditionally blue-collar jobs (healthcare support—includes nurses and home health aides, protective services—includes law enforcement and firefighters, and transportation—particularly motor vehicle operators). Combining both these strands of data, the study found that black female workers in healthcare support and transportation had the highest prevalence of obesity (49.2% and 46.6% respectively).
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Occupational Medicine Perspective—The Small Stuff Adds Up: Leslie J. Hutchinson, MD, MPH, FACOEM, of HLM Consultants warns: “There is a balance between calories taken in and calories burned. If a person takes in about 3,000 calories more than they burn, they will gain about a pound; burning 3,000 calories more than eaten will lead to about a one pound weight loss. For example one Dutch pretzel is about 100 calories—not much, but eating one pretzel a day more than one burns will add up to 3,000 excess calories per month, or a gain of one pound per month, 12 pounds per year, 60 pounds in five years. The small stuff adds up.”
Interestingly, while the prevalence of obesity increased at a steady pace during the time period 2004-2007 across all gender and race/ethnicity groups, it held relatively constant thereafter (2008-2011). Taken at face value this may appear to be good news; however, celebrations are premature. According to the study, the reason it held constant is that while the obesity rate among blue-collar workers was checked during both time periods, obesity levels among white-collar workers “significantly increased”. That being said, the highest rates of obesity are still found in the aforementioned blue-collar jobs (healthcare support, protective services and transportation, particularly motor vehicle operators) while the lowest prevalence of obesity is still in traditionally white-collar jobs (architecture/engineering, healthcare practitioners and arts/sports/media). However, the recent rate of increase in white-collar jobs relative to blue-collar jobs drives home the point that no occupational field can afford to be complacent about obesity concerns.
Why is this happening?
The obvious question is why. Why are occupations that previously posted mild levels of obesity now seeing those levels rise? The study posits several possible explanations. It notes preliminarily that the problem is multi-faceted, with both cultural and occupational forces at play. Looming large amongst occupational influences is the increasingly sedentary nature of the workplace (the study points to research showing that some 80% of current occupations are sedentary, a 20% increase over the past 50 years). Indeed, the highest prevalence of obesity was found in transportation workers, specifically motor vehicle operators. Other studies have shown these workers have long stretches of sedentary behavior and are also at risk for an unhealthy diet.
Risk Management Tip: According to Rebecca Shafer, JD, President of Amaxx Risk Solutions and author of Your Ultimate Guide to Mastering Workers’ Comp Costs, “The data from these studies consistently show the America culture slipping into poor health habits. The employer that is not aware if this and proactively seeking a solution through health and wellness programs is paying the price. Not only is obesity a problem, but these workers generally have many other co-morbidities including cardiovascular problems, chronic pain and diabetes which prolong the length of time out of work. According to a Duke University study, obese workers account for twice as many claims, 13 times more lost workdays, 7 times higher medical costs, and 11 times higher indemnity costs. Employers who are serious about controlling these costs and having a positive healthy impact on their workforce need to implement a comprehensive wellness program to help employee’s modify their lifestyle and improve their overall health. Sponsoring on-site health fairs and classes are a good way to begin a wellness program.”
Another significant occupational factor is stress, with different occupations presenting different stress factors (e.g., shift work, organizational pressures, time pressures etc.). This study showed that the second highest prevalence of obesity was in protective services, including the high stress occupations of law enforcement and firefighting. The researchers noted the results of other studies indicating that obese firefighters were three times more likely than their slimmer colleagues to file Workers’ Compensation claims.
Another recent study adds heft to these findings. Published in the Journal of Occupational and Environmental Medicine, the article Adiposity Predicts Self-Reported Frequency of Poor Health Days Among Male Firefighters, notes that the prevalence of obesity among firefighters is greater than that of the general population and concludes that there is a “positive association” between overweight and obese firefighters and the frequency of days on which the firefighter reports feeling in poor health. For further discussion of this topic, see our blog post.
What can be done to mitigate the problem?
This study joins the expanding chorus of researchers who are sounding the alarm on obesity and urging greater activity in the workplace as one potentially mitigating step. This could include anything from redesigning offices (for example, installing standing workstations, “treadmill” or “pedal” desks, placing the printers further away from workstations etc.). to encouraging walks at break-times and promoting other forms of workplace health initiatives.
Occupational Medicine Perspective—The Most Important Exercise Is the Push-Away: Leslie J. Hutchinson, MD, MPH, FACOEM, of HLM Consultants explains: “The signal that tells the brain when a person has had enough to eat is primarily a combination of two hormones secreted in the small intestine. From the time one starts eating to the time the small intestine can secrete enough to tell the brain ‘we’re good’ is about 45 minutes. Most of us can put away a lot of food in 45 minutes. The most important exercise is the push-away. Push away from the table while you are still hungry. Thirty minutes later, you will usually not only not feel hungry; you will have more energy than usual after a meal.”
On the other side of the equation, of course, is diet—an issue most likely requiring intervention on a broader level (the study notes that some European countries, also struggling with obesity issues, are attempting to alleviate the problem by taxing unhealthy foods and ingredients). As this study makes clear, however, obesity is increasing and creeping into occupations previously considered low-risk. The concomitant social and financial costs are too great to ignore, and a consensus is seemingly emerging to urge that the problem be tackled with all due haste.
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