Understanding and Counteracting the Obesogenic Work Environment

Transcription

1 A Research and Innovation Center for a Healthier Workforce Understanding and Counteracting the Obesogenic Work Environment Suzanne Nobrega, M.S. Project Director University of Massachusetts Lowell Department of Work Environment

2 CPH-NEW: Who We Are University of MA Lowell Occ. Health & Safety Epidemiology Biostatistics Economics Nursing University of CT Health Center Ergonomics Medicine Health Policy University of CT Storrs Psychology Health Promotion

3 Objectives Understand pathways between work environment and obesity/overweight. Identify factors relevant to low wage workforce. Describe strategies for addressing workrelated risk factors for obesity/overweight. 3

4 Contributors Nicole Champagne, Ed.D., University of Massachusetts Lowell, Lowell, MA Laura Punnett, Sc.D., University of Massachusetts Lowell, Lowell, MA Marlene Abreu, BS, University of MA Lowell, Masters candidate, Community Social Psychology Laura Kernan, BS, University of MA Lowell, Masters candidate, Occupational Epidemiology 4

5 Funding support CPH-NEW is supported by Grant Number 1 U19 OH from the U.S. National Institute for Occupational Safety and Health. This material is solely the responsibility of the authors and does not necessarily represent the official views of NIOSH. 5

6 Part 1 BACKGROUND: WORKSITE PROGRAMS TO ADDRESS OVERWEIGHT AND OBESITY 6

7 Obesity in the U.S. Obese Body Mass Index (BMI) 30 or more; overweight BMI Obesity associated with heart disease, stroke, high blood pressure, osteoarthritis 34.9% 23.6% % Obese adults Healthy People 2020 Goals: Increase to 33.9% people at healthy weight Reduce to 30.6% obese adults BRFSS

8 Tobacco Use, Physical Inactivity, and Obesity Obese employees (BMI > 35) have 4.2% higher health-related productivity loss, equal to $506 per employee per year J Occup Environ Med. 2008;50(1):39-45 Medical costs (2008) associated with obesity estimated at $147 billion; medical costs paid for obese individuals $1,429 higher annually than for normal weight Health Affairs. 2009;28(5):w

9 Workplace intervention strategies to control obesity/overweight Analytic framework for worksite nutrition and physical activity interventions to improve weight status 9

10 Effectiveness varies Most common: information/behavioral More intense, more effective No one silver bullet Average 2.3 lbs lost (9 studies); Average BMI reduction 0.5 (6 studies) GAP--Programs often do not address job related drivers of overweight. Guide to Community Preventive Services. Obesity prevention and control: worksite programs. Am J Prev Med 2009;37(4):

11 Physical working conditions Individual or lifestyle factors are influenced by the environment including working conditions Work organization & psychosocial conditions Health behaviors Smoking Diet, nutrition Leisure exercise Obesity 11

12 Work Organization A risk factor for obesity? the combination of the way in which work processes are designed and arranged, as well as the broader organizational practices that influence job design. NIOSH, The Changing Organization of Work and the Safety and Health of Working People (2002) How often? When? Who does what? Work Organization How? 12

13 Work Organization Work Organization Physical loading patterns Psychosocial stressors effort required frequency duration (lack of) variation job demands decision making social support job insecurity 13

14 Part 2 JOB-RELATED PREDICTORS OF OBESITY 14

15 Work factors leading to obesity What does the science tell us? Shifts/Sleep Insufficiency Job Stress Sedentary occupation Obesity Other exposures 15

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17 Work factors leading to obesity: Sedentary occupations 1 Sedentary Occupations Reported by 69.5% of workers in sample of 2,019 U.S. workers. Common in high education groups (executive, administrative, managerial, professional) Significant associations between obesity among U.S. workers when combined with LOW physical demand. Choi et. al. AJIM

18 Work factors leading to obesity Shift work; sleep disruption/insufficiency Associated with disease outcomes Long work hours High BMI, Diabetes Cardiovascular Disease (CVD) Hypertension Increased dependency on job site foods Limited sleep (<6hrs/night) Disrupts insulin metabolism fat production Increases hunger, food intake 18

19 Work factors leading to obesity Job stress Associated with disease outcomes CVD Anxiety Depression Musculoskeletal Disorders (MSDs) Associated with behavioral outcomes Low leisure-time physical activity Low participation and adherence in workplace exercise programs Can influence food choice, eating patterns 19

20 Job Conditions Associated with Stress High workload and long hours Low job control Authoritarian management style Poor interpersonal relationships Ambiguous work roles Job insecurity Unsafe or extreme environmental conditions 20

21 Higher job stress is associated with greater prevalence of lifestyle risk factors: Smoking, drinking, obesity, physical inactivity dksjlfkskdlfjsdfsd Odds fsdfsdfsdfsfsfsfd Ratio 2.5 for sdfsdfdsdssdfsdf high ERI 2.0 sdsfsfsjlkjlkjlkjlkjj score jjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjj 1.5 jjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjj jjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjj 1.0 jjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjj jjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjj 0.5 jjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjj j 0.0 Men Women 1 risk 2 risks 3-4 risks Kouvonen et al. 2006, Job stress measured as Effort Reward Imbalance (ERI) 21

22 Work factors leading to obesity Chemical irritants Chemicals (e.g. herbicides) Insulin metabolism diabetes obesity Asthmagens (breathable dusts, chemicals) More common among obese adults May limit ability physical activity 22

23 Work factors leading to obesity Secondary Pathways Secondary to disability Secondary to medication post-injury asthma other medical conditions that might reduce exercise frequency/ intensity anxiety or depression (stress, assault) other potentially work-related conditions 23

24 Obesity/overweight and the role of working conditions: Results of a qualitative and participatory investigation Food environment at work Available food choices Kitchen equipment Space to eat at work Psychosocial stressors High demands Low control Low social Physically demanding work Illnesses and injuries Leisure time activity Time pressure Scheduling Multiple jobs/responsibilities Unpublished data, CPH-NEW 24

25 Maria s Story Lifting the mattress and tucking in the sheets over 240 times a day and bending down to clean up to 30 bathtubs causes us pain as we rush to clean 30 rooms. Maria, housekeeper 90% of the hotel housekeepers, including Maria, took pain medication regularly for injuries they associated with work, making it possible for them to keep earning their living. After taking the pain medication for several months, Maria found that her weight had dramatically increased. 25

26 Jose s Story We suffered for years while our employer stole money from our wages and forced us to work in dangerous conditions. I was beaten up by my supervisor and my coworkers also faced physical and verbal abuses, - Jose, employee at a warehouse of a large supermarket chain for fourteen years. Jose told MassCOSH that the injury he suffered from his assault caused him to become so depressed he needed to take medication. His wife too became depressed and took medication. Jose experienced weight gain and his wife became morbidly obese. 26

27 Part 3 INTERVENTIONS 27

28 Create healthier workplace work environments AND lifestyles 1. Address work organization -- TOP priority! 2. Also offer programs for individuals to help with lifestyle risk factors. GOLD STANDARD Combining organizational AND individual stress management approaches for best results. 28

29 What does an integrated approach to weight management look like? Healthy environment Healthy work scheduling Flexible work policies Jobs designed for variety, control Well equipped, clean break room for meals Policies for mealtime and rest breaks Strong health, safety, ergonomic protections Healthy lifestyles Clean eating facilities Healthy food choices Stress management Well lighted, safe facility Management support for rest, movement breaks, flexibility 29

30 Sedentary work Healthy workplace Supervisors trained, rewarded for encouraging moving breaks, MODELS Printers down the hall Comfortable, adjustable workstations Job redesign or rotation: add movement to the job! Standing/walking meeting Healthy lifestyle Education: personal habits about stretching and movement Lifestyle and weight loss programs Safe, well lighted grounds Incentives, flexible hours to accommodate non-work physical activity 30

31 Shift work/sleep disruption Healthy workplace Healthy scheduling policies Shifts avoid 12 hrs+ No mandatory overtime Healthy lifestyle Education: awareness about staying healthy with night work. Education about sleep hygiene Healthy food options on site Well equipped break room Incentives, flexible hours to accommodate nonwork physical activity 31

32 Job Stress Healthy workplace Participatory management styles Supervisor training Work-family supports Healthy job design and career-pathing Culture of communication and respect Mental health services Healthy lifestyle Stress management or mindfulness training Lifestyle and weight loss programs Healthy foods on site Safe well-lighted facility 32

33 Environmental exposures Healthy workplace Strengthen safety culture and safety program to reduce exposures Safety audit air quality Supervisor training New employee training Healthy lifestyle Lifestyle and weight loss programs Healthy foods on site Safe well-lighted facility Smoking cessation Personal Protective Equipment 33

34 Best Practices for Worksite Intervention Planning Gain leadership support Engage all levels of employees in planning interventions Ensure that strategies are sustainable, integrated Use multiple strategies Customize the strategies for employees 34

35 Summary Health behaviors leading to overweight and obesity are influenced by the work environment. Creating healthier work environments and lifestyles requires an integrated, yet adaptable, approach that addresses work organization and individual risk factors. Leadership support and employee engagement are essential components for planning sustainable interventions. 35

36 Contacts and Acknowledgements University of Massachusetts Lowell Sandy Sun Tel: CPH-NEW general CPH-NEW main website: University of Connecticut Jeff Dussetschleger Tel: University of Connecticut CPH-NEW website: Join our Mail List! The Center for the Promotion of Health in the New England Workplace is supported by Grant Number 1 U19 OH from the National Institute for Occupational Safety and Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH. 36

37 References Anderson LM, Quinn TA, Glanz K, Ramirez G, Kahwati LC, Johnson DB, Ramsey Buchanan L, Archer WR, Chattopadhyay S, Kalra GP, Katz DL, Task Force on Community Preventive Services. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review. [PDF MB] Am J Prev Med 2009;37(4): Centers for Disease Control and Prevention (CDC). (2011). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services. Church, T. S., Thomas, D. M., Tudor-Locke, C., Katzmarzyk, P. T., Earnest, C. P., Rodarte, R. Q., &... Bouchard, C. (2011). Trends over 5 decades in U.S. occupation-related physical activity and their associations with obesity. Plos ONE, 6, 1-7. doi: /journal.pone Finkelstein, E. A., Trogdon, J. G., Cohen, J. W., & Dietz, W. (2009). Annual medical spending attributable to obesity: Payer- and service-specific estimates. Health Affairs, 28w822-w831. doi: /hlthaff.28.5.w822 Gates, D. M., Succop, P., Brehm, B. J., Gillespie, G. L., & Sommers, B. D. (2008). Obesity and presenteeism: The impact of body mass index on workplace productivity. Journal Of Occupational And Environmental Medicine, 50, doi: /jom.0b013e31815d8db2 37

38 References Guide to Community Preventive Services. (2011). Obesity prevention and control: Worksite programs. Kouvonen, A., Kivimäki, M., Virtanen, M., Heponiemi, T., Elovainio, M., Pentti, J., &... Vahtera, J. (2006). Effort-reward imbalance at work and the co-occurrence of lifestyle risk factors: cross-sectional survey in a sample of 36,127 public sector employees. BMC Public Health, 6, doi: / National Institute of Occupational Safety and Health (NIOSH). (2002). The changing organization of work and the safety and health of working people. Retrieved from Wang, F., McDonald, T., Champagne, L., & Edington, D. (2004). Relationship of body mass index and physical activity to health care costs among employees. Journal Of Occupational & Environmental Medicine, 46(5),