The Skinny on Work: obesity on the job Julia Buss I have no conflicts of interest to disclose Objectives Occupations and obesity? Obesity on the job Identify the occupations with highest prevalence of obesity Summarize the work factors associated with risk of obesity Obesity is a body mass index of 30 or above Luckhaupt et al. (2014) American Journal of Preventive Medicine www.bls.gov/soc/ 1
Luckhaupt, (2014) American Journal of Preventive Medicine Luckhaupt et al. (2014) American Journal of Preventive Medicine Prevalence of obesity in the US workforce Luckhaupt, (2014) American Journal of Preventive Medicine Luckhaupt, (2014). American Journal of Preventive Medicine 2
Prevalence of Self Reported Obesity among US Adults 2015 Obesity Trends Among U.S. Adults 1990 2009 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% (*BMI 30, or about 30 lbs. overweight for 5 4 person) Source: CDC Healthy worker effect 3
Social relational aspects of work Social factors Prevalence Ratio (95%CI) 1.3 1.26 1.2 Prevalence ratio 1.1 1 0.9 1.13 1.02 1.13 1.05 0.98 1.11 1.02 0.92 0.8 Hostile work environment Job insecurity Work family imbalance lower 1.02 0.98 0.92 upper 1.26 1.13 1.11 point estimate 1.13 1.05 1.02 Luckhaupt, (2014). American Journal of Preventive Medicine 4
43% of people eat more when stressed 36% skip a meal American Psychological Society, (2007). Stress in America; O Connor, (2008). Health Psychology. Zellner, (2006). Physiology and Behavior; Oliver, (2000). Psychosomatic Medicine. http://www.cdc.gov/niosh/topics/stress/ Soloveiva, (2013). Scandinavian Journal of Work & Environmental Health Wardle, (2011). Obesity Nyberg, (2012). Journal of Internal Medicine Soloveiva, (2013). Scandinavian Journal of Work & Environmental Health 5
Bureau of Labor Statistics, U.S. Department of Labor, (2014) The Economics Daily Soloveiva, (2013). Scandinavian Journal of Work & Environmental Health Magee, (2010). Journal of Occupational and Environmental Medicine So far we have seen evidence for Long work hours Shift work Sleep duration Hostile work environment Job stress Antunes, (2010). Nutrition Research Reviews Cappuccio, (2008). Sleep Patel, (2016). Obesity O Keefe, (2016). Workplace Health and Safety Other areas being researched Food environment Sedentary job Peer group norms Labor laws Obesogens 6
Food environment Sedentary job Wansink (2006) International Journal of Obesity Story (2008) Annual Review of Public Health Wanner, (2016). International Journal of Obesity Rezende, (2014). PloS ONE Proper, (2011). American Journal of Preventive Medicine Income level may contribute to the higher prevalence of obesity in the United States than in similar countries 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Prevalence of obesity for adults age 20+ by poverty level in the U.S. and on average in comparable countries, age adjusted, 2012 38.3% United States: Below 100% FPL 40.1% United States: 100% 199% FPL 37.0% United States: 200% 399% FPL 30.2% United States: 400% FPL or more 35.3% United States: All income levels 21.2% Comparable Countries: Average Source: Data by poverty level are from CDC/National Center for Health Statistics, Health, United States, 2014: With Special Feature on Adults Aged 55 64, available at http://www.cdc.gov/nchs/hus.htm; comparable country data are from OECD (2016), "Non-medical determinants of health", OECD Health Statistics (database). DOI: http://dx.doi.org/10.1787/data-00546-en (Accessed on 21 January 2016). Note: Comparable countries here include Australia, Canada, Germany, Japan, and the United Kingdom. Data for Australia are for 2011 and data for Canada are for 2013. Obesogens Endocrine disrupting chemicals (EDCs) act by altering some aspect of hormone action metabolic disruptors are EDCs associated with obesity Promote the number and size of fat cells Shift energy balance to favor storage Alter gut microbiota to promote food storage Alter the hormones of appetite control (satiety and hunger) Alter brain circuits controlling food intake Impact insulin levels Janesick et al., (2016) Am J Obstet Gynecol 7
Mice exposed to arsenic in utero The control mouse was not exposed to arsenic during embryonic development and is a normal weight. In comparison, mice exposed to arsenic at 10 parts per billion, center, and 42 parts per million are visibly heavier. The study also determined that these exposed mice entered puberty earlier than controls. Rodriguez KF, et al. 2015. Environ Health Perspectives Why does it matter? Obesity is a disease At work: Lost productivity from diseases attributable to overweight and obesity estimated at $988.8 billion The Obesity Society, (2014). White Paper The Milken Institute (2016) Luckhaupt, (2014) American Journal of Preventive Medicine Weight related comorbidities : Cardiovascular disease Venous stasis ulcers/thrombophlebitis Hyperlipidemia Obstructive sleep apnea Obesity hypoventilation syndrome Pulmonary hypertension Asthma Insulin resistance Type 2 diabetes Polycystic ovarian syndrome Deep venous thrombosis Pulmonary embolism Gastroesophageal reflux disease Abdominal hernia Non alcoholic fatty liver disease Gallstones Stress urinary incontinence Urinary tract infections Infertility Miscarriage Gestational diabetes Degenerative joint disease Chronic back pain Plantar fasciitis Carpal tunnel syndrome Stroke Depression Anxiety All cancers except esophageal and pancreatic Illness and injury Absent from work Gu, (2016). Journal of Safety Research Rush, (2016). Obesity Ostbye (2007). Archives Internal Medicine Hammond (2010). Diabetes, Metabolic Syndrome and Obesity Keeny (2013) J Occup Environ Med 8
NIOSH Total Worker Health The National Institute for Occupational Safety and Health (NIOSH) takes the Total Worker Health approach TWH recognizes work as a social determinant of health Control of hazards and exposures The organization of work Built environment Leadership Compensation and benefits Community supports Changing workforce demographics Policy issues New employment patterns Your role as a health care provider U.S. Preventative Services Task Force Screen all adults for obesity. Clinicians should offer or refer patients with a body mass index (BMI) of 30 kg/m2 or higher appropriate weight loss advice 9
The Take 5 Challenge www.obesitycareweek.org Practical Guide for Identifying, Evaluating and Treating Obesity at: www.nhlbi.nih.gov/files/docs/guidelines/prctgd_c.pdf 1. At every patient visit health care providers should: A. Avoid talking about weight B. Screen all adults for obesity & offer appropriate weight loss advice C. Blame the patient for their weight status D. Refer those with BMI >25 to treatment 2. Weight related co morbidities include: A. Degenerative joint disease B. Fatty liver disease C. Sleep apnea D. All of the above 10
3. Which of the following is NOT an example of the Total Worker Health integrative approach? A. Stress management at work that address workplace stressors and provides ways to help build individual resiliency B. Combined Safety and Health Promotion committees C. Gym membership discounts for workers D. Comprehensive screenings for work related and non work related health risks Thank you! jbuss@berkeley.edu Useful References 1. Luckhaupt, S. E., Cohen, M. A., Li, J., & Calvert, G. M. (2014). Prevalence of Obesity Among U.S. Workers and Associations with Occupational Factors. American Journal of Preventive Medicine, 46(3), 237 248. 2. Solovieva, S., Lallukka, T., Virtanen, M., & Viikari Juntura, E. (2013). Psychosocial factors at work, long work hours, and obesity: a systematic review. Scandinavian Journal of Work & Environmental Health, 16(10). 3. Proper, K. I., Singh, A. S., van Mechelen, W., & Chinapaw, M. J. M. (2011). Sedentary Behaviors and Health Outcomes Among Adults: A Systematic Review of Prospective Studies. American Journal of Preventive Medicine, 40(2), 174 182. 4. The Obesity Society. (2008). Obesity as a Disease: The Obesity Society Council Resolution. Obesity, 16(6), 1151 1151. 5. Gu, J. K., Charles, L. E., Andrew, M. E., Ma, C. C., Hartley, T. A., Violanti, J. M., & Burchfiel, C. M. (2016). Prevalence of work site injuries and relationship between obesity and injury among U.S. workers: NHIS 2004 2012. J Safety Res, 58, 21 30. 11