I have no conflicts of interest to disclose Occupations and obesity? - - PDF document

2/27/2017 1

The Skinny on Work: obesity on the job Julia Buss

I have no conflicts of interest to disclose

Objec Objectiv ives es

• Obesity on the job
• Identify the occupations with highest prevalence
• f obesity
• Summarize the work factors associated with risk
• f obesity

Obesity is a body mass index of 30 or above

Occupations and obesity?

Luckhaupt et al. (2014) American Journal of Preventive Medicine www.bls.gov/soc/

2/27/2017 2

Luckhaupt, (2014) American Journal of Preventive Medicine Luckhaupt et al. (2014) American Journal of Preventive Medicine Luckhaupt, (2014) American Journal of Preventive Medicine

Prevalence of obesity in the US workforce

Luckhaupt, (2014). American Journal of Preventive Medicine

2/27/2017 3

Prevalence of Self‐Reported Obesity among US Adults 2015

Obesity Trends Among U.S. Adults

2009 1990

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

2/27/2017 4

Social relational aspects of work

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

1.02 0.98 0.92 1.26 1.13 1.11 1.13 1.05 1.02 0.8 0.9 1 1.1 1.2 1.3

Prevalence ratio

Social factors Prevalence Ratio (95%CI)

Luckhaupt, (2014). American Journal of Preventive Medicine

2/27/2017 5

• 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

2/27/2017 6

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 Antunes, (2010). Nutrition Research Reviews Cappuccio, (2008). Sleep Patel, (2016). Obesity O’Keefe, (2016). Workplace Health and Safety

So far we have seen evidence for

• Long work hours
• Shift work
• Sleep duration
• Hostile work environment
• Job stress
• Other areas being researched
• Food environment
• Sedentary job
• Peer group norms
• Labor laws
• Obesogens

2/27/2017 7

Food environment

Wansink (2006) International Journal of Obesity Story (2008) Annual Review of Public Health

Sedentary job

Wanner, (2016). International Journal of Obesity Rezende, (2014). PloS ONE Proper, (2011). American Journal of Preventive Medicine

38.3% 40.1% 37.0% 30.2% 35.3% 21.2% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% United States: Below 100% FPL United States: 100%‐199% FPL United States: 200%‐399% FPL United States: 400% FPL or more United States: All income levels 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.

Income level may contribute to the higher prevalence of

• besity in the United States than in similar countries

Prevalence of obesity for adults age 20+ by poverty level in the U.S. and on average in comparable countries, age‐adjusted, 2012

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

2/27/2017 8

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

• verweight 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

2/27/2017 9

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

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

Your role as a health care provider

2/27/2017 10

The Take 5 Challenge 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

2/27/2017 11

• 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

• f 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

• besity and injury among U.S. workers: NHIS 2004‐2012. J Safety Res, 58, 21‐30.