Managing obesity among the working population has remained a pressing issue for employers. The relationship between obesity, work, and health status is complex. In addition to direct health risks such as type II diabetes, heart disease, and osteoarthritis, obesity exacts far-reaching consequences on an occupational level with increasing medical expenditures, lost time, and presenteeism.
In the workplace, this translates to a diminished ability to handle both the physical and cognitive demands of job tasks. Research shows that exercise interventions help mitigate this epidemic by improving critical health and safety outcomes among the working population.
Obesity is clinically defined as having a BMI of 30 or above, compared to the normal range of 18.5 to 25. As of 2016, approximately 36.5% of U.S. adults are obese [CDC].
Aside from a few rare exceptions, the cause of obesity itself is simple. From a practical standpoint, obesity is a condition “in which the amount of body fat exceeds the biological need of an individual [Wiklund].” We gain weight when energy intake exceeds energy expenditure, and lose weight when more energy is expended than consumed. As anyone who’s ever tried to lose weight can tell you, this principle appears much easier on paper than when translated into day-to-day behavioral changes.
Population weight gain: how did we get here?
Over the past several decades, the national obesity rate has climbed to unprecedented levels, creating a serious public health crisis. While the U.S. contains 4.4% of the world’s population, it claims 11% of the world’s obese population.
Behind this concerning trend are two variables: an increase in sedentary behavior, and an increase in food intake. Up until the late 1970s, daily energy intake had been increasing consistently, but slowly. As technological advances in food production contributed to higher food availability than had ever been thought possible, the average American’s daily caloric intake increased dramatically—and with it, population weight gain.
The widespread increase in sedentary behavior can be attributed in part to the mechanization of energy-expending tasks: for example, the most prevalent modes of transport to work—once biking or walking—are now driving or public transportation, both of which are significantly more passive in comparison. The nature of the work itself has also changed. Over the past five decades, the collective shift from manual labor to desk jobs has led to a significant decrease in daily occupation-related energy expenditure [Church].
Obesity at work
Although occupations that require manual material handling are perhaps the most directly impacted by excessive body mass, obesity creates adverse health and safety outcomes in nearly every job type imaginable.
Health status
Numerous studies have shown a high level of comorbidity between obesity and various chronic health conditions. The degree of obesity is directly proportional to the risk of coronary heart disease, type II diabetes, hypertension, and cancers increased mortality.
Nearly two-thirds of adults with pre-diabetes or type II diabetes are also obese, which can be explained by the well-established link between obesity and insulin resistance [DiBonaventura].
The various chronic conditions tied to obesity contribute to higher healthcare utilization and medical expenses. Increases in employee BMI are directly associated with an increased number of both physician visits and emergency room visits [DiBonaventura].
Physiological function
From a biomechanical standpoint, excess weight . Obesity increases the amount of stress placed on joints during physical activity and reduces joint range of motion. (source: https://ir.uiowa.edu/cgi/viewcontent.cgi?article=4869&context=etd)
Higher fat mass is associated with lower muscle quality and an accelerated loss of lean mass in later years [Koster].
Obesity-related movement limitations include:
- Reduced muscle strength
- Impaired postural control
- Increased stress on joints
- Reduced joint range of motion
Injury risk
The most common work-related injuries associated with obesity are bone fractures, dislocations, strains, and sprains; in terms of risk factors precipitating these injuries, obese employees were found to be at higher risk of slips, trips, falls, and sudden body movement. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0077178#pone.0077178-Pollack2
Work productivity
Obesity is positively associated with higher impairment of work productivity across job types, with construction workers demonstrating the highest levels of impairment. On average, obese employees report significantly lower productivity than normal weight employees. As BMI increases, work productivity levels tend to decrease proportionally [DiBonaventura].
Obesity-related health conditions are most certainly a factor in this phenomenon; employees with “clusters” of cardiometabolic risk factors report 179% more missed work days and 147% more days in bed than those without [Sullivan].
The cumulative and multivariate risks of obesity not only has an adverse bottom-line impact on employers, it also diminishes the quality of life and earning potential of the obese working population.
Exercise keeps the weight off
Experts conclude that the problem of obesity in America can be attributed to changes in both environmental factors and health behaviors. Although genetic factors do play some role in an individual’s risk of becoming obese, the condition is highly preventable. In fact, many people who have a genetic predisposition to obesity do not become overweight.
Studies show that physical activity is considerably more effective for obesity mitigation than weight loss programs—the majority of weight-loss programs have proven unsustainable over time as participants often gain back any weight they had initially lost.
Recent findings suggest that physical activity is also critical to the long-term maintenance of weight loss [Jakicic]. Further insight can be found in data from the National Weight Control Registry, the largest ongoing study of long-term weight loss management [Catenacci]. On average, the individuals who were able to successfully maintain their weight loss reported engaging in significantly higher levels of structured, daily exercise.
“Voluntary exercise is the most important discretionary component of total daily energy expenditure, and thus has the potential to affect energy balance. This has been illustrated in a number of longitudinal studies [Wiklund].”
Prevention for older adults can mitigate loss of musculoskeletal ability.Exercise that builds muscle mass, such as strength and conditioning programs, helps the body maintain higher levels of energy expenditure each day.
References
Wiklund, P. (2016). The role of physical activity and exercise in obesity and weight management: Time for critical appraisal. Journal Of Sport And Health Science, 5(2), 151-154. doi: 10.1016/j.jshs.2016.04.001
https://www.cdc.gov/obesity/data/adult.html
Goettler, A., Grosse, A., & Sonntag, D. (2017). Productivity loss due to overweight and obesity: a systematic review of indirect costs. BMJ Open, 7(10), e014632. doi: 10.1136/bmjopen-2016-014632
Jakicic, J. (2009). The Effect of Physical Activity on Body Weight. Obesity, 17(n3s), S34-S38. doi: 10.1038/oby.2009.386
Catenacci, V., Grunwald, G., Ingebrigtsen, J., Jakicic, J., McDermott, M., & Phelan, S. et al. (2010). Physical Activity Patterns Using Accelerometry in the National Weight Control Registry. Obesity, 19(6), 1163-1170. doi: 10.1038/oby.2010.264
Kudel, I., Huang, J., & Ganguly, R. (2018). Impact of Obesity on Work Productivity in Different US Occupations. Journal Of Occupational And Environmental Medicine, 60(1), 6-11. doi: 10.1097/jom.0000000000001144
DiBonaventura, M., Lay, A., Kumar, M., Hammer, M., & Wolden, M. (2015). The Association Between Body Mass Index and Health and Economic Outcomes in the United States. Journal Of Occupational And Environmental Medicine, 57(10), 1047-1054. doi: 10.1097/jom.0000000000000539
Sullivan, P., Ghushchyan, V., Wyatt, H., Wu, E., & Hill, J. (2007). Productivity Costs Associated with Cardiometabolic Risk Factor Clusters in the United States. Value In Health, 10(6), 443-450. doi: 10.1111/j.1524-4733.2007.00199.x
Koster, A., Ding, J., Stenholm, S., Caserotti, P., Houston, D., & Nicklas, B. et al. (2011). Does the Amount of Fat Mass Predict Age-Related Loss of Lean Mass, Muscle Strength, and Muscle Quality in Older Adults?. The Journals Of Gerontology Series A: Biological Sciences And Medical Sciences, 66A(8), 888-895. doi: 10.1093/gerona/glr070
Church, T., Thomas, D., Tudor-Locke, C., Katzmarzyk, P., Earnest, C., & Rodarte, R. et al. (2011). Trends over 5 Decades in U.S. Occupation-Related Physical Activity and Their Associations with Obesity. Plos ONE, 6(5), e19657. doi: 10.1371/journal.pone.0019657
