Occupations with High Obesity Prevalence in Washington State

If work and the workplace contribute to poor health behaviors, should employers attempt to improve those behaviors?  It likely is in the employer’s best interest to do so.

Poor health behaviors can lead to chronic disease.  Workers with chronic disease may be at higher risk for workplace injury, have more absenteeism, and diminished productivity at work. Once injured, workers with chronic diseases take a longer time to return to work.  So the best strategy would be for employers to promote healthy behaviors to prevent the occurrence of these chronic diseases.

Many state health departments offer chronic disease prevention programs. Surprisingly, there is a dearth of state-level information about the health behaviors of workers across occupations.  We recently presented findings from a research study;[1] where the main objective was to estimate the level of obesity and other worker health behaviors by occupation in Washington State. We used the Behavioral Risk Factor Surveillance System (BRFSS) survey for this research.  BRFSS is the world’s largest telephone health survey and a nationwide surveillance system, collecting on-going behavioral information in the U.S. and providing valuable public health data.

The prevalence of obesity among all Washington workers was 24.6%. However, the prevalence of obesity across occupations ranged from 11.6% to 38.6%.  The three occupational groups with the highest obesity prevalence were:

1.  Truck drivers, 38.6%.
2.  Transportation and material moving (bus drivers, crane operators, etc), 37.9%.
3. Protective services (for example, firefighters, police officers and correctional officers), 33.3%.

When compared to health diagnosing occupations (physicians and dentists, for example) and after adjusting for other covariates,[2] most occupations had significantly increased odds of obesity.

Inclusion of occupation on the BRFSS allows estimation of the prevalence of current smoking, adequate fruit and vegetable intake, and leisure time physical activity levels. Based on these measures, specific occupational groups can be evaluated against national and state efforts at promoting workplace wellness.  For example, of the 28 occupational groups, 10 had already met the Healthy People 2020 goal for smoking prevalence at less than 12%.-

Using occupation as a means to target workplace wellness and health promotion activities makes sense when you look at correlations between good and poor health behaviors.  In this research, occupations with a high prevalence of obesity had a lower prevalence of vigorous leisure time physical activity, a lower prevalence of adequate fruit and vegetable consumption and a higher prevalence of smoking.

Only 2003, 2005, 2007 and 2009 BRFSS data were used because respondent’s information on fruit and vegetable intake was only collected those years.  Since there are very few systematic measures of the health of workers by occupation at the state level, we want to emphasize the value of capturing health information by occupation across all states in BRFSS.  The findings of this research study identify high risk occupational groups of obesity in Washington State for better allocation of financial and public health resources, and similar research could be done for other health concerns of the workforce in other states.

Also worthy of further exploration is the connection between the conditions and nature of the work within an industry sector and health behaviors.  The work demands, risks, schedules, remuneration, and other requirements that many jobs in certain industries and occupations entail have the potential to strongly influence the overall health of workers in those occupations.  How do these parameters affect health behaviors and ultimately health outcomes?  How can workplace policies, environments and conditions be made safer and more conducive to positive health opportunities and more informed decision-making?  How can we better understand the interaction between healthier, safer work and a healthier citizenry? Current research funded by NIOSH is beginning to examine these issues in a more comprehensive way.

The Washington findings from the BRFSS that the prevalence of obesity varies by occupation are consistent with another recent study out of NIOSH that examined the prevalence of obesity among workers by industry and occupation and by work organization factors using data from the 2010 National Health Interview Survey Occupational Health Supplement (NHIS-OHS).[3]  Like the BRFSS data, the NHIS data showed a relatively high prevalence of obesity among workers in protective service and transportation and material moving occupations.  After adjustment for covariates, employment in health care and social assistance and public administration industries, as well as architecture and engineering, community and social service, protective service, and office and administrative support occupations was also associated with increased obesity prevalence.  Among all workers, working for more than 40 hours per week and exposure to a hostile work environment were also significantly associated with obesity.

The NIOSH Total Worker Health^TM program takes a comprehensive approach to promoting worker health by advancing the integration of health protection and health promotion in the workplace.  The effort focuses on both improving the quality and safety of work and empowering workers for better health-related decision making.  Visit the NIOSH Total Worker Health^TM website to  find out more about the current research, interventions and promising practices.

For more information about the SHARP (Safety & Health Assessment & Research for Prevention) program at the Washington State Department of Labor and Industries visit the webpage.

Wendy Lu, MPH; David Bonauto, MD, MPH; Joyce Fan, PhD;  L. Casey Chosewood, MD;  Sara E. Luckhaupt, MD, MPH

Miss. Lu is an epidemiologist in SHARP research program at the Washington State Department of Labor and Industries.

Dr. Bonauto is the medical director of SHARP research program at the Washington State Department of Labor and Industries.

Dr. Fan is an epidemiologist in SHARP research program at the Washington State Department of Labor and Industries.

Dr. Chosewood is the Senior Medical Officer for Total Worker Health^TM at NIOSH.

Dr. Luckhaupt is a medical epidemiologist in the NIOSH Division of Surveillance, Health Evaluations and Field Studies.

[1] Bonauto DK, Lu D, Fan ZJ. Obesity Prevalence by Occupation in Washington State, Behavioral Risk Factor Surveillance System. Prev Chronic Dis 2014; 11:130219. www.cdc.gov/pcd/issues/2014/13_0219.htm?s_cid=pcd9e04_x. Accessed February 18, 2014.

[2] Other covariates include age, gender, race/ethnicity, annual household income, educational attainment, current smoking, leisure time and occupational physical activity levels and fruit and vegetable intake.

[3] Luckhaupt SE, Cohen M, Li J, Calvert GM. Prevalence of obesity among U.S. workers and associations with occupational factors. Am J Prev Med 2014;46(3):237–248. http://www.sciencedirect.com/science/article/pii/S074937971300617X