obesity has emerged as one in every of the most essential public health problems within the us. we assessed obesity prevalence rates as well as their trends among major us occupational teams. self-reported weight and height were collected annually on us workers, aged 18 years or older, coming from the 1986 to firmly 1995 and therefore the 1997 to firmly 2002 national health interview surveys. overall, occupation-, race-, and gender-specific rates of obesity ( defined being a body mass index30. zero kg/m^sup 2^ ) were calculated with information pooled from each study periods ( n600 000 ). annual occupation-specific prevalence rates were additionally calculated, as well as their time trends were assessed. obesity rates increased considerably eventually among employed workers, no matter race and gender. the average yearly amendment increased from zero. 61% ( ±. 04 ) throughout the episode from 1986 to firmly 1995 to firmly zero. 95% ( ±. 11 ) throughout the episode from 1997 to firmly 2002. average obesity prevalence rates and corresponding trends varied significantly across occupational teams ; pooled obesity prevalence rates were highest in motor vehicle operators ( 31. 7% in men ; 31. 0% in girls ). weight loss intervention programs targeting workers employed in occupational teams with high or increasing rates of obesity are urgently required.
objectives. obesity has emerged as one in every of the most essential public health problems within the us. we assessed obesity prevalence rates as well as their trends among major us occupational teams.
strategies. self-reported weight and height were collected annually on us workers, aged 18 years or older, coming from the 1986 to firmly 1995 and therefore the 1997 to firmly 2002 national health interview surveys. overall, occupation-, race-, and gender-specific rates of obesity ( defined being a body mass index30. zero kg/m^sup 2^ ) were calculated with information pooled from each study periods ( n600 000 ). annual occupation-specific prevalence rates were additionally calculated, as well as their time trends were assessed.
results. obesity rates increased considerably eventually among employed workers, no matter race and gender. the average yearly amendment increased from zero. 61% ( ±. 04 ) throughout the episode from 1986 to firmly 1995 to firmly zero. 95% ( ±. 11 ) throughout the episode from 1997 to firmly 2002. average obesity prevalence rates and corresponding trends varied significantly across occupational teams ; pooled obesity prevalence rates were highest in motor vehicle operators ( 31. 7% in men ; 31. 0% in girls ).
conclusions. weight loss intervention programs targeting workers employed in occupational teams with high or increasing rates of obesity are urgently required. ( am j public health. 2005 ;95 :1614-1622. doi :10. 2105/ajph. 2004. 050112 )
within the us, obesity has risen at an unprecedented rate throughout the previous 20 years, 1 and current analysis indicates that the situation is worsening instead of improving. from 1960 to firmly 1980, the prevalence of obesity among adults within the us was relatively stable ; though, recent findings coming from the national health and nutrition examination survey ( nhanes ) showed that 3 from each 10 us adults are obese. 2 additionally to firmly increasing mortality from all causes, obesity is linked to firmly an increased risk of developing hypertension, type 2 diabetes mellitus, dyslipidemia, gallbladder disease, osteoarthritis, coronary heart disease, stroke, asthma, and sleep apnea. 3-7 additionally, new proof suggests obesity may be a risk issue for endometrial, breast, prostate, and colon cancers. 8-10 the relationship between obesity and occupation has not been totally investigated. work-related factors, like job and position, job stress, and extended work ( together with overtime night work and sedentary work ) might promote weight gain and abdominal fat accumulation. 11-14 possibly one of the national healthy folks 2010 objectives is to cut back the prevalence rate of obesity among adults to firmly lower than 15%, 15 thus, as a result of treatment usually fails, analysis efforts targeted on prevention are needed. weight loss intervention and education programs targeting workers employed in numerous occupational teams are urgently required, however, unfortunately, nationally representative knowledge identifying occupational teams in the highest obesity rates are definitely not presently on the market. 16, 17 it's additionally not known that occupational teams are experiencing giant will increase in obesity rates. our analysis objective was to firmly evaluate overall, gender- and race-specific obesity rates as well as their 17-year trends, together with yesteryear decade, at intervals 41 occupational teams using nationally representative samples of one's us worker population.
ways
the national health interview survey ( nhis ) may be a continuous multipurpose and multistage chance space survey of one's us civilian noninstitutionalized population living at addressed dwellings. 18 every week, a chance sample of households is interviewed by trained personnel to firmly obtain data relating to the characteristics of each one membership owner the household. 19 within the majority of cases ( 63% ) within the 1986 to firmly 1996 nhis surveys, the participants themselves answered all the queries ; regarding the remaining participants, the responses were obtained from their relatives or any other proxies. though, starting in the 1997 nhis survey, all survey responses were self-reported. for simplicity, within the present study, each self-reported or proxy-reported knowledge are stated as reported. within the amount from 1986 to firmly 1996, annual nhis survey response rates ranged from 95% to firmly 98%20 ; within the amount from 1997 to firmly 2002, these rates fell to firmly 70%-80%, reflecting the trend of lower response rates in all national surveys. 21, 22
body mass index ( bmi ) is widely used to firmly define obesity and has actually been found to firmly closely correlate in the level of weight resulting in obesity. 23 bmi was calculated by dividing weight in kilograms by height in meters squared. respondents were classified as obese if their bmi was larger than 30. zero kg/m^sup 2^. 24 from 1986 to firmly 1995, the nhis reported weight and height values for those participants. knowledge due to 1996 survey year are definitely not presented as a result of, for that year, the national center for health statistics ( nchs ) reported knowledge solely for participants by having weight between 98 and 289 pounds as well as a height between 59 and 76 inches ; bmi regarding the 1996 participants outside of such weight and height ranges were not created on the market by nchs. beginning in 1997, the nhis was redesigned and therefore the nchs created on the market the bmi values for those participants, even those with weight and height outside the on top of ranges. 25 as a result of of such differences within the reporting, and as a result of the major redesign of one's sampling and interview format, we analyzed knowledge separately for nhis survey periods 1986 to firmly 1995 and 1997 to firmly 2002.
within the 1986 to firmly 1995 nhis, employment data was collected on several subjects aged 18 years or older who reported operating throughout the 2 weeks previous to firmly the survey26, 27 ; beginning in 1997, nchs collected employment data from adults who stated that they actually were operating throughout the week until the nhis survey. each of such definitions included paid and unpaid work. forty-one standardized occupational codes derived from a lot of detailed us census occupational codes were provided within the nhis database from 1986 to firmly 1995 and from 1997 to firmly 2002. 28, 29 we grouped survey participants within the trend knowledge analysis into white, black, or any other race class. alternative race included alternative, aleutian eskimo/american indian, asian/ pacific islander, and unknown/multiple races.
as a result of of one's advanced sample survey style, analyses were completed along with the sudaan package to bring into account sample weights and style effects. 30 for pooled prevalence estimates, sample weights were adjusted to firmly account for our aggregation of knowledge over multiple survey years by dividing the original weight by 10 ( the amount of years combined in survey years 1986 through 1995 ) and by 6 ( the amount of years combined in survey years 1997 through 2002 ). 18 to firmly assess obesity trends among every survey amount, a weighted linear regression model was fitted towards the annual design-adjusted rates among occupational teams. the load used for every annual rate was the inverse of its variance.
results
a total of 603 139 persons aged 18 years and older reported operating among the 2 weeks before their participation within the 1986 to firmly 1995 nhis surveys, and within the 1 week before their participation within the 1997 to firmly 2002 nhis surveys. among the 488 612 workers within the 1986 to firmly 1995 survey amount, the mean age ( ±sd ) was 38. 9 ±12. 8, with the use of a total of 226 128 girls ( 46. 3% ) ; the mean age of one's 114 527 workers direct from 1997 to firmly 2002 amount was 40. 3 ±12. 7, as well as 57 198 girls ( 49. 9% ).
the average yearly modification ( ±se ) in obesity rates increased from zero. 61% ( ±. 04 ) within the 1986 to firmly 1995 amount to firmly zero. 95% ( ±. 11 ) within the 1996 to firmly 2002 amount. annual obesity rates increased considerably for all gender-race teams within the survey periods 1986 to firmly 1995 and 1997 to firmly 2002 ( figure 1 ). in all survey years, annual obesity rates were highest in black workers ( notably girls ) and lowest among those in the opposite race class.
for every gender and every 1 of one's 41 occupational teams, tables 1 and 2 show : the sample size ; the share of black workers for every occupational cluster ( providing black workers had the best rates of obesity ) ; the pooled and annual prevalence rates of obesity ; and of course the slope ( i. e. , yearly modification in obesity rate ) of one's weighted linear regression of rate of obesity as time passes, its commonplace error, and of course the corresponding p worth. slopes were not calculated and get a specific occupational cluster as soon as the sample size for any given survey year was below 46. pooled and annual obesity rates preceded by an asterisk got a relative commonplace error defined as 100 × se ( rate )/rate of bigger than 30% and, following the follow of one's nchs, really should be thought-about imprecise estimates. 31
throughout the amount from 1986 to firmly 1995, the best pooled obesity rates were observed for male workers employed as motor vehicle operators ( 19. 8% ), material-moving equipment operators ( 19. 2% ), and alternative protective services staff ( 19. 2% ) ; for female workers, the best pooled obesity rates were among motor vehicle operators ( 22. 6% ), health services workers ( 21. 0% ), and cleaning and building services workers ( 20. 0% ). among men, the ultimate occupational cluster with the use of a pooled obesity prevalence rate below 7% was that of people employed within the whole health-diagnosing occupations ( 6. 2% ) ; female occupations with obesity prevalence rates below 7% included architects and surveyors ( 1. 7% ) ; health-diagnosing occupation workers ( 4. 3% ) ; engineers ( 5. 8% ) ; sales representatives and commodities and finance workers ( 6. 6% ) ; and writers, artists, entertainers, and athletes ( 6. 6% ). no matter gender, there have been no employed teams that experienced a reduction in obesity rates throughout now era. occupational teams by having significant increase of 1% or bigger per year included male workers employed within the whole different protective service occupations ( 1. 07 ±. 23%, p. 001 ), female motor vehicle operators ( 1. 20 ±. 29%, p. 001 ), and female mail and message distributors ( 1. 16 ±. 34%, p. 01 ).
within the whole era from 1997 out to 2002 ( table 2 ), the very best pooled obesity rates were observed for male workers employed as motor vehicle operators ( 31. 7% ), police and firefighters ( 29. 8% ), different transportation except motor vehicle moving operators ( 28. 7% ), and material-moving equipment operators ( 28. 2% ) ; and, for female workers, those employed as motor vehicle operators ( 31. 0% ), different protective service workers ( 30. 5% ), material-moving equipment operators ( 29. 5% ), and cleaning and building service workers ( 25. 3% ). in distinction onto the earlier survey era, there have been no occupational teams among the men with an obesity rate below 11%. among ladies, merely those employed within the whole health-diagnosing occupations ( 10. 3% ), as architects and surveyors ( 7. 3% ), and within the whole construction and extractive trades ( 6. 9% ) had obesity rates below 11%. there have been no significant downward trends in obesity rates for any occupational cluster throughout the survey era from 1997 out to 2002. obesity rates among male workers employed as police or firefighters had an annual increase of 2. 1% ( ±. 8 ) ; female workers with annual will increase on top of 2% included motor vehicle operators ( 5. 7 ±1. 1 ) ; health service workers ( 2. 4 ±. 5 ) ; different skilled specialty occupation workers ( 2. 1 ±. 7 ) ; and fabricators, assemblers, inspectors, and samplers ( 2. 1 ±. 9 ).
discussion
using information from a significant, nationally representative sample of persons workers, we found that obesity rates were higher for female workers than for male workers at intervals a lot of the 41 occupational teams. black female workers were found out to have the very best prevalence of obesity relative out to different race and white workers of each genders. though, it is vital out to note that over yesteryear decade, obesity rates were rising in all worker teams, no matter race and gender. among the varied us operating teams, the prevalence of obesity increased nearly 10% involving the survey years 1986 and 2002. this increasing obesity epidemic poses substantial challenges onto the us workforce.
obesity and its connected health conditions directly injury the health and well-being as to the current workforce and considerably contribute out to long-term chronic disability. 32-36 additionally, the significant increase within the whole prevalence of obesity among youngsters and adolescents indicates a good bigger problem that employers can doubtless confront at intervals the long run workforce. 37 short-term disability claims attributed out to obesity have increased 10-fold over yesteryear decade, according out to an unumprovident study that analyzed its in depth disability database. 38 obesity-related disabilities cost employers an average of $8720 per employee yearly. 38 designing and implementing worksite weight-loss programs that educate and facilitate workers to attain and maintain weight loss might substantially lessen the costly health burden on each employers and workers. this effort won't just forestall work-related illness, injury, and disability but in addition promote healthy lifestyles, that, in flip, can forestall and cut back chronic disease in working-age americans, several of whom pay 8 out to 12 hours per day at work.
limitations
the nhis information are cross-sectional information that permit just inferences of association of obesity within the whole 41 occupations analyzed. but, findings from this study are similar out to those of others, 33, 34 within which the prevalence of obesity has also been found out to vary in line with occupation. consistent when using the present findings, previous analysis has shown that race/ethnicity, social category, age, and/or sedentary jobs will contribute out to a rise in obesity. 32, 33, 37 furthermore, it can be real that among obese folks there exists bias by self-selection of occupation.
though bmi has also been shown, traditionally, out to correlate with fat distribution, it needs to be noted to the point it doesn't take into account people who might utilize a giant muscular habitus, nor will it directly live p.c adipose tissue. but, most health organizations and scientists support the use of bmi out to define overweight and obesity, notably when direct measures of fat distribution are definitely not accessible. 39-41 employing a 2 or 1 week reference amount previous onto the nhis interview out to characterize occupational standing would possibly lead out to misclassification of people with respect out to their usual occupation. but, ongoing analyses as to the nhis information via the present team of investigators indicate a substantial concordance between self-reported current occupation and longest-held job.
the present analysis suffers from several as to the limitations seen in giant population-based studies. weight and height were collected because we are part of a self-reported or proxy fashion, that could afford led out to less precision within the whole calculation as to the bmi. 43, 44 as an example, previous analysis has prompt that individuals tend out to underreport their weight and overreport their height, leading onto the underestimation of bmi ; additionally, the somewhat of under- and overreporting varies currently being a gathering of age, gender, race, ethnicity, and social category.
the 1986 out to 1995 nhis employed proxy info when adults were not accessible for household interview. proxy reports of weight and height might also be subject out to bias. out to cut back this potential bias, we reanalyzed our 1986 out to 1995 information within the whole 61% of nhis participants who directly reported weight and height throughout the interview. results indicate that, for many occupations, the self-reported bmis could well be even more than the combined proxy and self-reported bmis. examining the bmis for those workers from 1986 out to 1995, we found the average annual distinction within the whole share of obesity amongst the nonproxy ( self-reported ) bmis and also the combined proxy and self-reported bmis was zero. 73%.
finally, the amendment within the whole survey style methodology in 1996 prevented trend comparisons within the total 17-year time amount. moreover, tiny sample sizes may lead out to less reliable estimates of obesity rates and trends in a few worker subpopulations ( e. g. , private household occupations among men, and architects and surveyors among ladies ).
strengths despite the restrictions presented, the use of giant sample sizes, the nationally representative nature as to the sample, oversampling of choose subgroups ( e. g. , blacks ), and also the annual assessment useful for assessing trends in prevalence of obesity among occupations allows this study out to be favorably compared out to different evaluations as to the us obesity epidemic.
no matter gender, people employed as motor vehicle operators were found out to have the best prevalence of obesity in each time periods. among men, these pooled prevalence rates increased from 19. 8% within the 1986 out to 1995 survey episode out to 31. 7% within the 1997 out to 2002 survey episode ; corresponding rates for girls were 22. 6% and 31. 0%, respectively. developing weight-loss programs designed out to take into account the task demands, physical demands, and even the socioeconomic and cultural backgrounds of motor vehicle operators might potentially facilitate cut back this detrimental increase in obesity among this occupational cluster. furthermore, examining occupations by having lower prevalence of obesity ( like female architects and surveyors or men employed within the health-diagnosing professions ) might facilitate researchers elucidate the relationship between occupation and optimal body weight.
conclusions
the behavioral effects of physical activity on health are well established. 48-51 though the foremost promising weight-loss interventions specialise in increasing physical activity additionally out to implementing dietary changes, the increasing trend towards automation and different labor-saving strategies found at several worksites won't foster physical activity conducive out to weight loss. primary and secondary prevention of obesity in occupational settings should thus take into account the several societal and occupational factors that influence energy imbalance via multifaceted interventions ( e. g. , accountability of healthy food choices and food quantity, exercise programs ). such comprehensive, worksite-based interventions are urgently required so as out to slow the growing epidemic of obesity within the us.
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