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

2/27/2017 The Skinny on Work: obesity on the job Julia Buss I have no conflicts of interest to disclose Occupations and obesity? Objec Objectiv ives es • 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

2/27/2017 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 Luckhaupt, (2014). American Journal of Preventive Medicine 2

2/27/2017 Obesity Trends Among U.S. Adults Prevalence of Self ‐ Reported Obesity among US Adults 2015 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 3

2/27/2017 Social relational aspects of work Social factors Prevalence Ratio (95%CI) 1.3 1.26 1.2 Prevalence ratio 1.13 1.13 1.11 1.1 1.05 1.02 1.02 1 0.98 0.92 0.9 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

2/27/2017 • 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/ Wardle, (2011). Obesity Nyberg, (2012). Journal of Internal Medicine Soloveiva, (2013). Scandinavian Journal of Work & Environmental Health Soloveiva, (2013). Scandinavian Journal of Work & Environmental Health 5

2/27/2017 Soloveiva, (2013). Scandinavian Journal of Work & Environmental Health Bureau of Labor Statistics, U.S. Department of Labor, (2014) The Economics Daily 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 • Other areas being researched • Food environment • Sedentary job • Peer group norms • Labor laws Antunes, (2010). Nutrition Research Reviews Cappuccio, (2008). Sleep • Obesogens Patel, (2016). Obesity O’Keefe, (2016). Workplace Health and Safety 6

2/27/2017 Food environment Sedentary job Wanner, (2016). International Journal of Obesity Wansink (2006) International Journal of Obesity Rezende, (2014). PloS ONE Story (2008) Annual Review of Public Health Proper, (2011). American Journal of Preventive Medicine Income level may contribute to the higher prevalence of Obesogens obesity 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 45% • Endocrine disrupting chemicals (EDCs) act by altering some 40.1% 40% 38.3% 37.0% aspect of hormone action 35.3% 35% 30.2% • “metabolic disruptors” are EDCs associated with obesity 30% 25% • Promote the number and size of fat cells 21.2% 20% • Shift energy balance to favor storage 15% • Alter gut microbiota to promote food storage 10% • Alter the hormones of appetite control (satiety and hunger) 5% • Alter brain circuits controlling food intake 0% • Impact insulin levels United States: United States: United States: United States: 400% United States: All Comparable Below 100% FPL 100% ‐ 199% FPL 200% ‐ 399% FPL FPL or more income levels Countries: Average Janesick et al., (2016) Am J Obstet Gynecol 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. 7

2/27/2017 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 Weight ‐ related comorbidities : Why does it matter? Cardiovascular disease Venous stasis ulcers/thrombophlebitis Illness and injury Absent from work Hyperlipidemia Obstructive sleep apnea Obesity hypoventilation syndrome Pulmonary hypertension • Obesity is a disease Asthma Insulin resistance Type 2 diabetes • At work: Polycystic ovarian syndrome Deep venous thrombosis Pulmonary embolism • Lost productivity from Gastroesophageal reflux disease Abdominal hernia diseases attributable to Non ‐ alcoholic fatty liver disease Gallstones overweight and obesity Stress urinary incontinence Urinary tract infections estimated at $988.8 billion Infertility Miscarriage Gestational diabetes Degenerative joint disease Chronic back pain Plantar fasciitis Carpal tunnel syndrome The Obesity Society, (2014). White Paper Stroke Gu, (2016). Journal of Safety Research The Milken Institute (2016) Depression Luckhaupt, (2014) American Journal of Preventive Medicine Rush, (2016). Obesity Anxiety Ostbye (2007). Archives Internal Medicine All cancers except esophageal and pancreatic Hammond (2010). Diabetes, Metabolic Syndrome and Obesity Keeny (2013) J Occup Environ Med 8

2/27/2017 NIOSH Total Worker Health • The National Institute for Occupational Safety and Control of hazards and exposures • Health (NIOSH) takes the Total Worker Health The organization of work • approach Built environment • Leadership • TWH recognizes work as a social determinant of • Compensation and benefits • health 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

2/27/2017 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 2. Weight related co ‐ morbidities include: health care providers should: A. Avoid talking about weight A. Degenerative joint disease B. Screen all adults for obesity & offer appropriate weight loss advice B. Fatty liver disease C. Blame the patient for their weight status C. Sleep apnea D. Refer those with BMI >25 to treatment D. All of the above 10

2/27/2017 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 Thank you! C. Gym membership discounts for workers D. Comprehensive screenings for work ‐ related and non–work ‐ related jbuss@berkeley.edu health risks 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