Body mass index,waist circumference and employment: Evidence from older Irish adults

Data from the first wave of the Irish Longitudinal Study on Ageing are used to examine the relationship between fatness and obesity and employment status among older Irish adults. Employment status is regressed on one of the following measures of fatness: BMI and waist circumference entered linearly as continuous variables and obesity as a categorical variable defined using both BMI and waist circumference. Controls for demographic and socioeconomic characteristics, socioeconomic characteristics in childhood and physical, mental and behavioural health are also included. The regression results for women indicate that all measures of fatness are negatively associated with the probability of being employed and that the employment elasticity associated with waist circumference is larger than the elasticity associated with BMI. The results for men indicate that employment is not significantly associated with BMI and waist circumference when these are entered linearly in the regression, but it is significantly and negatively associated with obesity defined either using BMI or waist circumference as categorical variables. The results also indicate that the negative association between obesity and employment status is larger among women. For example, the probability of being employed for the obese category defined using BMI is around 8 percentage points lower for women and 5 percentage points lower for men.     

Maternal employment and childhood obesity in Russia

Existing research on childhood obesity shows that rising maternal employment is associated with increases in child weight. This paper aims to estimate the effect of maternal employment on childhood obesity in Russia, where obesity has been spreading quickly over the last 20 years. To address the endogeneity of maternal employment and estimate its effect on the weight outcomes of older siblings, I use plausibly exogenous variation in childcare enrolment for the youngest child in the household as an instrumental variable for maternal employment. Based on the Russian Longitudinal Monitoring Survey (RLMS-HSE), the results show that maternal employment leads to an increase in children’s BMI and in their probabilities of becoming overweight and obese. In exploring the potential underlying mechanisms, I find that maternal employment is related to less physical activity, to a higher probability of either watching TV or playing video games, and to poorer dietary habits among children.     

Long-term effects of obesity on employment and work limitations among U.S. Adults, 1986 to 1999

Objective: To determine the relationships between BMI and workforce participation and the presence of work limitations in a U.S. working‐age population. Research Methods and Procedures: We used data from the Panel Study of Income Dynamics, a nationwide prospective cohort, to estimate the effect of obesity in 1986 on employment and work limitations in 1999. Individuals were classified into the following weight categories: underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). Using multivariable probit models, we estimated the relationships between obesity and both employment and work disability. All analyses were stratified by sex. Results: After adjusting for baseline sociodemographic characteristics, smoking status, exercise, and self‐reported health, obesity was associated with reduced employment at follow‐up [men: marginal effect (ME) ?4.8 percentage points (pp); p < 0.05; women: ME ?5.8 pp; p < 0.10]. Among employed women, being either overweight or obese was associated with an increase in self‐reported work limitations when compared with normal‐weight individuals (overweight: ME +3.9 pp; p < 0.01; obese: ME +12.6 pp; p < 0.01). Among men, the relationship between obesity and work limitations was not statistically significant. Discussion: Obesity appears to result in future productivity losses through reduced workforce participation and increased work limitations. These findings have important implications in the U.S., which is currently experiencing a rise in the prevalence of obesity.     

The association of BMI with functional status and self-rated health in US adults

Objective: To examine the association of BMI with functional status and self‐rated health among US adults and how the association differs by age and sex. Methods and Procedures: All analyses are based on the National Health Interview Survey (NHIS), 1997–2005, a yearly, representative study of the US household population. We pooled all survey years and fitted logistic regression for the two sexes and three age strata (ages 18–44, 45–64, and ≥65). Results: Our study found that although underweight and severe obesity are consistently associated with increased disability and poorer health status, overweight and moderate obesity show associations that vary considerably by age and sex. For men, the adjusted odds ratios (ORs) for disability and poor/fair self‐rated health tended to be lowest among overweight persons, especially for ages ≥45. Among men with moderate obesity, the risk of disability was elevated for ages 18–44 but lower for ages ≥65. For women, the adjusted ORs for disability and poor/fair self‐rated health tended to be lowest among normal‐weight persons, particularly for ages ≤45. Compared to normal‐weight counterparts, overweight women aged ≥65 had a lower risk of disability but a somewhat elevated risk of poor/fair self‐rated health. Discussion: The results suggest that the association of BMI with functional status and self‐rated health varies significantly across ages and sexes. The variations in the association of BMI with functional status and self‐rated health suggest that a single “ideal body weight category” may not be appropriate for all persons or all health outcomes.     

BMI and health status among adults with asthma

Background: A convincing body of literature links obesity with a higher risk for developing adult‐onset asthma. The impact of obesity on asthma severity among adults with pre‐existing asthma, however, is less clear. Methods and Procedures: In a prospective cohort study of 843 adults with severe asthma, we studied the impact of BMI on asthma health status. Results: The prevalence of obesity and overweight were 44% (95% confidence interval (CI) 41–47%) and 28% (95% CI 25–32%). The obese BMI group was associated with a higher risk for daily or near daily asthma symptoms than was the normal BMI group (odds ratio (OR) 1.81; 95% CI 1.10–2.96). Compared to the normal BMI group, generic physical health status was worse in the overweight (mean score decrement ?2.42 points; 95% CI ?4.39 to ?0.45) and the obese groups (?6.31 points; 95% CI ?8.14 to ?4.49). Asthma‐specific quality of life was worse in the underweight (mean score increment 8.66 points; 95% CI 2.53–14.8) and obese groups (4.51 points; 95% CI 2.21–6.81), compared to those with normal BMI. Obese persons also had a higher number of restricted activity days that past month (5.05 days; 95% CI 2.90–7.19 days). Discussion: It appears that obesity has a substantive negative effect on health status among adults with asthma. Further work is needed to clarify the precise mechanisms. Clinicians should counsel dietary modification and weight loss for their overweight and obese patients with asthma.     

Educational Inequalities in Exit from Paid Employment among Dutch Workers: The Influence of Health,Lifestyle and Work

Background

Individuals with lower socioeconomic status are at increased risk of involuntary exit from paid employment. To give sound advice for primary prevention in the workforce, insight is needed into the role of mediating factors between socioeconomic status and labour force participation. Therefore, it is aimed to investigate the influence of health status, lifestyle-related factors and work characteristics on educational differences in exit from paid employment.

Methods

14,708 Dutch employees participated in a ten-year follow-up study during 1999–2008. At baseline, education, self-perceived health, lifestyle (smoking, alcohol, sports, BMI) and psychosocial (demands, control, rewards) and physical work characteristics were measured by questionnaire. Employment status was ascertained monthly based on tax records. The relation between education, health, lifestyle, work-characteristics and exit from paid employment through disability benefits, unemployment, early retirement and economic inactivity was investigated by competing risks regression analyses. The mediating effects of these factors on educational differences in exit from paid employment were tested using a stepwise approach.

Results

Lower educated workers were more likely to exit paid employment through disability benefits (SHR:1.84), unemployment (SHR:1.74), and economic inactivity (SHR:1.53) but not due to early retirement (SHR:0.92). Poor or moderate health, an unhealthy lifestyle, and unfavourable work characteristics were associated with disability benefits and unemployment, and an unhealthy lifestyle with economic inactivity. Educational differences in disability benefits were explained for 40% by health, 31% by lifestyle, and 12% by work characteristics. For economic inactivity and unemployment, up to 14% and 21% of the educational differences could be explained, particularly by lifestyle-related factors.

Conclusions

There are educational differences in exit from paid employment, which are partly mediated by health, lifestyle and work characteristics, particularly for disability benefits. Health promotion and improving working conditions seem important measures to maintain a productive workforce, particularly among workers with a low education.     

Disability prevalence among healthy weight,overweight, and obese adults

Objective:

Obesity is associated with adverse health outcomes in people with and without disabilities. However, little is known about disability prevalence among people who are obese. The purpose of this study is to determine the prevalence and type of disability among adults who are obese.

Design and Methods:

Pooled data from the 2003‐2009 National Health Interview Survey (NHIS) were analyzed to obtain national prevalence estimates of disability, disability type and obesity. The disability prevalence was stratified by body mass index (BMI): healthy weight (BMI 18.5‐<25.0), overweight (BMI 25.0‐<30.0), and obese (BMI ≥ 30.0).

Results:

In this pooled sample, among the 25.4% of US adults who were obese, 41.7% reported a disability. In contrast, 26.7% of those with a healthy weight and 28.5% of those who were overweight reported a disability. The most common disabilities among respondents with obesity were movement difficulty (32.5%) and work limitation (16.6%).

Conclusions:

This research contributes to the literature on obesity by including disability as a demographic in assessing the burden of obesity. Because of the high prevalence of disability among those who are obese, public health programs should consider the needs of those with disabilities when designing obesity prevention and treatment programs.     

Life expectancy and life expectancy with disability of normal weight, overweight, and obese smokers and nonsmokers in Europe

The goal of this study was to estimate life expectancy (LE) and LE with disability (LwD) among normal weight, overweight, and obese smokers and nonsmokers in Western Europe. Data from four waves (1998-2001) of the European Community Household Panel (ECHP) were used; a standardized multipurpose annual longitudinal survey. Self-reported health and socioeconomic information was collected repeatedly using uniform questionnaires for 66,331 individuals in nine countries. Health status was measured in terms of disability in daily activities. Multistate Markov (MSM) models were applied to obtain hazard ratios (HRs) and age-specific transition rates according to BMI and smoking status. Multistate life tables were computed using the predicted transition probabilities to estimate LE and LwD. Significant associations were observed between disability incidence and BMI (HR = 1.15 for overweight, HR = 1.64 for obese, compared to normal weight). The risk of mortality was negatively associated with overweight status among disabled (HR = 0.77). Overweight people had higher LE than people with normal-weight and obesity. Among women, overweight and obese nonsmokers expect 3.6 and 6.1 more years of LwD than normal weight persons, respectively. In contrast, daily smokers expect lower LE but a similar LwD. The same patterns were observed among people with high education and those with low education. To conclude, daily smoking is associated with mortality more than with disability, whereas obesity is associated with disability more than with mortality. The findings suggest that further tobacco control would contribute to increasing LE, while tackling the obesity epidemic is necessary to prevent an expansion of disability.     

Smoking Kills,Obesity Disables: A Multistate Approach of the US Health and Retirement Survey

Increasing BMI causes concerns about the consequences for health care. Decreasing cardiovascular mortality has lowered obesity‐related mortality, extending duration of disability. We hypothesized increased duration of disability among overweight and obese individuals. We estimated age‐, risk‐, and state‐dependent probabilities of activities of daily living (ADL) disability and death and calculated multistate life tables, resulting in the comprehensive measure of life years with and without ADL disability. We used prospective data of 16,176 white adults of the Health and Retirement Survey (HRS). Exposures were self‐reported BMI and for comparison smoking status and levels of education. Outcomes were years to live with and without ADL disability at age 55. The reference categories were high normal weight (BMI: 23–24.9), nonsmoking and high education. Mild obesity (BMI: 30–34.9) did not change total life expectancy (LE) but exchanged disabled for disability‐free years. Mild obesity decreased disability‐free LE with 2.7 (95% confidence limits 1.2; 3.2) year but increased LE with disability with 2.0 (0.6; 3.4) years among men. Among women, BMI of 30 to 34.9 decreased disability‐free LE with 3.6 (2.1; 5.1) year but increased LE with disability with 3.2 (1.6;4.8) years. Overweight (BMI: 25–29.9) increases LE with disability for women only, by 2.1 (0.8; 3.3) years). Smoking compressed disability by high mortality. Smoking decreased LE with 7.2 years, and LE with disability with 1.3 (0.5; 2.5) years (men) and 1.4 (0.3; 2.6) years (women). A lower education decreased disability‐free life, but not duration of ADL disability. In the aging baby boom, higher BMI will further increase care dependence.     

Influence of body mass index on the choice of therapy for depression and follow‐up care

Objective: Overweight and obese patients commonly suffer from depression and choice of depression therapy may alter weight. We conducted a cohort study to investigate whether obesity is associated with treatment choices for depression; and whether obesity is associated with appropriate duration of depression treatment and receipt of follow‐up visits. Design and Methods: Adults with a diagnosis of depression between January 1, 2006 and March 31, 2010 who had 1+ new episodes of an antidepressant medication and/or psychotherapy were eligible. Medication use, encounters, diagnoses, height, and weight were collected from health plan databases. We modeled receipt of the different therapies (medication and psychotherapy) by BMI and BMI trajectory during the 9‐months prior to initiation of therapy using logistic regression models that accommodated correlation within provider and adjusted for covariates. We modeled BMI via a restricted cubic spline. Fluoxetine was the reference treatment option in the medication models. Results: Lower BMI was associated with greater use of mirtazapine, and a declining BMI prior to treatment was associated with greater odds of initiating mirtazapine and paroxetine. Higher BMI was associated with greater odds of initiating bupropion even after adjustment for smoking status. Obese patients were less likely to receive psychotherapy and less likely to receive appropriate duration (180‐days) of depression treatment compared to normal weight subjects. Conclusions: Our study provides evidence that BMI is considered when choosing therapy but associations were weak. Our results should prompt discussion about recommending and choosing depression treatment plans that optimize depression care and weight management concurrently. Differences in care and follow‐up by BMI warrant additional research.     

Examining the temporal relationships between childhood obesity and asthma

Childhood obesity has become an issue of increasing concern to health researchers and policymakers in the United States. One important chronic health condition linked to obesity is pediatric asthma. Although researchers have speculated that both conditions may have common origins, the majority of research in this area has focused on a unidirectional relationship between obesity and later asthma. However, much of the literature is limited by its reliance on cross-sectional data and its failure to examine the possibility that asthma may influence weight fluctuations through changes in physical and sedentary activity. Using data from the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), I explore the bidirectional relationships between childhood obesity and asthma. The results in this paper suggest that past asthma levels are positively correlated with changes in BMI and the onset of obesity. However, only new onset asthma is positively correlated with subsequent changes in BMI. The potential mechanisms are unclear, as I find little evidence that asthma is structurally related to changes in physical or sedentary activity over time. When testing the prevailing hypothesis that obesity is related to subsequent asthma, I find that lagged weight status is strongly related to asthma prevalence levels but that the onset of overweight or obesity is not associated with the subsequent onset of asthma. These results suggest that the onset of asthma may be related to subsequent weight gain over time.     

Use of complementary and alternative therapies by overweight and obese adults

Objective: Obesity is associated with higher health‐care costs due, in part, to higher use of traditional health care. Few data are available on the relationship between obesity and the use of complementary and alternative medicine (CAM). Methods and Procedures: We analyzed data on CAM use from the 2002 National Health Interview Survey (NHIS) Alternative Medicine Supplement (n = 31,044). We compared the use of CAM overall, within the past 12 months, between normal weight (BMI from 18 to <25), overweight (from 25 to <30), mildly obese (from 30 to <35), moderately obese (from 35 to <40), and extremely obese (>40) adults. For the primary analysis, our multivariable model was adjusted for sociodemographic factors, insurance status, medical conditions, and health behaviors. We performed additional analyses to explore the association of BMI and the use of seven CAM modalities. Results: We found that adults with obesity have lower prevalence of use of yoga therapy, and similar prevalence of use of several CAM modalities, including relaxation techniques, natural herbs, massage, chiropractic medicine, tai chi, and acupuncture, compared to normal‐weight individuals. After adjustment for sociodemographic factors, insurance status, medical conditions, and health behaviors, adults with obesity were generally less likely to use most individual CAM modalities, although the magnitude of these differences were quite modest in many cases. Discussion: Even though adults with obesity have a greater illness burden and higher utilization of traditional medical care, adults with higher BMIs were no more likely to use each of the individual CAM therapies studied. Additional research is needed to improve our understanding of CAM use by adults with obesity.     

BMI, obesity, and sickness absence in the Whitehall II study

Objective: To study BMI and change in BMI from age 25 as predictors of sickness absence. Research Methods and Procedures: Data were collected from 2564 women and 5853 men, who were British civil servants (35 to 55 years) on entry to the Whitehall II study (Phase 1, 1985 to 1988). Employer's records provided annual medically certified (long, >7 days) and self‐certified (short, 1 to 7 days) spells of sickness absence. BMI at age 25 and Phase 1 were examined in relation to absences from Phase 1 to the end of 1998 (mean follow‐up, 7.0 years). Results: After adjustment for employment grade, health‐related behaviors, and health status, overweight (BMI = 25.0 to 29.9 kg/m²) and obesity (BMI > 30.0 kg/m²) at Phase 1 were significant predictors of short and long absences in both sexes; rate ratios (95% confidence intervals) ranged from 1.13 (1.05 to 1.21) to 1.51 (1.30 to 1.76) compared with a BMI of 21.0 to 22.9 kg/m². Additionally, a BMI of 23.0 to 24.9 kg/m² at Phase 1 predicted long absences in women, and underweight (BMI < 21.0 kg/m²) predicted short absences in men. Obesity at age 25 predicted long absences, and obesity at Phase 1 predicted short and long absences in both sexes. Chronic obesity was a particularly strong predictor of long absences in men, with a rate ratio of 2.61 (1.88 to 3.63). Discussion: Findings from this well‐characterized cohort suggest that the obesity epidemic in industrialized countries may result in significant increases in sickness absence. Further research is needed to determine the underlying mechanisms. Policy to reduce sickness absence needs to tackle the problem of excess weight in the working population.     

Association between obesity and patient satisfaction

Objective: To examine the relationship between BMI and patient satisfaction with health care providers using a nationally representative survey. Research Methods and Procedures: This analysis examined the 9914 adult patients who completed the 2000 Medical Expenditure Panel Survey and had visited a health care provider within 12 months of the survey. Linear regression models were employed with patient satisfaction as the dependent variable. The patient satisfaction scale was based on ratings from five questions assessing the quality of provider interactions. The independent variable was BMI, with adjustments for the domains of demographics, social‐economic status, health attitudes and behavior, health status, and health care use. BMI (weight in kilograms/square of height in meters) was classified as normal weight (18.5 to 24.9), overweight (25.0 to 29.9), or obese (≥30.0). Hierarchical models were used to evaluate how each domain modified the BMI‐satisfaction association. Results: Obese patients reported significantly greater satisfaction with their health care providers than their normal‐weight counterparts did (p < 0.05). There were no significant differences in satisfaction between normal‐weight and overweight patients or between overweight and obese patients. The health status domain produced the largest modification in the BMI‐satisfaction relationship. Examination of interaction effects revealed that the association between BMI and satisfaction was confined to older persons. Discussion: In this nationally representative sample of individuals, obese persons were more satisfied than their normal‐weight counterparts. This finding counters those of previous studies. Incomplete adjustments for health care use and insurance status may have led to those conclusions.     

Direct and indirect effects of body weight on adult wages

Previous estimates of the association between body weight and wages in the literature have been conditional on education and occupation. In addition to the effect of current body weight status (body mass index (BMI) or obesity) on wages, this paper examines the indirect effect of body weight status in the late-teenage years on wages operating through education and occupation choice. Using the National Longitudinal Survey of Youth 1979 data, for women, we find that a one-unit increase in BMI is directly associated with 1.83% lower hourly wages whereas the indirect BMI wage penalty is not statistically significant. Neither a direct nor an indirect BMI wage penalty is found for men. However, results based on clinical weight classification reveal that the indirect wage penalty occurs to a larger extent at the upper tail of the BMI distribution for both men and women via the pathways of education and occupation outcomes. Late-teen obesity is indirectly associated with 3.5% lower hourly wages for both women and men. These results are important because they imply that the total effect of obesity on wages is significantly larger than has been estimated in previous cross-sectional studies.     

From “Overweight” to “About Right”: Evidence of a Generational Shift in Body Weight Norms

In this article, we describe differences in the self‐perception of weight status in the United States between the two most recent National Health and Nutrition Examination Survey (NHANES) periods (1988–1994 and 1999–2004), and test the hypothesis that secular increases in adult mean BMI, adult obesity, and childhood obesity contributed to changes over time in weight perceptions. We find that the probability of self‐classifying as overweight is significantly lower on average in the more recent survey, for both women and men, controlling for objective weight status and other factors. Among women, the decline in the tendency to self‐classify as overweight is concentrated in the 17–35 age range, and is more pronounced among women with normal BMI than those with overweight BMI. Among men, the shift away from feeling overweight is roughly equal across age groups. Overweight men exhibit a sharper decline in feeling overweight than normal weight men. Despite the declines in feeling overweight between surveys, weight misperception did not increase significantly for men and decreased by a sizable margin among women. We interpret the findings as evidence of a generational shift in social norms related to body weight. As a result, people may be less likely to desire weight loss than previously, limiting the effectiveness of public health campaigns aimed at weight reduction. On the other hand, there may be health benefits associated with improved body image.     

Labor market consequences of childhood onset type 1 diabetes

This paper examines the effect of the onset of Type 1 Diabetes Mellitus (T1DM) before 15 years of age on labor market outcomes and contributes to the literature on effects of childhood health on adult socioeconomic status. Using national Swedish socioeconomic register data 1991–2010 for 2485 individuals born 1972–1978 with onset of T1DM in 1977–1993, we find that T1DM in childhood has a negative effect on labor market outcomes later in life. Part of the T1DM effect is channeled through occupational field which may be related to both choice and opportunities. Although the magnitude of the effect is only directly generalizable to illnesses with similar attributes as T1DM, the results suggest that causality in the often observed correlation between health and socioeconomic status, at least partly, is explained by an effect running from health to earnings. This has implications for research and policy on strategies to reduce socioeconomic-related health inequality. Our findings also shed light on productivity losses, measured by employment status and earnings due to childhood onset T1DM, which have implications for both the individual and society.     

Labor market effects of intrauterine exposure to nutritional deficiency: Evidence from administrative data on Muslim immigrants in Denmark

This paper examines whether nutritional disruptions experienced during the stage of fetal development impair an individual's labor market productivity later in life. We consider intrauterine exposure to the month of Ramadan as a natural experiment that might cause shocks to the inflow of nutrients essential for fetal development. Specifically, we use administrative data from Denmark to investigate the impact of exposure to Ramadan in utero on labor market outcomes of adult Muslim males, including employment status, annual salary, hourly wage rate, and hours of work. Our findings indicate that potential exposure to nutritional disruptions during a critical stage of fetal development is likely to have scarring effects on the fetus expressed as poor labor market outcomes later in life. Specifically, exposure to Ramadan around the 7th month of gestation results in a lower likelihood of employment and, to a lesser extent, a lower salary, and reduced labor supply. For example, the 7th month intrauterine exposure to Ramadan is associated with a 2.6 percentage points reduction in the likelihood of employment among Muslim males. We do not find an impact on the wage rate. Finally, we also document suggestive evidence that these results may partially be driven by increased disability and to a lesser extent by poor educational attainment among those who were exposed to Ramadan during this particular period in utero.