Obesity, weight change and work disability : a follow-up study among middle-aged employees

Obesity and overweight are common among working aged population. Obesity is associated with a number of long-term illnesses as well as increased mortality. Previous studies have found that obesity is also associated with some forms of work disability. However, longitudinal studies with register-based large data sets are scarce. The aim of this study was to examine the association between working conditions and subsequent weight gain as well as the associations between body weight, weight change and subsequent work disability in a cohort setting among middle-aged employees. This study is part of Helsinki Health Study (HHS), a cohort study on employees of the City of Helsinki. The data consists of a baseline mail questionnaire survey sent in 2000-2002 to 40-, 45-, 50-, 55- and 60-year old employees (respondents n=8960) and a follow-up questionnaire survey sent to the respondents of the baseline survey in 2007 (respondents n=7332). Questionnaire surveys yielded data on a wide range of factors such as socio-economic determinants, health and working conditions. The data from the surveys were combined with data from health check-ups that were carried out among the employees of the City of Helsinki during 2000-2002. The data were additionally linked with register data on employees sickness absence spells and disability retirements from the Finnish Centre for Pensions. Logistic regression analyses, the Cox proportional hazards model and Poisson regression analyses were used as statistical methods. A number of confounding factors were controlled for the analysis, including working conditions, health behaviours, previous health, and physical and mental functioning. Weight gain was common as one in four employees experienced major weight gain during the 5-7 year follow-up. For most of the studied working conditions, no association with weight gain was observed. Night shift work, work that was characterized as having hazardous exposures, passive work, and work where facing physical violence or threats was common were weakly associated with major weight gain. Both obesity and weight change (even among normal-weight employees) were associated with subsequent sickness absence. Obesity increased the risk of long spells of sickness absence in particular, but also elevated the risk of short spells. Weight loss, weight gain and stable obesity increased the risk of sickness absence spells of all lengths. Obesity was strongly associated with disability retirement due to musculoskeletal diseases, and to a lesser degree to mental disorders and other causes. Following adjustment for earlier health, working conditions and functioning, the association between obesity and long sickness absence spells and disability retirement was somewhat attenuated. The results of this study show that weight gain is common among middle-aged employees and that the studied working conditions are weakly or not at all associated with weight gain. The findings also indicate that weight gain and obesity are clearly and consistently associated with both temporary and permanent work disability. Obesity is thus not only a public health issue but also affects occupational health and work ability. Prevention of obesity and weight gain is increasingly important in primary health care as well as in occupational health care.Työikäisten ylipaino ja lihavuus on lisääntynyt Suomessa viime vuosiin saakka ja tällä hetkellä suurin osa Suomen työväestöstä on ylipainoisia. Lihavuus on yhteydessä useisiin pitkäaikaissairauksiin sekä lisääntyneeseen kuolleisuuteen. Aiemmissa tutkimuksissa on todettu, että lihavuus on yhteydessä myös työkykyongelmiin. Rekisteripohjaisia pitkittäistutkimuksia isoilla aineistoilla lihavuuden ja työkyvyn välisistä yhteyksistä on kuitenkin melko vähän. Tämän tutkimuksen tavoitteena oli tutkia työolosuhteiden, työntekijöiden painon ja painonvaihteluiden sekä työkyvyttömyyden välisiä yhteyksiä. Tutkimus on osa Helsinki Health Studya (HHS), joka on Helsingin kaupungin työntekijöiden keskuudessa vuonna 2000 käynnistynyt terveystutkimus. Tutkimuksen aineisto koostuu vuosina 2000 2002 postitse toteutetusta kyselystä, joka lähetettiin 40 - 60 -vuotiaille työntekijöille (vastaajia N=8960) sekä vuonna 2007 toteutetusta seurantakyselystä, joka lähetettiin kaikille ensimmäiseen kyselyyn vastanneille (vastaajia N=7332). Kyselyissä kerättiin laaja-alaisesti tietoa mm. työntekijöiden terveydestä, sosiodemografisista tekijöistä sekä työoloista. Kyselytutkimusten tietoja yhdistettiin aineistoon, joka on kerätty Helsingin kaupungin työntekijöille tehdyistä terveystarkastuksista vuosina 2000 2002. Lisäksi tietoja yhdistettiin kaupungin sairauspoissaolorekistereihin sekä Eläketurvakeskuksen työkyvyttömyyseläkerekisteritietoihin. Tutkimuksessa huomioitiin laajasti sekoittavia tekijöitä vakioimalla tuloksia mm. terveyskäyttäytymisen, aiemman terveyden, työolojen ja toimintakyvyn suhteen. Tilastollisina menetelminä käytettiin logistista regressioanalyysia, Coxin suhteellisten riskien mallia sekä Poissonin regressioanalyysia. Tulosten mukaan noin neljäsosalla työntekijöistä paino nousi merkittävästi 5-7 vuoden seuranta-aikana. Suurin osa tutkituista työolosuhteista ei kuitenkaan ollut yhteydessä painonnousuun. Yötyö ja työt, joissa raportoitiin haitallisia altisteita sekä työt, joissa koettiin fyysisen väkivallan uhkaa olivat heikosti yhteydessä merkittävään painonnousuun. Myös työstressin yhteys painonnousuun oli vähäinen. Sekä lihavuus että painonmuutokset olivat yhteydessä myöhempiin sairauspoissaoloihin. Lihavuus lisäsi erityisesti pitkien sairauspoissaolojen riskiä, mutta myös lyhyiden sairauspoissaolojen riski oli kasvanut. Sekä painonnousu että painonlasku pysyvän lihavuuden lisäksi lisäsivät sairauslomien riskiä. Lihavuus oli erityisesti yhteydessä tuki- ja liikuntaelinsairauksista aiheutuneisiin työkyvyttömyyseläkkeisiin, mutta lihavuus lisäsi lievästi riskiä myös mielenterveyssyistä ja muista syistä aiheutuneisiin työkyvyttömyyseläkkeisiin. Kun tutkimuksessa huomioitiin työolot, toimintakyky sekä aiempi terveys, lihavuuden yhteys sairauspoissaoloihin ja työkyvyttömyyseläkkeisiin heikkeni jonkin verran. Tämä tutkimus toi esiin, että painonnousu on yleistä keski-ikäisillä työntekijöillä ja että tutkittujen työolojen yhteys painonnousuun oli heikko tai puuttui kokonaan. Lisäksi tutkimus toi esiin, että painonnousu ja lihavuus olivat selkeästi yhteydessä tilapäiseen ja pysyvään työkyvyttömyyteen. Siten lihavuus ei ole vain kansanterveysongelma, vaan se vaikuttaa myös työterveyteen ja työkykyyn. Painonnousun ja lihavuuden ehkäisy ja hoito ovat siten tärkeitä sekä työterveyshuollossa että koko perusterveydenhuollossa. Työpaikoilla näitä tavoitteita voidaan tukea yhteistyössä työterveyshuollon kanssa. On kuitenkin tärkeä huomioida, että lihavuuteen yhdistyvien työkykyongelmien käsittely ei saa johtaa työntekijöiden eriarvoiseen kohteluun tai leimaantumiseen. Terveyden säilymistä tukeva ja terveyttä edistävä työpaikka lisää todennäköisesti työhyvinvointia ja auttaa vähentämään työkyvyttömyyden kustannuksia. Terveyttä edistäviä toimia työpaikalla voivat olla esimerkiksi työtapojen kehittäminen, työmatkaliikunnan tukeminen sekä panostaminen terveelliseen työpaikkaruokailuun ja terveisiin työaikoihin

Assessing the structures and domains of wellness models: A systematic review

Objective: This study systematically identifies different wellness domains, explores whether we are reaching any consensus, and presents an archetype of a wellness model. Methods: Studies were selected for review if they proposed a model for assessing individuals’ wellness, the model was generic (i.e., non-context or disease-specific), designed for adults and included at least physical, psychological and social domains. Furthermore, the study needed to be peer-reviewed with a full-text available in English. Based on this, 44 models were identified and their domains were extracted and grouped using thematic analysis, and placed under themes that were created using quantitative methods. Publication year and formed groupings were used to examine the evolution of models. Median, mode, and percentages were used to form the archetype. Results: The investigated models included 379 unique domains that could be clustered into 70 groups and under 14 themes. While the numbers of published wellness models increased, no consensus on the domains was reached. The majority of the models were presented at one level with five domains. Conclusions: Incorporating wellness into everyday practice requires comparable measures to evaluate and benchmark outcomes. Hence, we need to reach a mutual understanding on the structure and domains of wellness

The joint associations of smoking and obesity with subsequent short and long sickness absence : a five year follow-up study with register-linkage

Background: Both smoking and obesity are separately associated with sickness absence. Unhealthy lifestyle habits and health conditions may occur concurrently yet studies focusing on their joint association are few. This study examined the joint associations of smoking and obesity with sickness absence (SA). Methods: A mail survey among employees of the City of Helsinki, Finland, during 2000-2002 included data on obesity, smoking and covariates (N = 8960, response rate 67%, 80% women). These data were prospectively linked with register data on self-(1-3 days) and medically certified (4 days or longer) SA among those consenting to the linkage (n = 6986). Pregnant, underweight and those with missing data on key variables were excluded (n = 138). The total number of participants included in the analyses was 6847. The follow-up time was 5 years. Poisson regression was used to calculate rate ratios (RR). Results: Among women and men smoking and obesity were associated with self-certified SA. Among women there was a joint association with self-certified SA (obese smokers RR 1.81, 95% CI 1.59-2.07). Among women and men smoking and obesity were jointly associated with medically certified SA (for obese smoking women RR 2.23, 95% CI 1.93-2.57, for obese smoking men RR 2.69, 95% CI 2.03-3.55). Associations remained after adjustments for socioeconomic position, working conditions, health behaviours and self-rated health. Conclusion: Both smoking and obesity are jointly associated with all lengths of sickness absence. Support measures for smoking cessation and prevention of obesity could likely to reduce SA.Peer reviewe

Weight change among normal weight, overweight and obese employees and subsequent diagnosis-specific sickness absence : A register linked follow-up study

Aims: Obesity and weight change are associated with sickness absence; however, less is known about the diagnoses for sickness absence. We examined the association between stable and changing weight by body mass index groups with sickness absence due to any, musculoskeletal and mental diagnoses among midlife female and male employees. Methods: The Finnish Helsinki Health Study phase 1 survey took place in 2000-2002 (response rate 67%) and phase 2 in 2007 (response rate 83%). Based on self-reported body mass index, we calculated the weight change between phases 1 and 2 (body mass index change > 5%). The data were linked with registers of the Social Insurance Institution of Finland, including information on diagnoses (ICD-10) for sickness absence >9 days. We used a negative binom ial model to examine the association with sickness absence among 3140 women and 755 men during the follow-up (2007-2013). Results are presented as rate ratios. Covariates were age, sociodemographic factors, workload, health behaviors and prior sickness absence. Results: Weight-gain (rate ratio range=1.27-2.29), overweight (rate ratio range=1.77-2.02) and obesity (rate ratio range=2.16-2.29) among women were associated with a higher rate of sickness absence due to musculoskeletal diseases, compared to weight-maintaining normal-weight women. Similarly, obesity among men was associated with sickness absence due to musculoskeletal diseases (rate ratio range=1.55-3.45). Obesity among women (rate ratio range=1.54-1.72) and weight gain among overweight men (rate ratio=3.67; confidence interval=1.72-7.87) were associated with sickness absence due to mental disorders. Conclusions: Obesity and weight gain were associated with a higher rate of sickness absence, especially due to musculoskeletal diseases among women. Preventing obesity and weight gain likely helps prevent sickness absence.Peer reviewe

Weight change among normal weight, overweight and obese employees and subsequent diagnosis-specific sickness absence: A register-linked follow-up study

Aims: Obesity and weight change are associated with sickness absence; however, less is known about the diagnoses for sickness absence. We examined the association between stable and changing weight by body mass index groups with sickness absence due to any, musculoskeletal and mental diagnoses among midlife female and male employees. Methods: The Finnish Helsinki Health Study phase 1 survey took place in 2000–2002 (response rate 67%) and phase 2 in 2007 (response rate 83%). Based on self-reported body mass index, we calculated the weight change between phases 1 and 2 (body mass index change ⩾5%). The data were linked with registers of the Social Insurance Institution of Finland, including information on diagnoses (ICD-10) for sickness absence >9 days. We used a negative binom ial model to examine the association with sickness absence among 3140 women and 755 men during the follow-up (2007–2013). Results are presented as rate ratios. Covariates were age, sociodemographic factors, workload, health behaviors and prior sickness absence. Results: Weight-gain (rate ratio range=1.27–2.29), overweight (rate ratio range=1.77–2.02) and obesity (rate ratio range=2.16–2.29) among women were associated with a higher rate of sickness absence due to musculoskeletal diseases, compared to weight-maintaining normalweight women. Similarly, obesity among men was associated with sickness absence due to musculoskeletal diseases (rate ratio range=1.55–3.45). Obesity among women (rate ratio range=1.54–1.72) and weight gain among overweight men (rate ratio=3.67; confidence interval=1.72–7.87) were associated with sickness absence due to mental disorders. Conclusions: Obesity and weight gain were associated with a higher rate of sickness absence, especially due to musculoskeletal diseases among women. Preventing obesity and weight gain likely helps prevent sickness absence

Obesity, change of body mass index and subsequent physical and mental health functioning : a 12-year follow-up study among ageing employees

Background: Studies suggest an association between weight change and subsequent poor physical health functioning, whereas the association with mental health functioning is inconsistent. We aimed to examine whether obesity and change of body mass index among normal weight, overweight and obese women and men associate with changes in physical and mental health functioning. Methods: The Helsinki Health Study cohort includes Finnish municipal employees aged 40 to 60 in 2000-02 (phase 1, response rate 67%). Phase 2 mail survey (response rate 82%) took place in 2007 and phase 3 in 2012 (response rate 76%). This study included 5668 participants (82% women). Seven weight change categories were formed based on body mass index (BMI) (phase 1) and weight change (BMI change >= 5%) (phase 1-2). The Short Form 36 Health Survey (SF-36) measured physical and mental health functioning. The change in health functioning (phase 1-3) score was examined with repeated measures analyses. Covariates were age, sociodemographic factors, health behaviours, and somatic ill-health. Results: Weight gain was common among women (34%) and men (25%). Weight-gaining normal weight (-1.3 points), overweight (-1.3 points) and obese (-3.6 points) women showed a greater decline in physical component summary scores than weight-maintaining normal weight women. Among weight-maintainers, only obese (-1.8 points) women showed a greater decline than weight-maintaining normal weight women. The associations were similar, but statistically non-significant for obese men. No statistically significant differences in the change in mental health functioning occurred. Conclusion: Preventing weight gain likely helps maintaining good physical health functioning and work ability.Peer reviewe

Pairwise association of key lifestyle factors and risk of colorectal cancer : a prospective pooled multicohort study

Background Several lifestyle factors are associated with an increased risk of colorectal cancer (CRC). Although lifestyle factors co-occur, in most previous studies these factors have been studied focusing upon a single risk factor or assuming independent effects between risk factors. Aim To examine the pairwise effects and interactions of smoking, alcohol consumption, physical inactivity, and body mass index (BMI) with risk of subsequent colorectal cancer (CRC). Methods and results We used METCA cohort data (pooled data from seven population-based Finnish health behavior survey studies during years 1972-2015) consisting of 171 063 women and men. Participants' smoking, alcohol consumption, physical inactivity and BMI measures were gathered, and participants were categorized into those exposed and those not exposed. The incidence of CRC was modeled by Poisson regression with main and interaction effects of key lifestyle factors. The cohort members were followed-up through register linkage to the Finnish Cancer Registry for first primary CRC case until the end of 2015. Follow-up time was 1715, 690 person years. The highest pairwise CRC risk was among male smokers who had overweight (BMI >= 25 kg/m(2)) (HR 1.75, 95% CI 1.36-2.26) and women who had overweight and consumed alcohol (HR 1.45, 95% CI 1.14-1.85). Overall, among men the association of lifestyle factors and CRC risk was stronger than among women. In men, both having overweight and being a smoker combined with any other adverse lifestyle factor increased CRC risk. Among women, elevated CRC risks were observed for those who were physically inactive and who consumed alcohol or had overweight. No statistically significant interactions were detected between pairs of lifestyle factors. Conclusions This study strengthens the evidence of overweight, smoking, and alcohol consumption as CRC risk factors. Substantial protective benefits in CRC risk can be achieved by preventing smoking, maintaining BMI toPeer reviewe

Increased Health and Wellbeing in Preschools (DAGIS) Study – differences in children’s energy balance-related behaviors (EBRBs) and in long-term stress by parental educational level

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