Exploring links between working conditions and obesity in low-wage workers

It's no secret that the U.S. has a weight problem.   Nearly 36% of U.S. adults are obese and another 33% are overweight, with respective body mass indices of 30 or higher and 25 to 29.9.   Strategies to address this public health problem rely heavily on individuals' changing their behavior, such as increasing physical activity and reducing calorie intake.   These interventions are easier said than done, and may not be making a dent in the U.S. obesity epidemic.  A result analysis suggests that by 2030, 51% of the U.S. population will be obese.

A new report explores the potential links between working conditions and individuals' challenges in maintaining a healthy weight.   Researchers at UMass Lowell and the University of Connecticut teamed up with worker leaders and staff of MassCOSH and the Boston Workers' Alliance to investigate the experiences of low-wage with respect to eating patterns, physical activity, and their work environment.  They conducted eight  90-minute focus groups with a total of 63 low-wage workers.  Four individuals participated in longer, in-depth interviews.  Twenty-two percent of the participants were employed in restaurant/food service, 21% in healthcare/human services, 17% in construction and 13% in manufacturing; 83% of the participants were Hispanic or Latino; and 65% were female.

Four primary themes emerged from the focus group discussions:

  • Physically demanding work, such as jobs in construction or hotel housekeeping, and extended work hours, made it difficult to engage in exercise programs or other forms of physical activity.   As one worker reported: "I don't have the desire to do exercise after standing 15-16 hours.  I just want to eat and sleep."
  • Psychosocial stressors at work, such as high demands for performance and low control over how the work is organized, creates anxiety and leads to food consumption.  One participant explained: "The work that three people used to do is given to one person.  That creates more stress and eating more," and another said: "we had too much work so we didn't have time for lunch.  I needed the job..sometimes I work 10 or 12 hours...when I got home I ate fast food."
  • Time pressure and work schedules influence workers' eating patterns.  As one worker noted: "Rushing to the next job and wanting something quick...I buy a donut and coffee to help keep me awake."
  • The food environment at their jobs influence their meal options and eating habits.   One participant explained: "I don't have a microwave to heat up my food," and another said: "many factories only have 1 or 2 microwaves even though there are a lot of employees."   Worse yet, the participants reported: "there was no place to sit and eat," with another adding: "the 'cafeteria' is in a corner of a dirty and unsanitary room."

Nicole Champagne, Ed.D. of UMass Lowell’s Department of Community Health and Sustainability said

"This report shows what an important impact the conditions of a person’s workplace can have on their health.  When we are only looking at individual behaviors, such as diet and exercise habits as a way to improve health, we are missing a big piece of the puzzle.”

The worker participants and researchers offer a host of recommendations to improve working conditions in ways to address the obesity and overweight problem.  These include:

  • Employers supporting daily communications about rest and meal breaks to facilitate healthy meal planning;
  • Employers providing a clean space for eating with sufficient refrigerators and microwaves for the number of employees;
  • Policy makers including working conditions as a part of workplace wellness programs;
  • Worker advocacy groups and unions engaging members in participatory programs to improve their health status;
  • Insurance companies providing rate reductions for employers who make work environment improvements that affect obesity risk; and
  • Employers and governments adopting living wage policies to make the lives of low-wage workers less stressful.

Aaron Carroll writing at The Incidental Economist reminded me of a classic Doonesbury cartoon featuring Jane Fonda (actress and workout video star) and a housekeeper.

"Ms. Fonda tells the other woman that she looks worn down and that she should exercise more.  The cleaning lady replies that she doesn’t have time for such things.  Ms. Fonda than lectures her on the fact that no one is busier than her, as a 'wife, movie star, activist, and entrepreneur,' and that if she can find time to exercise, then anyone can."

"The cleaning lady responds with one of the most insightful retorts I have ever read. She says, 'you’re as busy as you want to be. I’m as busy as I got to be.  I hate to break it to you, but there’s a big difference.'"

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There is another factor at work here: "immiseration."

People whose working lives are made miserable by overwork and workplace stress, and importantly, by fundamental economic insecurity, may find that eating naughty foods in excess is one of the few points of pleasure in their lives. The answer to this is straightforward: improve the real quality of work life, and pay people sufficiently to afford a dignified standard of living for a single-income family.

Adverse health impacts in general are predictable outcomes of economic insecurity and poor working conditions. The ugly social darwinism that has become our societal norm is pathological and pathogenic. When that changes, health outcomes will change.

You can work out the policy implications, and they are convergent.