Effects of increased body mass index on employment status: a Mendelian randomisation study

Associations between Type of Bariatric Surgery and Obstructive Sleep Apnoea, Employment Outcomes, and Body Image Satisfaction: A Systematic Review and Meta-Analysis

INTRODUCTION

Bariatric surgery has been shown to provide significant patient benefits in terms of weight loss and mitigation of obesity-linked comorbidities, as well as providing improvements in occupational productivity and patient quality of life. However, the choice of which bariatric surgery procedure provides the most patient benefit in each of these cases is still in question. In this review, we provide a systematic review, with the objective of evaluating associations between different bariatric surgery procedures and mitigation of obesity-linked comorbidities, improvement in occupational productivity, and patient quality of life, concentrating on three areas: obstructive sleep apnoea (OSA), employment prospects, and body image.

METHODS

The CINAHL, PubMed, Web of Science, and CENTRAL databases were searched for eligible studies. Summary risk ratio (RR) and 95% confidence intervals were estimated using random-effects models. Thirty-three studies were included in this review, including 29 cohort studies and 4 randomised clinical trials (RCTs).

RESULTS

Pooled analysis of the observational studies showed significantly lower OSA remission in sleeve gastrectomy (SG) compared to Roux-en-Y gastric bypass (RYGB) across both short-term (1-2 years) and longer term (3+ years) follow-up periods (RR = 0.91, 95% CI = 0.84-0.99, p = 0.02; and RR = 0.88, 95% CI = 0.65-0.99, p = 0.03, respectively). In contrast, a meta-analysis of the RCT studies found no difference in OSA remission between SG and RYGB (RR = 1.01, 95% CI = 0.81-1.25, p = 0.93). An analysis of four studies showed significantly higher OSA remission for SG versus adjustable gastric banding (RR = 1.83, 95% CI = 1.57-2.14, p < 0.001). No significant difference was observed regarding improvement in employment status between SG and RYGB (RR = 0.77, 95% CI = 0.32-1.87, p = 0.57). A narrative synthesis of studies on body image reported no significant differences between body image scores and surgery types.

CONCLUSION

This review found significantly lower OSA remission in SG as compared to RYGB across different follow-up periods, while no significant statistical difference was observed in RCT studies. Further studies are recommended to assess the effectiveness of the various bariatric surgeries in relation to improving employment status and body image, where primary studies are lacking.

The impact of excess body weight on employment outcomes: A systematic review of the evidence

BACKGROUND

Excess body weight has been recognised as an important factor in influencing labour market outcomes. Several hypotheses explain the causal effect of excess body weight on employment outcomes, including productivity, labour supply, and discrimination. In this review, we provide a systematic synthesis of the evidence on the causal impact of excess body weight on labour market outcomes worldwide.

METHODS

We searched Econ Lit, and Web of Science databases for relevant studies published from 1st Jan 2010-20 th Jan 2023. Studies were included if they were either longitudinal analysis, pooled cross-sectional or cross-sectional studies if they used instrumental variable methodology based on Mendelian Randomisation. Only studies with measures of body weight and employment outcomes were included.

RESULTS

The number of potentially relevant studies constituted 4321 hits. A total of 59 studies met the inclusion criteria and were qualitatively reviewed by the authors. Most of the included studies were conducted in the USA (N=18), followed by the UK (N=9), Germany (N=6), Finland (N=4), and non-EU countries (N=22). Evidence from the included studies suggests that the effect of excess weight differs by gender, ethnicity, country, and time period. White women with excess weight in the USA, the UK, Germany, Canada, and in the EU (multi-country analyses) are less likely to be employed, and when employed they face lower wages compared to normal weight counterparts. For men there is no effect of excess weight on employment outcomes or the magnitude of the effect is much smaller or even positive in some cases.

CONCLUSIONS

This review has shown that despite ample research on the relationship between excess weight and employment status and wages, robust causal evidence of the effects of excess weight on employment outcomes remains scarce and relies significantly on strong statistical and theoretical assumptions. Further research into these relationships outside of USA and Western Europe context is needed.

Food insecurity is associated with metabolic syndrome among US adults: NHANES 2005-2016

The primary objective of this study was to examine the association between food security status and metabolic syndrome (MetS) using a nationally representative dataset. We hypothesized that food insecurity would be associated with an increased odds of having MetS. This was a cross-sectional analysis of data from the 2005-2006 to 2015-2016 National Health and Nutrition Examination Survey data collection cycles. Food security was measured using the US Food Security Survey Module. Presence of MetS was determined using the National Cholesterol Education Program Adult Treatment Panel III criteria. The association between food insecurity and MetS was examined using logistic regression models stratified by sex and adjusted for poverty to income ratio, age, race, marital status, educational attainment, smoking status, and body mass index. After adjusting for covariates, men with marginal (odds ratio, 1.64; 95% confidence interval [CI], 1.22-2.20) and low (odds ratio, 1.33; 95% CI, 1.02-1.73) food security had a higher odds of having MetS than men with full food security; however, this association was lost among men with very low food security. For women, very low food security was associated with a 1.61 times greater odds of having MetS (95% CI, 1.16-2.25). These results suggest that food insecurity is generally associated with an increased prevalence of MetS for women, but not necessarily for men. These findings highlight the need to address rising food insecurity rates, while also highlighting the need for further research to fully elucidate the role of gender and sex in food insecurity and chronic disease.

Causal effect of obesity on the probability of employment in women in Turkey

This study aims to investigate the causal effect of obesity on the employment probability of women in Turkey via the instrumental variable approach by using data from the 2018 Turkey and Demographic Health Survey. Obesity prevalence in the area of living and the overweight status of the oldest child, which are the most common types of instruments seen in the literature, are used as instruments. Consistent with the OLS result, the 2SLS estimate indicates that obese women are statistically significantly less likely to be employed when the overweight status of the child is used as an instrument. On the other hand, the statistically significant effect of obesity disappears when the area level obesity prevalence is used as the instrument. In addition, obesity in women decreases the likelihood of employment in the services sector and full-time jobs and employment with social security. Although the results of this study do not indicate the source of the effect found, the presence of a causal relationship for women should not be ignored when the economic burden of obesity for Turkey is considered.

The association of obesity-related traits on COVID-19 severity and hospitalization is affected by socio-economic status: a multivariable Mendelian randomization study

BACKGROUND

Due to its large impact on human health, socio-economic status (SES) could at least partially influence the established association between obesity and coronavirus disease 2019 (COVID-19) severity. To estimate the independent effect of body size and SES on the clinical manifestations of COVID-19, we conducted a Mendelian randomization (MR) study.

METHODS

Applying two-sample MR approaches, we evaluated the effects of body mass index (BMI, n = 322 154), waist circumference (WC, n = 234 069), hip circumference (n = 213 019) and waist-hip ratio (n = 210 088) with respect to three COVID-19 outcomes: severe respiratory COVID-19 (cases = 8779, controls = 1 000 875), hospitalized COVID-19 (cases = 17 992, controls = 1 810 493) and COVID-19 infection (cases = 87 870, controls = 2 210 804). Applying a multivariable MR (MVMR) approach, we estimated the effect of these anthropometric traits on COVID-19 outcomes accounting for the effect of SES assessed as household income (n = 286 301).

RESULTS

BMI and WC were associated with severe respiratory COVID-19 [BMI: odds ratio (OR) = 1.51, CI = 1.24-1.84, P = 3.01e-05; WC: OR = 1.48, 95% CI = 1.15-1.91, P = 0.0019] and hospitalized COVID-19 (BMI: OR = 1.50, 95% CI = 1.32-1.72, P = 8.83e-10; WC: OR = 1.41, 95% CI = 1.20-1.67, P = 3.72e-05). Conversely, income was associated with lower odds of severe respiratory (OR = 0.70, 95% CI = 0.53-0.93, P = 0.015) and hospitalized COVID-19 (OR = 0.78, 95% CI = 0.66-0.92, P = 0.003). MVMR analyses showed that the effect of these obesity-related traits on increasing the odds of COVID-19 negative outcomes becomes null when accounting for income. Conversely, the association of income with lower odds of COVID-19 negative outcomes is not affected when including the anthropometric traits in the multivariable model.

CONCLUSION

Our findings indicate that SES contributes to the effect of obesity-related traits on COVID-19 severity and hospitalization.

Effects of depression on employment and social outcomes: a Mendelian randomisation study

BACKGROUND

Depression is associated with socioeconomic disadvantage. However, whether and how depression exerts a causal effect on employment remains unclear. We used Mendelian randomisation (MR) to investigate whether depression affects employment and related outcomes in the UK Biobank dataset.

METHODS

We selected 227 242 working-age participants (40-64 in men, 40-59 years for women) of white British ethnicity/ancestry with suitable genetic data in the UK Biobank study. We used 30 independent genetic variants associated with depression as instruments. We conducted observational and two-sample MR analyses. Outcomes were employment status (employed vs not, and employed vs sickness/disability, unemployment, retirement or caring for home/family); weekly hours worked (among employed); Townsend Deprivation Index; highest educational attainment; and household income.

RESULTS

People who had experienced depression had higher odds of non-employment, sickness/disability, unemployment, caring for home/family and early retirement. Depression was associated with reduced weekly hours worked, lower household income and lower educational attainment, and increased deprivation. MR analyses suggested depression liability caused increased non-employment (OR 1.16, 95% CI 1.06 to 1.26) and sickness/disability (OR 1.56, 95% CI 1.34 to 1.82), but was not causal for caring for home/family, early retirement or unemployment. There was little evidence from MR that depression affected weekly hours worked, educational attainment, household income or deprivation.

CONCLUSIONS

Depression liability appears to cause increased non-employment, particularly by increasing disability. There was little evidence of depression affecting early retirement, hours worked or household income, but power was low. Effective treatment of depression might have important economic benefits to individuals and society.

Obesity- attributable costs of absenteeism among working adults in Portugal

Background

Obesity leads to poor health outcomes and may adversely affect work productivity. This study, aimed to investigate the obesity- attributable costs of absenteeism among working adults in Portugal.

Methods

The study population included individuals actively working at baseline from the Epidemiology of Chronic Diseases Cohort (EpiDoC), a large Portuguese population-based prospective study. Body mass index was measured at baseline and in two follow-up interviews. Absenteeism in each wave of the EpiDoC was assessed by the question “Did you have a sick leave in the previous 12 months? yes/no”, followed by “How many days did you miss work due to sickness in the previous twelve months?”. Body mass index (BMI) was classified into underweight, normal weight, overweight, and obese, based on the standard World Health Organization definition.

Association between obesity and absenteeism was estimated with the negative binomial regression model adjusted for BMI, chronic diseases, and lifestyle. Obesity- attributable costs were calculated using lost gross income during the time absent from work, through the human-capital approach.

Results

The EpiDoC included 4338 working adults at baseline. Of these, 15.2% were obese at the beginning of the study and 22.7% of the population had been absent from work in the last 12 months. Participants with obesity missed 66% more days at work (IRR: 1.66; CI 95%:1.13–2.44; (p = 0.009.) than those with normal weight. The odds of having been absent from work were 1.4 times higher in obese compared to non-obese individuals (CI 95%: 1.18–1.67; p < 0.01) adjusted to sex and type of work. Obese individuals missed 3.8 more days per year than those with normal weight (95%CI: 3.1–4.5). Extrapolating to the entire Portuguese working population, absenteeism due to obesity incurred an additional cost of €238 million per year.

Conclusion

Obesity imposes a financial burden due to absenteeism in Portugal. Employers and national health regulators should seek effective ways to reduce these costs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13337-z.