Productivity loss due to overweight and obesity: a systematic review of indirect costs

Real-world cross-sectional study evaluating patient characteristics, disease burden, and treatment approaches in people with obesity disease in Japan

AIM

To describe clinical characteristics, disease burden, and treatment patterns among people with obesity disease (PwOD) in Japan, using data from the Adelphi Real World Obesity Disease Specific Programme™ (DSP).

METHODS

Secondary data from the Japanese DSP cohort (July to December 2022) were analyzed. PwOD had a BMI ≥25 kg/m2 and ≥1 obesity-related complications (ORCs). Outcomes were summarized for all PwOD or stratified by obesity class (BMI ≥25-<35 or ≥35 kg/m2 [high-degree obesity disease]) and use of anti-obesity medications (AOMs).

RESULTS

The study included 442 PwOD (mean age: 52.8 years; 54.8% males; BMI ≥25-<35 kg/m2: 64.5%; BMI ≥35 kg/m2: 35.5%; AOM users: n = 228; non-AOM users: n = 214). High-degree obesity disease was associated with worsened SF-36v2 scores (Physical Component Summary, Physical Functioning, Bodily Pain, and General Health), greater activity impairment, and reduced work productivity. Common weight management approaches were diet (79.9%) and exercise (51.1%). Common prescription AOMs included traditional herbal medicine (67.5%) and mazindol (21.1%). People with high-degree obesity disease (BMI ≥35 vs. ≥25-<35 kg/m2) used more prescription AOMs (57.3 vs. 48.4%), behavioral therapy (9.6 vs. 1.8%), and weight loss surgery (2.6 vs. 0.4%). The difference in weight reduction between AOM and non-AOM users was modest.

CONCLUSIONS

People with high-degree obesity disease experienced greater disease burden. Diet and exercise are common for weight management, while behavioral therapy is less frequently implemented. These findings highlight the challenges and unmet medical needs in treating obesity in Japan and could inform better treatment strategies in Japan and globally among the Asian population.

Knowledge, Attitude, and Belief of Healthcare Professionals Toward Obesity Stigmatization

Objective

Obesity stigmatization, defined as the social devaluation and denigration of individuals because of their excess weight, represents a significant barrier to effective healthcare delivery. This study aimed to investigate healthcare professionals' knowledge about obesity-related health impacts, attitudes regarding weight bias (negative or discriminatory attitudes toward individuals with obesity), and beliefs about the causes and nature of obesity.

Methods

This cross-sectional study was conducted among healthcare professionals between Jan, 2024 and Feb, 2024 in The Department of General Medicine, Chengdu Second People's Hospital, using a self-designed questionnaire.

Results

A total of 388 valid questionnaires [303 (78.09%) female and a mean age of 37.71 ± 8.46 years] were included. The mean scores for knowledge, attitude, and belief were 6.70 ± 1.46 (possible range: 0-10), 38.41 ± 5.09 (possible range: 8-48), and 63.53 ± 15.35 (possible range: 0-120), respectively. Multivariate logistic regression analysis revealed that having body mass index ≥ 24.0 kg/m² (OR = 0.537, 95% CI: 0.331-0.873, P = 0.012) and nurse profession (OR = 0.546, 95% CI: 0.338-0.883, P = 0.014) were independently associated with knowledge. Knowledge (OR = 0.754, 95% CI: 0.600-0.949, P = 0.016), belief (OR = 0.915, 95% CI: 0.854-0.980, P = 0.011), and age (OR = 0.950, 95% CI: 0.906-0.995, P = 0.031) were independently associated with attitude. Moreover, structural equation modeling showed that knowledge had a significant direct effect on both belief (β = 0.845, P < 0.001) and attitude (β = -0.944, P < 0.001), as well as belief on attitude (β = -0.550, P < 0.001).

Conclusion

Healthcare professionals exhibited insufficient knowledge, negative attitude and belief toward obesity stigmatization. A pressing necessity arises for the implementation of targeted educational interventions and awareness programs within healthcare settings.

Perspectives on Obesity Management and the Use of Anti-Obesity Medicine from US Employees and Employers: Results from the OBSERVE Study

Personal health factors and direct and indirect costs of obesity affect employers and employees. This research aimed to understand perceptions of obesity management and anti-obesity medications (AOMs) among employers and employees. In 2022, people with obesity and employers completed cross-sectional surveys about perceptions of obesity and its management, including AOMs. Data were analyzed with descriptive statistics. Data from 461 employed people with obesity (EwO) and 51 employer representatives (ER) were analyzed. Both EwO and ER acknowledged the impact of obesity on future health problems (88.3%; 100.0%) and perceived obesity as a disease (60.5%; 80.4%) to varied degrees. Both groups perceived an incremental value in combining self-directed lifestyle changes and AOMs (57.5%; 66.7%) and perceived healthcare provider-guided lifestyle change alongside AOMs as the most effective approach for maintaining long-term weight reduction (56.4%; 66.6%). More than two-thirds (68.6%) of ER expressed willingness to revisit their AOM coverage decisions, though cost of medication coverage (72.5%) and affordability of medications for employees (68.7%) were identified as barriers. ER believed that data showing reductions in premiums and claims at their organizations (78.4%) would be helpful in supporting the coverage of AOMs. While EwO and ER were receptive toward AOMs, organization-level barriers existed with AOM coverage. Evidence demonstrating the benefits of evidence-based obesity care, direct/indirect cost reductions, and the impact of obesity may address barriers to AOM coverage and improve obesity care and outcomes of their workforces.

The Burden of Obesity in Saudi Arabia: A Real-World Cost-of-Illness Study

Background

The rising prevalence of obesity in the Kingdom of Saudi Arabia (KSA) poses a significant public health challenge. Estimates of the economic cost of obesity are crucial for prioritizing healthcare interventions, guiding policy choices, and justifying budget allocations aimed at reducing obesity prevalence. This study aimed to estimate the cost of obesity in the KSA in 2022.

Methods

A prevalence-based cost-of-illness approach was used to determine the cost of obesity. This analysis encompasses 29 diseases, namely obesity and twenty-eight diseases attributable to obesity. Both direct and indirect costs were considered. The annual cost of treatment for each obesity-attributable disease was obtained from the hospital records of one tertiary hospital in the KSA. Data on direct non-medical costs were obtained from the patient survey. The human capital approach was used to estimate the indirect costs of morbidity and mortality.

Results

The total economic burden of obesity (2022 values) was estimated at US$116.85 billion from a societal perspective and US$109.67 billion from a healthcare system perspective. From a societal perspective, the total direct medical cost accounted for the largest portion of the total cost (94%). In terms of direct medical costs, the cost of treating diseases attributable to obesity was substantially greater than the cost of treating obesity itself. According to the sensitivity analysis, the total cost ranged from 3.4% of the country's Gross domestic product (GDP) when the unit cost of treatment was reduced by 74% to 9.5% of the country's GDP when the prevalence of obesity and its comorbidities was reduced by 5%.

Conclusion

Obesity imposes a substantial economic burden on the healthcare system and society in the KSA. Interventions aimed at promoting healthier lifestyles to reduce the prevalence and incidence of obesity and its comorbidities are highly warranted to alleviate the impact of obesity in the country.

Modeling the cost of inaction in treating obesity in Canada

BACKGROUND

Obesity prevalence continues to rise in Canada, highlighting a growing public health concern. This study updates estimates of the societal cost of inaction in treating obesity, emphasizing the significant economic burden stemming from both direct healthcare costs and indirect productivity losses.

METHODS

We combined data from national surveys and published literature to estimate the 2023 national economic implications of obesity. Comparing adults with obesity (BMI ≥ 30) to those with healthy weight (25 > BMI ≥ 18.5), we assessed healthcare costs, absenteeism, presenteeism, disability pensions, mortality-related costs, workforce participation, and earnings. Canadian data were used where possible, supplemented by U.S. data, standardized to 2023 CAD$.

RESULTS

The cost of inaction in treating obesity in Canada was $27.6 billion in 2023, including $5.9 billion in direct healthcare and $21.7 billion in indirect costs. Excess healthcare costs are driven by higher utilization of medical services. Indirect costs include approximately $8.2 billion from reduced workforce participation, $6.8 billion from presenteeism, $3.8 billion in lower earnings among employed with obesity, $2.0 billion from lost wages due to premature mortality, $682 million from absenteeism, and $268 million from disability pensions.

CONCLUSIONS

The economic implications of not addressing obesity effectively are substantial, emphasizing the urgent need for utilizing effective chronic disease management strategies. Our findings highlight the disproportionate impact on women and the broader economic consequences, underscoring the imperative for tailored policy interventions. Investing in comprehensive, evidence-based obesity management not only enhances individual well-being but also yields significant societal and economic benefits.

Patient Perspectives on Impact of Weight and Weight Stigma on Breast and Cervical Cancer Treatment: A Qualitative Study

BACKGROUND

Higher weight individuals report experiencing weight-based stigma in the healthcare setting; within the cancer continuum, the most robust evidence exists for cancer screening. More research is needed to understand whether and how higher weight patients experience weight stigma during cancer treatment.

METHODS

We conducted semi-structured interviews with 15 breast and 15 cervical cancer survivors diagnosed 2017-2019 in Iowa who had a pre-diagnosis body mass index of 30+ kg/m2 calculated from their driver's license height and weight. Interviews focused on whether individuals perceived being treated differently because of their weight in daily life, in healthcare, or during cancer treatment. Data were coded using a combination of inductive and deductive approaches, and analyzed using a multi-phase thematic analysis.

RESULTS

Almost all interviewees reported positive experiences during cancer treatment; several described their weight as never being an issue. Some identified weight stigma during cancer diagnosis or treatment that resulted in delayed diagnoses or changes in treatment. Many interviewees described situations where their weight was discussed negatively during cancer treatment, but most did not identify these as stigmatizing because their providers were only "concerned about [their] health." Additional themes developed included experiencing environmental stigma, the discussion of cancer recurrence by providers only as it related to weight, and misconceptions of the causes and consequences of obesity.

CONCLUSIONS

While several participants did not feel that their weight impacted cancer treatment, some reported experiences of weight stigma pre-diagnosis and during treatment. When individuals noted their weight was discussed during treatment, internalized bias may have impacted whether they considered these discussions stigmatizing.

Building Healthier Communities in the Workplace: The Impact of a Year-Long Lifestyle Intervention on Food Access, Quality of Life, and Health Metrics

BACKGROUND/OBJECTIVES

The present study assessed the impact of a year-long community-engaged lifestyle intervention to improve healthy food access, anthropometric measures, and quality of life among factory workers.

METHODS

A total of 80 workers aged 20-65 participated in this quasi-experimental pre-post intervention with nine dietitian-led sessions, weekly physical activity classes, and adjustments to the factory food menu. Volunteer health leaders from the workforce played a pivotal role as project stakeholders, promoting the initiative, liaising with the food supplier, advocating for physical activity hours with management, and supporting activity dissemination. Data were collected at baseline, four months, and one year, including weight, waist circumference, dietary intake, physical activity, and quality of life (SF-36 questionnaire).

RESULTS

Waist circumference significantly decreased after 4 and 12 months. Regression models showed that each additional year of age correlated with a 0.72 cm reduction, while over 150 min of weekly physical activity was associated with a 6.58 cm decrease. The mental health component of the quality of life scores improved from 73.1 ± 18.5 to 78.7 ± 17.6 (p = 0.017), alongside reductions in sugar and sodium intake. The intervention cost ILS 4875 (EUR 1314 or USD 1369) per employee annually.

CONCLUSIONS

This community-engaged, dietitian-led intervention significantly improved factory workers' health and well-being, providing a cost-effective solution.

Experiences and overall impact reported by people living with obesity: results from a multinational study

Objectives

To explore the impact of obesity on clinical outcomes, health-related quality of life, emotional well-being, and work productivity in people/patients with obesity across six countries by body mass index and the presence of complications.

Methods

Adelphi Real World Obesity Disease Specific Programme™ captured data related to physicians and their consulting people/patients with obesity on a weight management program or anti-obesity medication in Brazil, Canada, China, Japan, Kingdom of Saudi Arabia, and the United Arab Emirates from April to December 2022. Physicians reported data for up to eight qualifying people/patients with obesity. People/patients with obesity voluntarily completed outcome measures: 36-Item Short Form Health Survey, emotional well-being, and Work Productivity and Activity Impairment.

Results

Of 1506 people/patients with obesity, 58% were female (mean ± standard deviation age: 41 ± 12.7 years; body mass index: 32.3 kg/m2 ± 7.7 kg/m2). Overall, 82% had ⩾1 complication (median and interquartile range: 2.0 (1.0-3.0)). People/patients with obesity struggled with weight for a mean ± SD of 64.1 ± 86.6 months with a median (interquartile range) of 3.0 (2.0-5.0) weight-loss attempts. Mean ± standard deviation 36-Item Short Form Health Survey scores for people/patients with obesity above the obesity threshold showed impairment in general health (42.3 ± 11.5), social functioning (44.3 ± 9.2), role-emotional (46.0 ± 9.3), and mental health (45.7 ± 9.6). People/patients with obesity with complications showed similar impairment. People/patients with obesity reported bother/embarrassment about their weight, with 72% worried about future weight gain. Work productivity and activity impairment scores among people/patients with obesity above the obesity threshold showed impairment in activity (36%), overall work (34%), and presenteeism (31%). Findings were similar for people/patients with obesity with complications.

Conclusion

Results suggest that obesity alongside the presence of complications negatively impacts health-related quality of life, emotional well-being, and work productivity, reinforcing the need for comprehensive interventions for this complex health issue.

Assessment of health behaviors of primary school teachers based on their nutritional knowledge and physical activity: A cross-sectional study in the Asir Region

BACKGROUND

Primary school teachers play a critical role as educators in imparting healthy eating behaviour and the importance of physical activity to prevent health issues. However, the teachers' health behaviors have not been studied much, particularly in Saudi Arabia. Understanding these factors is essential to developing interventions that enhance teachers' well-being and their ability to influence students positively. This study aims to assess nutritional knowledge and physical activity; to determine correlations between health behaviour factors and Body Mass Index (BMI), and evaluate BMI status concerning demographic factors among primary school teachers in the Asir Region, KSA.

METHODS

A cross-sectional design was employed, involving 370 primary school teachers. Data were collected using a self-administered questionnaire that covered sociodemographic details, anthropometric measurements, physical activity levels, and nutritional knowledge. Statistical analyses included Pearson's correlation and Chi-square tests, with significance at p < 0.05.

RESULTS

Among the participants, 38.6% were overweight, and 33.5% were obese, with 76% of married teachers classified as overweight or obese. Only 9.0% exhibited excellent nutritional knowledge, while 25.0% demonstrated poor knowledge. The majority (84.0%) engaged in low or minimal physical activity. A weak but significant correlation was observed between nutritional knowledge and BMI (p < 0.05), whereas no significant associations were found between physical activity levels and either BMI or nutritional knowledge.

CONCLUSION

The study highlights critical gaps in nutritional knowledge and physical activity among teachers, emphasizing the need for targeted school-based health education programs. Improving teacher health behaviors could enhance their well-being and enable them to act as positive role models for their students.

Incorporating Lifestyle Medicine Into Occupational Medicine Practice: ACOEM Guidance Statement

ABSTRACT

Lifestyle medicine (LM) utilizes evidence-based therapeutic lifestyle changes to address lifestyle factors that impact health, performance, and injury risk and recovery. By integrating LM principles into clinical care, workplace policies, and programs, along with other evidence-based methods, occupational and environmental medicine clinicians and medical directors can enhance worker health and performance, manage chronic disease, and facilitate faster recovery from injury and illness. This guidance addresses approaches that can be used in the clinic and workplace to address tobacco, substance misuse, nutrition, physical activity, overweight/obesity, sleep, mental well-being, and social connectedness.

Insights from a codesigned dynamic modelling study of child and adolescent obesity in Australia

Introduction

Child and adolescent obesity is associated with a range of immediate health issues and influences obesity in adulthood. The complex nature of health determinants that contribute to obesity makes it challenging to deliver effective public health interventions. This research presents insights from a system dynamics model of childhood and adolescent obesity aimed at supporting evidence-based decision-making.

Methods

A system dynamics model was developed using the best available evidence and data, with input from research and industry experts to map the hypothetical causal structure of the factors contributing to childhood and adolescent obesity in Australia. The model was calibrated to fit the historical prevalence of obesity (R 2 =0.97, mean squared error (MSE)=4.94E-04). Intervention-based scenarios were simulated to examine how changes in environmental factors and health-related behaviours may affect the prevalence of obesity. The potential economic benefits of the scenarios were estimated from changes in population healthcare spending and quality of life compared with base model projections.

Results

A series of interventions were explored in the model, including changes in early childhood behaviours, changes to diet and physical activity in childcare and school settings, financial support for organised sports and sugar-sweetened beverage taxation. The most promising individually implemented intervention scenario for reducing the prevalence of childhood and adolescent obesity was a sugar-sweetened beverage tax (0.57 percentage points and 0.61 percentage points, respectively) and government funding of organised sports (0.42 percentage points and 0.63 percentage points, respectively). When all interventions were implemented in combination, childhood obesity was reduced by 1.43 percentage points and 1.81 percentage points in adolescents.

Conclusions

The findings highlight the challenges faced by policy-makers and public health practitioners working to reduce childhood and adolescent obesity. Insights from the model emphasise the value of public health programmes over the life course. Implementing initiatives with broad reach that support healthy choices may reduce obesity, resulting in a healthier Australian population.

Insight into the main determinants of the struggle against overweight and obesity in Chile: Use of random forest techniques and econometric models

Overweight and obesity are considered the greatest public health problem in this emerging country, which worldwide has the second-highest percentage of overweight people among its population. The objective of this work was to analyse to what extent factors traditionally used in the study of overweight and obesity (such as sociodemographic and behavioural) and new variables proposed in the literature (such as stress, financial stress and emotional support) explain this disease in the adult population of Chile. Data were obtained from the III National Health Survey (ENS) administered by the Ministry of Health of Chile in 2017. The ENS collected a large amount of data with extensive geographic coverage. The survey comprised 4 questionnaires with a total of 576 questions, which were applied to a representative sample of the population in Chile. A double complementary methodological approach was adopted. A random forest (RF) classification model was used, and based on the results obtained, an econometric model of the censored dependent variable, specifically the Heckman sample selection model, was specified and estimated. The RF results allowed, for each of the factors considered in the research, the selection of variables with the greatest power to classify the individuals in the sample on the basis of nutritional state (normal weight, overweight or obese). Subsequently, the estimation of the parameters of the Heckman model made it possible to quantify the variables that most affected overweight and obesity. Most of the variables that make up the factors were found to be significant. Interestingly, psychosocial variables effectively influence overweight and obesity. In addition, the results for reviewing nutritional information and reviewing food warnings allow us to reflect on the impact that recent food policies have had on the Chilean population. The combination of RF and an econometric model allowed us to capitalize on the strength of both models to better explain the complex phenomenon of overweight and obesity. This approach allowed us to more accurately confirm the impact of traditional factors on overweight and obesity but to show also that other psychosocial factors are relevant and should be consider in future studies.

Assessing the economic impact of obesity and overweight on employers: identifying opportunities to improve work force health and well-being

BACKGROUND AND OBJECTIVES

Obesity is a major public health issue, significantly affecting national and individual health and economic well-being. This study quantifies the economic impact of excess body weight on employers and employees in 2023, offering insights for obesity prevention and treatment.

METHODS

We utilized data from the National Health Interview Survey, National Health and Nutrition Examination Survey, Medical Expenditure Panel Survey, and Current Population Survey. Published reports and original estimates were combined to assess the economic burden for the U.S. and across seven major industries (Construction, Education & Health, Financial Activities, Government, Manufacturing, Professional & Business Services, and Transportation & Utilities). We compared the economic outcomes for adults with obesity and overweight to those with healthy weight, focusing on direct and indirect costs. Potential savings from different weight loss scenarios were estimated using the Disease Prevention & Treatment Microsimulation Model.

RESULTS

In 2023, among 158 million civilian employees on nonfarm payrolls, 30% had obesity and 34% had overweight, resulting in a combined economic burden of $425.5 billion (obesity: $347.5 billion; overweight: $78 billion). This includes excess medical costs of obesity ($115 billion), presenteeism (obesity: $113.8 billion; overweight: $46.5 billion), absenteeism from obesity ($82.3 billion), excess medical costs of overweight ($31.5 billion), obesity-related disability payments ($31.1 billion), and workers' compensation payments ($5.2 billion). For a hypothetical firm with 10,000 employees (plus dependents), the annual costs were $22 million for obesity and $4.9 million for overweight, with average costs of $6472 per employee with obesity, $1244 per employee with overweight, $1514 per adult dependent with obesity, and $380 per adult dependent with overweight. Medical savings over 5 years range from $153.3 billion with a 5% weight loss to $326.1 billion with 25% weight loss at the industry level.

CONCLUSION

The substantial economic costs imposed by obesity and overweight on employers and employees highlight the need for resources dedicated to treatment and prevention, which can result in reduced medical expenses and improved productivity.

The cost of obesity and related NCDs in Brazil: An analysis of hospital admissions, disability retirement benefits, and statutory sick pay

OBJECTIVES

This study analyses the prevalence of overweight/obesity in Brazil, and its costs regarding hospital admissions (HA), disability retirement benefits (DRB), and statutory sick pay (SSP) associated with obesity-related non-communicable diseases (NCDs).

STUDY DESIGN

Time-series study.

METHODS

This study analyses data from the VIGITEL system (2010-2019) to calculate the body-mass index (BMI) of adult residents in Brazil's state capitals. Data on HA, DRB, and SSP were obtained from Brazil's SIH/SUS and AEPS Infologo systems. Pearson's correlation and linear regression models were applied. The study selected 23 diseases of the International Classification of Disease (ICDs) belonging to chapters C; E; I; and K. Cost values in BRL were deflated using IPCA.

RESULTS

The results showed a significant increase in overweight and obesity rates in Brazil, with BMI rising by 0.09 kg/m2 annually. Regression analysis revealed that each 1-point increase in the average BMI of the population is associated with an increase of 81,772 (BRL 237.51 million/year) new HA per year, 5541 (BRL 18.8 million/year) new DRB granted per year, and 42,360 (BRL 131 million/year) new SSP per year. Also, every 1 % increase in the share of the Brazilian population with obesity is associated with an increase of 16,973 (BRL 48.8 million/year) new HA per year, 1202 (BRL 3.97 million/year) new DRB granted per year, and 8686 (BRL 26.8 million/year) new SSP per year. Regressions for deflated values showed lower significance, suggesting a strong impact of inflation on health costs in Brazil.

CONCLUSIONS

Obesity prevalence in Brazil implies high direct and indirect costs for the Brazilian government, especially considering circulatory system diseases.

Awareness of Obesity and Weight Loss Management Among Adults in the Asir Region, Saudi Arabia

Obesity, a chronic disease marked by excessive fat accumulation and a body mass index (BMI) of 30 kg/m² or more, has become a major global health issue, affecting many adults worldwide and particularly prevalent in developed nations and Saudi Arabia. The condition can be caused by genetic, metabolic, and lifestyle factors. Understanding its awareness is imperative in designing effective health interventions. A cross-sectional study was done to assess awareness of obesity and weight loss management among adults in the Asir region of Saudi Arabia. A total of 638 participants were included in this study, a self-administered electronic questionnaire was distributed to 638 respondents, and data were analyzed using SPSS version 27. Our study revealed low practical adherence with 83.5% (533 participants) not following any specific diet and only 29.8% (190 participants) engaging in regular physical activity. Sleep and hydration patterns varied, with 51.9% (331 participants) of participants sleeping fewer than seven hours and 61.9% (395 participants) not meeting recommended water intake. While 66.1% (422 participants) acknowledged that medical conditions such as metabolic syndrome can contribute to obesity, a significant proportion lacked knowledge about the impact of medications and stress. Dietary habits showed that 24.5% (156 participants) practiced intermittent fasting, yet only 1.7% (11 participants) had undergone weight loss surgery. Gender, age, body weight, BMI, and self-perception of weight were significantly associated with knowledge levels, with females, younger participants, and those with normal BMI exhibiting higher awareness. There was reasonable awareness of obesity and weight loss management. However, practical adherence to healthy behaviors, such as regular physical activity and dietary management, remains low. Most participants recognize lifestyle-related factors contributing to obesity and favor non-surgical, non-medication-based weight management. Healthcare professionals should organize seminars and educational programs to enhance public understanding of obesity and weight management in Saudi Arabia.

Causal Relationship Between Physical Activity and Body Weight: A Maximum Likelihood Treatment Effect Model Approach Using Australian Longitudinal Data

BACKGROUND

More than two-thirds of Australians are overweight. Existing research based on non-experimental data has primarily established associations, rather than causal inferences, between physical activity (PA) and body mass index (BMI). PA and BMI likely affect each other, a reciprocal interplay most studies overlook. We investigate the causal relationship between PA and BMI using a quasi-experimental approach to overcome reverse causality bias.

METHOD

A maximum likelihood treatment effect model, a quasi-experimental method, was employed. Data was from an observational longitudinal dataset of 130,397 observations with 19,677 unique individuals aged 15-64 (52% are females) from the Household, Income, and Labour Dynamics in Australia survey 2006-2019. We first tested for the reverse relationships (whereby overweight limits PA) before estimating the effect of PA on BMI.

RESULTS

The first-stage modelling results showed that overweight and obese adults are less likely to engage in PA, as are those resource constrained (time or socioeconomically). In the second modelling stage, there was a clear and significant effect of PA on BMI. Being physically active more than three times a week led to a 2.55-point reduction in BMI (p < 0.001). For women, this effect was more pronounced, with a 2.92-point reduction (p < 0.001).

CONCLUSION

This study leverages existing longitudinal data to provide causal estimates of PA on BMI-finding that PA reduces BMI, particularly for women. As many individuals face resource constraints, campaigns to promote behavioural change need to be nuanced and shift some of the responsibility for physically activity from individuals to policy and organizational reforms.

Assessing the Fiscal Burden of Overweight and Obesity in Japan through Application of a Public Economic Framework

Introduction: Obesity continues to represent a significant public health concern, with a broad impact from both a health and economic perspective. Objective: This analysis assesses the fiscal consequences of overweight and obesity (OAO) in Japan by capturing obesity-attributable lost tax revenue and increased government transfers using a government perspective. Methods: The fiscal burden of OAO was estimated using an age-specific prevalence model, which tracked the Japanese population across different body mass index (BMI) categories. The model was populated with fiscal data for Japan, including employment activity and government spending, to calculate tax revenue and transfer costs. A targeted literature review was conducted to identify data estimating the impact of OAO on employment, income, sick leave, retirement, and mortality. These modifiers were applied to Japanese epidemiological and fiscal projections to calculate government tax revenue and spending. The incremental impact of reducing OAO in the general population was subsequently calculated. Results were estimated based on the 2023 Japanese working-age population aged 18 to 70 years. Results: The total fiscal burden of OAO in Japan, defined as BMI of at least 25, is estimated at US 13.41 b i l l i o n ( ¥ 1925 b i l l i o n ) , r e p r e s e n t i n g 0.4 6.3 billion (¥901 billion) and 1.2 b i l l i o n ( ¥ 179 b i l l i o n ) i n d i r e c t a n d i n d i r e c t t a x r e v e n u e , r e s p e c t i v e l y , d u e t o l o w e r e m p l o y m e n t a n d i n c o m e c o m b i n e d w i t h h i g h e r s i c k l e a v e . E x c e s s O A O - a t t r i b u t a b l e h e a l t h c a r e c o s t s w e r e 5.4 billion (¥769 billion), while additional pension payment spending of $0.5 billion (¥77 billion) was estimated, due to higher levels of early retirement. Conclusions: While the health implications of OAO are well documented, this fiscal analysis demonstrates the significant economic burden of OAO both to the healthcare system and broader government accounts. Policies aimed at reducing population-level obesity have the potential to benefit government accounts through increasing employment and reducing public spending, which can offset the cost of implementing these policies.

Robotic Single Anastomosis Duodenal-ileal Bypass With Sleeve Gastrectomy (SADI-S) for Morbid Obesity: A Systematic Review

BACKGROUND/AIM

The global obesity epidemic has seen a dramatic increase in prevalence since 1975, posing significant health and economic challenges worldwide. Robotic-assisted single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) has emerged as a promising surgical intervention for morbid obesity, offering potential advantages over traditional laparoscopic approaches in terms of precision, safety, and recovery outcomes. This study aimed to evaluate the efficacy and safety of robotic-assisted SADI-S, focusing on perioperative and postoperative outcomes including intraoperative complications, operative time, conversion rates, mortality, length of hospital stay, weight loss, and postoperative complications.

MATERIALS AND METHODS

A comprehensive literature search was conducted on PubMed, Scopus, and Cochrane Library, adhering to inclusion and exclusion criteria focused on obese adult humans undergoing robotic SADI-S. Seven studies, published between 2015 and 2024, involving 204 patients, were ultimately included for analysis.

RESULTS

The analysis revealed a low rate of intraoperative complications (0.49%), no mortality, and varied operative times (138 to 205.7 min). The median hospital stay ranged from 2 to 6.7 days, with minimal readmission rates. Postoperative complications occurred in 6.37% of patients, but no late complications (>30 days) were reported. Notably, significant weight loss outcomes were documented, with mean excess weight loss (EWL) up to 113.74% at 24 months follow-up.

CONCLUSION

Robotic-assisted SADI-S demonstrates a favourable safety profile with promising weight loss outcomes, highlighting its potential as a primary or revisional treatment for morbid obesity. Further research, including randomized controlled trials, is needed to establish its long-term efficacy and cost-effectiveness compared to traditional laparoscopic methods.

Taking a health economic perspective in monitoring health inequalities: A focus on excess weight

BACKGROUND

Traditional approaches to monitoring health inequalities predominantly rely on headcount methods. However, these methods fail to reflect the non-linear health economic implications of changes in disease severity. Alternative, distribution-sensitive metrics are available which could more adequately inform financial planning and policy decision making.

METHODS

We describe the design of the Foster-Greer-Thorbecke (FGT) index, and discuss its relative merits as a summary monitoring metric of health inequalities in the population, compared to the Erreygers concentration index. We illustrate the FGT index by conducting a comparative longitudinal analysis of adult excess inequalities in England using Health Survey for England data from 2009 to 2019.

FINDINGS

Excess weight inequalities have steadily increased in the English adult population, especially over the last five years. Going beyond headcount, the FGT index analyses revealed that, unlike the rest of the population, the average overweight adult from the most socio-economically deprived group is either obese (30.3 BMI for females) or at the brink of obesity (29.1 BMI for males). These results underscore a deepening divide in obesity severity between communities, with the most socioeconomically deprived groups being increasingly and disproportionally affected.

CONCLUSIONS

The FGT index can address some shortcomings of traditional approaches to inequality measurement and local governments should consider adopting it as an alternative population health metric. Future research should apply and develop more refined distribution-sensitive measures of health inequality.

The global burden of disease attributable to high body mass index in 204 countries and territories: Findings from 1990 to 2019 and predictions to 2035

AIM

Our study aims to provide an updated estimate of age- and sex-specific deaths and disability-adjusted life years (DALYs) associated with high body mass index (BMI) from 1990 to 2019 at the global, regional and national levels, and to forecast the global burden of disease attributed to high BMI from 2020 to 2035.

METHODS

We used the data for the number of deaths, DALYs, age-standardized rate (per 100 000 population), percentage change and population attributable fraction from the Global Burden of Disease Study 2019 (GBD 2019) to examine the disease burden attributable to high BMI. We further applied an autoregressive integrated moving average (ARIMA) model to predict the disease burden for the period 2020-2035.

RESULTS

From 1990 to 2019, the deaths and DALYs attributable to high BMI increased by 148% and 155.86% for men, and by 111.67% and 121.78% for women, respectively. In 2019, high BMI directly accounted for 8.52% [95% uncertainty intervals (UI) 0.05, 0.12] of all-cause deaths and 5.89% (95% UI 0.04, 0.08) of global DALYs. The highest death rates were observed in men aged 65-69 and women aged 75-79. The highest DALY rates were observed in the age group of 60-64 for both sexes. In 2019, the highest age-standardized deaths and DALY rates were observed in the Central Asia region [163.15 (95% UI 107.72, 223.58) per 100 000 people] and the Oceania region [4643.33 (95% UI 2835.66, 6902.6) per 100 000 people], respectively. Fiji [319.08 (95% UI 213.77, 444.96) per 100 000 people] and Kiribati [10 000.58 (95% UI 6266.55, 14159.2) per 100 000 people] had the highest age-standardized deaths and DALY rates, respectively. In 2019, the highest age-standardized rates of high BMI-related deaths and DALYs were observed in the middle-high socio-demographic index quintile and in the middle socio-demographic index quintile. The age-standardized deaths and DALY rates attributable to high BMI are projected to increase in both sexes from 2020 to 2035. The death rates are projected to rise from 62.79 to 64.31 per 100 000 people, while the DALY rates are projected to rise from 1946 to 2099.54 per 100 000 people.

CONCLUSIONS

High BMIs significantly contribute to the global disease burden. The projected rise in deaths and DALY rates attributable to high BMI by 2035 highlights the critical need to address the impact of obesity on public health. Our study provides policymakers with up-to-date and comprehensive information.

Adoption of a Societal Perspective in Economic Evaluations of Musculoskeletal Disorders: A Conceptual Paper

Economic evaluations are used to compare the costs and consequences of healthcare interventions, including those for musculoskeletal (MSK) disorders, which are very common and a major source of morbidity and absence from work. Reimbursement decisions for interventions for MSK disorders by decision-makers rely on the findings of economic evaluations, the design and results of which depend largely on the perspective adopted. Despite methodological advancements in economic evaluations, there are no clear guidelines on the perspective to adopt. This paper explores the adoption of a societal perspective in economic evaluations of MSK disorders. Within health economics evaluations, the most commonly used perspectives include the payer perspective, the healthcare perspective, and the societal perspective. To facilitate optimal resource allocation decisions in order to reduce the significant economic burden of MSK disorders and improve the health outcomes of individuals with these disorders, all costs and benefits associated with interventions for them should be included. Thus, the societal perspective is arguably a preferable option to the others for economic evaluations of interventions for MSK disorders.

Metabolic bariatric surgery, alcohol misuse and liver cirrhosis: a narrative review

Bariatric surgery and liver cirrhosis have considerable overlap. Bariatric procedures intend to reduce metabolic dysfunction-associated steatotic liver disease (MASLD); however, these procedures are thought to increase the propensity for alcohol misuse. This may predispose the bariatric surgical patient to a new form of liver insult in the postoperative period. This review explores the complex relationship between obesity and alcohol misuse in the context of the bariatric surgical patient. There is evidence to support the safety of bariatric procedures in compensated cirrhotic patients, with an improvement of liver function and architecture. However, data suggest that after a two-year period, these patients exhibit an increased propensity for alcohol misuse postoperatively, particularly after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) procedures. A paucity of evidence exists with respect to alcohol-induced liver dysfunction, or MASLD and increased alcohol intake (MetALD) in the post-bariatric surgery patient. This review aims to provide an overview of the current evidence and offer recommendations for further robust studies.

Obesity: Post-Pandemic Weight Management

Societal changes secondary to the coronavirus disease 2019 pandemic led to increased prevalence of adolescents with obesity and heightened awareness of weight stigma and size bias. During this time the American Academy of Pediatrics published its first clinical practice guidelines, and the Food and Drug Administration approved new weight loss drugs for adolescents, but insurance coverage is largely unavailable.

The impact of obesity on postoperative outcomes following surgery for colorectal cancer: analysis of the National Inpatient Sample 2015-2019

BACKGROUND

The global burden of obesity has reached epidemic proportions, placing great strain on the North American healthcare system. We designed a retrospective cohort database study comparing postoperative morbidity and healthcare resource utilization between patients living with and without obesity undergoing surgery for colorectal cancer.

METHODS

Adult patients undergoing resection for colorectal cancer were identified from the 2015 to 2019 National Inpatient Sample database. Patients were stratified according to obesity status (i.e., body mass index of 30 kg/m2). Propensity score matching (PSM) with 1:1 nearest-neighbour matching was performed according to demographic, operative, and hospital characteristics. The primary outcome was postoperative morbidity. Secondary outcomes included system-specific postoperative complications, postoperative mortality, length of stay, total admission healthcare cost, and post-discharge disposition. McNemar's and Wilcoxon matched pairs signed rank tests were performed.

RESULTS

After PSM, 7565 non-obese and 7565 obese patients were included. Patients with obesity had a 10% increase in relative risk of overall in-hospital postoperative morbidity (23.1% versus 25.6%, P = 0.0015) and a $4564 increase in hospitalization cost ($70 248 USD versus $74 812 USD, P = 0.0004). Patients with obesity were more likely to require post-operative ICU admission (5.0% versus 8.0%, P < 0.0001) and less likely to be discharged home after their index operation (68.3% versus 64.2%, P = 0.0022).

CONCLUSION

Patients with obesity undergoing surgery for colorectal cancer may be at an increased risk of in-hospital postoperative morbidity. They may also be more likely to have increased hospitalization costs, post-operative ICU admissions, and to not be discharged directly home. Preoperative optimization via weight loss strategies should be further explored.

The association between body mass index and health-related quality of life in the 2017 and 2018 health survey of England data: A cross-sectional observational analysis

AIM

To provide an updated estimate of the association between body mass index (BMI) and health-related quality of life (HRQoL) among the general population in England and to identify population subgroups with the highest potential utility gains from obesity interventions.

MATERIALS AND METHODS

The sample included 12 158 adults with valid HRQoL and BMI data from the 2017 and 2018 Health Survey for England. Robust standard error linear regression, controlling for demographic and socioeconomic characteristics, lifestyle behaviours and obesity-related comorbidities, was used for the baseline analysis. Robustness checks assessed the impact of (a) estimator selection; (b) model specifications; (c) statistical outliers at high BMI; (d) potential BMI measurement error; and (e) data pooling.

RESULTS

The study found a significant association between HRQoL and BMI, which exhibited an inverted U-shaped relationship. The mean HRQoL peaked at 25.7 kg/m2 in men and 22.6 kg/m2 in women and was reduced in the underweight, overweight and obesity BMI ranges. Sensitivity analyses reported similar coefficients, suggesting a robust model specification.

CONCLUSIONS

Reduced HRQoL beyond optimal BMI underlines the importance of maintaining a normal BMI range for overall health. The rising prevalence of class III obesity is a major public health concern given its disproportionate impact on health, health care utilization and costs. Obesity management is key to preventing the reduction in HRQoL associated with obesity-related comorbidities, and this analysis supports the development of targeted policies and population health initiatives for people with class III obesity.

Potential health and economic impact of achieving Kenya's overweight and obesity reduction target: a modelling study

Introduction

Kenya has adopted the WHO target of halting the rise of overweight, including obesity, by 2025. This paper assesses the potential impact of achieving the set target on health, healthcare cost and productivity.

Methods

We used a proportional multistate life table model (Kenya Obesity Model) to simulate the 2019 population of Kenya over their lifetime. We compared a scenario in which body mass index (BMI) distributions stabilise in 2025 against one whose BMI distributions stabilise in 2044, and quantified changes in disease-specific health outcomes, healthcare costs and productivity. We searched the literature to identify the best estimates of the total and disease-specific healthcare costs in Kenya. We used the Human Capital Approach to estimate productivity gains.

Results

If BMI distributions stabilised in 2025, an estimated 6.8 million health-adjusted life years (HALYs) (95% uncertainty interval (UI) 5.8-7.9 million) would be saved over the lifetime of the 2019 Kenyan population (135 HALYs per 1000 persons). A total of US$755 million in body mass-related healthcare costs could be saved by 2044 (US$15 per capita). For context, this equates to 16% of Kenya's annual healthcare expenditure. Over the lifetime, ~US$3 billion healthcare costs could be saved (US$62 per capita). By 2044, the total productivity gain resulting from a reduction in high BMI-related mortality and morbidity (combined) was ~US$5.8 billion (~US$237 per capita).

Conclusion

Achieving Kenya's overweight and obesity reduction target could improve health outcomes and also yield substantial healthcare cost savings and productivity gains.

Demographic, health, physical activity, and workplace factors are associated with lower healthy working life expectancy and life expectancy at age 50

Although retirement ages are rising in the United Kingdom and other countries, the average number of years people in England can expect to spend both healthy and work from age 50 (Healthy Working Life Expectancy; HWLE) is less than the number of years to the State Pension age. This study aimed to estimate HWLE with the presence and absence of selected health, socio-demographic, physical activity, and workplace factors relevant to stakeholders focusing on improving work participation. Data from 11,540 adults in the English Longitudinal Study of Ageing were analysed using a continuous time 3-state multi-state model. Age-adjusted hazard rate ratios (aHRR) were estimated for transitions between health and work states associated with individual and combinations of health, socio-demographic, and workplace factors. HWLE from age 50 was 3.3 years fewer on average for people with pain interference (6.54 years with 95% confidence interval [6.07, 7.01]) compared to those without (9.79 [9.50, 10.08]). Osteoarthritis and mental health problems were associated with 2.2 and 2.9 fewer healthy working years respectively (HWLE for people without osteoarthritis: 9.50 years [9.22, 9.79]; HWLE with osteoarthritis: 7.29 years [6.20, 8.39]; HWLE without mental health problems: 9.76 years [9.48, 10.05]; HWLE with mental health problems: 6.87 years [1.58, 12.15]). Obesity and physical inactivity were associated with 0.9 and 2.0 fewer healthy working years respectively (HWLE without obesity: 9.31 years [9.01, 9.62]; HWLE with obesity: 8.44 years [8.02, 8.86]; HWLE without physical inactivity: 9.62 years [9.32, 9.91]; HWLE with physical inactivity: 7.67 years [7.23, 8.12]). Workers without autonomy at work or with inadequate support at work were expected to lose 1.8 and 1.7 years respectively in work with good health from age 50 (HWLE for workers with autonomy: 9.50 years [9.20, 9.79]; HWLE for workers lacking autonomy: 7.67 years [7.22, 8.12]; HWLE for workers with support: 9.52 years [9.22, 9.82]; HWLE for workers with inadequate support: 7.86 years [7.22, 8.12]). This study identified demographic, health, physical activity, and workplace factors associated with lower HWLE and life expectancy at age 50. Identifying the extent of the impact on healthy working life highlights these factors as targets and the potential to mitigate against premature work exit is encouraging to policy-makers seeking to extend working life as well as people with musculoskeletal and mental health conditions and their employers. The HWLE gaps suggest that interventions are needed to promote the health, wellbeing and work outcomes of subpopulations with long-term health conditions.

Economic Evaluation of a Personalized Nutrition Plan Based on Omic Sciences Versus a General Nutrition Plan in Adults with Overweight and Obesity: A Modeling Study Based on Trial Data in Denmark

BACKGROUND

Since there is no diet that is perfect for everyone, personalized nutrition approaches are gaining popularity to achieve goals such as the prevention of obesity-related diseases. However, appropriate choices about funding and encouraging personalized nutrition approaches should be based on sufficient evidence of their effectiveness and cost-effectiveness. In this study, we assessed whether a newly developed personalized plan (PP) could be cost-effective relative to a non-personalized plan in Denmark.

METHODS

Results of a 10-week randomized controlled trial were combined with a validated obesity economic model to estimate lifetime cost-effectiveness. In the trial, the intervention group (PP) received personalized home-delivered meals based on metabolic biomarkers and personalized behavioral change messages. In the control group these meals and messages were not personalized. Effects were measured in body mass index (BMI) and quality of life (EQ-5D-5L). Costs [euros (€), 2020] were considered from a societal perspective. Lifetime cost-effectiveness was assessed using a multi-state Markov model. Univariate, probabilistic sensitivity, and scenario analyses were performed.

RESULTS

In the trial, no significant differences were found in the effectiveness of PP compared with control, but wide confidence intervals (CIs) were seen [e.g., BMI (-0.07, 95% CI -0.51, 0.38)]. Lifetime estimates showed that PP increased costs (€520,102 versus €518,366, difference: €1736) and quality-adjusted life years (QALYs) (15.117 versus 15.106, difference: 0.011); the incremental cost-utility ratio (ICUR) was therefore high (€158,798 to gain one QALY). However, a 20% decrease in intervention costs would reduce the ICUR (€23,668 per QALY gained) below an unofficial gross domestic product (GDP)-based willingness-to-pay threshold (€47,817 per QALY gained).

CONCLUSION

On the basis of the willingness-to-pay threshold and the non-significant differences in short-term effectiveness, PP may not be cost-effective. However, scaling up the intervention would reduce the intervention costs. Future studies should be larger and/or longer to reduce uncertainty about short-term effectiveness.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov registry (NCT04590989).

Effect of weight on depression using multiple genetic instruments

A striking global health development over the past few decades has been the increasing prevalence of overweight and obesity. At the same time, depression has become increasingly common in almost all high-income countries. We investigated whether body weight, measured by body mass index (BMI), has a causal effect on depression symptoms in Finland. Using data drawn from the Cardiovascular Risk in Young Finns Study (N = 1,523, mean age 41.9, SD 5), we used linear regression to establish the relationship between BMI and depression symptoms measured by 21-item Beck's Depression Inventory. To identify causal relationships, we used the Mendelian randomization (MR) method with weighted sums of genetic markers (single nucleotide polymorphisms, SNPs) as instruments for BMI. We employ instruments (polygenic risk scores, PGSs) with varying number of SNPs that are associated with BMI to evaluate the sensitivity of our results to instrument strength. Based on linear regressions, higher BMI was associated with a higher prevalence of depression symptoms among females (b = 0.238, p = 0.000) and males (b = 0.117, p = 0.019). However, the MR results imply that the positive link applies only to females (b = 0.302, p = 0.007) but not to males (b = -0.070, p = 0.520). Poor instrument strength may explain why many previous studies that have utilized genetic instruments have been unable to identify a statistically significant link between BMI and depression-related traits. Although the number of genetic markers in the instrument had only a minor effect on the point estimates, the standard errors were much smaller when more powerful instruments were employed.

The Potential Effects of Dietary Antioxidants in Obesity: A Comprehensive Review of the Literature

Obesity has become a global health concern, with its prevalence steadily increasing in recent decades. It is associated with numerous health complications, including cardiovascular diseases, diabetes, and certain types of cancer. The aetiology of obesity is multifactorial, involving genetic, environmental, and lifestyle factors. In recent years, oxidative stress has emerged as a potential contributor to obesity and its related metabolic disorders. Dietary antioxidants, which can counteract oxidative stress, have gained significant attention for their potential role in preventing and managing obesity. This comprehensive review aims to explore the impact of dietary antioxidants on obesity and its associated metabolic dysregulations, discussing the underlying mechanisms and highlighting the potential therapeutic implications.

Lifestyle factors associated with presenteeism among city government office workers: a cross-sectional study

OBJECTIVES

Presenteeism is a critical issue in occupational health. This study aimed to examine the association between presenteeism and subjective sleep quality, smoking status, and alcohol consumption.

METHODS

Anonymous data of 777 workers in a Japanese city were retrospectively obtained from City Government Office A. They included variables like absolute presenteeism scores (measured using the Japanese version of the World Health Organization Health and Work Performance Questionnaire short form), gender, age, family status, subjective sleep quality, smoking status, and alcohol consumption. A binary logistic regression analysis was performed with gender, age, family status, subjective sleep quality, smoking status, and alcohol consumption as the independent variables, and absolute presenteeism scores equal to or below 40 as the dependent variable. A gender-stratified binary logistic regression analysis was also performed.

RESULTS

The logistic regression analysis results revealed that absolute presenteeism was positively associated with poor subjective sleep quality among all respondents (odds ratio [OR], 1.70; 95% CI, 1.18-2.44) and men (OR, 1.85; 95% CI, 1.12-3.05) and with current drinkers among women (OR, 3.49; 95% CI, 1.36-8.92); it was negatively associated with age among those who were ≥50 years old (OR, 0.50; 95% CI, 0.27-0.93) and with current drinkers among men (OR, 0.43; 95% CI, 0.20-0.92).

CONCLUSIONS

The factors associated with presenteeism differed between men and women office workers, suggesting that gender differences need to be considered when working toward improving workers' productivity.

Pharmacotherapy for obesity: moving towards efficacy improvement

Obesity is a chronic, recurring, progressive disease and a major public health problem associated with several other diseases that lead to disability, morbidity, and mortality. The prevalence of obesity has increased at pandemic levels, along with increasing weight-related comorbidities and deaths worldwide. Lifestyle interventions alone provide clinically significant long-term weight loss in only a small proportion of individuals, and bariatric surgery is not suitable or desirable for all patients. Historically, anti-obesity medications achieved a mean efficacy with weight loss between 5 and 10%, which significantly impacted several comorbidities and risk factors, but the average efficacy of these medications remained lower than that expected by both patients and health care professionals and eventually curbed long-term use. Moreover, there is no direct evidence on the impact of anti-obesity medications on cardiovascular outcomes. Semaglutide is a newer anti-obesity medication that changes the overall landscape, as phase 3 studies show a mean weight loss near the 15% threshold and significant proportions of patients with a weight loss of greater than 20%. In this review, we focus on the currently available anti-obesity medications, discuss the results of semaglutide, and present perspectives on the future of obesity treatment after semaglutide.

Predictors of Clinical Performance Among Emergency Nurses: A Cross-Sectional Study

Introduction

Poor nursing performance is considered a threat to patient safety, affecting the quality of care provided and ultimately impacting patient outcomes.

Objectives

The main aim of this study was to identify the predictors of nursing performance.

Methods

A cross-sectional predictive design was used. A convenient sampling technique was used to recruit 251 emergency nurses in three health sectors. They were assessed using the secondary traumatic stress scale and the nursing performance scale. Data were collected between June and August 2022.

Results

Nurses experienced severe levels of secondary traumatic stress (M = 57.9, SD = 14.94). The nursing performance level was below average (M = 27.48, SD = 9.36), and the mental performance subscale received the lowest rating (M = 5.82, SD = 2.69). There was a strong negative association between the secondary traumatic stress total score and the total score of nursing performance (r = -.77). Additionally, factors such as high body mass index, smoking, the presence of chronic diseases, working overtime, and high levels of secondary traumatic stress were identified as significant predictors of nursing performance.

Conclusion

It is recommended that emergency nurses be provided with treatment programs and interventions to reduce their secondary traumatic stress to improve their performance, thereby ensuring high-quality patient care.

Comorbidity, Eating Behaviors and Smartphone Addiction in Italian Nurses' Characteristics

BACKGROUND

Evidence suggested how nurses experienced worse lifestyles than the general population by recording deterioration rates in healthy conditions.

AIM

To assess differences between comorbidity, eating behavior, and smartphone addiction according to sex, Body Mass Index (BMI), age, work experience, shift, alcohol assumption, and physical activity in Italian nurses.

METHODS

An online questionnaire was spread through some professional internet pages. Data included demographic characteristics, the Charlson Comorbidity Index (CCI), the Italian Version of the Dutch Eating Behavior Questionnaire, and the Smartphone Addiction Scale (SAS-SV).

RESULTS

A total of 456 nurses were recruited. Significant differences were registered in the smartphone addiction score (p=0.030) and BMI scores and work experience (p=0.001), as underweight participants reported higher scores in the smartphone addiction attitude (2.4714 ± 1.25812) than the other subjects and also participants with the highest number of years in work experience also reported higher smartphone addiction scores (2.8074 ± 1.2022). Significant difference was reported in the CCI scores according to age (p<0.001): subjects aged over 61 years recorded higher scores in the CCI (1.67 ± 1.528) and also according to work experience and CCI scores (p<0.001), as participants employed between 21 and 30 years reported higher scores in the CCI (1.27 ± 1.382) and also to night shift (p=0.037), as participants who worked during the night shift also reported higher scores in the CCI. A significant difference was reported only for restrained eating attitude (p=0.034), as participants who declared to assume alcohol 2-3 times per month recorded higher levels in this eating attitude aspect (32.32 ± 7.181).

CONCLUSION

Female nurses, overweight and obese nurses with low physical activity practice, seemed to spend more time with their smartphones. Healthcare organizations should consider findings to prevent unhealthy lifestyles among nurses, which could negatively influence the whole healthcare system.

Assessing the Fiscal Burden of Obesity in Canada by Applying a Public Economic Framework

INTRODUCTION

Rising obesity prevalence is a health priority for many governments because of its impact on population health and economic consequences. We sought to estimate the broader consequences of obesity in Canada by applying a government perspective framework that captures lost tax revenues and increased government spending on social benefit programs.

METHODS

An age-specific prevalence-based model was built to quantify the fiscal burden of disease for government attributed to people living with obesity. The model was populated with age-specific wages, employment activity and government benefits received to estimate taxes and transfer costs. A targeted literature search was conducted to identify modifiers of employment status, wages and disability status attributed to people with obesity, and applied to employment and epidemiological projections which enabled us to estimate government costs and tax losses. Government tax revenue and costs attributed to obesity were projected over a 10-year period and discounted at 3%.

RESULTS

The fiscal burden of obesity in Canada is estimated at CAD$22,974 million (2021). This figure consists of obesity-attributed revenue losses of CAD$9404 million from direct taxes due to decreased employment activity and CAD$2374 million from indirect tax revenue losses due to reduced consumption taxes. Healthcare costs are estimated at CAD$7881 million annually and disability costs of CAD$3686 million annually. This fiscal burden of disease distributed amongst taxpayers in 2021 is estimated to be CAD$752 per capita. We estimate for every 1% reduction in obesity prevalence, CAD$229.7 million net fiscal gains can be achieved annually.

CONCLUSIONS

Obesity is associated with substantial clinical and economic burden not only to the healthcare system but also to wider government budgets as demonstrated using fiscal analysis. Reductions in obesity prevalence are likely to have positive fiscal gains for government from reduced spending on public benefits and increased tax revenue attributed to employment changes.

Economic costs of obesity: a systematic review

INTRODUCTION

Obesity is a growing public health problem leading to substantial economic impact. This study aimed to summarize the economic impact of obesity and to critically analyze the methods used in the cost-of-illness (COI) studies on obesity.

METHODS

We conducted systematic search in PubMed and Scopus from September 1, 2016, to July 22, 2022. Original COI studies estimating the economic cost of obesity and/or overweight in at least one country, published in English were included. To facilitate the comparison of estimates across countries, we converted the cost estimates of different years to 2022 purchasing power parity (PPP) values using each country's consumer price index (CPI) and PPP conversion rate.

RESULTS

Nineteen studies were included. All studies employed a prevalence-based approach using Population Attributable Fraction (PAF) methodology. About half of the included studies (53%) were conducted in high-income countries while the others (47%) were conducted in middle-income countries. The economic burden of obesity ranged between PPP 15 million in Brazil to PPP 126 billion in the USA, in the year 2022. Direct medical costs accounted for 0.7% to 17.8% of the health system expenditure. Furthermore, the total costs of obesity ranged from 0.05% to 2.42% of the country's gross domestic product (GDP). Of the seven studies that estimated both direct and indirect costs, indirect costs accounted for the largest portion of five studies. Nevertheless, a variety in methodology across studies was identified. The number of co-morbidities included in the analysis varied across studies.

CONCLUSIONS

Although there was a variety of methodologies across studies, consistent evidence indicated that the economic burden of obesity was substantial. Obesity prevention and control should be a public health priority, especially among countries with high prevalence of obesity.

Factors Influencing the Degree of Employee Involvement in Preventive Nutrition and Physical Activity Web-Based Programs in Medium and Small Enterprises

This cross-sectional study was part of a comprehensive workplace health promotion program (WHPP) implemented in the work environment of small- and medium-sized enterprises (SMEs) in Western Slovenia, which included web-based educational campaigns aimed at promoting positive lifestyle changes among workers, including healthy eating habits and physical activity. As part of this program, which included campaigns in the areas of stress management, ergonomics, sleep hygiene, communication, work climate, and absenteeism, we developed and examined the engagement frequency in web-based content on healthy eating and physical activity for the companies included in the WHPP. This part of the project lasted from 2020 to 2022. Prior to the educational campaign, participants voluntarily completed a screening questionnaire. We analyzed the patterns of 370 workers in terms of their job classification (predominantly sedentary, predominantly standing, or predominantly physical), body mass index (BMI), gender, age, and selected indicators of diet and physical activity. Of the 88 companies participating in the WHPP, 26 took part in our web-based educational campaigns on nutrition and physical activity. Through an empirical analysis using descriptive and inferential statistics and a linear regression, we found that, on average, the engagement frequency (i.e., proportion of educational personal e-mails read) was highest among men with sedentary work, with older employees participating more actively than expected. Moreover, workers with good dietary habits and a favorable BMI proved to be the most avid readers of the web-based campaigns. Despite the overall low participant engagement frequency, it is clear that web-based educational campaigns are more appealing to workers with sedentary jobs and good dietary habits. This study provides valuable information on the potential effectiveness of appropriate workplace health promotion campaigns for SMEs and public health practices.

A Comprehensive Obesity Benefit as a Guide for Employers on the Core Components of Obesity Care: Guidance From the American College of Occupational and Environmental Medicine (ACOEM) Roundtable on Obesity

OBJECTIVE

The need to confront the obesity epidemic and its impact on employers requires a serious look at how we address the treatment of obesity. This article focuses on the core components of obesity care and the need for employers to offer a comprehensive obesity benefit (COB) as part of employee insurance coverage.

METHODS

In May 2022, the American College of Occupational and Environmental Medicine convened a roundtable meeting, which brought together five corporate medical directors and representatives from aerospace/defense and energy industries to learn about the disease of obesity and provide clinical insights regarding health and safety in their respective industries. The goals of the program were to provide awareness of benefits for the treatment of obesity and identify the feasibility for employers of implementing a COB for their employees. Participants learned how a comprehensive approach to covering obesity treatments is necessary, and what benefits should be offered to employees.

RESULTS

Participants were invited to review the insurance benefits they currently offer to employees and compare them to the COB. Outcomes were limited by a lack of participation by the employers invited to participate. Participants identified actions that need to be addressed for employers to develop a more comprehensive approach to obesity care.

CONCLUSION

Implementing a COB can help employers increase access and utilization of comprehensive obesity care by employees.

Overnutrition in adolescents and its associated factors in Dale district schools in Ethiopia: a cross-sectional study

Background

Adolescence is the critical stage of an individual's growth and development that determines their nutritional status in the future. Adolescent overnutrition has become an increasing public health concern in developing countries like Ethiopia.

Objective

This study was designed to determine the magnitude and determinants of overnutrition among school-going adolescents in Dale District of Ethiopia.

Methods

An institution-based cross-sectional study was done between November and December 2020. A total of 333 school-going adolescents aged 10-19 years participated in this study. Socio-demographic, lifestyle, physical activity level, dietary energy intake, and height and weight data were collected. Body Mass Index for age Z-score (BAZ) was computed. Binary and multivariable logistic regression models were used to determine the association of outcome variable with explanatory variables, and results were reported using adjusted odds ratio (AOR) with 95% confidence interval.

Results

The magnitude of overnutrition was 7.2% (10.8% in the urban versus. 3.6% of rural schools). Overnutrition was positively associated with lack of sufficient play area within the school (AOR = 2.53, 95% CI [1.02-6.26]), being an urban resident (AOR = 3.05, 95% CI [1.12-8.29]), positive energy balance (AOR = 9.47, 95% CI [1.58-56.80]), consuming fast foods within a month before the survey date (AOR = 2.60, 95% CI [1.93-6.83]), having moderate (AOR = 9.28, 95% CI [6.70-71.63]) or low physical activity (PA) (AOR = 7.95, 95% CI [1.12-56.72]), and consuming snack within last one week before the survey date (AOR = 3.32, 95% CI [1.15-9.58]).

Conclusion

The magnitude of overnutrition among school-going adolescents was suboptimal. Sedentary lifestyles, excess calorie intake, having inadequate play areas within the school, and having snack and fast foods were determinants for overnutrition in the study area.

Population Interest in Information on Obesity, Nutrition, and Occupational Health and Its Relationship with the Prevalence of Obesity: An Infodemiological Study

OBJECTIVE

To identify and analyze population interest in obesity, nutrition, and occupational health and safety and its relationship with the worldwide prevalence of obesity through information search trends.

METHOD

In this ecological study, data were obtained through online access to Google Trends using the topics "obesity", "nutrition", and "occupational health and safety". Obesity data were obtained from the World Health Organization (WHO) website for crude adult prevalence and estimates by region. The variables studied were relative search volume (RSV), temporal evolution, milestone, trend, and seasonality. The temporal evolution of the search trends was examined by regression analysis (R2). To assess the relationship between quantitative variables, the Spearman correlation coefficient (Rho) was used. Seasonality was verified using the augmented Dickey-Fuller (ADF) test.

RESULTS

The RSV trends were as follows: obesity (R2 = 0.04, p = 0.004); nutrition (R2 = 0.42, p < 0.001); and occupational health and safety (R2 = 0.45, p < 0.001). The analysis of seasonality showed the absence of a temporal pattern (p < 0.05 for all terms). The associations between world obesity prevalence (WOP) and the different RSVs were as follows: WOP versus RSV obesity, Rho = -0.79, p = 0.003; WOP versus RSV nutrition, Rho = 0.57, p = 0.044; and WOP versus RSV occupational health and safety, Rho = -0.93, p = 0.001.

CONCLUSIONS

Population interest in obesity continues to be a trend in countries with the highest prevalence, although there are clear signs popularity loss in favor of searches focused on possible solutions and treatments, with a notable increase in searches related to nutrition and diet. Despite the fact that most people spend a large part of their time in the workplace and that interventions including various strategies have been shown to be useful in combating overweight and obesity, there has been a decrease in the population's interest in information related to obesity in the workplace. This information can be used as a guide for public health approaches to obesity and its relationship to nutrition and a healthy diet, approaches that are of equal utility and applicability in occupational health.

The DECON pilot project investigates predictive markers for successful bariatric surgery

Obesity is a chronic, multifactorial disease which is linked to a number of adverse endocrinological and metabolic conditions. Currently, bariatric surgery is one of the most effective treatments for individuals diagnosed with severe obesity. However, the current indications for bariatric surgery are based on inadequate metrics (i.e., BMI) which do not account for the complexity of the disease, nor the heterogeneity among the patient population. Moreover, there is a lack of understanding with respect to the biological underpinnings that influence successful and sustained weight loss post-bariatric surgery. Studies have implicated age and pre-surgery body weight as two factors that are associated with favorable patient outcomes. Still, there is an urgent medical need to identify other potential factors that could improve the specificity of candidate selection and better inform the treatment plan of patients with obesity. In this report, we present and describe the cohort of the DECON pilot project, a multicenter study which aims to identify predictive biomarkers of successful weight loss after bariatric surgery.

Planning engagement with web resources to improve diet quality and break up sedentary time for home-working employees: A mixed methods study

As home working becomes more common, employers may struggle to provide health promotion interventions that can successfully bridge the gap between employees' intentions to engage in healthier behaviors and actual action. Based on past evidence that action planning can successfully encourage the adoption of healthier behaviors, this mixed-methods study of a web-based self-help intervention incorporated a randomized planning trial that included quantitative measures of engagement and follow-up qualitative interviews with a subsample of participants. Participants either (a) selected a movement plan for incorporating a series of 2-min exercise videos into their work week to break up sedentary time and a balanced meal plan with recipe cards for a week's lunches and dinners or (b) received access to these resources without a plan. Selecting a movement plan was more effective at increasing engagement with the web resources compared to the no-plan condition. In the follow-up interviews, participants indicated that the plan helped to remind participants to engage with the resources and made it simpler for them to follow the guidance for exercises and meals. Ease of use and being able to fit exercises and meals around work tasks were key factors that facilitated uptake of the resources, while lack of time and worries about how colleagues would perceive them taking breaks to use the resources were barriers to uptake. Participants' self-efficacy was associated with general resource use but not plan adherence. Overall, including plans with online self-help resources could enhance their uptake. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Occupational Health of Health-Care Workers with Overnutrition: Scoping Review with Meta-Analysis

(1) Objective: To review the scientific literature on the impact of interventions to enhance the occupational health of health-care workers with overnutrition. (2) Methods: Scoping review with meta-analysis. Data were obtained by consulting the following bibliographic databases: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature on Health Sciences (LILACS), and Medicina en Español (MEDES). The terms used as descriptors and as text in the title and abstract fields of the records were "health workers", "overnutrition", and "occupational health", using the filters "human", "adult": 19+ years", and "clinical trial". The search update date was January 2023. The documentary quality of the articles was evaluated using the CONSORT questionnaire and the presence of bias was assessed using the Rob 2.0 tool. (3) Results: From the 611 digitally retrieved references, 17 clinical trials were selected after applying the inclusion and exclusion criteria. CONSORT scores ranged from a minimum of 14.6% to a maximum of 91.7%, with a median of 68.8%. According to the SIGN criteria, this review provided "1" evidence with a grade B recommendation. Six different types of intervention were tested, grouped into strategies ranging from a single intervention to a combination of four interventions. The summary effect of the meta-analysis showed significant weight loss, but no association with reduced body mass index. (4) Conclusions: While workplace interventions have been shown to be potentially effective, and strategies using different types of interventions have been proven to be useful in tackling overnutrition, an effective and sustainable solution for changing the behavior of health professionals to tackle overweight and obesity has yet to be identified.

Positive Predictive Value for Multitarget Stool DNA After Bariatric and Metabolic Surgery

BACKGROUND AND AIMS

Bariatric and metabolic surgery (BMS) may adversely affect noninvasive stool tests for colorectal cancer (CRC) screening through several mechanisms. Multitarget stool DNA (mt-sDNA) is approved for CRC screening; however, performance in post-BMS patients is unknown. As the rates of BMS are anticipated to increase with rising incidence of obesity, it is important to evaluate mt-sDNA test performance among these patients.

METHODS

In a multisite academic and community-based practice, we obtained mt-sDNA results from 10/2014 to 12/2019 through electronic records and an institutional BMS registry. Average CRC risk patients with BMS prior to a positive mt-sDNA underwent a detailed chart review. Follow-up colonoscopy findings were compared to those among BMS patients screened with colonoscopy alone and a historical cohort of patients without BMS, screened by mt-sDNA. The primary study endpoint was the positive predictive value (PPV) for advanced colorectal neoplasia.

RESULTS

Among 336 average-risk patients who had mt-sDNA after BMS, mt-sDNA was positive in 49 (14.6%), 47/49 (96%) underwent follow-up colonoscopy, and the PPV for advanced neoplasia was 12/47 (25.5%). This is similar to the PPV for advanced colorectal neoplasia (425/1542, 28%) in a historical cohort of persons without prior BMS, screened by mt-sDNA at our center (P = .86). Among those who had prior BMS, the rate of advanced neoplasia was higher after mt-sDNA compared to screening colonoscopy alone.

CONCLUSION

Despite anatomic and physiologic mechanisms that could alter blood or DNA content in stool, BMS does not appear to adversely affect the PPV of mt-sDNA.

Factors of Overweight and Obesity Among Employees of Petrochemical Manufacturing Companies

The high prevalence of overweight and obesity is a major contributor to the global burden of disease, and create an economic burden for nations, including both direct and indirect costs. Although the Kingdom of Saudi Arabia is rapidly industrializing and the economy is now less dependent on oil, oil industry is still the main contributor to the Saudi labor force (41%). However, the productivity growth lags behind many developing countries. No studies have been conducted to explore the factors that can be associated with the lower productivity in this population of Saudi Arabia. This study aimed to estimate the prevalence of overweight/obesity and examine the association between overweight/obesity and lifestyle habits among employees of petrochemical manufacturing companies in the Kingdom of Saudi Arabia. A total of 1000 employees were surveyed. Chi-square test and logistic regression were used to predict odds ratios for obesity. About 47% of the sample was normal weight, while 28.5% was overweight and 21.2% was obese. Four factors were found to be predictive of obesity: feelings about weight, age, marital status, and childhood region. More than 52% of employees reported being happy with their weight. Those unhappy with their weight had more than six times greater odds of obesity as compared to those happy with their weight. Married employees were about twice as likely as unmarried to be obese. The findings of high prevalence of overweight and obesity among employees of petrochemical manufacturing suggest that more efforts are needed to promote healthy behaviors among employees. Workplace wellness programs and educational campaigns are recommended to encourage healthy lifestyle habits at both the workplace and in the community.

The association between obesity, health service use, and work productivity in Australia: a cross-sectional quantile regression analysis

The burden of disease attributable to obesity is rapidly increasing and becoming a public health challenge globally. Using a nationally representative sample in Australia, this study aims to examine the association of obesity with healthcare service use and work productivity across outcome distributions. We used Household, Income and Labour Dynamics Australia (HILDA) Wave 17 (2017-2018), including 11,211 participants aged between 20 and 65 years. Two-part models using multivariable logistic regressions and quantile regressions were employed to understand variations in the association between obesity levels and the outcomes. The prevalence of overweight and obesity was 35.0% and 27.6%, respectively. After adjusting for socio-demographic factors, low socioeconomic status was associated with a higher probability of overweight and obesity (Obese III: OR = 3.79; 95% CI 2.53-5.68) while high education group was associated with a lower likelihood of being high level of obesity (Obese III OR = 0.42, 95% CI 0.29-0.59). Higher levels of obesity were associated with higher probability of health service use (GP visit Obese, III: OR = 1.42 95% CI 1.04-1.93,) and work productivity loss (number of paid sick leave days, Obese III: OR = 2.40 95% CI 1.94-2.96), compared with normal weight. The impacts of obesity on health service use and work productivity were larger for those with higher percentiles compared to lower percentiles. Overweight and obesity are associated with greater healthcare utilisation, and loss in work productivity in Australia. Australia's healthcare system should prioritise interventions to prevent overweight and obesity to reduce the cost on individuals and improve labour market outcomes.

The association between health costs and physical inactivity; analysis from the Physical Activity at Work study in Thailand

Introduction

Physical inactivity increases the risks of several common yet serious non-communicable diseases, costing a tremendous amount of health expenditure globally. This study aimed to estimate the association between health costs and physical inactivity in Thailand.

Methods

Data from the Physical Activity at Work cluster randomized controlled trial participants with valid objective physical activity data were extracted. Health costs were collected using the Health and Welfare Survey and the Work Productivity and Activity Impairment Questionnaire and were categorized into past-month outpatient illness, past-year inpatient illness, and past-week presenteeism and absenteeism. Time spent in moderate-to-vigorous physical activity was used to determine the activity level according to the current guideline (i.e., ≥150 minutes moderate-intensity or ≥75 minutes vigorous-intensity equivalent physical activity per week). The primary analysis evaluated the association between direct cost (treatment and travel costs) and societal cost (direct cost plus absenteeism due to the illness) of past-month outpatient illness and physical inactivity using a two-part model.

Results

In total, 277 participants with a mean age of 38.7 were included. Average direct and societal cost due to past-month outpatient illness were 146 THB (3.99 USD) (SD = 647 THB) and 457 THB (12.5 USD) (SD = 1390 THB), respectively. Compared to active participants, direct and societal cost of past-month outpatient illness were 153 THB (4.18 USD) (95%CI: -54.7 to 360 THB) and 426 THB (11.7 USD) (95%CI: 23.3 to 829 THB) higher in physically inactive individuals, respectively, adjusted for covariates. The additional societal cost of past-month outpatient illness was 145% higher in physically inactive participants compared to active participants. On the other hand, there was no significant association in direct and societal cost of past-year inpatient illness nor past-week indirect costs between physically active and non-active participants.

Discussion

Results were similar to recent findings in different countries. However, the findings should be generalized with caution due to the small sample size and potential bias from reverse causation. Future research is crucial for clarifying the health costs of physical inactivity in Thailand and other countries.

Productivity Loss and Musculoskeletal Symptoms in Brazilian Presenteeism: A Cross-sectional Study

Background:

The work has been brought to nursing professionals, denoting an increase in illness and consequent decrease in productivity.

Objective:

This study aims to verify the relationship between productivity and the presence of musculoskeletal symptoms in presenteeism.

Methods:

This is a cross-sectional and analytical study conducted with 305 Nursing workers from an emergency hospital in the Brazilian Midwest region. For data collection, four self-applied instruments were used, namely: the Sociodemographic Work and Health Conditions Questionnaire (QSCTS), the Stanford Presenteeism Scale (SPS-6), the Work Limitations Questionnaire (WLQ), and the Brazilian version of the Nordic Musculoskeletal Questionnaire (NMQ), Nordic Musculoskeletal Symptom Questionnaire (QNSO). The “presenteeism” and “presenteeism degree” dependent variables were related to the independent variables using the logistic regression model.

Results:

Presenteeism was identified in 134 (43.8%) workers. Overall productivity loss was 8.8%. Regarding the relationship between presenteeism and the occurrence of musculoskeletal symptoms, workers with problems in the upper back, knees, and neck in the last year were 6.5, 2.7, and 2.2 more likely to be presenteeism, respectively.

Conclusion:

The study confirmed the relationship between greater productivity losses and the incidence of musculoskeletal symptoms with presenteeism events in the Nursing team.

The health and economic burden associated with sugar-sweetened beverage consumption in Trinidad and Tobago

BACKGROUND

In Trinidad and Tobago, non-communicable diseases (NCDs) are the leading cause of death. Unhealthy diet is one modifiable NCD risk factor, which contributes to the NCD burden. The consumption of sugar-sweetened beverages (SSBs) has been associated with an increased risk of NCDs.

AIM

The aim of this paper is to estimate the burden of disease and economic costs associated with the consumption of SSBs in Trinidad and Tobago as evidence to support the implementation of health and fiscal policies on SSB consumption.

METHODS

The results of this study were obtained through the use of a mathematical model which used a comparative risk assessment approach to estimate the health and economic burden associated with SSB intake, by sex and age.

RESULTS

Estimates for one year showed that SSB consumption was associated with approximately 15,000 cases of overweight and obesity in adults and 11,700 cases in children, 28% of all the cases of diabetes and overall, an estimated 387 deaths and 9000 years of healthy life were lost due to premature death and disability. Approximately US$23.1 million was spent in the public healthcare system to treat diseases associated with consumption of sugary beverages.

CONCLUSIONS

The consumption of SSBs is associated with increases in diseases, deaths and rising healthcare costs in Trinidad and Tobago. It is hoped that the results of this study will provide an added rationale and impetus for the implementation of policies to reduce the consumption of SSBs.

Sickness Presence among Teachers, Nurses and Private Sector Office Workers

INTRODUCTION

Sickness presence is used to denote an employee who feels unwell but still attends work, thus avoiding absence. The intention of this paper is to compare sickness presence in a group of the following professions: teachers, nurses and private sector office workers.

MATERIAL AND METHODS

For the purpose of this study, a survey based on the original PAPI form (Paper-and-Pen Personal Interview) was carried out. Non-probability sampling, the snowball method (N = 507: teachers n = 174, nurses n = 165 and private sector office workers n = 168), covering the whole of Poland, was adopted. Non-parametric hypotheses were verified using the chi-squared test with a statistical significance α = 0.05.

RESULTS

Compared to nurses and private sector office workers, teachers more frequently attended work when sick (p < 0.05). Out of the reported ailments that respondents worked with, teachers more often indicated rhinitis (p < 0.05), sore throat and cough (p < 0.05) and increased temperature (p < 0.05). This may be associated with a threat to the health of individuals in their charge. Teachers commonly complained about joint and bone pain (p < 0.05) and gastrointestinal disorders (p < 0.05). Contrary to nurses and private sector office workers, teachers did not point to 'lack of a replacement' as the reason for their presence at work when sick (p < 0.05). Exclusively, teachers added financial issues and difficulties in access to healthcare if they are working fewer hours to the list of reasons for attending work when sick.

CONCLUSIONS

Results suggest that there is a need for further studies on the presence of sick employees in the workplace, especially for teachers. The sickness presence of teachers and nurses may be a threat from a public health perspective. The workplace itself is a significant place to prevent many diseases.