A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia, New Zealand, and the United Kingdom
Introduction
Worldwide, in 2008 it was estimated that more than 500 million people aged over 20 years were obese (Body Mass Index or BMI ≥ 30). In most countries obesity prevalence is increasing with a global predicted rise to 700 million by 2015 (Nguyen and El-Serag, 2010, World Health Organisation, 2011). Whilst obesity is a growing universal concern, it is particularly pertinent in developed nations such as Australia, New Zealand (NZ), and the United Kingdom (UK). In England, 24% of men and 25% of women over the age of 15 were classified as obese in 2008, with predictions that prevalence will rise to 47% and 36% respectively by 2025 (The NHS Information Centre Lifestyles Statistics, 2010). Similar obesity prevalence (26.5%) was reported in New Zealand in 2007 (New Zealand Ministry of Health, 2008) and whilst Australia reported lower obesity rates in 2008 (17.5%) this represented a 14.5% increase compared with the 2005 prevalence (Access Economics, 2008). Obesity represents one of the largest proportions of health budgets in developed countries, estimated from 6% (Antipatis and Gill, 2001) to as much as 10% depending on obesity rates (Visscher et al., 2010). The direct health costs of obesity to Australia in 2008 were $8.28 billion and with indirect costs of loss of well-being at $49.9 billion obesity represents a national economic burden of $58.2 billion (Access Economics, 2008).
The increasing prevalence of obesity has serious health implications for the onset of chronic diseases, and can also negatively affect workforce participation (Klarenbach et al., 2006) and is linked with higher risks of occupational injury (Janssen et al., 2011). The impact on the workforce is important to nursing and midwifery, disciplines already experiencing a global shortage of qualified professionals (Buchan and Aiken, 2008, Buchan and Dal Poz, 2002, Klarenbach et al., 2006, Oulton, 2006). A recent World Health Organisation (WHO) survey of 77 member states showed that despite efforts to address the shortage of nurses and midwives over 70% of survey respondents indicated that their country was experiencing a deficiency of nurses and midwives (World Health Organisation, 2009). Weight-related health concerns amongst nurses and midwives may further reduce the capacity of the workforce and perpetuate this shortage.
Until recently occupation had not been a focus of most weight research (Sobal, 2001) however there is increasing attention on the prevalence of obesity in occupational groups and evidence that obesity and overweight might be related in part to adverse work conditions (Schulte et al., 2007) and that health professionals may be at risk. A recent study examined weight-related health in a large sample (n = 19,960) emergency services professionals and found that nearly three-fourths were overweight or obese (Studnek et al., 2010) although nurses were not included in the sample. A smaller comparative health study (n = 79) of Alabama nurses found 72% were overweight or obese and raised concerns about the potential decline in health status of caregivers (Holman et al., 2009). Indeed studies which draw upon the Harvard Nurses Health Study cohort have demonstrated that weight gain substantially increased the risk of diabetes (Colditz et al., 1995), stroke (Rexrode et al., 1997) and reduced quality of life (Fine et al., 1999) and this may have consequences for longevity. In a sample of 194 hospital based nurses, 28% were reported to be obese and 37% overweight (Zapka et al., 2009), and a prospective cohort study of 17,065 women found that those who were obese had 79% lower odds of healthy survival to at least 70 years (Sun et al., 2009). Furthermore, the work setting, especially shift type has been found to contribute to ‘abnormal eating’ (Wong et al., 2010), and nurses reportedly eat snacks and sweet foods as a way of coping with stress (Hoppe and Ogden, 1997, Lim et al., 2011). In addition to work related factors, individual demographic factors such as age, gender, ethnicity and marital status have been demonstrated to impact on body weight (Sobal et al., 2009) as have reproductive factors including number of births, age at first birth and menopause (Wen et al., 2003) and late reproductive years (Sammel et al., 2003). However, there is a paucity of research on the obesity prevalence in the nursing and midwifery workforce (Zapka et al., 2009) and the associated demographic, reproductive and work factors.
The aim of this study was to examine the prevalence of overweight and obesity and the association with demographic, reproductive and work variables in a representative sample of working nurses in Australia, NZ and the UK, making this the first study of obesity prevalence and potential aetiological factors in nurses and midwives across three countries.
Section snippets
Methods
The Nurses and Midwives e-Cohort Study (NMeS) is an innovative web-based longitudinal cohort study of the nursing and midwifery workforce. The purpose of the study is to examine factors associated with both workforce and health outcomes in a cohort of nurses & midwives in Australia, NZ and the UK. The study has systematically sampled, recruited and maintained a large cohort using electronic methods and as such has pioneered Internet-based cohorts. Full details of the methodology have been
Results
At the time of initial recruitment approximately 290,000 registered (and enrolled) nurses and midwives in Australia, 660,000 in the UK and 44,400 registered nurses in New Zealand were eligible to join the study. Almost 5000 nurses and midwives who joined the study, completed the baseline survey, were registered with the relevant regulatory authority and working in either nursing or midwifery (or both) were included. Fig. 1 outlines the sampling frame for this study.
Across all three
Discussion
In this sample nurses and midwives exhibited a higher prevalence of obesity than in the general reference population. Greater than sixty percent of nurses and midwives across the jurisdictions were outside the healthy weight range, and the underweight group accounted for the smallest proportion. This is surprisingly given that health professionals should have a more acute understanding of the sequelae of, and the strategies to avoid, or overcome, obesity. Whilst this finding is in keeping with
Conclusion
This study has explored patterns of obesity across three jurisdictions, and found that working nurses and midwives are more likely to be overweight and obese than the general source populations. Whilst identification of demographic and reproductive characteristics associated with overweight and obesity (increasing aged, male gender, being primiparous or menopausal) in our sample are consistent with risks identified in contemporary research, our analysis reveals higher occupational risks
Acknowledgements
The research on which this paper is based was conducted as part of the Nurse and Midwives e-Cohort Study (http://e-cohort.net), at The University of Queensland.
Conflict of interest: The authors have nothing to disclose.
Funding: Funding support was received from the Australian Research Council, the National Health and Medical Research Council, Queensland Health and the Department of Health, South Australia. This is project is supported by grants from the Australian Research Council (LP0562102),
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