Prevalence of overweight and obesity among nurses in Scotland: A cross-sectional study using the Scottish Health Survey

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Abstract

Background

Increasing prevalence of overweight and obesity represents a global pandemic. As the largest occupational group in international healthcare systems nurses are at the forefront of health promotion to address this pandemic. However, nurses own health behaviours are known to influence the extent to which they engage in health promotion and the public's confidence in advice offered. Estimating the prevalence of overweight and obesity among nurses is therefore important. However, to date, prevalence estimates have been based on non-representative samples and internationally no studies have compared prevalence of overweight and obesity among nurses to other healthcare professionals using representative data.

Objectives

To estimate overweight and obesity prevalence among nurses in Scotland, and compare to other healthcare professionals and those working in non-heath related occupations.

Design

Cross-sectional study using a nationally representative sample of five aggregated annual rounds (2008–2012) of the Scottish Health Survey.

Setting

Scotland.

Participants

13,483 adults aged 17–65 indicating they had worked in the past 4 weeks, classified in four occupational groups: nurses (n = 411), other healthcare professionals (n = 320), unqualified care staff (n = 685), and individuals employed in non-health related occupations (n = 12,067).

Main outcome measures

Prevalence of overweight and obesity defined as Body Mass Index  25.0.

Methods

Estimates of overweight and obesity prevalence in each occupational group were calculated with 95% confidence intervals (CI). A logistic regression model was then built to compare the odds of being overweight or obese with not being overweight or obese for nurses in comparison to the other occupational categories. Data were analysed using SAS 9.1.3.

Results

69.1% (95% CI 64.6, 73.6) of Scottish nurses were overweight or obese. Prevalence of overweight and obesity was higher in nurses than other healthcare professionals (51.3%, CI 45.8, 56.7), unqualified care staff (68.5%, CI 65.0, 72.0) and those in non-health related occupations (68.9%, CI 68.1, 69.7). A logistic regression model adjusted for socio-demographic composition indicated that, compared to nurses, the odds of being overweight or obese was statistically significantly lower for other healthcare professionals (Odds Ratio [OR] 0.45, CI 0.33, 0.61) and those in non-health related occupations (OR 0.78, CI 0.62, 0.97).

Conclusions

Prevalence of overweight and obesity among Scottish nurses is worryingly high, and significantly higher than those in other healthcare professionals and non-health related occupations. High prevalence of overweight and obesity potentially harms nurses’ own health and hampers the effectiveness of nurses’ health promotion role. Interventions are therefore urgently required to address overweight and obesity among the Scottish nursing workforce.

Introduction

Increasing prevalence of people who are overweight or obese represents a global pandemic (Swinburn et al., 2011). Between 1980 and 2013 the proportion of overweight and obese adults, defined as those with a Body Mass Index (BMI)  25.0, increased worldwide by 27.5% (Ng et al., 2014). In the United Kingdom (UK), two-thirds of the male population (66.6%) and over a half of females (57.2%) are overweight or obese (Ng et al., 2014), and in Scotland 68.2% of males and 60.4% of females are overweight or obese (Scottish Government, 2012). Increasing prevalence is concerning due to the links between being overweight or obese and morbidity and its impacts on health care budgets. Obesity has been associated with increased risk of heart disease (Must et al., 1999, BMI et al., 2014), diabetes mellitus (Mokdad et al., 2003), cancer (Pan et al., 2004, Renehan et al., 2008), lower back injury (Shiri et al., 2010), and reduced health-related quality of life (Wang et al., 2011). The estimated cost of overweight and obesity to the UK National Health Service (NHS) is currently £6 billion, and will likely increase to between £10 billion and £12 billion by 2030 (Dobbs et al., 2014). In Scotland, in 2007/08 the costs of overweight and obesity to the NHS were estimated at £312 million and obesity alone cost NHS Scotland £175 million, equivalent to 2% of the total budget allocated to NHS Boards (Scottish Government, 2010). Given these health and financial impacts UK Governments have committed to addressing overweight and obesity as a public health priority (Scottish Government, 2010). This raises an important question for health care professionals around what their contribution to these public health goals may be.

Nurses have an established and expanding public health role (Whitehead, 2005, Bücher et al., 2009) and a regulatory requirement to engage in health promotion with their patients (Nursing Midwifery Council (NMC), 2008). Seizing ‘teachable moments’ during routine patient interactions to provide health education is understood to be a key element in promoting positive behaviour change (Lawson and Flocke, 2009). As the largest occupational group in the NHS (Health Social Care Information Centre (HSCIC), 2014, Information Services Division, 2014) nurses therefore play a pivotal role in addressing the pandemic through provision of advice and education around protective behaviours, including the importance of maintaining a healthy diet and frequent participation in physical activity. However, it is known that nurses’ own levels of physical activity are associated with the frequency of provision of exercise advice (Lobelo and de Quevedo, 2014). Evidence also suggests that nurses have a role modelling effect insofar as the public are less confident in overweight nurses’ ability to provide advice about diet and exercise (Hicks et al., 2008). Despite this, in comparison to ‘normal’ weight nurses, overweight nurses perceive themselves to be equally competent to provide advice and counselling (Miller et al., 2008) and to hold more positive attitudes towards obese patients (Zhu et al., 2011). Hence, personal experience might enhance the care provided during interactions between overweight nurses and patients (Aranda and McGreevy, 2014). However, given the potential impact on both their own health and the potentially adverse impact on engagement in health education, estimating the prevalence of overweight and obesity among nurses is important.

Reported prevalence of overweight and obesity among nurses internationally ranges between 54.5% and 79.1% (Miller et al., 2008, Zitkus, 2011, Bogossian et al., 2012, Goon et al., 2013). Prevalence has been observed to be lowest in the United States of America (USA) (54.5% (Miller et al., 2008); 57% (Zitkus, 2011)), followed by the UK (59.1%), Australia (61.3%) and New Zealand (61.8%) (Bogossian et al., 2012), and highest in South Africa (79.1%) (Goon et al., 2013). Prevalence of overweight and obesity among nurses in Scotland is not known. International studies comparing obesity prevalence among nurses with the general population have been equivocal, reporting higher prevalence in the UK, Australia and New Zealand (Bogossian et al., 2012), comparable prevalence in South Africa (Goon et al., 2013) and lower prevalence in the USA (Miller et al., 2008, Zitkus, 2011). Prevalence estimates have, however, been based on non-representative samples and to the best of our knowledge no studies have compared prevalence of overweight and obesity among nurses to other healthcare professionals. The aim of this study is to estimate the prevalence of overweight and obesity among nurses in Scotland using representative administrative data, and compare prevalence to other healthcare professionals and the general working population. The study represents a step towards assessing the extent to which health care professionals, and especially nurses, are able to effectively contribute to the delivery of health education to address the obesity pandemic.

Section snippets

Study design and participants

Analysis was conducted using the Scottish Health Survey, a cross-sectional survey of the Scottish population designed by the Scottish Government to yield a nationally representative sample. The Scottish Health Survey is used to estimate prevalence of health conditions, disease risk factors, track health trends over time and measure government performance against targets. Sampling, recruitment and data collection processes used in the Scottish Health Survey are described in detail elsewhere (

Sample

The initial dataset included 43,524 people after aggregating. Including only those who were aged 17–65 years and who had worked in the previous four weeks reduced this number to 17,294 individuals. Initial analysis found a number of individuals for whom data was missing. Excluding these people from the analysis left a total of 13,483 people in the final dataset for analysis.

The sample included 411 (3.0%) nurses, 320 (2.2%) other healthcare professionals, 685 (5.1%) care workers, and 12,067

Discussion

Our study found a high prevalence of nurses in the Scottish workforce to be overweight or obese: 7 in 10 (69.1%) nurses in Scotland were overweight or obese; 4 in 10 were overweight (39.7%) and 3 in 10 obese (29.4%). Prevalence of overweight and obesity is therefore higher among nurses in Scotland than those in the UK (Bogossian et al., 2012), Australia (Bogossian et al., 2012), New Zealand (Bogossian et al., 2012), and the USA (Miller et al., 2008, Zitkus, 2011). Moreover, our study found that

Conclusions

Over two-thirds of Scottish nurses were found to be overweight or obese. Prevalence of overweight and obesity among the Scottish nursing workforce was found to be statistically significantly higher than other healthcare professionals and those in non-health related occupations. Observed prevalence was higher than previous studies in the UK, Australia and New Zealand. High prevalence of overweight and obesity potentially harms nurses’ own health and hampers the effectiveness of health promotion

Data sharing statement

Data were provided and downloaded from the UK Data Archive.
Conflict of interest: None declared.
Funding: This study was not externally funded.
Ethical approval: The study was approved by the Research Ethics Committee in the School of Health Sciences, University of Stirling, UK.

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