worker’s perception environmental factors influencing obesity at the workplace

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American Journal of Health Studies: 23(2) 2008

WORKERS PERCEPTION: ENVIRONMENTAL FACTORS INFLUENCING OBESITY AT THE WORKPLACE

Cecilia M. Watkins, PhD, Assistant ProfessorCHES, Grace K. Lartey, PhD, Assistant ProfessorVijay Golla, PhD, Assistant ProfessorJagdish Khubchandani, MBBS, MPH, Doctoral Student

Abstract. The present study examines the potential influence perceptions may have on workers nutritional and exercise behaviors, which could allow for more explicit intervention design. Surveys were administered in four workplaces in Kentucky to measure workers perceptions of environmental factors at the workplace and their influence on obesity rates. The majority of employees perceived that the quality of food and stress influenced their choice of food, while the lack of a worksite gym prevented them from getting enough exercise at the workplace. Time affected both their eating and exercise habits at the workplace.

INTRODUCTIONSedentary lifestyles, decreased physical activity,

and high caloric intake are a few of the many behav-ioral determinants associated with obesity. The long-term effects associated with obesity are heart disease, cancer, stroke, and Type II diabetes. These diseases are included in the top leading causes of death in the United States (CDC, 2007).

According to the Centers for Disease Control and Prevention, being overweight or obese increases the risk of many diseases and health conditions. For adults, overweight and obesity ranges are determined by using weight and height to calculate body mass index (BMI). An adult who has a BMI of 30 or higher is considered obese (CDC, 2007). Due to rising rates over the past several years, obesity is now considered a public health issue.

For many years, obesity was only a self-reported disease; however, many task forces established inter-nationally, nationally, and locally now obtain raw data concerning this issue. The global epidemic of overweight and obesity -- globesity -- is rapidly be-coming a major public health problem in many parts of the world (WHO, 2007). The obesity pandemic originated in the U.S. and crossed to Europe and the worlds other rich nations before it penetrated the worlds poorest countries, especially in their urban areas (Prentice, 2006). In the United States, obesity has become prevalent in both urban and rural popu-lations. In 2006, Kentucky, considered a mostly rural

state, ranked fifth highest in the U.S. for adults who are overweight or obese, eighth for adult diabetes levels and seventh for rates of hypertension (Trust for Americans Health Reports, 2006).

Physical and social environmental factors play a big role in the rising rates of obesity among adults and children. In the worksite, adults are a captive audience. In fact, employed adults spend a quar-ter of their lives at work, and the pressure and de-mands of work may affect their eating habits and activity patterns, which may lead to overweight and obesity (Schulte, Blanciforti, Cutlip, Krajnak, & Luster, 2007). This could have significant impact in America, considering that the workforce in the United States as of February, 2008 is 146,000,000 (U.S. Bureau of Labor Statistics, 2008).

Obesity has a significant financial impact on employers, communities, and the economy in gen-eral. According to a study conducted by the Centers for Disease Control and Prevention, the national costs attributed to both overweight and obesity medical expenses accounted for 9.1% of total U.S. medical expenditures in 1998, which translate into $78.5 billion, and has grown to $92.6 billion in 2002 (CDC, 2008). It is estimated that employers spend more than $75 billion annually on obesity-attributable health care (Gates, Brehm, Hutton, Singler, & Poeppelman, 2006). Increases in obesity rates have impacted health care providers, especially among the nursing profession. In Washington State

Cecilia M. Watkins, PhD, CHES, is an Assistant Professor, Department of Public Health, Western Kentucky University. Grace K. Lartey, PhD, is an Assistant Professor, Department of Public Health, Western Kentucky University. Vijay Golla, PhD, is an Assistant Professor, Department of Public Health, Western Kentucky University. Jagdish Khubchandani, MBBS, MPH, is a Doctoral Student, Department of Health and Rehabilitation Services, University of Toledo. Please address all correspondence to Cecilia M. Watkins, Department of Public Health, Western Kentucky University, 1906 College Heights Blvd # 11082, Bowling Green, Ky 42101-1082, Phone: 270-745-4796, Fax: 270-745-4337, Email: [email protected].

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in 2005, the Bureau of Labor Statistics reported one in 10 health care employees to have an injury, with the majority being back injuries, triggered by patient handling activities. Obesity rates in part, have led many hospitals to implement zero lift policies in an attempt to prevent work related back injuries (Charney, Simmons, Lary, & Metz, 2006).

The business economy, a fast-paced environ-ment that strives to meet the demands of consumers, places a great deal of stress on manufacturing com-panies. The stress affects workers and their families. Employees at manufacturing companies may be at increased risk for obesity due to the static nature of many of the jobs, low socioeconomic status, limited availability of healthy food alternatives, and lack of available space and time for physical activity (Gates, Brehm, Hutton, Singler, & Poeppelman, 2006). Because employees spend the majority of their time at work, creating a healthy environment for workers seems like a sensible thing to do. Since employers of-ten bear the financial burden of obesity-related costs, they often are motivated to offer worksite health behavior interventions that may prevent negative obesity-related health outcomes and thus reduce long-term healthcare costs (Shimotsu, 2007). Healthy workplaces prevent occupational disease/accidents, promote the concept of positive lifestyle behaviors and facilitate organizational development (Whitehead, 2006).

Several programs have been implemented in the workplace to address the obesity pandemic and other health concerns such as diabetes and cardiovascular disease, as well as the factors leading to these con-cerns (i.e., physical inactivity and unhealthy eating habits). Although these issues are being addressed through health promotion interventions, researchers have done little work examining workers percep-tions of the environmental factors that affect these issues, especially with obesity.

In terms of previous research that has gained insight on perceptions, Lassen, Bruselius-Jensen, Sommer, Thorsen, and Trolle (2007) conducted a study that assessed the factors influencing workers attitudes toward promoting healthy eating among blue-collar workers. This study was conducted in Copenhagen with the General Workers Union in Denmark, an organization of unskilled workers. The study listed environmental, social, and individual barriers to participation in health promotion pro-grams. Such barriers include the time to participate, shift work, resistance to changing bad habits, the perception that wellness programs have nothing to do with their work culture (the macho factor), and/or skepticism about managements commitment to improve workers health. In addition, they found that people consider their food intake and overall health as a personal issue (Lassen, Bruselius-Jensen,

Sommer, Thorsen, & Trolle, 2007). The main fac-tors that were examined included: (a) employees awareness of current health promotion programs available at the worksite and to what extent: and (b) employees attitudes toward promoting healthy eat-ing at the worksite (Lassen, Bruselius-Jensen, Som-mer, Thorsen, & Trolle, 2007).

From this study, Lassen and colleagues (2007) determined that 81% of respondents at baseline re-ported that they thought their worksite should take part in promoting healthy eating to at least some ex-tent. In addition, 97% of participants at the conclu-sion of the study viewed the intervention program, Food at Work, positively, and 80% agreed that par-ticipation among the employees was perceived to be generally high. Although this study did not assess the physical environmental factors, it gives insight to the employees perspective on how they perceive health promotion programs dealing with obesity. It suggests that workers are receptive to programs that would improve their health at the worksite. The results also provide support for developing inter-ventions that not only focus on adjusting physical environmental factors, but the social environment as well.

Other researchers have begun to examine the levels of intervention in the workplace setting and are using an ecological approach. The ecological work-place physical activity model developed by Plotnikoff and colleagues identifies six environment levels in the workplace including: (a) Individual (i.e., employees characteristics, skills and knowledge as related to physical activity); (b) Social (i.e., social peer and su-pervisor relationships as related to physical activity); (c) Organizational (i.e., the aspiration of the work-place to promote physical activity); (d) Community (i.e., how the workplace interacts with the commu-nity to promote physical activity); (e) Policy (i.e., how the policies in the workplace promote physical activity); and (f ) Physical Environment (i.e., how the buildings, grounds and surrounding areas of the workplace can influence physical activity). The eco-logical method identifies and considers the environ-mental interactions between the individuals homes, workplace, and socio-cultural settings as well as the climate they live in. With this approach, the envi-ronmental factors are assessed at the individual level, through the relationships between the individual and co-workers, through the physical environment at the workplace and through the community of the orga-nization itself and its relation to health promotion (Prodaniuk, Plotnikoff, Spence, & Wilson, 2004). A study on self-efficacy and outcome expectations in the workplace, conducted by Prodaniuk, Plotnikoff, Spence, and Wilson (2004), found small correla-tions between the environment and levels of physical activity among employees. They found that factors

Watkins, Lartey, Golla & Khubchandani

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influencing physical activity include biological fac-tors, support in the workplace (physical and social) for such behaviors, and the employees perception of the workplace environment (Prodaniuk, Plotnikoff, Spence, & Wilson, 2004).

In these studies, researchers looked into the physical environmental factors for methods of in-terventions to increase physical activity and increase healthy eating habits. Both studies provide evidence that interventions that focus on environmental factors have only modest success in achieving goal behaviors among employees. Engbers, van Poppel, Chin, and van Mechelen (2006) offer more insight in their investigation that significantly changed be-havioral determinants towards healthier eating hab-its through social support, self efficacy and attitude. These studies offer support that workplaces should adopt all-encompassing strategies that focus on more than just environmental factors, including strategies that recognize the importance of personal health practices as well as social factors (Makrides, Heath, Farquharson, & Veinot, 2006).

Environmental factors are important contribu-tors to excessive weight and obesity Gates, Brehm, Hutton, Singler, and Poeppelman, (2006). Minimal work, however, has been done to gain insight on workers perceptions on obesity. Studies have revealed that workers desire that their employers also par-ticipate in worksite wellness programs (Whitehead, 2006). Environmental approaches offer companies a low-cost option (Gates, Brehm, Hutton, Singler, & Poeppelman, 2006). Based on current literature, a multi-faceted ecological approach should be used to identify environmental, social, and individual barriers to participation in health promotion pro-grams. Ecological models of change in health be-havior provide a conceptual framework for targeting and measuring environmental variables (Shimotsu, 2007). This approach includes corporate members from leadership as well as the worksite community, resources, government bodies that foster physical activities, and policies regarding physical activity. Programs to reduce the prevalence of obesity and its related costs must include environmental (Gates, et al., 2006) and social approaches aimed at the places people live, work, and play. The present study ob-serves how workers perceptions of environmental factors at the workplace can influence behaviors of eating and exercise. The intent was to compare and contrast perceptions of employees to identify less fa-vorable environmental factors within the workplace that contribute to overweight and obesity.

METHODSELECTION OF PARTICIPANTS To increase participation, all employees from four selected workplaces were invited to participate

in the study. The number of employees in each workplace was obtained from the human resources departments. Industry 1 had 150 employees; industry 2 had 170; industry 3 had 1,887; and industry 4 had 800 employees. A total of 3,007 questionnaires were sent out; 1,072 were returned.

INSTRUMENT DEVELOPMENTAn open invitation was sent to all employees

at an industrial workplace (not a participant workplace in this study) to participate in focus group discussions. The focus groups were designed to assess employees perceptions about environmental factors in the workplace and the influence these factors have on the prevalence of obesity. Twenty-seven employees accepted the invitation to participate. Focus group data were analyzed for common themes. The identified themes were used in the development of the instrument. The final instrument was 2 pages and assessed employees perceptions about environmental factors in the workplace and their influence on obesity.

PROCEDURESTo ensure complete confidentiality and

anonymity, the questionnaires, which consisted of a cover letter explaining the purpose of the study and assuring confidentiality, with prepaid postage were mailed to the human resource departments to be distributed to employees. The questionnaires were coded and employees were encouraged to keep their codes. Employees had the opportunity to win a $100 gift certificate for participating. Codes were entered in a raffle and winners codes and gift certificates were e-mailed to the various human resource departments to be announced to the employees.

DATA ANALYSISSPSS 14.0 was used to analyze the data.

Frequencies, means, and standard deviations were used to describe the demographic characteristics. Analysis of variance (ANOVA) tests and t tests were calculated to determine the relationship between the independent variable (i.e., the workers perceptions of environmental factors) and the dependent variables (i.e., eating and exercise habits). Chi-square tests were used to analyze the categorical data. Level of significance was set at p < 0.05.

RESULTSDEMOGRAPHIC AND BACKGROUND CHARAC-TERISTICS

A total of 3,007 surveys were sent to the em-

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ployees in the four selected workplaces; 1,072 (36%) were returned. The majority of employees were fe-male (75%) and most of them were between 28 and 57 years old (73%) (Table 1).

TIME CONSTRAINTSTwo items assessed time constraints regarding

exercise and eating habits at the workplace. The ma-jority of employees believed time affected their eat-ing and exercise habits at the workplace. Fifty-seven percent believed time constraints prevented them from eating healthy food while 59% of employees believed it affected their exercise habits.

COST OF FOODTwo items looked at healthy eating habits in

the workplace. The majority of employees (59%) be-lieved the quality of food at the workplace influenced their eating habits; however, only 28% of employees believed the cost of food at the workplace influenced their eating habits. Chi-square analysis of quality of food by employees gender found a significant dif-ference (2 = 4.15, df = 1, p < .05). Seventy-eight percent of female employees believed quality of food at the workplace influenced their eating habits.

PHYSICAL EXERCISESixty-five percent of employees believed the lack

of a worksite gymnasium prevented them from get-ting enough exercise at the workplace, while 42% of employees believed their work assignments prevent-ed them from exercising. A one-way analysis of vari-ance (ANOVA) test was conducted to evaluate the relationship between physical exercise at the work place and employees age. Results were significant for the lack of an exercise facility at the workplace [F(5, 1066) = 8.3, p < .001]. Compared to other age groups, the 28-37 year olds exercise habits are influenced more by the lack of an exercise facility at the workplace than their work assignments.

STRESS AT THE WORKPLACESix items assessed the effects of workplace stress

on employees eating and exercise habits. The ma-jority of employees did not believe workplace stress influenced their eating or exercise habits (Table 2). Using t-test analyses, statistically significant differ-ences were found. A significant difference was found on the hypothesis that workplace stress influenced employees to eat less. Female employees influenced

Table 1: Demographic and Background Characteristics of Employees (N = 1072)__________________________________________________________________________ Item n (%) __________________________________________________________________________

Gender Female 808 (75)

Male 264 (25)

Age (years) 18-27 197 (18)

28-37 237 (22)

38-47 293 (27)

48-57 253 (24)

58-67 82 (8)

68+ 10 (1) Type of Workplace Workplace A 95 (9)

Workplace B 109 (10)

Workplace C 849 (79)

Workplace D 19 (2)____________________________________________________________________________________________


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by workplace stress tend to eat less compared to male employees [t(395) = -2.960, p

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1, p < .001). Eighty percent of female employees are influenced by their work shift to eat less. Male em-ployees, on the other hand, tended to eat more junk food compared to female employees [t(458) = 2.92, p < .01]. In addition, female employees tended to eat healthier food when influenced by work shift [t(341) = -2.4, p < .05]. Female employees exercised more compared to their male counterparts [t(318) = -2.5, p < .05]. Analysis of variance (ANOVA) tests were conducted to determine the relationship between work shift and employees age. Statistically signifi-cant differences were found on eating less food [F(5, 1066) = 2.6, p < .05] and eating junk food [F(5, 1066) = 5.5, p < .001]. Compared to the 58-57 year olds, 18-27 year olds tended to eat less due to their work shift. In addition, 18-27 year olds and 28-37 year olds tended to eat more junk food due to their work shift compared to 38-47 year olds.

CO-WORKERSThe majority of employees did not believe their

co-workers influenced them to eat less food (94%) or eat larger amounts of food (76%) (Table 4). Statisti-cally significant differences were found when t-test analyses were conducted. Male employees were more influenced by their co-workers to eat more [t(488) = 2.1, p < .05] and eat more junk food [t(470) = 5.4, p < 001]. On the other hand, female employees were influenced more by their co-workers to exercise less [t(379) = -2.8, p < .05]. Analysis of variance (ANOVA) tests were conducted to determine the re-lationship between the influence of co-workers and employees age. A statistically significant difference was found on eating more junk food [F(5, 1066) = 3.9, p < .01]. Compared to the 38-47 year olds, em-ployees between 18 and 27 are influenced by their

co-workers to eat more junk food.

DISCUSSION Workers perceive that some environmental fac-

tors at the workplace can influence their eating and exercise behaviors. This study reveals that the major-ity of employees perceived that the quality of food and stress influenced their choices of food, while the lack of a worksite gym prevented them from getting enough exercise at the workplace. Time affected both their eating and exercise habits at the workplace.

With these significant findings, employers ef-forts to refine food selections at the workplace would certainly provide an incentive for workers to eat a healthier diet. In addition, stress and time manage-ment classes could also be utilized to build skills for workers to cope with challenges found not only at the workplace, but also at home. The advantage of having an on-site gym for workers would have to be considered on a site-to-site situation. Some work-sites, due to cost restraints, may consider reduced or free memberships at a local gym. The advantages of implementing policies in the workplace for flex time would encourage workers to either implement or improve their eating and exercise habits.

All of these health promotion components for the worksite would focus on the issues that work-ers perceive as influencing their health behaviors. These components, while beneficial to the long-term health of the company, are also an immediate and costly investment for employers. Many companies in the U.S. are dealing with sky-rocketing health-care costs, losing business to foreign enterprises and struggling to keep above the break-even line. To en-courage these companies to invest upfront in their workforce, the government should offer incentives,

Table 4: Employees Perceptions of the Influence of Coworkers on Their Eating and Exercise Habits (N = 1072)________________________________________________________________________________________Item Yes No n (%) n (%)________________________________________________________________________________________Does your coworkers influence you to:

Eat larger amounts of food 262 (24.4) 810(75.6)

Eat less food 68 (6.3) 1004 (93.7) Eat more junk food 507 (47.3) 565 (52.7)

Eat healthier food 177(16.5) 895 (83.5) Exercise more 138 (2.3) 934 (87.1)

Exercise less 129(12.0) 943 (88.0)________________________________________________________________________________________


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from http://www.cdc.gov/nccdphp/dnpa/obesity/index.htmCenters for Disease Control and Prevention (2008). Overweight and Obesity. Economic Consequences.

Retrieved March 28, 2008 from http://www.cdc.gov/nccdphp/dnpa/obesity/economic-consequences.htm

Charney, W., Simmons, B., Lary, M., Metz, S. (2006). Zero lift programs in small rural hospitals in Washington State. AAOHN Journal, 54, 355-357.

Engbers, L.H., van Poppel, M.N.M., Chin A Paw, M., van Mechelen, W. (2006) The effects of a controlled worksite environmental intervention on determinants of dietary behavior and self-reported fruit, vegetable and fat intake. BMC Public Health, 6, 253-262.

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Kentucky.gov (2008). Bill Watch. Retrieved April 11, 2008 from http://www.Secure Kentucky.gov/billwatch/billsummary

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Makrides, L., Heath, S., Farquharson, J., Veinot, PL. (2007). Perceptions of workplace health: building community partnerships. Clinical Governance: An International Journal, 12, 178-187.

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which will support these companies through the ini-tial stages of program setup and maintenance. One example of government support is a bill introduced in the Kentucky House of Representatives, which would establish a wellness project tax credit for em-ployees implementing wellness programs. This is a progressive step for worksite wellness (Kentucky.gov, 2008).

As noted by Gates, et al. (2006), the increased risks for obesity at the workplace, which includes limited healthy food choices and limited time for exercise, support the findings in this study. Lassen, et al. (2007) also listed time as a major barrier for workers to participate in health promotion programs at the worksite.

Limitations of this study include content validi-ty, the low response rate (36%), and the convenience

sampling. The design of the questionnaire was in-tended to be short and simple in the anticipation of a high rate of return. This could contribute to a question of content validity. The low response rate can be attributed to the nature of the working envi-ronment. Often at work, people are rushed and will not take time to answer a questionnaire. Also, many people, despite the assurance of confidentiality, may believe their answers could be used against them in their job evaluations. While incentives were offered to increase participation rates, job type, education level, low morale or even general antipathy toward the study may have influenced the response rate. Finally, the participants were chosen by their will-ingness to fill out the questionnaire. A large random sample would have better represented the working population than a convenience sample.

worker’s perception environmental factors influencing obesity at the workplace

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