|Year : 2016 | Volume
| Issue : 2 | Page : 55-59
Prevalence and correlates of obesity and overweight in healthcare workers at a tertiary hospital
Musa Dankyau, Joy Adeyinka Shu'aibu, Ayodele Emmanuel Oyebanji, Oluwatobi Victoria Mamven
Department of Family Medicine, Bingham University Teaching Hospital, Jos, Nigeria
|Date of Web Publication||13-Oct-2016|
Department of Family Medicine, Bingham University Teaching Hospital, PMB 2238, Jos, Plateau State, 930214
Source of Support: None, Conflict of Interest: None
Background: Obesity and overweight are increasing consequences for the health system. Previous studies suggest that prevalence and correlates might be different in health workers compared to the general population. This study aims to determine prevalence and correlates of obesity and overweight.
Subjects and Methods: A cross-sectional study involving health workers at a 250-bed, urban, faith-based tertiary hospital in North-Central Nigeria consisting of 320 eligible full-time employees.
Results: Response rate was 68.8%. Most respondents were female (66.4%), young (mean age 41.6 ± 9.88), and married (70.5%); had tertiary education (61.8%), mean duration of employment 11.3 ± 9.79 years, and median duration of employment 7.0 years (range 0-37); and were mainly (55.9%) health service providers. Mean body mass index (BMI) was 26.6 ± 4.85 kg/m 2 . Males had lower BMI compared to females (23.8 ± 3.43 kg/m 2 vs. 28.1 ± 4.83 kg/m 2 , P < 0.0001, odds ratio [OR] 4.3, 95% confidence interval [CI] 3.1-5.6). Overall, 63.4% (23.2% obese, 31.4% overweight) were overweight or obese and 60% had abdominal obesity. Females had higher mean waist circumference than males (92.1 ± 11.8 cm vs. 83.0 ± 9.8 cm, P = 0.016, OR 9.1, 95% CI 6.0-12.3). Female staff (OR 4.9, 95% CI 2.6-9.2) and married staff (OR 2.5, 95% CI 1.3-4.9) were more likely to be obese or overweight.
Conclusions: The prevalence of obesity, overweight, and abdominal obesity was high. Females and married status were associated with overweight and obesity. This calls for workplace interventions to address causes of overweight and obesity in health workers.
Keywords: Abdominal obesity, body mass index, health personnel, obesity, overweight, waist circumference
|How to cite this article:|
Dankyau M, Shu'aibu JA, Oyebanji AE, Mamven OV. Prevalence and correlates of obesity and overweight in healthcare workers at a tertiary hospital. J Med Trop 2016;18:55-9
|How to cite this URL:|
Dankyau M, Shu'aibu JA, Oyebanji AE, Mamven OV. Prevalence and correlates of obesity and overweight in healthcare workers at a tertiary hospital. J Med Trop [serial online] 2016 [cited 2017 Sep 20];18:55-9. Available from: http://www.jmedtropics.org/text.asp?2016/18/2/55/188533
| Introduction|| |
Overweight and obesity, defined as excessive fat accumulation that may impair health, have become significant preventable, global, public health challenges in the 21 st century.  Worldwide, more than 1.9 billion adults were overweight in 2014.  Of these, over 600 million were obese.  A recent systematic review reported overweight/obesity prevalence in Nigeria ranging from 4% to 49%. 
Obesity is fundamentally caused by an energy imbalance between calories consumed and calories expended. Globally, there has been an increased intake of high fat, energy-dense foods coupled with increased physical inactivity.  Although Sub-Saharan Africa is still in the early stages of nutrition transition, overweight and obesity are rising with rising gross domestic product.  While obesity remains a significant public health issue, particularly among urban Africans, there is little evidence of proper diagnosis, treatment, and/or prevention. 
A recent review from Nigeria indicated that female gender, marriage, low physical activity level, positive family history, urban area of residence, and age ≥40 years were the most significant socioeconomic determinants of obesity.  Two-thirds of urban, professional, high socioeconomic Nigerian adults were also reported to be either overweight or obese. 
Investigators have reported a high prevalence of obesity among health workers in Jos,  Ido-Ekiti,  Enugu,  Benin,  Ogbomosho,  Ibadan,  Bayelsa,  and Lagos, Nigeria.  These high prevalence rates are occurring in the same context where more than 80% of urban, professional Nigerian adults do not meet the World Health Organization (WHO) recommendations for physical activity. 
Obesity and overweight are associated with increased personal risk of cardiovascular disease (CVD), musculoskeletal disorders, cancers, and other chronic diseases. ,,,,,,,,,,, In employees, obesity imposes significant costs. A recent US study indicated that morbid obesity in employees costs $8067 in covered medical, sick days, short-term disability, and workers' compensation claims combined, a statistic more than double the $3830 for normal-weight employees. 
The workplace and health professionals play a critical role in the prevention of obesity and its consequences.  It is therefore vital to carry out research into the burden and factors associated with obesity among health workers because this will give critical insight into designing workplace programs to prevent and control obesity and overweight in healthcare settings. Increased awareness of healthcare workers regarding their own diet and physical activity can also help them to be models for patients, clients, and the communities they serve.
This study was therefore carried out to assess the prevalence of obesity and overweight as well as the key sociodemographic and clinical correlates among healthcare workers in an urban, tertiary healthcare institution.
| Subjects and Methods|| |
The research was conducted in a 250-bed, faith-based, urban tertiary hospital in North-Central Nigeria. At the time of the study, there were 350 full-time employees consisting of several Nigerian and expatriate consultants, resident doctors in family medicine, nurses, pharmacists, and other support staff.
Approval to conduct the study was granted by the Hospital Research and Ethics Committee. All participants gave informed consent.
A cross-sectional descriptive study of all consenting staff of the hospital was carried out between July and September 2013.
Sample size and data collection:
The sample size was determined using the formula for descriptive studies. 
N = Z 2 PQ/d 2 .
where N = Minimum sample size.
Z = Standard deviation score at 95% = 1.96.
P = Prevalence of obesity and overweight based on body mass index (BMI) of health workers in Jos reported at 72%  =0.72.
Q = Complimentary probability (1 – P) =1 – 0.72 = 0.28.
d = Error margin = 5%.
Substituting, N = (1.96) 2 × 0.72 × 0.28/(0.05) 2 = 309.7.
This was corrected for a finite population of 350 to give a minimum sample size of 202, rounded up to 220 to cover for 10% nonresponse. The target population was given a participant's information sheet and a consent form. All consenting staff were then given a questionnaire assessing sociodemographic data, followed by physical examination to take weight, height, and waist circumference (WC). Weight and height were recorded using a weight beam/stadiometer (Detecto, US) in line with the WHO protocols.  WC was also measured in line with the WHO protocol using a nonstretch tape measure (Butterfly, China). 
Data were analyzed with SPSS version 21, IBM Corp Armonk, NY. Results were reported as proportions and means while relationships were tested with Chi-square test, t-test, and multinomial logistic regression. P < 0.05 was accepted as statistically significant.
| Results|| |
There were 350 full-time employees of the hospital at the time of the study. A total of 20 staff declined consent, five members of the research team, and an additional five pregnant and very ill staff were excluded from the study. A total of 320 questionnaires were distributed, but completed questionnaires and physical measurements were retrieved for a total of 220 staff indicating a 68.6% response rate.
Most of the respondents were female (146, 66.4%), relatively young (mean age 41.6 ± 9.88), and married (155, 70.5%); had tertiary education (136, 61.8%), with a median duration of employment of 7 years (range 0-37). Most (123, 55.9%) were in the health service provider category with nurses consisting of about half (62, 50.4%) of this category [Table 1].
|Table 1: Sociodemographic and anthropometric characteristics of study participants|
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The prevalence of obesity was 23.2% (51) while a further 31.4% (69) were overweight. Overall, 63.4% (120) of the healthcare workers were either overweight or obese. The overall prevalence of abdominal obesity was 60% [Table 1].
A total of 36 (16.4%) of the participants comprising 29 females and seven males had high WC while a total of 96 (43.6%) comprising 95 females and one male had very high WC. More females (124, 84.9%) than males (8, 10.8%) had central obesity (P < 0.0001, odds ratio [OR] 46.5 95% confidence interval [CI] 19.6-110.2).
Multivariate analysis showed that female gender and married status were significant predictors of overweight and obesity [Table 2].
|Table 2: Multinomial logistic regression of factors predicting overweight/obesity in study participants|
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When restricted to predictors of obese category alone, the multivariate analysis indicated that female gender and married status were significant predictors of obesity while younger age group (<44 years) was less likely to be associated with obesity [Table 3].
|Table 3: Multinomial logistic regression of factors predicting obesity in study participants|
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| Discussion|| |
The study determined the prevalence of obesity as 23.2% in this cohort of health workers, with a further 31.4% overweight. Overall, 54.6% of the health workers were either obese or overweight, and 60% had abdominal obesity as evidenced by their high WC measurements. The prevalence of overweight and obesity (54.6%) was however less than the reported finding of 72% from a different tertiary hospital in the same city. 
Female staff were almost 5 times more likely than males (OR 4.9, 95% CI 2.6-9.2) to be overweight and obese, and married staff were 2½ times more likely than unmarried staff (OR 2.5, 95% CI 1.3-4.9). When restricted to obesity alone, female staff were 12 times as likely to be obese as male staff (OR 12.3, 95% CI 3.6-42.1); married staff were 4 times more likely to be obese than singles (OR 4.0, 95% CI 1.6-10.0); and younger staff had about 2½ times less odds compared to those >44 years of age (OR 0.4, 95% CI 0.2-0.9) of been obese.
Female, older, married healthcare workers were more likely to be obese and even more likely to have increased abdominal obesity. These measures were higher than previously published prevalence of obesity among outpatients in the same institution (17.4%).  It was also much higher than the prevalence of obesity (4.2%) and overweight (17.2%) in a healthy adult community sample from the same city.  It was however less than the overall prevalence of obesity and overweight of 86.8%, with 38% recorded as obese among chief executive officers in the same city.  This pattern of higher prevalence of obesity and overweight in health workers compared to the prevalence in the community has been previously reported from Ghana.  Considering the current significant human resource for health limitations in Nigeria, obesity and overweight with the consequent long-term health implications are a potential disaster for the already fragile health system and have been noted previously.  This is worsened by the fact that overweight hospital staff, as was previously reported, almost always failed to self-identify themselves as overweight.  This has also been noted to affect the effectiveness of healthcare workers in prevention and counseling for obesity in patients and clients in the community. 
The fact that female health workers who were mostly nurses in our study were more likely to be obese has also been a consistent finding by other investigators. ,,,,,, Isah et al. had previously reported several negative medical and psychological effects of night shift work on nurses.  The finding may also be linked to the fact that obesity is also generally related to increasing age and parity in women.  A large proportion of the study population were older, female nurses, but we did not obtain data on their parity. It is also possible that this finding could be related to the previously reported body image preferences for larger body size among black South African women  and among Yoruba women in Nigeria. 
| Conclusion|| |
This study found a high prevalence of obesity and overweight among health workers at a tertiary hospital in an urban setting. Female workers and married staff were more likely to be obese and overweight. A key strength is that all physical measurements were carried out in line with the WHO descriptions for standard physical measurements. However, our findings are limited by the fact that this was a cross-sectional study in a relatively small tertiary hospital. The waist to hip ratio and other measures of CVD risk were also not done.
These findings have implications for health administrators as they consider workplace policies and interventions to engender a healthier workplace for health staff, and the need for female health worker-focused initiatives. It also calls for future research to investigate workplace-based factors influencing obesity in health workers and the effect of shift work on obesity. Other studies can also test hospital workplace interventions that would reduce the risk of obesity in health workers.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]