Obesity, body fat distribution and incidence of sick leave in the Belgian workforce: the Belstress study

Abstract

OBJECTIVES:In many studies, obesity has been associated with morbidity or mortality, but only a few have studied the relation between obesity and sick leave. Our aim is to analyse the independent effects of both adiposity and body fat distribution in relation to the 1-y incidence of sick leave in a large cohort of male and female workers covering a variety of occupations, taking into account a wide range of socio-demographic, behavioural and bioclinical variables. DESIGN AND SETTING: The baseline survey of the Belstress study was conducted in 25 companies across Belgium between 1994 and 1998. A cohort of 20 463 workers (15 557 males and 4906 females) aged 35-59 y was followed for absenteeism during 1 y. The 75th percentile of the distribution of the total annual sickness days was used as a cutoff to classify the workers with a high 1-y incidence rate of sick leave. The relation between sick leave and both obesity and body fat distribution assessed by the body mass index (BMI) and the waist circumference, respectively, was analysed by multivariate logistic regression models. RESULTS: Using a backward procedure based on the likelihood ratio, we found central abdominal fatness to be an independent predictor of sick leave in both genders (high sick-leave incidence and long spells), but not BMI. In men, the odds ratios was 1.31 (99% CI 1.12-1.52, Po0.0001) and in women it ranged from 1.32 (99% CI 1.03-1.70, P ¼ 0.005) to 1.47 (99% CI 1.14-1.90, Po0.0001). Two baseline covariables, respiratory problems and perceived health, are confounders or mediators. CONCLUSIONS: In this study, body fat distribution was associated with a high annual sick-leave incidence and long spells of sickness absence. If this link is reversible, employers may benefit from programs aiming at the prevention and treatment of central obesity.

The relationship between overweight and obesity, and sick leave: a systematic review

“…Out of these, a total of 13 longitudinal studies met the inclusion criteria. [17][18][19][20][21][22][23][24][25][26][27][28][29] One publication 30 described a study that was described partly in two earlier publications. 27,28 Although the most recent publication slightly differed from the other publications in that it combined the study populations of the two earlier ones and added another oil refinery, it did not provide additional data that were relevant to this review.…”

“…All studies used BMI as independent variable, with one study using both BMI and waist circumference. 24 Weight was evaluated by self-report in half of the studies. Generally, the same BMI cut-off points were used to define overweight or obesity, namely 25-29.9 and X30 kg/m 2 , respectively.…”

“…Some studies distinguished between short-and long-term sick leave, but differed in the operationalisation. For example, Labriola et al 23 and Moreau et al 24 applied a cutoff point of 7 days to distinguish between short-and longterm sick leave, whereas another study applied a cut-off point of 3 days of sick leave. 22 Another study examined the relationship between overweight and obesity with multiple measures of sick leave, including very short (1-2 days), short (3-7 days), medium (8-21 days), and long (X22 days).…”

“…22 Another study examined the relationship between overweight and obesity with multiple measures of sick leave, including very short (1-2 days), short (3-7 days), medium (8-21 days), and long (X22 days). 21 In total, eight studies investigated the relationship between overweight and/or obesity with long-term sick leave, [19][20][21][22][23][24]28,29 of which five studies also investigated the relationship with shorter spells of sick leave. [20][21][22][23][24] The remaining five studies did not distinguish between duration of sick leave; they investigated the relationship between overweight and obesity and total duration of sick leave.…”

“…21 In total, eight studies investigated the relationship between overweight and/or obesity with long-term sick leave, [19][20][21][22][23][24]28,29 of which five studies also investigated the relationship with shorter spells of sick leave. [20][21][22][23][24] The remaining five studies did not distinguish between duration of sick leave; they investigated the relationship between overweight and obesity and total duration of sick leave. 17,18,[25][26][27] Further, two studies investigated the relationship with a specific measure of sick leave, namely absence owing to respiratory complaints and musculoskeletal problems, respectively.…”