'1 in 4 nurses in England are obese,' survey finds

"One in four nurses are obese, warn experts," the Mail Online reports after the publication of a study looking at body mass index (BMI) among health professionals.

This UK study estimated the prevalence of obesity among health professionals in England. The highest levels of obesity were found to be in nurses (25%) and unregistered care workers (33%).

According to government figures, 27% of adults in England were obese in 2015. The researchers specifically wanted to look at rates within the health workforce.

They hope their findings will see policymakers pay more attention to improving staff health, as this has implications for not only the workforce, but also patient care.

Although the study wasn't able to look at the reasons behind the high levels of obesity seen in healthcare professionals, the researchers suggested it may be the result of disruptive shift work. Further research is needed to look into this.

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Where did the story come from?

The study was carried out by a team of researchers from Edinburgh Napier University and London South Bank University.

It was funded by the Burdett Trust for Nursing, the Royal College of Nursing, and the Royal College of Nursing Foundation in collaboration with C3 Collaborating for Health.

The study was published in the peer-reviewed BMJ Open. This is an open access journal, so the study is free to read online.

The UK media's coverage of the study was generally accurate.

Many news outlets suggested reasons for the unexpected levels of obesity in nurses, such as the negative impact of shift working, stress-related overeating, and the limited provision of healthy food in healthcare settings.

While these suggestions are plausible, the study didn't investigate the possible underlying reasons behind this trend.

The Daily Telegraph failed to use the latest government estimate of the prevalence of obesity in England (27% of the population) when deriding nurses for being "more dangerously fat than those they care for".

What kind of research was this?

This cross-sectional study aimed to estimate the prevalence of obesity among health professionals in England.

The researchers wanted to compare their findings with the prevalence of obesity in people who work in other sectors.

This study is an important piece of research for several reasons:

• Obesity can lead to the onset of several long-term conditions. Knowing the prevalence of obesity in the workforce can help work out what burden this would have on the capacity of the workforce.
• It could lead to further research into the reasons for the increase in obesity rates – for example, through research into whether the workforce has access to healthy meals on site and the impact of shift working.
• If health professionals themselves are obese, it may hinder health promotion efforts because the general population often look to the health workforce as role models.

Cross-sectional studies are designed to estimate how common a particular condition is in a population at any given point in time.

But they're limited in that they aren't able to look into cause and effect. This means this study isn't able to predict what may have caused any changes in the rates of obesity.

What did the research involve?

The researchers used data from the Health Survey for England (HSE), a nationally representative sample of private households in England.

Data was collected from adults over the age of 16 using computer-assisted personal interviewing.

The researchers used aggregated HSE data from 2008-12 (66,283 individuals). The four measures this analysis specifically looked at were obesity, occupation, gender and age.

Obesity

Body mass index (BMI) categories were:

• underweight – BMI less than 18.5
• normal – BMI 18.5 to 24.9
• overweight – BMI 25.0 to 29.9
• obese – BMI over 30

Because of the small sample size, the underweight and normal categories were aggregated into a single category for this analysis.

Occupation

Occupations were categorised into four groups:

• nurses
• other health professionals
• unregistered care workers (people who work in health or social care but don't have a related qualification)
• non-healthcare occupations

Sociodemographic characteristics

• gender was looked at because most nurses in England tend to be women
• data only included economically active people aged 17 to 65

Once these measures were accounted for, the final sample was reduced to 20,103.

This included 422 nurses, 412 other healthcare professionals, 736 unregistered care workers, and 18,533 respondents in non-healthcare occupations.

The prevalence of obesity was calculated in each occupation group and compared between nurses and other working groups.

What were the basic results?

The prevalence of obesity among the four occupation groups was:

• 31.88% for unregistered care workers (95% confidence interval [CI] 28.44% to 35.32%)
• 25.12% for nurses (95% CI 20.88% to 29.37%)
• 14.39% for other healthcare professionals (95% CI 11.00% to 17.77%)
• 23.51% for those in non-healthcare professions (95% CI 22.92% to 24.10%)

Similar patterns were also found when looking at the prevalence of overweight people in the four occupations.

Once the analysis was adjusted for age, sex and survey year, the results showed that:

• compared with nurses, the odds of being obese were 48% lower for other healthcare professionals (adjusted odds ratio [aOR] 0.52, 95% CI 0.37 to 0.75)
• the odds of being obese were 46% higher for unregistered care workers than nurses (aOR 1.46, 95% CI 1.11 to 1.93)
• there was no statistically significant difference between the prevalence of obesity in nurses and those working in non-healthcare occupations (aOR 0.94, 95% CI 0.74 to 1.18)

How did the researchers interpret the results?

The researchers concluded: "High obesity prevalence among nurses and unregistered care workers is concerning as it increases the risks of musculoskeletal conditions and mental health conditions that are the main causes of sickness absence in health services."

Conclusion

This cross-sectional study estimated the prevalence of obesity among health professionals in England, and compared the findings with rates among people who don't work in healthcare.

The highest levels of obesity were found in nurses and unregistered care workers.

But this data has some limitations in terms of its accuracy. The estimates for nurses and care workers were based on small numbers of survey respondents in these jobs.

The data is also at least five years out of date. As there's been a general rise in obesity in England over the past five years, the picture may have got worse.

Nevertheless, the high rates of obesity among nurses and care workers are important findings.

Although the study didn't look into the causes of these high rates, the researchers suggest they may be down to disruptive working patterns and shift work.

They believe their findings have implications for policy and practices and should encourage investment in staff health.

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