Letter re: On Dietary Habits of Healthcare Workers and Association With Burnout

Dear Editor,

I read with interest Utter et al.’s (2023) article on dietary behaviors of healthcare professionals (HCPs) and the association with burnout. ¹ In this study, the authors found that less than 40% of HCPs surveyed had excellent or very good dietary habits; in particular, there was inadequate consumption of fruits and vegetables, with excessive intake of sweetened drinks. ¹ Interestingly, the article further reported an association between poor dietary habits among HCPs and higher rates of self-reported burnout. ¹ While this is a highly commendable study which draws attention to a prevalent occupational health problem of poor nutrition and eating habits among HCPs, with its associated mental health implications, I herein highlight two areas for further discussion: firstly, the difficulties in establishing a cause–effect relationship between nutrition and burnout from this study, and secondly, consideration possible contributory factors and practical solutions to poor dietary habits of HCPs.

Firstly, burnout is a highly prevalent psychological phenomenon afflicting HCPs, with multiple identified risk factors such as personal attributes, work-related factors, and systemic/organizational variables. ² Among physicians, work-related variables such as heavy clinical load, long working hours, and regular on-call duties are known risk factors for burnout. ² Consequently, it is probable that those who are predisposed to burnout from unfavorable working conditions would also be more likely to skip meals or have poor dietary habits due to inadequate or irregular mealtimes. Hence, the study could be improved if more co-variates were incorporated, with multivariable analysis performed to rule out potential confounders that could influence the association between nutrition of HCPs and the risk of burnout. In addition, this is also a cross-sectional study that makes it impossible to draw a definitive conclusion on temporal association between studied variables. Logically, it is indeed possible that HCPs who suffer from burnout end up having poorer and unhealthy dietary choices as a result of their mental state rather than the other way around.

Secondly, I highlight several work-related barriers to good nutrition such as lack of proper meal times due to heavy workload, work scheduling issues, and personal work ethic/professionalism (always putting patients and work first) as well as having limited access to healthy food choices at workplaces.^3-5 Besides, unhealthy food and drink choices may be exacerbated by certain occupational habits, for example, the practice of “coffee rounds” during office hours, or obtaining snacks and drinks during night shifts or on-call duties from the nearest convenience stores and vending machines. To mitigate these contributors to unhealthy dietary patterns among HCPs, there are practical strategies that can be implemented, such as scheduled meal breaks, ⁶ encouraging pre-packed/home-cooked meals, ³ healthy nutritional messaging, ⁷ and increasing the availability of healthy food choices in hospitals. ⁷ However, there should also be proper and adequate hospital infrastructure (e.g., well-equipped pantry areas) for storage of ready-to-eat meal items and consumption of food during scheduled breaks. Otherwise, if there are inadequate food storage areas in the hospital, ⁴ this can increase the risk of contamination of pre-prepared food items leading to food-borne infections. ⁸