Evaluate work absence, work productivity, and disruption of work, social, and family life among individuals of varying body mass index (BMI) with or at risk for diabetes mellitus.
Design.
Cross-sectional analysis of survey data.
Setting.
Community-based U.S. population.
Subjects.
Respondents (n = 15,132; n = 7338 working adults) participating in the U.S. Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD) study were stratified by combinations of BMI (i.e., ≥ 30 kg/m2 [obese], 25 to 29.9 kg/m2 [overweight], and < 25 kg/m2 [normal weight]) and diabetes (i.e., type 2 diabetes mellitus [T2DM], type 1 diabetes mellitus [T1DM], and high risk [HR] or low risk [LR] of T2DM).
Measures.
Work impairment was measured using the Work Productivity and Activity Impairment Questionnaire: General Health. Disruption in life was measured using the Sheehan Disability Scale. HR was defined as 3 to 5 of the following factors: abdominal obesity, BMI ≥ 28 kg/m2, reported diagnosis of “cholesterol problems,” reported diagnosis of “hypertension,” or history of coronary heart disease or stroke. LR was defined as ≤ 2 of these factors.
Results.
Percentage of work impairment and proportion with severe disruption of work, family, and social life increased systematically from normal weight to obese (p < .001). Obese individuals had the greatest impairment at work (11%-15% of work time), greatest impairment of daily activities (20%-34% of time), and greatest overall impairment (11%-15% of time) in the LR, HR, and T2DM groups. Obesity and T2DM were independent predictors of overall work impairment and life disruption (p < .001). Between 5% and 7% of total variance was explained in the regression models with BMI category, diabetes/risk group, age, gender, race, income, and household size as variables.
Conclusion.
Greatest impairment of work and daily activities was evident among obese individuals for all groups.
National Center for Health Statistics. Prevalence of overweight and obesity among adults: US, 2003–2004. Available at: http://www.cdc.gov/nchs/fastats/overwt.html. Accessed September 14, 2008.
2.
KatzDLO'ConnellMYehMC. Public health strategies for preventing and controlling overweight and obesity in school and worksite settings: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep.2005;54:1–12.
3.
JefferyRW. Community programs for obesity prevention: the Minnesota Heart Health Program. Obes Res.1995;3(suppl 2):283s–288s.
4.
YeeSLWilliams-PiehotaPSorensenA. The Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases: monitoring progress in funded states. Prev Chronic Dis.2006;3:A23.
5.
BurtonSCreyerEHKeesJHugginsK. Attacking the obesity epidemic: the potential health benefits of providing nutrition information in restaurants. Am J Public Health.2006;96:1669–1675.
6.
State-specific prevalence of obesity among adults—United States, 2005. MMWR Morb Mortal Wkly Rep.2006;55:985–988.
7.
WangGZhengZJHeathG. Economic burden of cardiovascular disease associated with excess body weight in US adults. Am J Prev Med.2002;23:1–6.
8.
WolfAMColditzGA. Current estimates of the economic cost of obesity in the United States. Obes Res.1998;6:97–106.
9.
RicciJACheeE. Lost productive time associated with excess weight in the US workforce. J Occup Environ Med.2005;47:1227–1234.
10.
YuAPWuEQBirnbaumHG. Short-term economic impact of body weight change among patients with type 2 diabetes treated with antidiabetic agents: analysis using claims, laboratory, and medical record data. Curr Med Res Opin.2007;23:2157–2169.
11.
YancyWSJrOlsenMKWestmanEC. Relationship between obesity and health-related quality of life in men. Obes Res.2002;10:1057–1064.
12.
HassanMKJoshiAVMadhavanSSAmonkarMM. Obesity and health-related quality of life: a cross-sectional analysis of the US population. Int J Obes Relat Metab Disord.2003;27:1227–1232.
13.
GroesslEJKaplanRMBarrett-ConnorEGaniatsTG. Body mass index and quality of well-being in a community of older adults. Am J Prev Med.2004;26:126–129.
14.
FordESMoriartyDGZackMM. Self-reported body mass index and health-related quality of life: findings from the Behavioral Risk Factor Surveillance System. Obes Res.2001;9:21–31.
15.
JiaHLubetkinEI. The impact of obesity on health-related quality-of-life in the general adult US population. J Public Health (Oxf).2005;27:156–164.
16.
OkosunISChoiSMatamorosTDeverGE. Obesity is associated with reduced self-rated general health status: evidence from a representative sample of white, black, and Hispanic Americans. Prev Med.2001;32:429–436.
17.
SturmRWellsKB. Does obesity contribute as much to morbidity as poverty or smoking?Public Health.2001;115:229–235.
18.
DixonJBDixonMEO'BrienPE. Depression in association with severe obesity: changes with weight loss. Arch Intern Med.2003;163:2058–2065.
19.
FlegalKMCarrollMDOgdenCLJohnsonCL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA.2002;288:1723–1727.
20.
GiovannucciEAscherioARimmEB. Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann Intern Med.1995;122:327–334.
21.
WilsonPWD'AgostinoRBSullivanL. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med.2002;162:1867–1872.
22.
FieldAECoakleyEHMustA. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med.2001;161:1581–1586.
23.
WangTJPariseHLevyD. Obesity and the risk of new-onset atrial fibrillation. JAMA.2004;292:2471–2477.
24.
TuckerLAFriedmanCM. Obesity and absenteeism: an epidemiologic study of 10,825 employed adults. Am J Health Promot.1998;12:202–207.
25.
PronkNPMartinsonBKesslerRC. The association between work performance and physical activity, cardiorespiratory fitness, and obesity. J Occup Environ Med.2004;46:19–25.
26.
HertzRPUngerANMcDonaldM. The impact of obesity on work limitations and cardiovascular risk factors in the US workforce. J Occup Environ Med.2004;46:1196–1203.
27.
TunceliKBradleyCJNerenzD. The impact of diabetes on employment and work productivity. Diabetes Care.2005;28:2662–2667.
28.
VijanSHaywardRALangaKM. The impact of diabetes on workforce participation: results from a national household sample. Health Serv Res.2004;39:1653–1669.
29.
MusichSHookDBaanerSEdingtonDW. The association of two productivity measures with health risks and medical conditions in an Australian employee population. Am J Health Promot.2006;20:353–363.
30.
KannanHThompsonSBolgeSC. Economic and humanistic outcomes associated with comorbid type-2 diabetes, high cholesterol, and hypertension among individuals who are overweight or obese. J Occup Environ Med.2008;50:543–549.
31.
SullivanPWGhushchyanVWyattHR. Productivity costs associated with cardiometabolic risk factor clusters in the United States. Value Health.2007;10:443–450.
32.
BaysHEChapmanRHGrandyS. , for the SHIELD Investigators' Group. The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia: comparison of data from two national surveys. Int J Clin Pract.2007;61:737–747.
33.
BaysHEBazataDDClarkNG. Prevalence of self-reported diagnosis of diabetes mellitus and associated risk factors in a national survey in the US population: SHIELD (Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes). BMC Public Health.2007;7:277.
34.
US Census Bureau. Annual Supplement to the Current Population Survey: Census Bureau Resident Population Estimates of the United States.Washington, DC: US Census Bureau; 2003.
35.
American Diabetes Association. Standards of medical care in diabetes–2007. Diabetes Care.2007;30(S1):S4–S41.
36.
Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults: Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA.2001;285:2486–2497.
37.
ReillyMCZbrozekASDukesEM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics.1993;4:353–365.
38.
LeonACOlfsonMPorteraL. Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. Int J Psychiatry Med.1997;27:93–105.
39.
ReillyMCTannerAMeltzerEO. Work, classroom and activity impairment instruments: validation studies in allergic rhinitis. Clin Drug Invest.1996;11:278–288.
40.
ReillyMCLavinPTKahlerKHPariserDM. Validation of the dermatology life quality index (DLQI) and the work productivity and activity impairment: chronic hand dermatitis questionnaire (WPAI-ChHD) in chronic hand dermatitis (ChHD). J Am Acad Dermatol.2003;48:128–130.
41.
WahlqvistPCarlssonJStalhammarN-OWiklundI. Validity of a work productivity and activity impairment questionnaire for patients with symptoms of gastro-esophageal reflux disease (WPAI-GERD)—results from a cross-sectional study. Value Health.2002;5: 106–113.
42.
KobeltGBorgstromFMattiassonA. Productivity, vitality and utility in a group of healthy professionally active individuals with nocturia. Br J Urol Int.2003;9:190–195.
43.
AndreassonESvenssonKBerggrenF. The validity of the work productivity and activity impairment questionnaire for patients with asthma (WPAI-asthma): results from a web-based study [abstract]. Value Health.2003;6:780.
44.
ReillyMCBraccoARicciJF. The validity and accuracy of the work productivity and activity impairment questionnaire—irritable bowel syndrome version (WPAI:IBS). Aliment Pharmacol Ther.2004;20:459–467.
45.
JacobsRJDavidsonJRGuptaSMeyerhoffAS. The effects of clonazepam on quality of life and work productivity in panic disorder. Am J Manag Care.1997;3:1187–1196.
46.
MeltzerEOCasaleTBNathanRAThompsonAK. Once daily fexofenadine HCl improves quality of life and reduces work and activity impairment in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol.1999;83:311–317.
47.
DeanBCrawleyJSchmittCM. The burden of illness of gastro-oesophageal reflux disease: impact on work productivity. Aliment Pharmacol Ther.2003;17:1309–1317.
48.
WittchenHUBelochE. The impact of social phobia on quality of life. Int Clin Psychopharmacol.1996;11:15–23.
49.
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Am J Clin Nutr.1998;68: 899–917.
50.
ArenaVCPadiyarKRBurtonWNSchwerhaJJ. The impact of body mass index on short-term disability in the workplace. J Occup Environ Med.2006;48:1118–1124.
51.
TunceliKLiKWilliamsLK. Long-term effects of obesity on employment and work limitations among US adults, 1986 to 1999. Obesity.2006;14:1637–1646.
