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. Author manuscript; available in PMC: 2015 Dec 16.
Published in final edited form as: J Occup Environ Med. 2014 May;56(5):516–528. doi: 10.1097/JOM.0000000000000133

Prevalence of Obesity by Occupation Among US Workers

The National Health Interview Survey 2004–2011

Ja K Gu 1, Luenda E Charles 1, Ki Moon Bang 1, Claudia C Ma 1, Michael E Andrew 1, John M Violanti 1, Cecil M Burchfiel 1
PMCID: PMC4681272  NIHMSID: NIHMS742401  PMID: 24682108

Abstract

Objective

To estimate the prevalence of obesity and the change of prevalence of obesity between 2004–2007 and 2008–20011 by occupation among US workers in the National Health Interview Survey.

Methods

Self-reported weight and height were collected and used to assess obesity (body mass index ≥ 30 kg/m2). Gender-, race/ethnicity-, and occupation-specific prevalence of obesity were calculated.

Results

Prevalence of obesity steadily increased from 2004 through 2008 across gender and race/ethnicity but leveled off from 2008 through 2011. Non-Hispanic black female workers in health care support (49.2%) and transportation/material moving (46.6%) had the highest prevalence of obesity. Prevalence of obesity in relatively low-obesity (white-collar) occupations significantly increased between 2004–2007 and 2008–2011, whereas it did not change significantly in high-obesity (blue-collar) occupations.

Conclusions

Workers in all occupational categories are appropriate targets for health promotion and intervention programs to reduce obesity.

The number of obese (body mass index [BMI] ≥ 30 kg/m2) individuals in the United States has steadily increased over the past 30 years.1 Data from the 2009–2010 National Health and Nutrition Examination Survey show that the prevalence of obesity has reached 40% among US adults.2 Results from the National Health and Nutrition Examination Survey show that the prevalence of obesity among women is much higher than among men and it is also higher among non-Hispanic (NH) blacks than among other racial/ethnic groups. Obesity and overweight (BMI ≥ 25 kg/m2) are linked to an increased risk of developing hypertension, dyslipidemia, type 2 diabetes, metabolic syndrome, stroke, coronary heart disease, sleep apnea, gallstones, ovulatory infertility, osteoarthritis, and some cancers (colon, breast, endometrial, and gallbladder).3 In addition, recent studies have found that obesity is a risk factor for dementia,4 proteinuria,5 gout,6 hirsutism,7 and urinary incontinence.8

Even though the prevalence of obesity in US workers has been lower than in the general US population, the prevalence by gender and race/ethnicity in US workers has shown a similar pattern to the US general population (ie, higher prevalence in women and highest in NH blacks).9, 10 Obesity among workers may have adverse occupation-related consequences.9,11,12 Each profession has different job characteristics (labor vs sedentary, shift vs non-shift, most often regular hours vs frequent overtime, non-stressful vs stressful), and there may be differences in prevalence of obesity by occupation type. Caban and colleagues,10 for the first time, published prevalence of obesity by occupation among US workers during the periods of 1986–1995 and 1997–2002. Their analyses of data during the period of 1997–2002 showed that the occupations with the highest overall prevalence of obesity were motor vehicle operation (31.7%) and police and firefighting (29.8%) for male workers in 41 occupational categories. The highest overall prevalence of obesity for female workers was in the occupations of motor vehicle operation (31.0%) and other protective service (30.5%). The occupations having the lowest prevalence during the same period were health technologists/technicians (13.7%) and architects/surveyors (14.5%) for male workers, and construction/extractive trades (6.9%) and architects/survey (7.3%) for female workers. During the period of 1986–2002, the prevalence of obesity among US workers significantly increased regardless of race and gender. Nevertheless, the trend of prevalence of obesity after 2002 among US workers has not been reported.

The aims of this study were (1) to estimate the prevalence of obesity by occupation among US workers over the 8-year period from 2004 through 2011 using the latest National Health Interview Survey (NHIS) public released data and (2) to compare the prevalence of obesity in both 23 major occupational groups and selected subgroups by race/ethnicity. We also compared the prevalence of obesity changes between 2004–2007 and 2008–20011 by occupations in each gender and racial/ethnic group.

METHODS

Study Population

Temporal individual-level data on obesity were derived from the 2004−2011 NHIS. The NHIS, which is developed and administered by National Center for Health Statistics in the US Centers for Disease Control and Prevention, is a nationwide survey on the health of the civilian noninstitutionalized US population.13 The NHIS is a national representative of in-person household interview conducted annually and based on a multistage clustered area probability sample. The total initial interviewed sample size from the Sample Adults survey (aged 18 years or older) in 2004−2011 was 220, 105, with an average response rate of 79.8%. We included paid workers aged 18 years and older who were “working at a job or business” or “with a job or business but not at work” and also included unpaid workers who were “working, but not for pay, at a job or business” during the week prior to their interview. The final sample size used in our analyses was 125,992 working adults, after excluding those who did not work during the week before the interview survey (n = 87,890) and those who were pregnant or missing the BMI variable (n = 6223).

Body Mass Index

Body mass index was used to assess obesity, calculated by dividing weight in kilograms by height in meters squared. In the Sample Adults questionnaire, participants were asked their height in inches (“How tall are you without shoes?”) and their weight in pounds (“How much do you weigh without shoes?”). If participants’ BMI measurements were 30 or greater, they were classified as obese.

Employment, Occupation, and Race/Ethnicity

Employment information was collected on all adults 18 years or older who reported working during the week before the NHIS survey and included paid and unpaid workers.

Occupational coding in the NHIS public use data files utilized 2-digit codes with 23 broad (major) occupational groups and 93 minor occupational groups. These 2-digit codes were based on the Standard Occupation Classification, which is produced by the US Census Bureau. Data prior to 2004 were not included in these occupational groups since the public use data files prior to 2004 contained 14 major occupational groups and 42 minor occupational groups. In the analysis tables for NH white, we show both 23 major and 93 minor occupational groups. Nevertheless, in the prevalence tables for NH blacks and Hispanics, we show 23 major and limited minor occupational groups because there were insufficient sample sizes. Race/ethnicity was self-reported and was classified as NH white, NH black, Hispanic, and NH others.

Statistical Analysis

We combined NHIS data across years using the NHIS guidelines as presented in the following reports: Variance Estimation and Other Analytic Issues, NHIS 1995–2005, and Variance Estimation and Other Analytic Issues, NHIS 2006–2010.14 To more accurately represent the population of the United States, all analyses were performed using a weighting variable, which was divided by 8 to take into consideration the 8 survey years 2004–2011. To attain unbiased estimates from the NHIS data, all analyses were weighted to account for the complex survey design and survey nonresponse using the SAS-callable SUDAAN v12 software (Research Triangle Institute, Research Triangle Park, NC). Standard errors were estimated using Taylor series linearization methods. Analyses were conducted separately for males and females by race/ethnicity. The sample size, the age-adjusted prevalence of obesity, and the percent change in prevalence of obesity between 2004–2007 and 2008–2011 are shown in Tables 1 to 4. A weighted linear regression model was fitted to the annual design-adjusted rates (ie, the slope in Table 1). The weight used for each annual rate was the inverse of its variance. Prevalence estimates that are derived from sample sizes less than 50 or relative standard errors (calculated as standard error of prevalence divided by prevalence) greater than 0.3 should be considered unreliable estimates.15 All unreliable prevalence estimates are marked with an asterisk (*) in the tables. The two-sample t test was used to test the prevalence difference between the two time periods (2004–2007 vs 2008–2011) for each occupational group. If the difference was statistically significant (P < 0.05), we placed a symbol (†) beside the prevalence difference.

TABLE 1.

Prevalence of Obesity (BMI ≥30 kg/m2) and Trends in Obesity Among US Workers, 2004–2011.

Sample Size Estimated US Population Overall Prevalence* Prevalence of Obesity* 2004–2011
2004 2005 2006 2007 2008 2009 2010 2011 Slope (SE)† P
Overall 125,992 134,218,503 26.2 23.5 24.9 25.4 26.0 26.8 27.4 27.7 27.6 0.607 (0.063) <0.001
Male all 64,086 73,709,744 26.9 24.0 25.8 26.0 27.3 27.3 28.2 28.2 28.4 0.594 (0.086) <0.001
 White (non-Hispanic) 39,600 51,082,726 27.0 24.0 26.5 26.8 27.0 27.6 27.7 28.1 28.1 0.494 (0.115) 0.005
 Black (non-Hispanic) 7,652 7,199,154 31.7 29.0 29.7 29.2 33.4 29.3 35.3 32.7 35.3 0.845 (0.259) 0.017
 Hispanic 12,771 11,466,438 28.2 25.0 24.1 25.4 28.2 29.8 31.1 30.4 30.8 1.087 (0.172) 0.001
 Others (non-Hispanic) 4,063 3,899,332 13.8 11.4 12.6 12.7 18.1 11.5 13.6 15.4 14.6 0.407 (0.281) 0.197
Female all 61,906 60,508,759 25.3 22.9 23.8 24.5 24.3 26.3 26.5 27.0 26.7 0.605 (0.074) <0.001
 White (non-Hispanic) 37,110 42,357,885 23.1 20.6 21.3 22.9 23.2 23.7 24.4 24.5 24.1 0.571 (0.086) 0.001
 Black (non-Hispanic) 10,661 7,764,020 40.0 38.6 36.0 38.3 37.6 41.3 41.8 42.2 43.5 0.939 (0.218) 0.005
 Hispanic 10,491 7,029,058 28.5 25.1 29.3 26.6 24.9 30.8 28.4 30.4 31.5 0.746 (0.296) 0.046
 Others (non-Hispanic) 3,644 3,357,796 12.1 10.6 15.6 9.3 7.2 13.7 13.6 17.0 9.7 0.138 (0.515) 0.797
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*

The unit of prevalence of obesity is percent (%).

†

A weighted linear regression model was fitted to the annual design-adjusted rates. The weight used for each annual rate was the inverse of its variance.

TABLE 4.

Age-Adjusted Prevalence of Obesity Among Hispanic Adults by 23 Major and Selected Minor Occupational Groups

Occupational Group Hispanic Male Workers
Hispanic Female Workers
Sample Size
2004–11		 Prevalence*
2004–11		 Prevalence*
2004–07		 Prevalence*
2008–11		 Prevalence*
Difference† 		Sample Size
2004–11		 Prevalence*
2004–11		 Prevalence*
2004–07		 Prevalence*
2008–11		 Prevalence*
Difference†
All non-Hispanic Male 12,771 28.6 25.8 30.4 4.6‡ 10,491 29.1 26.6 30.2 3.6‡
  1. Management 607 29.9 31.6 28.5 −3.1 484 25.9 21.4 29.5 8.1
  2. Business and financial operations 207 31.3 29.7 31.6 1.9 333 28.6 22.4 32.9 10.5‡
  3. Computer and Mathematics 184 37.3 36.9 40.5 3.6 67 29.1 7.3§ 4.8§ ‖
  4. Architecture and Engineering 174 34.6 22.9 44.4 21.5‡ 38 24.9§ ‖
  5. Life, physical, and social science 50 38.7 – – ‖ 55 23.9 3.4§ 0.0§ ‖
  6. Community and social services 91 40.5 34.8§ 46.3 ‖ 183 34.8 28.2 39.1 10.9
  7. Legal 26 30.6§ ‖ 77 26.3 10.5§ 16.5§ ‖
  8. Education, training, and library 172 31.6 28.3 34.6 6.3 661 28.8 25.2 31.7 6.5
  9. Arts, design, entertainment, sports and media 140 27.1 23.9 27.4 3.5 131 18.6 15.4 21.1 5.7
10. Health care practitioners and technicians 135 34.5 39.2 30.5 −8.7 369 30.4 29.9 31.7 1.8
 Health diagnosing and treating practitioners 80 27.3 16.3§ 37.6§ ‖ 209 29.5 27.5 31.8 4.3
 Health technologists and technicians 53 43.1 62.8§ 19.9§ ‖ 159 33.4 32.0 33.7 1.7
11. Health care support 77 24.7 13.5§ 33.1§ ‖ 549 33.2 33.6 32.8 −0.8
 Nursing, psychiatric, and home health aides 46 27.0§ ‖ 342 32.4 35.8 29.4 −6.4
12. Protective service 309 43.2 38.0 47.0 9.0 89 25.3 29.1§ 0.0§ ‖
 Firefighting and prevention workers 26 25.1§ ‖ 1 0.0§ ‖
 Law enforcement workers 131 39.9 30.3 45.7 15.4 35 18.3§ ‖
 Others protective service 133 54.3 58.5 50.7 −7.8 48 25.5§ ‖
13. Food preparation and serving related 996 21.9 21.9 21.6 −0.3 869 31.1 32.3 29.7 −2.6
 Supervisors 101 24.4 26.4 24.1§ ‖ 85 39.6 34.5§ 39.0§ ‖
 Cooks and food preparation workers 534 26.1 24.9 26.0 1.1 399 34.2 39.1 27.8 −11.3
 Food and beverage serving working 194 14.2 15.5§ 13.2§ ‖ 296 20.9 14.9 26.6 11.7‡
14. Building and grounds cleaning and maintenance 1,081 23.2 22.1 24.1 2.0 1,165 25.5 25.3 25.6 0.3
 Supervisors 56 38.7 40.5§ 38.5§ ‖ 34 31.7§ ‖
 Building cleaning and pest control workers 494 24.3 23.7 25.3 1.6 1,115 25.4 25.0 25.7 0.7
 Grounds maintenance workers 531 20.6 18.8 22.1 3.3 16 13.9§ ‖
15. Personal care and service 138 32.2 28.3 35.3 7.0 712 31.5 32.0 30.6 −1.4
16. Sales and related 822 31.2 26.9 36.1 9.2‡ 1,149 26.1 21.6 29.9 8.3‡
 Supervisors 232 36.3 32.6 38.3 5.7 195 23.8 16.0 30.2 14.2
 Retail sales workers 351 29.4 23.5 35.2 11.7 709 28.2 23.4 31.8 8.4‡
17. Office and administrative support 813 30.3 29.3 30.8 1.5 1,904 30.9 29.6 32.1 2.5
18. Farming, fishing, and forestry 357 21.7 22.0 21.2 −0.8 133 31.3 32.5 28.3 −4.2
 Agricultural workers 324 20.9 20.2 22.2 2.0 129 31.3 32.1 29.1 −3.0
19. Construction and extraction 2,445 25.9 22.7 29.5 6.8‡ 35 5.2§ 4.9§ 4.6§ ‖
 Supervisors 136 42.1 37.1 45.1 8.0 5 0.0§ ‖
 Construction trades workers 2,182 23.7 20.9 26.8 5.9‡ 26 7.5§ ‖
20. Installation, maintenance, and repair 826 30.9 29.4 32.3 2.9 39 21.8§ ‖
21. Production 1,341 26.0 22.5 30.5 8.0‡ 862 25.5 22.3 29.4 7.1
22. Transportation and material moving 1,391 32.3 30.2 34.2 4.0 310 36.4 32.2 40.4 8.2
 Motor vehicle operators 641 38.3 36.8 39.6 2.8 70 52.4 36.6§ 63.4§ ‖
 Material moving workers 672 27.4 25.2 29.2 4.0 222 33.8 32.4 35.4 3.0
23. Military specific 11 7.6§ ‖ 2 0.0§ ‖
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*

The unit of prevalence of obesity is percent (%).

†

Prevalence difference between 2008–2011 and 2004–2007.

‡

Statistically significant difference (P <0.05) between prevalence in 2008–2011 and prevalence in 2004–2007.

§

The obesity estimate is unreliable because the relative standard error of the estimate is larger than 30% or the sample size is less than 50.15

‖

(Percent change is not calculated because the prevalence in either 2004–2007 or 2008–2011 is unreliable or no data exist.

Rate of prevalence of obesity for 2004–2007 (or 2008–2011) is not estimated because the rate for 2004–2011 is unreliable.

RESULTS

The mean age for the all workers in this study from 2004 to 2011 was 41.3 (SE = 13.5) years, with women comprising 45.1% of the study sample. Table 1 shows the trends in prevalence of obesity by race/ethnicity among male and female workers. Annual prevalence of obesity increased significantly between 2004 and 2011 among all racial/ethnic groups except NH others. During this period, the fastest growing prevalence of obesity was among Hispanic male workers (slope = 1.087, P = 0.001). Among male workers, the prevalence of obesity for Hispanics surpassed that for NH whites from 2007 through 2011. The overall prevalence of obesity was highest among NH black female workers (40.0%) and lowest among NH white female workers (23.1%).

Table 2 presents the age-adjusted prevalence of obesity and obesity change in percent between 2004–2007 and 2008–2011 among NH whites for 23 major and 93 minor occupational groups. In the 23 major occupational groups, the highest prevalence of obesity was found for NH white males who worked in health care support (36.3%), followed by protective service (34.3%), and transportation and material moving (33.7%). Between the 2 periods (2004–2007 vs 2008–2011), the prevalence of obesity among male employees in computer and mathematics, legal area, and protective service significantly increased—10.4% (P <0.001), 8.3% (P = 0.047), and 8.1% (P = 0.015), respectively. There were decreases in prevalence of obesity in farming/fishing/forestry (−4.7%), personal care and service (−2.8%), and transportation and−material moving (−2.4%), but these differences were not significant. In the 93 minor occupational groups, individuals with the highest age-adjusted prevalence of obesity were used as motor vehicle operators (39.2%), other construction and related workers (38.6%), law enforcement workers (38.2%), and nursing, psychiatric, and home health aides (38.1%), whereas the lowest age-adjusted prevalence of obesity was observed among individuals used as health diagnosing and treating practitioners (15.4%), military specific (16.1%), art and design workers (16.6%), and post-secondary teachers (16.8%). The first-line supervisors/managers of protective service had the largest increase in prevalence of obesity (21.0%, P = 0.011), followed by the counselors/social workers/other community/social service specialists (17.5%, P = 0.013). Among NH males, we observed decreased prevalence of obesity in one third of 93 occupations but none of these were statistically significant.

TABLE 2.

Age-Adjusted Prevalence of Obesity Among Non-Hispanic White Adults by 23 Major and 93 Minor Occupational Groups

Occupational Group Non-Hispanic White Male Workers
Non-Hispanic White Female Workers
Sample Size
2004–11		 Prevalence*
2004–11		 Prevalence*
2004–07		 Prevalence*
2008–11		 Prevalence*
Difference† 		Sample Size
2004–11		 Prevalence*
2004–11		 Prevalence*
2004–07		 Prevalence*
2008–11		 Prevalence
Difference†
All non-Hispanic 39,600 27.0 26.1 27.9 1.8‡ 37,110 21.6 22.0 24.2 2.2‡
1. Management 5,214 26.0 25.2 26.9 1.7 3,175 20.6 18.5 22.6 4.1‡
 Chief executives, general and operations managers; legislators 903 28.3 28.4 28.2 −0.2 334 20.5 16.4 24.2 7.8
 Advertising, marketing, promotions, public relations, and sales managers 303 21.1 22.7 20.4 −2.3 262 16.4 16.1 17.5 1.4
 Operations specialties managers 834 29.7 30.5 29.2 −1.3 631 22.2 22.1 22.5 0.4
 Others 3,174 25.1 23.3 26.9 3.6 1,948 20.7 17.7 23.8 6.1‡
2. Business and financial operations 1,719 24.9 23.8 25.7 1.9 1,983 21.9 20.1 23.6 3.5
 Business operations specialists 865 27.0 25.3 28.7 3.4 1,009 20.4 18.8 21.9 3.1
 Financial specialists 854 22.7 22.7 22.3 −0.4 974 23.5 21.2 25.6 4.4
3. Computer and Mathematics 1,514 27.0 20.7 31.1 10.4‡ 574 26.1 23.2 27.4 4.2
 Computer specialists 1,465 27.0 20.7 30.9 10.2‡ 517 26.9 23.8 28.4 4.6
 Mathematical science occupations 49 27.0§ ‖ ‖ 60 19.3§ 23.1§ 16.7§ 1
4. Architecture and Engineering 1,409 26.0 23.7 28.3 4.6 264 21.7 21.1 21.3 0.2
 Architects, surveyors, and cartographers 111 22.4 20.6§ 24.0§ 34 10.8§ ‖ ‖ 1
 Engineers 960 25.5 23.8 27.6 3.8 167 18.3 17.7 17.7 0.0
 Drafters, engineering, and mapping technicians 338 29.3 25.6 32.2 6.6 63 37.6 25.1§ 42.9§
5. Life, physical, and social science 466 21.5 18.8 24.3 5.5 431 12.3 11.2 13.8 2.6
 Life scientists 110 22.2 21.1 24.4 3.3 103 4.7§ ‖ ‖
 Physical scientists 136 22.9 19.6 26.1 6.5 59 11.4 8.7§ 19.6§
 Social scientists and related workers 118 18.8 15.0§ 23.3 191 13.0 10.7 15.7 5.0
 Life, physical, and social science technicians 102 23.8 21.8 26.0§ 78 22.6 22.4 26.7 1
6. Community and social services 484 32.7 30.0 36.1 6.1 805 24.3 24.2 24.9 0.7
 Counselors, social workers, and other community and social service specialists 223 34.1 27.4 44.9 17.5‡ 705 24.5 24.0 25.0 1.0
 Religious workers 261 30.7 32.2 26.0 −6.2 100 22.1 24.6 23.5§ 1
7. Legal 543 21.8 17.8 26.1 8.3‡ 533 14.8 14.2 14.9 0.7
 Lawyers, judges, and related workers 465 21.1 18.7 24.0 5.3 207 11.5 11.1 9.9 −1.2
 Legal support workers 78 26.6 14.2§ 41.4§ 324 17.0 15.4 18.8 3.4
8. Education, training, and library 1,439 22.7 22.6 22.9 0.3 3,985 18.7 16.8 20.8 4.0‡
 Postsecondary teachers 465 16.8 19.3 14.7 −4.6 470 16.1 15.5 16.8 1.3
 Primary, secondary, and special education school teachers 732 27.0 26.1 27.8 1.7 2,566 18.4 15.6 20.8 5.2‡
 Other teachers and instructors 151 22.3 19.4 27.3 7.9 282 18.4 15.3 21.6 6.3
 Librarians, curators, and archivists 43 9.8§ ‖ ‖ 181 25.8 18.1 30.0 11.9
 Other educations, training, and library occupations 48 18.4§ ‖ ‖ 486 22.4 23.4 21.6 −1.8
9. Arts, design, entertainment, sports and media 930 20.2 21.4 19.1 −2.3 891 15.5 15.5 15.5 0.0
 Art and design workers 325 16.6 18.3 14.8 −3.5 356 14.5 13.6 14.8 1.2
 Entertainers and performers, sports and related workers 238 21.9 22.1 22.4 0.3 156 17.9 15.0§ 19.1§
 Media and communications workers 240 23.6 21.4 26.1 4.7 331 16.4 16.4 16.5 0.1
 Media and communication equipment workers 127 21.4 30.4 15.9§ 48 14.0§ ‖ ‖
10. Healthcare practitioners and technicians 1,042 18.9 20.2 17.6 −2.6 3,358 20.9 18.1 23.6 5.5‡
 Health diagnosing and treating practitioners 772 15.4 16.6 13.9 −2.7 2,357 19.3 16.1 22.4 6.3‡
 Health technologists and technicians 239 29.8 32.9 26.3 −6.6 989 24.7 23.6 26.4 2.8
 Others 31 11.4§ ‖ ‖ 12 16.3§ ‖ ‖
11. Healthcare support 158 36.3 32.9 38.3 5.4 1,278 29.2 27.2 31.0 3.8
 Nursing, psychiatric, and home health aides 91 38.1 29.8§ 48.6§ 710 32.5 30.0 34.3 4.3
 Occupational and physical therapist assistants and aides 10 9.6§ ‖ ‖ 30 27.2§ ‖ ‖
 Others 57 36.3 33.1§ 30.7§ 538 25.1 25.0 26.5 1.5
12. Protective service 1,149 34.3 30.3 38.4 8.1‡ 287 28.8 25.1 33.9 8.8
 First-line supervisors/managers 131 34.6 24.8 45.8 21.0‡ 15 40.1§ ‖ ‖
 Firefighting and prevention workers 156 30.4 22.3 36.5 14.2 9 0.0§ ‖ ‖
 Law enforcement workers 517 38.2 36.0 40.5 4.5 124 27.3 23.7 31.6 7.9
 Others 345 27.3 23.0 29.2 6.2 139 30.8 29.4 36.7 7.3
13. Food preparation and serving related 1,124 27.3 27.5 27.5 0.0 2,059 23.6 23.2 24.2 1.0
 Supervisors 231 27.6 29.0 27.7 −1.3 203 36.6 40.2 31.5 −8.7
 Cooks and food preparation workers 373 32.0 34.1 34.1 0.0 517 29.7 28.6 31.5 2.9
 Food and beverage serving working 420 19.7 20.6 21.2 0.6 1,171 18.1 15.3 21.0 5.7
 Others 100 35.9 36.7 38.1 1.4 168 24.9 23.6 25.5 1.9
14. Building and grounds cleaning and maintenance 1,266 29.7 27.6 31.9 4.3 824 25.9 25.6 26.5 0.9
 Supervisors 190 37.3 39.0 35.4 −3.6 62 30.4 30.4§ 26.3§
 Building cleaning and pest control workers 673 29.7 26.5 33.2 6.7 704 26.9 25.8 28.6 2.8
 Grounds maintenance workers 403 27.7 27.1 28.7 1.6 58 9.5§ ‖ ‖
15. Personal care and service 405 24.5 25.9 23.1 −2.8 1,825 25.4 27.0 24.3 −2.7
 Supervisors 23 34.9§ ‖ ‖ 51 13.9§ ‖ ‖
 Animal care and service workers 28 26.7§ ‖ ‖ 126 21.3 23.8§ 21.5
 Entertainment attendants and related workers 88 31.2 31.2§ 27.4§ 70 22.9 9.4§ 29.5§
 Funeral service workers 9 13.3§ ‖ ‖ 3 7.0§ ‖ ‖
 Personal appearance workers 60 18.0 22.6§ 13.0§ 452 18.7 20.6 18.3 −2.3
 Transportation, tourism, and lodging attendants 34 15.8§ ‖ ‖ 49 13.8§ ‖ ‖
 Others 163 21.0 27.4 16.3 −11.1 1,074 30.1 32.0 28.5 −3.5
16. Sales and related 4,373 26.2 25.1 27.3 2.2 4,033 22.4 22.2 22.6 0.4
 Supervisors 1,343 26.6 26.8 26.1 −0.7 980 20.3 19.2 22.0 2.8
 Retail sales workers 1,244 27.6 26.4 29.2 2.8 1,789 26.5 26.0 27.0 1.0
 Sales representatives, services 702 23.1 22.9 23.2 0.3 455 19.7 19.5 19.6 0.1
 Sales representatives, wholesale and manufacturing 618 30.2 25.3 35.0 9.7‡ 239 14.0 15.7 14.0 −1.7
 Others 466 22.6 19.7 26.2 6.5 570 20.0 21.8 18.4 −3.4
17. Office and administrative support 2,363 28.5 29.4 27.6 −1.8 7,841 26.7 25.9 27.8 1.9
 Supervisors 218 30.5 29.1 32.5 3.4 572 26.1 25.8 26.7 0.9
 Communications equipment operators 9 46.4§ ‖ ‖ 43 19.6§ ‖ ‖
 Financial clerks 185 33.5 34.8 35.0 0.2 1,470 28.0 26.9 29.1 2.2
 Information and record clerks 579 30.5 30.1 29.6 −0.5 1,908 26.7 27.0 26.5 −0.5
 Material recording, scheduling, dispatching, and distributing workers 962 28.8 31.0 26.6 −4.4 718 27.4 25.9 29.2 3.3
 Secretaries and administrative assistants 77 25.4 41.7§ 12.9§ 1,826 23.4 23.1 23.9 0.8
 Others 333 20.9 22.0 22.4 0.4 1,304 29.7 27.2 32.7 5.5
18. Farming, fishing, and forestry 302 29.3 31.1 26.4 −4.7 79 35.9 44.0§ 24.3§
 Supervisors 23 31.1§ ‖ ‖ 4 0.0§ ‖ ‖
 Agricultural workers 200 29.1 32.4 24.9 −7.5 71 38.9 45.5§ 27.5§
 Fishing and hunting workers 30 24.6§ ‖ ‖ 2 0.0§ ‖ ‖
 Forest, conservation, and logging workers 49 24.3§ ‖ ‖ 2 0.0§ ‖ ‖
19. Construction and extraction 3,792 26.3 24.0 28.5 4.5 136 16.4 17.4 15.7§
 Supervisors 443 28.2 29.3 26.9 −2.4 15 11.4§ ‖ ‖
 Construction trades workers 3,025 25.0 22.3 27.6 5.3‡ 107 19.8 22.6 16.0
 Helpers, construction trades 25 31.2§ ‖ ‖ 3 15.7§ ‖ ‖
 Other construction and related workers 213 38.6 37.8 39.3 1.5 11 4.9§ ‖ ‖
 Extraction workers 86 29.1 – – – 0 0§ ‖ ‖
20. Installation, maintenance, and repair 2,682 28.5 29.0 27.7 −1.3 121 26.8 33.3 22.5§
 Supervisors 163 35.2 32.9 36.7 3.8 11 21.6§ ‖ ‖
 Electrical and electronic equipment mechanics, installers, and repairers 376 27.6 25.5 30.2 4.7 46 36.8§ ‖ ‖
 Vehicle and mobile equipment mechanics, installers, and repairers 990 27.7 30.1 24.9 −5.2 16 15.9§ ‖ ‖
 Others 1,153 27.8 27.9 27.8 −0.1 48 20.0§ ‖ ‖
21. Production 3,084 29.8 29.6 30.1 0.5 1,254 30.4 29.8 30.7 0.9
 Supervisors 343 31.9 30.3 34.1 3.8 78 35.4 46.3§ 25.8§
 Assemblers and fabricators 369 26.1 26.3 25.9 −0.4 232 29.7 27.5 34.3 6.8
 Food processing workers 116 35.1 37.0§ 37.1 100 32.6 36.2§ 25.1
 Metal workers and plastic workers 852 31.0 33.1 28.0 −5.1 116 25.0 23.7 22.0 −1.7
 Printing workers 149 21.1 18.1 23.3 5.2 59 33.3 46.9§ 26.3§
 Textile, apparel, and furnishings workers 90 24.4 18.7§ 37.6§ 179 31.4 30.9 32.3 1.4
 Woodworkers 96 31.2 36.9 23.4§ 14 14.4§ ‖ ‖
 Plant and system operators 141 28.6 27.7 30.0 2.3 4 0.0§ ‖ ‖
 Others 928 30.7 29.8 31.9 2.1 472 30.7 26.3 35.4 9.1
22. Transportation and material moving 3,088 33.7 34.9 32.5 −2.4 652 31.5 32.9 30.5 −2.4
 Supervisors 78 27.6 25.9§ 27.5§ 19 16.5§ ‖ ‖
 Air transportation workers 98 10.6§ ‖ ‖ 23 1.7§ ‖ ‖
 Motor vehicle operators 1,707 39.2 40.2 38.2 −2.0 322 36.5 37.6 36.5 −1.1
 Rail transportation workers 57 37.2 29.1§ 45.8§ 4 5.0§ ‖ ‖
 Water transportation workers 22 14.8§ ‖ ‖ 2 0.0§ ‖ ‖
 Other transportation workers 77 30.9 31.8 32.6 14 25.7§ ‖ ‖
 Material moving workers 1,049 28.4 30.3 26.5 −3.8 268 28.2 30.3 24.6 −5.7
23. Military specific 59 16.1 3.0§ 21.2§ 26 15.0§ ‖ ‖
Open in a new tab
*

The unit of prevalence of obesity is percent (%).

†

Prevalence difference between 2008–2011 and 2004–2007.

‡

Statistically significant difference (P <0.05) between prevalence in 2008–2011 and prevalence in 2004–2007.

§

The obesity estimate is unreliable because the relative standard error of the estimate is larger than 30% or the sample size is less than 50.15

‖

Rate of prevalence of obesity for 2004–2007 (or 2008–2011) is not estimated because the rate for 2004–2011 is unreliable.

[Percent change is not calculated because the prevalence in either 2004–2007 or 2008–2011 is unreliable or no data exist.

Among NH white female workers, the highest overall age-adjusted prevalence of obesity in the 23 major occupational groups was in farming/fishing/forestry (35.9%), followed by transportation and material moving (31.5%) and production (30.4%), whereas the lowest age-adjusted prevalence of obesity was in life/physical/social science (12.3%), followed by legal areas (14.8%) and arts/design/entertainment/sports/media (15.5%). Significant increases in prevalence of obesity from 2004–2007 to 2008–2011 was found among female workers in management (4.1%, P = 0.012), followed by education/training/library (4.0%, P = 0.005) and health care practitioners and technicians (5.5%, P < 0.001). In the 93 minor occupational groups, the individuals having the top 4 highest age-adjusted prevalence of obesity were agricultural workers (38.9%), motor vehicle operators (36.5%), drafters/engineering/mapping technicians (37.6%), and supervisors for food preparation and serving related (36.6%).

The overall age-adjusted prevalence of obesity of NH black female workers (39.5%) was much higher than that of NH black male workers (31.7%) in Table 3, whereas the overall age-adjusted prevalence for NH white female workers (21.6%) was lower than that of NH white male workers (27.0%). Among NH black female workers, the major occupational groups with an age-adjusted prevalence of obesity more than 40% were health care support (49.2%), transportation and material moving (46.6%), protective service (45.8%), personal care and service (45.9%), community and social services (44.7%), food preparation and serving related (44.1%), and health care practitioners and technicians (40.2%). The minor occupational groups with the highest prevalence of obesity were among persons who worked as motor vehicle operators (64.0%); supervisors for food preparation and serving related (52.2%); nursing-, psychiatric-, and home health aides (51.1%); and other protective service (50.0%). NH black females in all occupations had relatively high prevalence of obesity. There was a rare occupational group where the prevalence was less than 30% among NH black females; computer and mathematics (28.3%) and legal area (28.4%). Changes in prevalence of obesity between 2004–2007 and 2008–2011 were significant in management (15.8%, P = 0.001), business and financial operations (13.8%, P = 0.002), community and social services (13.7%, P = 0.034), and personal care and service (10.5%, P = 0.030).

TABLE 3.

Age-Adjusted Prevalence of Obesity Among Non-Hispanic Black Adults by 23 Major and Selected Minor Occupational Groups

Occupational Group Black Male Workers
Black Female Workers
Sample Size
2004–11		 Prevalence*
2004–11		 Prevalence*
2004–07		 Prevalence*
2008–11		 Prevalence*
Difference† 		Sample Size
2004–11		 Prevalence*
2004–11		 Prevalence*
2004–07		 Prevalence*
2008–11		 Prevalence*
Difference†
All non-Hispanic Male 7,652 31.7 30.2 33.2 3.01 10,661 39.5 37.6 42.2 4.61
  1. Management 466 31.4 31.0 31.7 0.7 541 36.2 28.1 43.9 15.81
  2. Business and financial operations 247 32.6 37.7 29.2 −8.5 495 38.5 31.1 44.9 13.81
  3. Computer and Mathematics 192 33.1 25.4 38.6 13.2 112 28.3 21.9 34.8 12.9
  4. Architecture and Engineering 100 33.9 29.8§ 34.4 22 31.4§
  5. Life, physical, and social science 46 38.1§ ‖ 56 35.2 ‖
  6. Community and social services 168 36.3 28.0 49.6 21.61 383 44.7 37.7 51.4 13.71
  7. Legal 34 34.7§ ‖ 98 28.4 30.6§ 27.1 ‖
  8. Education, training, and library 211 30.3 28.2 33.1 4.9 774 39.1 38.6 39.5 0.9
  9. Arts, design, entertainment, sports and media 126 21.6 17.0§ 26.2 ‖ 83 34.6 38.1§ 27.3§ ‖
10. Health care practitioners and technicians 157 26.8 22.0 29.1 7.1 767 40.2 38.2 41.4 3.2
 Health diagnosing and treating practitioners 82 19.4 14.6§ 20.8§ ‖ 423 41.4 39.4 43.2 3.8
 Health technologists and technicians 73 36.7 30.3§ 41.5§ ‖ 340 38.4 37.0 39.0 2.0
11. Health care support 114 30.0 29.1 31.1 2.0 896 49.2 49.9 48.2 −1.7
 Nursing, psychiatric, and home health aides 85 29.8 24.4§ 33.8§ ‖ 741 51.1 51.4 50.2 −1.2
12. Protective service 385 42.6 36.4 48.0 11.61 253 45.8 44.4 46.7 2.3
 Firefighting and prevention workers 19 61.7§ ‖ 2 0.0§ ‖
 Law enforcement workers 134 49.9 44.3 57.1 12.8 100 47.6 55.1 41.0 −14.1
 Others protective service 198 38.7 34.8 38.9 4.1 131 50.0 42.9 55.6 12.7
13. Food preparation and serving related 370 31.4 22.6 35.8 13.21 604 44.1 45.5 43.0 −2.5
 Supervisors 59 36.3 40.4§ 35.4§ ‖ 103 52.2 46.2 48.2§ ‖
 Cooks and food preparation workers 187 35.2 26.2 39.3 13.1 256 48.1 50.9 46.2 −4.7
 Food and beverage serving working 83 31.1 8.4§ 38.5 ‖ 196 38.1 36.3 38.7 2.4
14. Building and grounds cleaning and maintenance 496 31.8 28.4 34.0 5.6 465 40.0 39.4 40.9 1.5
 Supervisors 33 21.7§ ‖ 34 53.4§ ‖
 Building cleaning and pest control workers 366 32.8 27.9 36.4 8.5 427 38.3 35.2 41.9 6.7
 Grounds maintenance workers 97 31.2 31.7 30.0 ‖ 4 46.1§ ‖
15. Personal care and service 175 24.8 19.7 28.8 9.1 717 45.9 40.1 50.6 10.5‡
16. Sales and related 533 28.0 28.9 27.3 −1.6 973 33.6 31.0 35.9 4.9
 Supervisors 154 27.7 31.3 24.6 −6.7 190 31.9 28.1 33.3 5.2
 Retail sales workers 207 31.9 38.7 24.8 −13.9 618 35.6 32.7 38.3 5.6
17. Office and administrative support 767 31.6 29.7 33.0 3.3 2,149 40.0 38.5 41.3 2.8
18. Farming, fishing, and forestry 31 13.5§ ‖ 10 44.0§ ‖
 Agricultural workers 19 9.6§ ‖ 10 44.0§ ‖
19. Construction and extraction 528 30.1 30.8 29.8 −1.0 21 50.0§ ‖
 Supervisors 33 38.6§ ‖ 4 26.0§ ‖
 Construction trades workers 459 29.9 31.9 27.8 −4.1 15 48.5§ ‖
20. Installation, maintenance, and repair 386 30.4 32.7 28.3 −4.4 35 14.7§ ‖
21. Production 692 33.9 31.3 36.9 5.6 519 40.5 38.0 44.5 6.5
22. Transportation and material moving 1,129 33.8 32.1 34.9 2.8 279 46.6 45.6 47.6 2.0
 Motor vehicle operators 547 40.7 42.6 37.9 −4.7 151 64.0 57.5 73.9 16.4
 Material moving workers 491 29.1 23.1 34.2 11.1‡ 109 32.3 32.4 37.9 5.5
23. Military specific 14 60.2§ ‖ 11 35.2§ ‖
Open in a new tab
*

The unit of prevalence of obesity is percent (%).

†

Prevalence difference between 2008–2011 and 2004–2007.

‡

Statistically significant difference (P <0.05) between prevalence in 2008–2011 and prevalence in 2004–2007.

§

The obesity estimate is unreliable because the relative standard error of the estimate is larger than 30% or the sample size is less than 50.15

‖

(Percent change is not calculated because the prevalence in either 2004–2007 or 2008–2011 is unreliable or no data exist.

Rate of prevalence of obesity for 2004–2007 (or 2008–2011) is not estimated because the prevalence rate for 2004–2011 is unreliable.

Among NH black male workers, the major employment groups with high prevalence of obesity were in protective services (42.6%), community and social services (36.3%), production (33.9%), and transportation and material moving (33.8%). The minor employment groups with the highest were among NH black males who worked as law enforcement officers (49.9%) and motor vehicle operators (40.0%). Community and social services, protective services, and food preparation and serving-related occupations had significantly increased obesity between 2004–2007 and 2008–2011 (21.6%, 11.6%, and 13.2%, respectively). We observed that male motor vehicle operators had a 4.7% decrease in prevalence of obesity between 2004–2007 and 2008–2011, whereas motor vehicle operators had an increase of 16.4% female during the same time period.

Unlike NH whites and NH blacks, Hispanic female workers had a similar age-adjusted prevalence of obesity to Hispanic male workers (29.1% vs 28.6%, respectively) (Table 4). Hispanic male workers used in protective services (43.2%); community and social services (40.5%); life, physical, and social science (38.7%); and computer and mathematics (37.3%) had the highest age-adjusted prevalence of obesity among the major employment groups. Among the minor employment groups, the highest age-adjusted prevalence of obesity was observed in other protective services (54.3%). Jobs in farming/fishing/forestry (21.7%), food preparation and serving related (21.9%), and building and grounds cleaning and maintenance (23.2%) were occupations with relatively small prevalence of obesity among Hispanic males. Between 2004–2007 and 2008–2011, there were significant increases in prevalence− of obesity among Hispanic male workers in architecture and engineering (21.5%, P = 0.010), sales and related (9.2%, P = 0.018), construction and extraction (6.8%, P = 0.003), and production (8.0%, P = 0.005).

Among Hispanic female workers, age-adjusted prevalence of obesity were highest for those used in transportation and material moving (36.4%), community and social services (34.8%), and health care support (33.2%). The motor vehicle operators (54.2%) had the highest prevalence of obesity in the minor groups. From 2004–2007 to 2008–2011, food and beverage serving workers had the highest increase in prevalence of obesity (11.7%, P = 0.042), whereas cooks and food preparation workers (−11.3%, P = 0.056) had a decrease in prevalence of obesity.

DISCUSSION

Differences in the overall prevalence of obesity have been observed between male and female workers and racial/ethnic groups.16 In addition, prevalence of obesity has been examined by gender among US workers,10 but it has not been explored across racial/ethnic groups by occupational group in this population. In this study, we estimated the prevalence of obesity by occupation in US workers, by gender and racial/ethnic groups.

Our results show that the prevalence of obesity among men and women significantly increased during 2004–2011. Nevertheless, prevalence of obesity between 2008 and 2011 remained mostly stable and did not show a statistically significant increase. In previous studies, the slope for the prevalence of obesity among the US population rapidly increased from the early 1980s to the mid-1990s, then slowly increased between the mid-1990s to the mid-2000s, and has been steady since the mid-2000s.2, 17 Flegal and colleagues17 reported that the prevalence of obesity in US adults was not significantly different during 2003 through 2010.

Our results also showed that the overall prevalence of obesity significantly increased 4.1% (0.51% annually) between 2004 and 2011. This prevalence during the period 2004–2011 increased much more slowly than in the period 1996 to 2002 (0.95% annually), which was observed by Caban and colleagues.10 Obesity was much more prevalent among NH black female workers than among NH white female workers. Burke et al18 reported that the big gap in prevalence of obesity between NH black females and NH white females may be partially explained by different perceptions of what constitutes overweight. In addition, Hispanic male workers had the biggest increase in prevalence of obesity over the same period. D’Alonzo et al19 found that Hispanic immigrants have developed obesity during acculturation process of allostatic load. Some Hispanic immigrants tend to have poorer diets; less vegetable and fruit consumption and higher sweet drink consumption.20

The results of our study indicate that workers in health care support, protective service, and transportation and material moving have high prevalence of obesity. This finding is also consistent with a previous study.10 Workers in architecture and engineering, health care practitioners and technicians, and arts/design/entertainment/sports/media had relatively low prevalence of obesity compared with other workers regardless of gender and race/ethnicity.

In our study, the highest prevalence of obesity was in workers of transportation and material moving, especially motor vehicle operators, irrespective of gender and race/ethnicity. Flórez Pregonero et al21 reported that workers in the transportation industry are at greater risk of an improper diet and long duration of sedentary behavior, which could lead to excessive weight gain, especially in the abdominal region. Obesity in motor vehicle operators has been associated with elevated risk of obstructive sleep apnea,22 traffic accidents,23 and fatigue.24 Hirata revealed that bus drivers had a high frequency of cardiovascular risk factors, such as obesity, hypertension, hyperlipidemia, and hyperglycemia.25 This study showed that the prevalence of obesity of motor vehicle operators among NH white and NH black males did not increase any more during the study period 2004–2011. In addition, both NH white male and female workers in personal care and services had decreased prevalence of obesity.

The second highest prevalence of obesity was in protective service workers. NH black males and Hispanic males had much higher prevalence of obesity than did NH white males. Employees in high-stress occupations, like police officers and correctional security officers, may have had different types of stressors, for example, overtime work, shift work, and administrative and organizational pressures. Recent studies found that job-related demands, depression, and psychological distress among male law enforcement officers were related to weight gain and BMI.26–29

Several studies show that obesity among workers may have adverse occupation-related consequences such as work absence,11 work impairment,11 work limitation,9 and workplace injury.12 Hertz and colleagues9 found that workers who were obese had more than double the work limitation of workers who were of normal weight (7% vs 3%). Obesity in workers also results in greater health care costs. Kuehl and colleagues30 showed that firefighters with a BMI greater than 30 kg/m2 were 3 times more likely to file Workers’ Compensation claims than firefighters with a normal BMI. In another study, rates of Workers’ Compensation claims were twice as high, medical claims costs were 7 times higher, and indemnity claim costs were 11 times higher among the heaviest employees compared with employees who had recommended weights.31

This study has some limitations. First, BMI, the measure used to define obesity, might not be as precise a measure as one would expect. Height and weight were self-reported measures, which could possibly have led to inaccurate BMI measurements for the workers. In 2 studies, underreporting of weight occurred among overweight females and overreporting of height occurred among the older individuals.32–33 In addition, BMI does not estimate lean muscle mass and body fat composition. Nevertheless, an advantage is that BMI is highly correlated with percent body fat and is widely used as the definition of obesity. Second, the sample sizes of some of the listed occupations (eg, NH blacks in farming, forestry, and fishing) were relatively small, resulting in imprecise estimates. The National Center for Health Statistics considers a sample size of less than 50 to be unreliable. Finally, the NHIS data are collected cross-sectionally every year, and thus causal inference is not possible. The strength of this study is that it adds to the literature on obesity among persons in several occupations.

To summarize, our analyses of the NHIS 2004–2011 data show that prevalence of obesity of US workers steadily increased up to 2008 across gender and race/ethnicity but leveled off from 2008 through 2011. The prevalence of obesity in relatively low-obesity occupations (eg, white-collar jobs) significantly increased between 2004–2007 and 2008–2011, whereas the prevalence in high-obesity occupations (eg, blue-collar jobs) did not change significantly. Church and colleagues34 found that a significant portion of the increase in US weight gain can be accounted for by declining workplace physical activity. Eighty percent of the current occupations are sedentary and involve light physical activity compared with 60% in 1960s.34 Over the past 5 decades, there have been fewer opportunities for physical activity in the workplace. Employers should consider ways of increasing physical activity among their employees. A couple of examples are taking walks during breaks and redesigning offices (standing workstations, treadmill style desks, and placing printers away from desks).35 Employers for indoor service jobs could increase workplace health initiatives and pay more attention to permitting employees to engage in some form of physical activity in the workplace. Tudor-Locke and colleagues36 recently reported that workstation alternatives—sitting on a stability ball, sit-stand/standing desk, or treadmill and pedal desks—have much more daily energy expenditure than the traditional seated condition. Also, workers could be educated to recognize that the consumption of high-quality and healthy food and drinks without added sugars may be an effective strategy to achieve weight loss or weight maintenance. Since the 1980s, many European countries have seen rapidly increased obesity rates similar to the United States, and some European countries have taxed unhealthy foods and ingredients such as fast food, pastries, soft drinks, and other food containing lots of sugar, fat, and artificial sweeteners.37

Acknowledgments

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health.

Footnotes

None of the authors have any conflicts of interest. Authors used CDC public leased data.

References

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