The major findings from our study were that working full time, job insecurity, food insecurity, and SPD were associated with obesity. The cluster of predictive indicators suggests that, on average, working in America may result in significant psychosocial stressors. Working full time as compared to working fewer hours, demonstrated a dose response. In other words, full time workers who worked more hours compared to those who worked fewer hours were at greater risk for obesity . This is not to say that all work is detrimental. US adults may enjoy emotionally and financially rewarding careers. However, poor work conditions, low pay, and financial hardship may exact physical and psychological tolls that undermine well-being.
It is possible that psychosocial stressors may come from numerous sources unrelated to work, such as juggling commutes and home life, having children and meeting other outside commitments [22, 23]. However, taken together, these findings suggest that work environments exert a distinct risk for stress leading to obesity that comes from unstable employment and the economic need to work. An additional compelling finding of psychosocial stressors from work is that many adults with obesity worked while sick for prolonged periods of time. American workers with obesity were also more likely to have sick leave benefits which further suggests that Americans may select jobs with this benefit. It is possible the American workers who have obesity seek this benefit to engage in self-care to address their health needs. Even with a sick leave benefit, however, American workers who have obesity may perceive that a job loss was likely.
Food insecurity among workers with obesity is a paradoxical finding. It suggests that American workers with obesity trying to make ends meet tend to rely on calorie dense, low-quality food to nourish themselves , in lieu of consumption of more expensive and lower calorie foods such as fresh produce and fruits . We found a positive relationship between the number of children in the household and the increased risk for food insecurity, and that not living with their spouse may place an adult at increased risk for food insecurity . A potential interpretation of our findings is that American workers with obesity may make sacrifices to feed their children, and meet the material needs of their families, at the cost of their physical well-being [25, 26].
American workers may be stretched to their limits financially, especially compared to earlier generations [12, 13]. Concerns about losing their jobs may be the result of salaries that do not cover basic needs such as food or allow for the accumulation of savings. Incomes in the US have reportedly not kept pace with real earnings for several decades . Consequently, lack of savings and an inability to accumulate wealth, in contrast to earlier generations, may increase stressors about the workplace and financial remuneration for American workers [12, 13]. Financial distress in US workers, and its corresponding association with obesity, could be, in part, the end result of a downward economic spiral for many US workers that began in the 1970s, with the decline of the United States’ manufacturing sector, which has continued to date . Sadly, the stress of reduced earnings appears to exacerbate this downward cycle, as poor mental health is associated with further reduced earnings .
There are documented physiological relationships between psychosocial stressors and increased risk for obesity. Excessive caloric intake is a function of psychosocial stressors and the urge to consume “comfort” food . In times of stress the hypothalamic-pituitary-adrenal cortical (HPA) axis responds by releasing the corticotrophin hormone or factor (CRH or CRF), which in turn results in elevated levels of anxiety [7, 30]. Overeating or the consumption of comfort foods can act to shut down this stress response system by regulating the release of CRH or CRF . Moreover, fat storage changes in response to stress eating from peripheral to central distribution, making it more likely to be a risk factor for disease .
The consumption of less healthy food due to work stress would be consistent with our observation that US workers in lower income and educational groups, as well as Black workers compared to all other race and ethnic groups, were at greatest risk for obesity [31, 32]. Racial status may be a proxy for access to valued resources and, by extension, access to the availability to health promoting coping options [7, 33, 34]. For example, more affluent workers can afford to go a gym  and live in environments where they can access and eat healthy food. In contrast, low socioeconomic status (SES) is often associated with limited access to safe and affordable recreational areas and healthy eating options . Under these circumstances lower SES individuals are more likely to respond to stress by engaging in unhealthy coping behaviors . Thus, work stress becomes a pattern in which the need for comfort from stress, combined with accessibility to poor quality food that feels comforting, results in obesity [7, 33, 37]. It should be noted that the interaction between full time employment and education and full time employment and income was not significant suggesting that relative impact of education and income does not differ for predicting obesity among full time working adults. Although the number of women who had obesity was greater than that of men in our sample, it did not achieve statistical significance. Previous reported data found that women had a greater likelihood of having obesity compared to men (38). The lack of difference may be an artifact of COVID-19 as everyone was part of lock down and rates of obesity increased due to COVID-19 (39).
Strengths and Limitations
The data reported here may have underestimated food insecurity at the height of the Covid-19 pandemic. March 2020 marked the beginning of the COVID-19 shutdown, and most states reopened between April and June of 2021 . However, by 2021 federal aid programs such as the American Rescue Plan Act (ARPA), that had been implemented in part to reduce food insecurity, greatly improved the circumstances of disadvantaged Americans [41, 42, 43]. Moreover, it is also possible that our sample of working adults only minimally benefitted from the federal aid programs which included the extension of unemployment payments [42, 43]. We also underscore that the psychosocial stressors from economic conditions may have been exacerbated during COVID-19. However, the time trend for reduced economic power in American workers has been reported to be ongoing for decades .
Cross sectional data did not allow an assessment of temporal ordering. In addition, we also did not have specific occupational data although we were able to make inferences based on education and income level. We also lacked data about commuting and working remotely, both of which could have impacted the risk for having obesity. Job stability may have been reduced over decades because of the diminishment in the relationship between the employer and employee (44). Future research may investigate the more recent trend towards remote working, in this context. The strength of our study is the use of the NHIS, from which current national rates of obesity in US workers and work-related risk factors can be examined.