International Journal of Obesity is a monthly. Psychoneuroendocrine characteristics of common obesity clinical subtypes: J M Martins. Larocque S, McCormick C, Shanks N. International Journal of Obesity - Work stress, weight gain and weight loss: evidence for bidirectional effects of job strain on body mass index in the Whitehall II study. Top of page. Introduction. Work stress and high body mass index (BMI) are both risk factors for cardiovascular disease,1, 2, 3, 4 but the extent to which they are associated with each other remains unclear. According to a dominant theoretical model, persistent work stress is generated by a combination of high job demands and low control at work: job strain. While some studies have found an association between high strain,6, 7 high demands,6, 8, 9 low control,3, 1. BMI, other studies have reported no associations between these psychosocial characteristics of the work environment and BMI,1. BMI. 1. 5, 1. 6 Associations of job strain and its components with BMI have been found to vary by sex, but not in a consistent manner. BMI beyond the work context. Mixed findings on work stress and BMI may reflect a failure to take into account the possibility that stress may cause some people to eat more, but others to eat less. Dalman et al. 2. 0 demonstrated that eating high fat and carbohydrate caloric content 'comfort' food may help in reducing biological stress system activity and concomitant negative emotions during chronic stress. The tendency to eat such energy- dense foods under stress is likely to contribute to weight gain. Both physical inactivity and lack of time to prepare healthy meals further increase weight gain among people with chronic stress. 129 127 To PE, or Not to PE, That is the Question PATTI-JEAN NAYLOR, JOAN WHARF HIGGINS. Methods: The BNI is an adolescent version of the Larocque Obesity Questionnaire (Stotland. On the other hand, chronic stress may also trigger physiological processes which lead to weight loss,2. As sex is a factor that appears to confer differential sensitivity to stress and may also affect choice of coping strategy,2. In this report from the Whitehall II study, we examined the association between work stress and BMI with particular attention to the hypothesis that chronic work stress may induce weight gain in some individuals but weight loss in others. If such individual differences are stable and accumulate, then the tendency to weight gain under stress is likely to be more common among people with high BMI while among those with low BMI the tendency will be towards further weight loss. Top of page. Methods. Participants. The target population for the Whitehall II study is all London- based office staff working in 2. Civil Service departments during recruitment in 1. Official site of the Caribbean Community and Common Market. Includes profile, mission, projects, and statistics. Positive energy balance is the major cause of obesity. Obesity Assessment Questionnaire Questions Your Doctor May Ask - and Why! During a consultation, your doctor will use various techniques to assess the symptom: Obesity. These will include a physical examination and. The contribution of occupation and work organization conditions (skill. The impact of self loathing on disordered eating attitudes among obese females. The impact of self loathing on disordered eating attitudes among obese females. Stotland & Larocque. And Self-reported Behavioral Observations during Obesity Treatment S C Stotland1,2. 1 The Larocque Obesity Questionnaire is administered online. With a participation rate of 7. The true participation rate was probably higher, however, because around 4% of those invited had, in fact, moved employment before the study and were not eligible for inclusion. Baseline screening and a follow- up screening in 1. BMI. This study focused on those 5. BMI at baseline and follow- up. The 2. 34. 3 employees excluded had slightly higher BMI (2. P- values< 0. 0. Measurements. Assessment of work stressors was based on a modified Job Content Questionnaire comprised of the job demand scale (4 items, Cronbach's =0. Job demand and job control scores are standardized mean scores from the respective scales. Job strain is a standardized score derived from the equation: job demand score – job control score,3. Whitehall II study. We repeated the analyses with a more commonly used binary variable defining job strain as a job demand score above the median combined with a job control score below the median. Other baseline characteristics were sex, age (years), employment grade (1=administrative, 2=professional, 3=clerical) and BMI, calculated as weight in kilograms divided by height in meters squared. Weight was measured with all items of clothing removed except underwear. A Soehnle scale was used to read weight to the nearest 0. If the reading alternated between two readings > 0. Height was measured to the nearest mm using a stadiometer with the participant standing completely erect with the head in the Frankfurt plane. Assessment of BMI was repeated at follow- up. Weight gain was indicated if BMI increased and weight loss if BMI decreased between the measurements. Data analysis. The associations between each work stressor (high strain, high demands and low control) and BMI at follow- up were examined with separate linear regression models including age, grade and BMI at baseline as covariates. The associations between each work stressor and weight gain or loss were examined by using logistic regression analysis. Adjustments were made for age, grade and BMI at baseline. We tested the effect of an interaction between each stressor and baseline BMI on weight gain and weight loss by including the corresponding interaction term in regression models that already included the main effects. To illustrate the form of significant interactions, the associations between stressors and weight gain/weight loss were calculated separately for the top and bottom quintiles of baseline BMI in addition to the combined three middle quintiles. A significant interaction supports our hypothesis that the work stressor predicts weight gain in the top quintile (i. In addition, we tested potential interaction between employment grade and baseline BMI on weight gain and weight loss, as employment grade is associated with metabolic syndrome in the Whitehall II study. All analyses were conducted separately for men and women. All analyses were performed with the use of SAS software, version 8. SAS Institute). Top of page. Results. Table 1 presents sample characteristics by sex. On average, the men were younger than the women and a greater proportion were employed in higher- grade jobs. Men also had higher job demands, higher job control, lower job strain, and lower BMI at baseline and follow- up (P< 0. In both sexes, BMI increased over the 5- year- period between the two Phases (P< 0. Table 2 shows the associations between work stressors at baseline and BMI at follow- up after adjustment for age, grade and BMI at baseline. In men, no association between stressors and subsequent BMI was found. In women, higher job demands were weakly associated with higher BMI at follow- up. Table 3 presents results of the tests of interaction between stressors and baseline BMI on weight gain and weight loss (as only one woman and four men had exactly the same BMI at baseline and at follow- up, the P- values were similar for the tests examining interaction for weight gain and weight loss and are therefore presented only once). In men, the interactions of baseline BMI with job strain, treated as a continuous variable, and job control were statistically significant. No interaction was found for job demands in men or for any work stressors among women. Repeating the analysis with the cruder dichotomous job strain variable also failed to provide significant interaction (P=0. P=0. 6. 0 in women). To illustrate the significant interactions, the effects of high strain and low job control as predictors of weight gain and weight loss are presented by baseline BMI level in Table 4. The pattern was the opposite to that of the regression towards mean. Among the 9. 86 men who already had high BMI at baseline (> 2. In contrast, higher strain and lower control were associated with a higher likelihood of weight loss among the 1. BMI (< 2. 2 kg/m. The corresponding odds ratios were 1. P=0. 0. 7) and 1. P=0. 0. 02), respectively. Among the 3. 51. 9 men with intermediate BMI at baseline (between 2. There was no interaction between employment grade and baseline BMI on weight gain or weight loss (P=0. P=0. 0. 9 in women). Top of page. Discussion. This prospective study suggests that work stress, as indicated by job strain and low job control, increases the likelihood of weight gain among men with a higher BMI, but seems to predict weight loss among lean men who have no need for weight reduction. In contrast to these bidirectional effects, there was some evidence of a prospective association between work stress and increased BMI in women. Our investigation is based on a large well- characterized cohort of British employees and a prospective study design with an average follow- up of 5 years. A recent review concluded that evidence does not support a consistent association between job strain and BMI and this conclusion seems also to apply to studies that were not included in the review. Data from employees in New York City public and private sector worksites revealed no association between change in job demands or job control, the components of job strain, and change in overweight. Similarly, a Finnish study of industrial employees found no association between job strain, job demands and subsequent BMI, but low job control predicted a modest increase in BMI during a 1. Our findings of bidirectional effects for work stress in men raise the possibility that the overall null associations between work stress and BMI observed in previous studies represent the canceling out of these opposing relationships. Existing physiological models, which describe plausible mechanisms indicate that work stress may result in either weight gain or weight loss. On one hand, a stress- induced increase in glucocorticoid levels is assumed to increase ingestion of comfort food,2. Animal studies, which offer the opportunity to examine the effect of stress on food intake while controlling for confounding factors, have generally reported hypophagia (reduced food intake) in relation to chronic stress models. However, systematic manipulations of stressor intensity suggest that hypophagia is induced at higher intensities, but that at lower intensities hyperphagia (increase in food intake) is seen. In human beings, bidirectional effects are widely recognized in relation to depression, another consequence of chronic work stress. Indeed, the American Psychiatric Association's Diagnostic and Statistical Manual includes opposite pairs, such as weight gain/weight loss and hyperphagia/hypophagia, among criteria for a diagnosis of depression.
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