Obesity, weight status and employability: Empirical evidence from a French national survey
Introduction
Obesity and overweight have been recognised by the World Health Organisation (WHO) as major worldwide public health concerns, jeopardising health for adults as well as for children (WHO, 1997). More than 1 billion adults are overweight, at least 300 million of whom are clinically obese. Obesity and overweight are known to be major risk factors for severe chronic diseases, especially type 2 diabetes, cardiovascular disease, hypertension, stroke and certain cancers (WHO, 2003).
There is vast literature, both epidemiological and economic, about both the time trend of this worldwide epidemic and its costs to society. In the United States, the number of obese adults has grown by >50% since the late 1970s. A total of 65.7% of American adults are overweight or obese, 30.6% are obese and 5.1% are extremely obese (Hedley et al., 2004, Flegal et al., 2002). With 112,000 premature deaths caused each year in the United States by illnesses induced or worsened by excess body weight (Flegal et al., 2005), obesity has become a major cause of avoidable death (Sturm, 2002). In the United States, estimations of the economic cost of obesity range from 75 to 100 billion dollars (Finkelstein et al., 2004, Philipson et al., 2004, Wolf and Colditz, 1998), which represents up to 9.5% of total annual medical expenditures. In western European countries, except to some extent Great Britain, the prevalences of overweight and obesity are by far less than those in the United States (Seidell and Deerenberg, 1994, Vlad, 2003). In France, the rates of overweight and obesity increased only slightly, until 1990 (Maillard et al., 1999). In 2000, a total of 41.6% of French adults were overweight or obese, 11.3% were obese and 2.5% were severely obese (Basdevant et al., 2002). In 1992, the direct economic cost of obesity in France was estimated to be 0.6–1.1 billion euros (Detournay et al., 2000, Levy et al., 1995), which represented 0.7–1.5% of the country's total health expenditures.
Obesity and overweight have been found by a large number of previous studies in the United States (Chou et al., 2004, Robert and Reither, 2004, Zhang and Wang, 2004), Europe (Cavelaars et al., 2000, Wardle et al., 2002) and France (Maillard et al., 1999) to be strongly linked to socioeconomic status (SES). On the basis of these findings, obesity is considered to be one of the numerous socioeconomic factors correlated with health status (Fuchs, 2004, Smith, 1998), among which causal paths for many have yet to be identified (Adams et al., 2003). In 2001, as he addressed a research agenda, Philipson (2001) urged organisations to contribute economic resources that would help improve understanding of the worldwide increase in the prevalence of obesity.
The majority of the articles about obesity and overweight have focused on how low SES might be associated with excessive body mass index (BMI), particularly how low SES might cause obesity or overweight. But conversely, attempts to explore how obesity and overweight might affect the main economic features at the individual level are scarcer. The present article explores the extents to which obesity and weight gain affect employability. Indeed, in France more than in other countries, there is a significant risk of stigmatisation of and even discrimination against obese people (Drury and Louis, 2002, Puhl and Brownell, 2001) [and populations such as short men (Herpin, 2005)], which might be associated with the relative rarity of obesity, especially compared with the prevalence of this condition in the United States.
Employability is defined in much of the literature with reference to obtaining a job and then sustaining employment. Hillage and Pollard (1998) define employability with reference to the ability to get a job, the subsequent ability to retain employment, independence in the labour market (i.e., the ability to choose the employer) and the quality of employment. Our article examines the ability to obtain and retain employment in France, using the latest data from the 2003 French national decennial survey on health and health care consumption (Section 2) to evaluate the impact of obesity, overweight and underweight on the percentage of time spent unemployed during working years (Section 3) and on the probability of regaining employment after a period of unemployment (Section 4).
Section snippets
Data
Data are from the Decennial Health Survey (DHS, Enquête Décennale Santé, http://www.cnis.fr/ind_doc.htm) the only source of systematic statistical data about the health of, health care consumption by and socioeconomic characteristics of French households. Data are collected every 10 years during a large-scale survey by the French National Institute of Statistics and Economic Studies (Institut National de la Statistique et des Etudes Economiques [INSEE]). Data have been collected through a
Obesity and percentage of working years spent unemployed
In the previous section, strategies for estimating the relationship between obesity and the percentage of working years spent unemployed were introduced. The goal of this section is to determine whether obese people or people with a BMI higher or lower than the median BMI at the age of 20 years are at greater risk for unemployment. From a general point of view, DHS data unsurprisingly reveal a statistically significant difference between the unemployment rates for nonobese adults and obese
Obesity and the likelihood of regaining employment
In this section, we evaluate how deviations from the median BMI might change the probability of regaining employment. We use a Cox partial-likelihood model (i.e., a semiparametric model) that takes censored data into account. Censored data are defined here as data for individuals for whom the event “regaining employment” had not occurred by the end of the study period.
Conclusion
The association between a number of workplace characteristics and obesity has been investigated. Specifically, we considered how obesity and overweight were likely to constrain the ability of individuals to obtain employment. Because the prevalences of overweight (approximately 40%) and obesity (approximately 10%) are much lower in France than in other western developed countries (especially the United States), these conditions might be more likely to predispose persons to stigmatisation and
Acknowledgements
Financial support from Provence-Alpes-Côte d’Azur regional council is greatly acknowledged. We are grateful to four anonymous referees for helpful comments, which undoubtedly improved the first drafts of the paper. Any remaining errors are our own.
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