Prevalence of overweight and obesity among health care professionals: A Multi-institutional Cross-Sectional Study

Prevalence of overweight and obesity among health care professionals: A Multi-institutional Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of overweight and obesity among health care professionals: A Multi-institutional Cross-Sectional Study Fariha Ashraf, Sana Silvia, Bushra Ayub, Kanwal Nisa, Ghulam Murtaza This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5720050/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract · KEYPOINTS: High Prevalence of Overweight and Obesity: The study found a significant number of healthcare workers in Pakistan are overweight or obese. · Use of Asia Pacific BMI: The research utilized the Asia Pacific BMI classification, which is considered more suitable for assessing weight status in this region compared to the traditional Western BMI. · Identification of Risk Factors: The study aimed to identify potential occupational risk factors that contribute to the high prevalence of overweight and obesity among healthcare workers. · Need for Interventions: The findings emphasize the need for targeted interventions to improve the health and well-being of healthcare workers in Pakistan, such as promoting healthy lifestyles, creating supportive work environments, and providing relevant training and education programs. Overweight Obesity Healthcare Workers (HCWs) Prevalence Asia Pacific BMI INTRODUCTION Over the past 40 years, the rise in overweight and obesity has become a serious concern for public health ( 1 ). Health care workers (HCW) i.e. doctors, nurses, paramedics, Health Management & Support workers have also been struck by this pandemic as with other professionals. Health Care workers (HCWs) are vital for providing, sustaining and improving quality care, either directly or indirectly. Quality health care depends upon the health status of HCWs, one important indicator of quality HCWs is ideal body weight, which unfortunately is hugely underestimated by HCWs due to their nature of job, sedentary lifestyle, stress, long working hours, lack of sleep, exercise time, unhealthy snacking etc. ( 2 ). It is interesting to note that HCWs, who play a crucial role in promoting health, face challenges with overweight and obesity themselves. Studies have shown that HCWs tend to have higher rates of obesity as compared to the general population ( 3 , 4 ). Various job categories within the health care field can have different levels of risks when it comes to being overweight and obese. The nature of work and different job scopes can indirectly contribute to a higher risk of obesity among HCWs ( 5 ). A study conducted at Johns Hopkins Bloomberg School of Public Health, USA, showed that obese physicians feel less confident in providing advice on health, nutrition and exercise to their patients ( 6 ). A study conducted in U.A.E (2020), showed that the prevalence of obesity and overweight among health care workers was found to be 47.3% ( 7 ). Another study conducted at Bingham university teaching hospital in Nigeria (2016), 63.4% of the healthcare workers were found to be either obese (23.2%) or overweight (31.4%) ( 8 ). Multiple studies done in Malaysia have shown a higher prevalence of overweight and obesity among HCWs when compared to age matched general population ( 9 , 10 ). To the best of our knowledge, existing research have not used the revised Asia specific WHO definitions of overweight and obesity ( 11 ) and have not explored different occupation related risk factors associated in HCWs for obesity and overweight. Moreover, no previous studies have included the healthcare workers who are indirectly involved in hospital services or patient care. Therefore, this study’s main objective was to determine the prevalence of obesity among all HCWs according to BMI category of ASIA PACIFIC population and the potential associations between specific occupational risk factor and obesity so a multifaceted approach should be adopted to decelerate this rising pattern of concern. MATERIAL AND METHODS Study Design and Sampling: This Multi-Institutional Cross-Sectional Study was carried out in three tertiary care hospitals of Karachi from June 1st till 31st July in the year 2021 and included health care workers involving directly or indirectly in the delivery of health care [Doctors, Integrated health professionals (Nursing Personnel, Technicians, Physiotherapist, Nutritionist) and non-medical personnel (Hospital management and janitorial staff)]. HCWs who were pregnant or up to 3 months post-partum, hypothyroid, taking steroids were excluded. The sample size was estimated to be 312 using WHO sample size calculator. The confidence interval (CI) was kept at 95% with 5% level of significance (α). The Anticipated Frequency of Obesity: 28.2% ( 12 ) and absolute precision was kept at 5% (0.05). Participants were recruited using non-probability consecutive sampling. Written and informed Consent was taken by each participant. For participants who could not read, the primary or the co-investigators verbalized the consent and took permission. Approval to conduct the study was granted by the Hospital Ethics Research Committee. All participants were interviewed by surgical residents. Participants were gathered in separate rooms at surgical OPD. Self-made, well-structured questionnaire which included questions about socio-demographic characteristics, anthropometric measurements, medical and family history, nature and duration of job, mode and duration of transport, dietary habits, physical activity, sleeping hours and quality of life was filled individually for each participant by principal investigators and co- investigators from participants who agreed to participate and met the inclusion criteria. Participants' identities were kept anonymous by giving each participant a unique serial number. Weight and height were recorded twice to reduce intra-observer error using standard weight beam/ stadiometer. (Hydro, weighing capacity min: 120kg, max 160kg, readability 0.5kg) the machine was placed in a private room and each participant was called one by one to maintain privacy. Participants were asked to remove their shoes, lab. Coats, stethoscopes and other accessories i.e. mobile phones, wallet. BMI was calculated as body weight (Kg) divided by height (m) squared (BMI = weigh(kg)t/ (Height (m) 2 ) classified according to South Asian classification cut-off values as ‘underweight’ ( 30) and also with WHO classification as underweight’ (< 18.5), ‘normal' (BMI 18.5–24.9), ‘overweight' (BMI 25–29.9), ‘obese I' (BMI 30-34.9), ‘Obese II’ (35.0-39.9) ( 11 ). STATISTICAL ANALYSIS: All the collected data was entered into Microsoft excel sheets and then uploaded to SPSS software version 23.0 for analysis. Categorical data was presented as frequency and percentages while numerical data was presented as mean and Standard deviation, following a normal distribution. Descriptive statistics were computed for all variables within each group. Groups-A (under or normal weight) was compared with group-B (overweight & obese) for categorical variables by using chi-square test and continuous variables by using student t-test. A p -value < 0.05 was considered statistically significant. RESULTS A total of 312 participants (mean ± SD age: 30.62 ± 9.16 years) were included in this study and were categorized into groups based on BMI using both WHO and Asia Pacific classifications. Patients were either categorized as: group-A normal or underweight (BMI less than or equal to 22.9 in Asia Pacific Group, BMI less than or equal to 24.9 in WHO group) or Group-B: Overweight and obese (BMI more than or equal to 23 in Asia Pacific group and BMI more than or equal to 25 in WHO group) (Table 1). A substantial discrepancy was observed between the two classifications, with a higher proportion of individuals classified as overweight and obese according to the Asia Pacific criteria (54.8%) compared to the WHO criteria (38.7%) (Table 1,2,3). In both the groups the highest percentage of participants with overweight and obesity was found in age group 20–30 years (Asia pacific 57.3% and WHO 54.2%). There was no significant difference of gender in either of the groups. In both the groups’ married individuals were more likely to have higher BMI than unmarried individuals with a significant p value 0.014 (OR = 1.771, 95% CI: 1.120–2.801) (Table- 4). A significant relationship was observed (p = 0.001) in participants as per their duty shifts. Individuals with evening shifts were predominantly in the lower BMI category (OR = 0.385, 95% CI:0.1720–0.745, P = 0.006), while mixed-shift workers had higher BMIs. Individuals who perceived a weight increase following the commencement of their current employment demonstrated higher BMIs (49.7%, p-value 0.007). Meal skipping was significantly associated with BMI (p = 0.046), with more skipping observed in the lower BMI category. Smoking status, the presence of co-morbidities, physical activities and sleeping hours did not show significant differences across BMI categories in either classification (Table 5). Participants were classified into three professional categories: physicians, integrated healthcare providers, and non-medical staff. Among the 171 individuals in the Overweight and Obesity category (as defined by Asia Pacific criteria), 66 (38.6%) were physicians, 76 (44.4%) were integrated healthcare providers, and 29 (17%) were non-medical staff. This distribution was comparable across the Normal and Underweight group. DISCUSSION The prevalence of overweight and obesity among HCWs in our study was found to be 54.8% (according to Asia pacific classification) and 38.7% (WHO classification) which is higher than the reported prevalence of overweight and obesity in general population of Pakistan. A study conducted by M. Asif et al. in 2020 estimated that 22.8% of our population (23.9% of the women and 21.1% of the men) are overweight, and 5.1% (6.3% of the women and 3.2% of the men) are obese ( 14 ). World Health Organization (WHO) in 2000 estimated that 26% of women and 19% of men in Pakistan are obese ( 11 ). Jafar et al. in 2006 reported the prevalence of being overweight and obese in general population in Pakistan as high as 25% ( 13 ). Moreover, all above mentioned studies had utilized WHO classification to categorize BMI. In our study a higher percentage of participants were categorized within the overweight and obese ranges when utilizing the Asia Pacific BMI classification system, as opposed to the WHO classification system. The higher rate of obesity among healthcare professionals, relative to the general adult population, could be due to their increased vulnerability to weight gain resulting from erratic and prolonged work schedules, unhealthy eating patterns, and occupational stress. Worldwide, overweight and obesity are major public health concerns that affect people of all demographics. These conditions have harmful effects on all bodily systems. Additionally, they increase the risk of developing chronic diseases. The health issues resulting from excessive weight and obesity further strain the limited resources of healthcare providers ( 16 ). Healthcare workers (HCWs), like individuals in other professions, are susceptible to obesity. As role models, HCWs should promote obesity prevention and encourage patients to adopt healthier lifestyles. Paradoxically, despite working in a field dedicated to health and wellness, studies have shown a concerning trend of increasing obesity rates among HCWs, often exceeding those of the general population ( 3 ). The outcomes of this study are in line with international research, which has consistently indicated higher rates of overweight and obesity among healthcare workers compared to the general population. Studies by Iwuala et al. ( 4 ), Sharma et al. ( 15 ), and Hazmi et al. ( 9 ) have also reported comparable trends with overweight and obesity rates as high as 44.7%, 78.8%, and 53.4%, respectively. To foster a healthier and more productive healthcare workforce, it is imperative to address the significant issue of overweight and obesity among healthcare workers (HCWs). By implementing strategies such as promoting physical activity, encouraging balanced diets, and managing stress, healthcare organizations can create supportive environments that empower HCWs to make healthier choices. Additionally, raising awareness about the health risks associated with overweight and obesity and providing guidance on healthy lifestyle practices can significantly contribute to improving the overall health and well-being of HCWs. Furthermore, addressing underlying factors like poor working conditions, excessive stress, and inadequate support can play a crucial role in reducing the prevalence of overweight and obesity among HCWs. No study in Pakistan till date has taken in to account the Asia Pacific criteria of BMI classification. While past studies in Pakistan predominantly used the WHO classification, this approach may overlook the true extent of overweight and obesity in the region. Our research emphasizes the importance of employing the Asia Pacific criteria to provide a more accurate evaluation of BMI and its related health consequences. Risk factors: Limitations & strengths: CONCLUSION This study reveals a concerningly high prevalence of overweight and obesity among healthcare workers (HCWs) in Pakistan, exceeding the rates observed in the general population. The findings align with global trends, highlighting the urgent need for effective interventions. To address this issue, it is crucial to prioritize strategies that promote healthy lifestyles, create supportive work environments, and raise awareness about the health risks associated with excessive weight. By implementing these measures, healthcare organizations can significantly improve the health and well-being of their workforce and ultimately enhance patient care. Declarations FUNDING AND DECLARATIONS None. Author Contribution S.S. and G.M. conceptualized the research question, S.S. and F.A. K.N. worked in writing the synopsis and getting the ethical approval, data collection and data entry. G.M, F.A, S.S. , B.A. worked on date entry, analysis, results interpretation. F.A. and G.M and S.S. worked on manuscript writing, B.A. helped in writing results. F.A. and G.M, and K.N. were involved in correcting, rewriting and completing the manuscript. All the authors were involved in reviewing the manuscript. Acknowledgement Dania Javed, Areesha Shakeel References World Health Organization. Obesity and overweight [Internet]. 2020 [cited 2024 Nov 25]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight Chou CF, Johnson PJ. Health disparities among America's health care providers: Evidence from the Integrated Health Interview Series, 1982 to 2004. J Occup Environ Med. 2008;50:696–704. doi: 10.1097/JOM.0b013e31816515b5 Adaja T, Idemudia O. Prevalence of overweight and obesity among health-care workers in University of Benin Teaching Hospital, Benin City, Nigeria. Ann Trop Pathol. 2018;9:150–4. doi: 10.4103/atp.atp_30_18 Iwuala SO, Ayankogbe OO, Olatona FA, Olamoyegun MA, OkparaIgwe U, Sabir AA, et al. Obesity among health service providers in Nigeria: Danger to long term health worker retention? Pan Afr Med J. 2015;22:1. doi: 10.11604/pamj.2015.22.1.5586 Hegde SKB, Sathiyanarayanan S, Venkateshwaran S, Sasankh A, Parasuraman G, Ramraj B. Prevalence of Diabetes, Hypertension and Obesity among doctors and nurses in a Medical College Hospital in Tamil Nadu, India. Natl J Res Community Med. 2015;4:235–9. Bleich SN, Bennett WL, Gudzune KA, Cooper LA. Impact of physician BMI on obesity care and beliefs. Obesity (Silver Spring, Md.). 2012;20(5):999–1005. doi: 10.1038/oby.2011.402 Randhawa H, Ghaedi Y, Khan S, Al-Sharbatti S. The prevalence of overweight and obesity among health care providers in the emirate of Ajman, UAE. J Complement Med Res. 2020;11(3):40–5. doi: 10.1177/2156988020933952 Dankyau M, Shu'aibu JA, Oyebanji AE, Mamven OV. Prevalence and correlates of obesity and overweight in healthcare workers at a tertiary hospital. J Med Trop. 2016;18(2):55. doi: 10.4103/0976-9668.180023 Hazmi H, Ishak WR, Jalil RA, Hua GS, Hamid NF, Haron R, et al. Traditional cardiovascular risk factors among healthcare workers in Kelantan, Malaysia. Southeast Asian J Trop Med Public Health. 2015;46(3):504–11. Mustafa J, Salleh NM, Isa ZM, Ghazi HF. Overweight problem among primary health care workers in suburban district of Hulu Langat, Selangor, Malaysia. Pak J Nutr. 2013;12(4):291–6. doi: 10.3923/pjn.2013.291.296 WHO/IASO/IOTF. The Asia-Pacific perspective: redefining obesity and its treatment. Melbourne: Health Communications Australia; 2000. Mahmood S, Najjad MK, Ali N, Yousuf N, Hamid Y. Predictors of obesity among post graduate trainee doctors working in a tertiary care hospital of public sector in Karachi, Pakistan. J Pak Med Assoc. 2010;60(9):758. Jafar TH, Chaturvedi N, Pappas G. Prevalence of overweight and obesity and their association with hypertension and diabetes mellitus in an Indo-Asian population. Asif M, Aslam M, Altaf S, Atif S, Majid A. Prevalence and Sociodemographic Factors of Overweight and Obesity among Pakistani Adults. J Obes Metab Syndr. 2020;29(1):58–66. doi: 10.7570/jomes19039 . PMID: 32045513. Sharma SV, Upadhyaya M, Karhade M, Baun WB, Perkison WB, Pompeii LA, Brown HS, Hoelscher DM. Are hospital workers healthy?: A study of cardiometabolic, behavioral, and psychosocial factors associated with obesity among hospital workers. J Occup Environ Med. 2016;58(11):1231–8. doi: 10.1097/JOM.0b013e31816515b5 . Caterson ID. Medical management of obesity and its complications. Ann Acad Med Singapore. 2009;38(1):22–7. Tables Table 1 to 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5720050","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":399020056,"identity":"5e15a373-6dc9-4e08-8a82-1c45a4284265","order_by":0,"name":"Fariha Ashraf","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYBAC9gYGhsMghgEQf/gAJNjYCWjhOYDQwjhzBkgLMxFamGFaZvOAWAS1sJ99eLigxs7eXPrww2abX9vk+ZgZGD98zMGjhSfd4PCMY8mJO/vSDJtz+24btjEzMEvO3IZbiz1DGsNhHjbmBIMzDOaPc3tuMwK1sDHz4tHCw/8MqOVfvb3BGfaPzZY9t+0Ja5EA2sLbdphxwxkew2aGH7cTidACtIW373giUEthY2/D7eQ2ZsZmvH7h4U9j/szzrRrksI0NP/7ctp3f3nzww0c8WlABYxuYbCBWPQj8IUXxKBgFo2AUjBQAAOpgT8vdh9mMAAAAAElFTkSuQmCC","orcid":"","institution":"Patel Hospital, Karachi Pakistan","correspondingAuthor":true,"prefix":"","firstName":"Fariha","middleName":"","lastName":"Ashraf","suffix":""},{"id":399020057,"identity":"056368a1-3232-47a5-9866-88be07aa19a4","order_by":1,"name":"Sana Silvia","email":"","orcid":"","institution":"Patel Hospital, Karachi Pakistan","correspondingAuthor":false,"prefix":"","firstName":"Sana","middleName":"","lastName":"Silvia","suffix":""},{"id":399020058,"identity":"dc060097-7ade-4db8-93a8-fb34178b574c","order_by":2,"name":"Bushra Ayub","email":"","orcid":"","institution":"Patel Hospital, Karachi Pakistan","correspondingAuthor":false,"prefix":"","firstName":"Bushra","middleName":"","lastName":"Ayub","suffix":""},{"id":399020059,"identity":"243bf72c-fe1f-485b-8b14-6fe8b277d57c","order_by":3,"name":"Kanwal Nisa","email":"","orcid":"","institution":"Patel Hospital, Karachi Pakistan","correspondingAuthor":false,"prefix":"","firstName":"Kanwal","middleName":"","lastName":"Nisa","suffix":""},{"id":399020060,"identity":"17826155-d772-42f3-8799-354fdf69d9a4","order_by":4,"name":"Ghulam Murtaza","email":"","orcid":"","institution":"Patel Hospital, Karachi Pakistan","correspondingAuthor":false,"prefix":"","firstName":"Ghulam","middleName":"","lastName":"Murtaza","suffix":""}],"badges":[],"createdAt":"2024-12-27 08:23:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5720050/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5720050/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":74569699,"identity":"98fee864-87ec-4efe-9958-5c8ad08eec0a","added_by":"auto","created_at":"2025-01-23 14:09:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":325259,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5720050/v1/0221f385-00b9-434a-9dd5-b6c010969216.pdf"},{"id":73231791,"identity":"88f57877-814c-4bc5-8a04-eb3386e5f63a","added_by":"auto","created_at":"2025-01-08 03:54:54","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":28147,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-5720050/v1/52a55c2cbecddc804ef00eb4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of overweight and obesity among health care professionals: A Multi-institutional Cross-Sectional Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eOver the past 40 years, the rise in overweight and obesity has become a serious concern for public health (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Health care workers (HCW) i.e. doctors, nurses, paramedics, Health Management \u0026amp; Support workers have also been struck by this pandemic as with other professionals. Health Care workers (HCWs) are vital for providing, sustaining and improving quality care, either directly or indirectly. Quality health care depends upon the health status of HCWs, one important indicator of quality HCWs is ideal body weight, which unfortunately is hugely underestimated by HCWs due to their nature of job, sedentary lifestyle, stress, long working hours, lack of sleep, exercise time, unhealthy snacking etc. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It is interesting to note that HCWs, who play a crucial role in promoting health, face challenges with overweight and obesity themselves. Studies have shown that HCWs tend to have higher rates of obesity as compared to the general population (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eVarious job categories within the health care field can have different levels of risks when it comes to being overweight and obese. The nature of work and different job scopes can indirectly contribute to a higher risk of obesity among HCWs (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). A study conducted at Johns Hopkins Bloomberg School of Public Health, USA, showed that obese physicians feel less confident in providing advice on health, nutrition and exercise to their patients (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA study conducted in U.A.E (2020), showed that the prevalence of obesity and overweight among health care workers was found to be 47.3% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Another study conducted at Bingham university teaching hospital in Nigeria (2016), 63.4% of the healthcare workers were found to be either obese (23.2%) or overweight (31.4%) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Multiple studies done in Malaysia have shown a higher prevalence of overweight and obesity among HCWs when compared to age matched general population (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, existing research have not used the revised Asia specific WHO definitions of overweight and obesity (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and have not explored different occupation related risk factors associated in HCWs for obesity and overweight. Moreover, no previous studies have included the healthcare workers who are indirectly involved in hospital services or patient care. Therefore, this study\u0026rsquo;s main objective was to determine the prevalence of obesity among all HCWs according to BMI category of ASIA PACIFIC population and the potential associations between specific occupational risk factor and obesity so a multifaceted approach should be adopted to decelerate this rising pattern of concern.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Sampling:\u003c/h2\u003e \u003cp\u003e This Multi-Institutional Cross-Sectional Study was carried out in three tertiary care hospitals of Karachi from June 1st till 31st July in the year 2021 and included health care workers involving directly or indirectly in the delivery of health care [Doctors, Integrated health professionals (Nursing Personnel, Technicians, Physiotherapist, Nutritionist) and non-medical personnel (Hospital management and janitorial staff)]. HCWs who were pregnant or up to 3 months post-partum, hypothyroid, taking steroids were excluded.\u003c/p\u003e \u003cp\u003eThe sample size was estimated to be 312 using WHO sample size calculator. The confidence interval (CI) was kept at 95% with 5% level of significance (α). The Anticipated Frequency of Obesity: 28.2% (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and absolute precision was kept at 5% (0.05). Participants were recruited using non-probability consecutive sampling.\u003c/p\u003e \u003cp\u003e Written and informed Consent was taken by each participant. For participants who could not read, the primary or the co-investigators verbalized the consent and took permission. Approval to conduct the study was granted by the Hospital Ethics Research Committee.\u003c/p\u003e \u003cp\u003eAll participants were interviewed by surgical residents. Participants were gathered in separate rooms at surgical OPD. Self-made, well-structured questionnaire which included questions about socio-demographic characteristics, anthropometric measurements, medical and family history, nature and duration of job, mode and duration of transport, dietary habits, physical activity, sleeping hours and quality of life was filled individually for each participant by principal investigators and co- investigators from participants who agreed to participate and met the inclusion criteria. Participants' identities were kept anonymous by giving each participant a unique serial number.\u003c/p\u003e \u003cp\u003eWeight and height were recorded twice to reduce intra-observer error using standard weight beam/ stadiometer. (Hydro, weighing capacity min: 120kg, max 160kg, readability 0.5kg) the machine was placed in a private room and each participant was called one by one to maintain privacy. Participants were asked to remove their shoes, lab. Coats, stethoscopes and other accessories i.e. mobile phones, wallet.\u003c/p\u003e \u003cp\u003eBMI was calculated as body weight (Kg) divided by height (m) squared (BMI\u0026thinsp;=\u0026thinsp;weigh(kg)t/ (Height (m)\u003csup\u003e2\u003c/sup\u003e) classified according to South Asian classification cut-off values as \u0026lsquo;underweight\u0026rsquo; (\u0026lt;\u0026thinsp;18.5), \u0026lsquo;normal' (BMI 18.5\u0026ndash;22.9), \u0026lsquo;overweight' (BMI 23.0\u0026ndash;24.9), \u0026lsquo;obese I' (BMI 25-29.9), \u0026lsquo;Obese II\u0026rsquo; (\u0026gt;\u0026thinsp;30) and also with WHO classification as underweight\u0026rsquo; (\u0026lt;\u0026thinsp;18.5), \u0026lsquo;normal' (BMI 18.5\u0026ndash;24.9), \u0026lsquo;overweight' (BMI 25\u0026ndash;29.9), \u0026lsquo;obese I' (BMI 30-34.9), \u0026lsquo;Obese II\u0026rsquo; (35.0-39.9) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSTATISTICAL ANALYSIS:\u003c/h2\u003e \u003cp\u003eAll the collected data was entered into Microsoft excel sheets and then uploaded to SPSS software version 23.0 for analysis. Categorical data was presented as frequency and percentages while numerical data was presented as mean and Standard deviation, following a normal distribution. Descriptive statistics were computed for all variables within each group. Groups-A (under or normal weight) was compared with group-B (overweight \u0026amp; obese) for categorical variables by using chi-square test and continuous variables by using student t-test. A \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 312 participants (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD age: 30.62\u0026thinsp;\u0026plusmn;\u0026thinsp;9.16 years) were included in this study and were categorized into groups based on BMI using both WHO and Asia Pacific classifications. Patients were either categorized as: group-A normal or underweight (BMI less than or equal to 22.9 in Asia Pacific Group, BMI less than or equal to 24.9 in WHO group) or Group-B: Overweight and obese (BMI more than or equal to 23 in Asia Pacific group and BMI more than or equal to 25 in WHO group) (Table\u0026nbsp;1). A substantial discrepancy was observed between the two classifications, with a higher proportion of individuals classified as overweight and obese according to the Asia Pacific criteria (54.8%) compared to the WHO criteria (38.7%) (Table\u0026nbsp;1,2,3).\u003c/p\u003e \u003cp\u003eIn both the groups the highest percentage of participants with overweight and obesity was found in age group 20\u0026ndash;30 years (Asia pacific 57.3% and WHO 54.2%). There was no significant difference of gender in either of the groups. In both the groups\u0026rsquo; married individuals were more likely to have higher BMI than unmarried individuals with a significant p value 0.014 (OR\u0026thinsp;=\u0026thinsp;1.771, 95% CI: 1.120\u0026ndash;2.801) (Table- 4). A significant relationship was observed (p\u0026thinsp;=\u0026thinsp;0.001) in participants as per their duty shifts. Individuals with evening shifts were predominantly in the lower BMI category (OR\u0026thinsp;=\u0026thinsp;0.385, 95% CI:0.1720\u0026ndash;0.745, P\u0026thinsp;=\u0026thinsp;0.006), while mixed-shift workers had higher BMIs. Individuals who perceived a weight increase following the commencement of their current employment demonstrated higher BMIs (49.7%, p-value 0.007). Meal skipping was significantly associated with BMI (p\u0026thinsp;=\u0026thinsp;0.046), with more skipping observed in the lower BMI category.\u003c/p\u003e \u003cp\u003eSmoking status, the presence of co-morbidities, physical activities and sleeping hours did not show significant differences across BMI categories in either classification (Table\u0026nbsp;5).\u003c/p\u003e \u003cp\u003eParticipants were classified into three professional categories: physicians, integrated healthcare providers, and non-medical staff. Among the 171 individuals in the Overweight and Obesity category (as defined by Asia Pacific criteria), 66 (38.6%) were physicians, 76 (44.4%) were integrated healthcare providers, and 29 (17%) were non-medical staff. This distribution was comparable across the Normal and Underweight group.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe prevalence of overweight and obesity among HCWs in our study was found to be 54.8% (according to Asia pacific classification) and 38.7% (WHO classification) which is higher than the reported prevalence of overweight and obesity in general population of Pakistan. A study conducted by M. Asif et al. in 2020 estimated that 22.8% of our population (23.9% of the women and 21.1% of the men) are overweight, and 5.1% (6.3% of the women and 3.2% of the men) are obese (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). World Health Organization (WHO) in 2000 estimated that 26% of women and 19% of men in Pakistan are obese (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Jafar et al. in 2006 reported the prevalence of being overweight and obese in general population in Pakistan as high as 25% (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Moreover, all above mentioned studies had utilized WHO classification to categorize BMI. In our study a higher percentage of participants were categorized within the overweight and obese ranges when utilizing the Asia Pacific BMI classification system, as opposed to the WHO classification system. The higher rate of obesity among healthcare professionals, relative to the general adult population, could be due to their increased vulnerability to weight gain resulting from erratic and prolonged work schedules, unhealthy eating patterns, and occupational stress.\u003c/p\u003e \u003cp\u003eWorldwide, overweight and obesity are major public health concerns that affect people of all demographics. These conditions have harmful effects on all bodily systems. Additionally, they increase the risk of developing chronic diseases. The health issues resulting from excessive weight and obesity further strain the limited resources of healthcare providers (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHealthcare workers (HCWs), like individuals in other professions, are susceptible to obesity. As role models, HCWs should promote obesity prevention and encourage patients to adopt healthier lifestyles. Paradoxically, despite working in a field dedicated to health and wellness, studies have shown a concerning trend of increasing obesity rates among HCWs, often exceeding those of the general population (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe outcomes of this study are in line with international research, which has consistently indicated higher rates of overweight and obesity among healthcare workers compared to the general population. Studies by Iwuala et al. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), Sharma et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and Hazmi et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) have also reported comparable trends with overweight and obesity rates as high as 44.7%, 78.8%, and 53.4%, respectively.\u003c/p\u003e \u003cp\u003eTo foster a healthier and more productive healthcare workforce, it is imperative to address the significant issue of overweight and obesity among healthcare workers (HCWs). By implementing strategies such as promoting physical activity, encouraging balanced diets, and managing stress, healthcare organizations can create supportive environments that empower HCWs to make healthier choices. Additionally, raising awareness about the health risks associated with overweight and obesity and providing guidance on healthy lifestyle practices can significantly contribute to improving the overall health and well-being of HCWs. Furthermore, addressing underlying factors like poor working conditions, excessive stress, and inadequate support can play a crucial role in reducing the prevalence of overweight and obesity among HCWs.\u003c/p\u003e \u003cp\u003eNo study in Pakistan till date has taken in to account the Asia Pacific criteria of BMI classification. While past studies in Pakistan predominantly used the WHO classification, this approach may overlook the true extent of overweight and obesity in the region. Our research emphasizes the importance of employing the Asia Pacific criteria to provide a more accurate evaluation of BMI and its related health consequences.\u003c/p\u003e \u003cp\u003eRisk factors:\u003c/p\u003e \u003cp\u003eLimitations \u0026amp; strengths:\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study reveals a concerningly high prevalence of overweight and obesity among healthcare workers (HCWs) in Pakistan, exceeding the rates observed in the general population. The findings align with global trends, highlighting the urgent need for effective interventions. To address this issue, it is crucial to prioritize strategies that promote healthy lifestyles, create supportive work environments, and raise awareness about the health risks associated with excessive weight. By implementing these measures, healthcare organizations can significantly improve the health and well-being of their workforce and ultimately enhance patient care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFUNDING AND DECLARATIONS\u003c/b\u003e\u003c/h2\u003eNone.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.S. and G.M. conceptualized the research question, S.S. and F.A. K.N. worked in writing the synopsis and getting the ethical approval, data collection and data entry. G.M, F.A, S.S. , B.A. worked on date entry, analysis, results interpretation. F.A. and G.M and S.S. worked on manuscript writing, B.A. helped in writing results. F.A. and G.M, and K.N. were involved in correcting, rewriting and completing the manuscript. All the authors were involved in reviewing the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eDania Javed, Areesha Shakeel\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Obesity and overweight [Internet]. 2020 [cited 2024 Nov 25]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChou CF, Johnson PJ. Health disparities among America's health care providers: Evidence from the Integrated Health Interview Series, 1982 to 2004. 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Ann Acad Med Singapore. 2009;38(1):22\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Overweight, Obesity, Healthcare Workers (HCWs), Prevalence, Asia Pacific BMI","lastPublishedDoi":"10.21203/rs.3.rs-5720050/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5720050/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e· \u003cstrong\u003eKEYPOINTS: \u0026nbsp;\u003c/strong\u003eHigh Prevalence of Overweight and Obesity: The study found a significant number of healthcare workers in Pakistan are overweight or obese.\u003c/p\u003e\n\u003cp\u003e· Use of Asia Pacific BMI: The research utilized the Asia Pacific BMI classification, which is considered more suitable for assessing weight status in this region compared to the traditional Western BMI.\u003c/p\u003e\n\u003cp\u003e· Identification of Risk Factors: The study aimed to identify potential occupational risk factors that contribute to the high prevalence of overweight and obesity among healthcare workers.\u003c/p\u003e\n\u003cp\u003e· Need for Interventions: The findings emphasize the need for targeted interventions to improve the health and well-being of healthcare workers in Pakistan, such as promoting healthy lifestyles, creating supportive work environments, and providing relevant training and education programs.\u003c/p\u003e","manuscriptTitle":"Prevalence of overweight and obesity among health care professionals: A Multi-institutional Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-08 03:54:50","doi":"10.21203/rs.3.rs-5720050/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e7da8466-5142-437a-a7fe-afa5dbdcf984","owner":[],"postedDate":"January 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-23T14:08:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-08 03:54:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5720050","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5720050","identity":"rs-5720050","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}