Obesity and labor market participation: a prospective cohort study of transitions between work, unemployment and sickness absence

Abstract

Introduction Obesity is an important risk factor for several health complications and is an immense cost to society. Individuals who are obese, are often targets of stigmatization and discrimination, e.g. in the labor market, where obese employees are ascribed multiple negative characteristics including being lazy, sloppy, less competent, and lacking in self-discipline. Furthermore, when a resume is accompanied by a picture of an obese person, the applicant is rated more negatively and is less likely to be hired. Another mechanism by which obesity could affect labor market status is health; excessive weight is a risk factor for a range of morbidities, which could lead to decreased productivity. Employment and economic security contribute to good health maintenance and being outside of the labor market is, on the other hand, associated with poor life style and health problems. Exclusion from the labor market could add to the negative consequences of obesity, increasing the burden for the individual as well as for society. It is well established, that obese individuals earn less and have a higher risk of exiting employment through disability pension compared to normal weight individuals. However, it is controversial whether obese individuals have a higher risk of exiting employment through other pathways and if they have a lower chance of getting hired than their non-obese peers. We aim to test the hypothesis that being obese is associated with higher risk of unemployment and sickness absence as well as a lower chance of employment compared to being normal weight. Method A sample of 84,671 men and women (age range: 18–60 years) from the Danish National Health Survey 2010 (DNHS-2010) participated in the study. The exposure was divided into five categories according to body mass index (BMI): underweight (BMI Results Being obese or severely obese were both associated with a higher risk of unemployment and sickness absence as well as a lower chance of employment compared to being normal weight. For example, the hazard ratios (HR) for severely obese individuals were 1.42 (95% CI: 1.31–1.55) for unemployment and 1.53 (95% CI: 1.44-1.64) for sickness absence when comparing to participants of normal weight. Among unemployed individuals, the HR for being employed was 0.80 (95% CI: 0.72–0.90) for severely obese compared to normal weight participants. When stratifying by gender, similar trends were seen for both men and women. However, a lower chance of employment among obese and severely obese individuals was only significant among women. Conclusion Obesity was associated with an increased risk of unemployment and sickness absence compared with individuals of normal weight. Additionally, overweight and obesity was associated with a decreased chance of employment among unemployed women.