Tag Archives: UKHLS

Out of work and overweight: Think again.

There’s a widely held preconception that people who are out of work are overweight, perpetuated by the media and, indeed, reinforced by some academic studies. But recent robust evidence throws a whole new light on things and indicates that unemployed people are in fact much more likely to be underweight, and less likely to be overweight, than their peers who have not recently been unemployed. Amanda Hughes from the Institute for Social and Economic Research explains how she came to question narratives about benefit claimants being lazy and overweight and go on to undertake research she believes provides a more accurate picture.

While I was doing my PhD, I volunteered at a foodbank, and noticed that there were more people coming in who were painfully thin than too heavy. Some had not eaten that day or the day before. Others had walked for two hours to get there, because paying for a return bus journey was out of the question.

Of course, not all people who are out of work turn to food banks, and not all people who turn to foodbanks are unemployed. But that experience got me thinking: have researchers and public health officials been so concerned with obesity that they have missed a crucial part of the story? If weight loss or weight gain can occur during unemployment depending on personal circumstances, might there be an overlooked ‘U-shaped’ association of unemployment and body weight, with excess obesity and excess underweight among jobseekers?

We know that risk of dying is higher for jobseekers than for employed peers, and it is often assumed that increased overweight and obesity among jobseekers plays a role. But studies on the relationship of unemployment and body weight have been inconclusive; some document weight gain with unemployment, but others suggest weight loss. However, previous studies have compared only average effects – average change in body weight following job loss, or average differences between unemployed people and controls, and may have missed a more complicated ‘U-shaped’ association.

Working age BMI

Using Understanding Society, a longitudinal, nationally representative survey of more than 40,000 UK households, my colleague Meena Kumari and I were able to look at the BMI (body mass index) of 10,737 working-age adults between 2010 and 2012.

What was different about our study, was that we did not assume unemployment would impact BMI in the same direction for everyone. Rather, we allowed for a simultaneously raised risk among jobseekers of both underweight and obesity, by comparing the probabilities of being underweight, overweight, and obese between current jobseekers, recent jobseekers, and people who had not been unemployed since the start of the survey (the control group). To isolate the impact of unemployment itself, we took into account other factors such as demographics, chronic health conditions and mental health, smoking and physical activity.

A small proportion (0.7 per cent) of the people in our study who were employed were classed as underweight (i.e. had a BMI below 18.5). But for those in our sample who were unemployed, the proportion shot up to almost 4 per cent. This pattern remained when we took into account factors such as their education, gender, smoking, overall health, physical activity and alcohol consumption.

Certain groups were especially at risk: there were more extreme effects for longer-term unemployed people, for men, and people from lower-income households, suggesting household reserves or the support of family members may act as a sort of buffer against weight-loss effects. At the same time, currently unemployed people were much less likely to be overweight than peers who had not recently been unemployed (29 per cent v 40 per cent).

We did find that unemployed people were more likely to be obese, perhaps suggesting changes in dietary quality following unemployment towards energy-dense but nutrient-poor foods. However, this was only the case for non-smokers, which might reflect competing priorities between tobacco, food and other essentials for smokers on severely restricted budgets.

Quantitative evidence

Together, these results point to a complex picture in which jobseekers, depending on the complexities of individual lives, are at increased risk of both underweight and obesity, each with their own associated health risks.

The elevated underweight and reduced overweight among current jobseekers are quantitative evidence that many unemployed people are not eating enough in simple caloric terms. Despite the political importance of this question, evidence of this effect has so far been fairly anecdotal.

Our results make an important contribution to research trying to explain the increased risk of chronic illness and mortality for unemployed people – suggesting that, at least in contemporary Britain, being underweight may contribute to that much more than previously realised.

At the very least, I hope our evidence will be used to challenge preconceptions and debunk myths about unemployment. It has implications for the way politicians, journalists and the wider public perceive unemployment, and for anyone concerned with the health effects of being out of work.

Unemployment, underweight and obesity: Findings from Understanding Society is research by Amanda Hughes and Meena Kumari at the Institute for Social and Economic Research at the University of Essex, and published in the journal Preventive Health.

You can also read an article about this research in The Guardian.

Photo credit: At Work in the Capital Area Foodbank Warehouse, Geoff Livingston

Having any job at all is better than being unemployed, right?

“Bad work just doesn’t fit in 2017!” Those are the words of Matthew Taylor, head of the Government’s recent review of modern work practices, who has called on politicians to make “all work good.” In an interview with the BBC, Mr Taylor, said that, as well as being bad for productivity and the economy, poor quality jobs were bad for people’s health and well-being. Recent research from Tarani Chandola from the University of Manchester has added further weight to those claims, finding that unemployed people who move into poor quality work have worse health than their peers who remain out of work. He explains more about the research findings and how they challenge the idea that having any job is good for your health.

There is considerable evidence to show that being out of work isn’t good for our health and that being in work can bring us a range of benefits, not just financial. It follows, then, that a move out of unemployment and into work is likely to be good for us, but does that hold true if the job we go into is a bad one?

Using rich social, economic and health data from the UK Household Longitudinal Study (UKHLS), our research examined the stress levels of a group of unemployed people aged 30-75, some of whom moved into poor quality jobs, some into good jobs and some who remained unemployed.

We also looked to see if any other factors, including their health at the outset of our study, had any bearing on the likelihood of them moving into a poor or good quality job.

Twelve biomarkers

As well as physical measurements such as height, weight and blood pressure, and self-reported information on their physical and mental health, some participants in the study gave blood samples. These could be tested for a range of markers, high levels of which might indicate diabetes, heart or kidney disease, acute or chronic stress. In total, we had 12 separate biomarkers, providing us with a comprehensive picture of participants’ health and an overall measurement of their stress, something referred to as their allostatic load.

How much people earned, how secure their job was and their working environment were all considered, in order to get a sense of the quality of their employment. Participants were asked how satisfied they were at work, how anxious or worried they felt about their job, how much control they had at work and whether they thought they might lose their job in the coming 12 months.

The people studied were divided into four groups:

  • Remained unemployed
  • Employed in a good quality job
  • Employed in a job with one poor quality measure
  • Employed with at least two poor quality measures

Stress levels

When we looked at the stress levels of the different groups, a clear pattern emerged. Unsurprisingly, people who moved out of unemployment and into a good job had the lowest levels of stress. People who went from being unemployed to working in a bad job (with more than two poor quality job measures) had the highest stress levels. These were 1.5 times higher than for those people who remained unemployed.

We took into consideration a host of other factors that might have had some role in propelling an unemployed person into a good or bad job, but even when we looked at their health at the outset of the study, this did not really play a role, other than to note that the people in better health moved into both good and bad jobs. In other words it wasn’t simply that people already in poor health were moving into the worse jobs.

Although numbers for this research were relatively small, the methods and analysis were extremely robust and we can, with some confidence, challenge the widespread belief that any employment, even poor quality work, is better for our health and wellbeing than being unemployed.

The findings serve to illuminate research published by the RSA and Populus recently, showing that three out of four people think we should do more as a country to improve the quality of work. Even more telling was the contrast between the over two thirds who think we can make all work fair and decent, and the less than one in ten who think this is already the case.

Making good work matter

Mr Taylor makes the case that “good work matters” and the RSA’s social media campaign #GoodWorkIs is a laudable effort to engage the wider public in a discussion about what good work looks like.

However, he, like many others, has said that the “worst work status for health is unemployment”. Our research shows that’s not necessarily the case, and our findings, together with more research in this area, should be considered carefully as strategies are hopefully developed to make his call to “make all work good” a reality not a pipedream, especially in the current political climate.

Re-employment, job quality, health and allostatic load biomarkers: Prospective evidence from the UK Household Longitudinal Study is research by Tarani Chandola and Nan Zhang and is published in the International Journal of Epidemiology.

 

How travelling to work can work for you

There can’t be too many commuters who aren’t now aware that ditching the car and walking to work is much better for them. Considerable evidence has shown that walkers and cyclists are likely to weigh less and be slimmer than their car commuting counterparts. What they may be less aware of is that ditching the car in favour of the bus, train or the tube could have nearly the same benefits. A programme of research by a team at the London School of Hygiene and Tropical Medicine and the ESRC International Centre for Lifecourse Studies, UCL has been taking a closer look at the benefits of being an ‘active commuter’. As researcher Ellen Flint explains, the findings point to some clear ways forward, not just for individuals, but for policy makers too.

Physical inactivity and being sedentary for large parts of the day are a leading cause of obesity and premature death. In England alone something like two thirds of adults do not meet the recommended levels of daily exercise. At the same time there are growing numbers of people commuting to work. In England and Wales that figure is around 24 million people, 67% of whom take the car.

The time of life when most adults become obese is in middle age, with 50-65 year-olds less than half as likely as young adults aged 16-29 to use public transport, nearly half as likely to walk to and from work and two thirds less likely to get on their bikes. So it’s this age group that we have focused on in our programme of research looking at the relationship between active commuting and obesity in mid life.

To help us do this, we have used information from a long term household survey called Understanding Society and a large study called UK Biobank.

Public transport benefits

Our first piece of research used Understanding Society and showed us that not just walking or cycling to work but even catching the bus or the tube are all linked to lower body weight and body fat composition compared with those who get to work by car.

7,534 BMI and 7,424 percentage body fat measurements from men and women who took part in the survey were used in conjunction with information about journeys to work.

Men who commuted via public or active modes had BMI scores around 1 point lower than those who used private transport, equating to a difference in weight of 3kg (almost half a stone) for the average man.

Women who commuted via public or active transport had BMI scores around 0.7 points lower than their private transport using counterparts, equating to a difference in weight of 2.5kg (5.5lb) for the average woman.

When it came to body fat, men who actively travelled to work (walking, cycling or public transport) had body fat that was roughly one per cent point lower than those who commuted by car, confirming the picture seen when looking at BMI.

What’s important to note here is that these differences are larger than those seen in the majority of individually focused diet and physical activity interventions to prevent overweight and obesity.

Second study reinforces

In work just published in The Lancet Diabetes and Endocrinology, we were able to use information from more than 70,000 men and 80,000 women aged 40-69.

More than 60% of these people commuted by car, with only 4 percent and 7 percent respectively reporting walking as their only method of commute and 4 percent and 2 percent cycling. Around one in five was an active commuter some or all of the time.

Except for those who mixed car and public transport, all other groups had significantly lower BMI and percentage body fat than those men and women who ONLY commuted by car.

The biggest differences were for cyclists and the results stayed strong even when we accounted for a wide range of other factors such as social and economic background, their general health and even whether or not they did exercise outside of their daily commute.

The men who cycled were around 5 kg lighter whilst women cyclists were on average nearly 4.5kg lighter than their car commuting counterparts.

Unsurprisingly, walking to work had the next biggest association with reduced obesity. Compared with their car commuting counterparts, men who walked to work were on average 3.0kg lighter; and women typically weighed 2.1kg less.

However, what was perhaps more interesting, and what also reinforced our interesting earlier findings from Understanding Society, was that even those who used a mixture of public transport and active methods of commuting still had significantly lower BMI and body fat percentage than those who commuted exclusively by car.

In fact, it was similar to those who only walked to work. Compared with car commuters, men and women who mixed public transport with some walking or cycling typically weighed 3.1kg and 2.0kg less, respectively.

Active commuting at heart of policy

Separately these two studies make interesting reading, but together they combine to make a powerful and growing body of evidence around the benefits of active commuting and do more than hint at potential interventions for policy makers.

There is now a clear case for the health benefits of active commuting to be taken into consideration by transport planners, town planners and urban designers.

Cities can be active by design and the more evidence that we have to confirm that people who commute actively really are lighter and have a healthier body composition, the more impetus there is for these health related outcomes to be at the heart of policy.

It is time to realise the untapped population health improvements potential of these big shifts we can make in how people travel to and from work.

Photo credit: Chris Rubberdragon