Overweight and Obesity among Workers of the Public Transportation Service of Lima

1. INTRODUCTION

According to the World Health Organization (WHO), 39% of adults aged 18 years and over (39% of men and 40% of women) are overweight. These represent around 2 billion adults. Of these, more than 650 million are obese [1]. In European countries, overweight and obese adults account for 53.1% of the population [2]. In contrast, the prevalence of obesity among adults in the United States is 42.4% [3]. In Peru, 60% of people aged 15 and over suffer from excess body weight, of which 22% correspond to obesity [4].

Obesity has a multifactorial etiology. However, the most convincing factor in the increased risk of obesity is sedentary lifestyles and high intake of energy-dense foods. In contrast, regular physical activity and a high dietary intake of fiber decrease the risk of obesity [5]. Overweight and obesity have a major impact on physical, mental, and social health [6]. Regarding physical health, obesity and overweight are associated with a variety of health problems such as cardiovascular diseases, diabetes, kidney disease, osteoarthritis, cancer, sleep apnea, gallbladder disease, fatty liver disease, etc. These can lead to death or chronic disability [6, 7].

In 2015, high Body-Mass Index (BMI) contributed to 4.0 million deaths, representing 7.1% of total deaths worldwide. Cardiovascular diseases were the leading causes of death, accounting for 2.7 million deaths. Diabetes mellitus was the second leading cause of BMI-related deaths and contributed to 0.6 million deaths. At the same time, chronic kidney disease and cancers each accounted for less than 10% of all BMI-related deaths [8].

About 61% of Italian professional drivers are overweight or obese; bus drivers have half the risk of being obese compared to truck drivers [9]. In Ghana, the prevalence of obesity and overweight is 19.0% and 35.3%, respectively [10]. In Iran, the prevalence of overweight and obesity in long-distance professional drivers is 39.1% and 10.8%, respectively [11].

In the transport system, the most significant problem corresponds to traffic accidents. Different factors have been evaluated among drivers, including mental health indicators, attitudes towards the consumption of alcoholic beverages, behavioral styles, levels of tiredness, and drowsiness [12]. Peruvian population shows a high proportion of overweight adults [4]. However, the drivers of public transport vehicles (characterized by a sedentary lifestyle and unhealthy eating habits) seem to show a higher proportion of excess weight compared to the general population and also compared to professional drivers from other regions [9-11]. The objective of the study was to determine the frequency of excess weight and its associated factors among workers of the public transport service in Lima.

2. MATERIALS AND METHODS

3. RESULTS

A total of 238 workers of both sexes participated, with a median age of 39 years (interquartile range: 47-32; min. 18, max. 70). Of the sample, 93.7% (n = 223) were male, 63.4% (n = 151) were between 30 and 49 years of age, 67.6% (n = 161) worked in the driver's position and the rest as ticket collectors. Other characteristics of the participants are shown in Table 1.

Table 2 shows the information about food consumption and healthy and harmful habits. Breakfast, lunch, and dinner are mainly consumed at home. There is the regular consumption of snacks and sugary drinks. A high proportion of workers report consuming fruits and vegetables with low frequency. However, less than half perform any physical activities. Regarding the consumption of harmful substances, 66% (n=157) reported the consumption of alcoholic beverages, and 25.6% (n=61) reported the consumption of tobacco.

According to BMI, 81.1% (n=193) had excess weight, of which 44.1% (n=105) corresponded to the overweight and 37% (n=88) to the obesity category. Of the sample, only 18.9% (n = 45) were in the normal range (Table 3).

Excess weight occurred in a higher proportion in workers of the age group of 30 to 49 years (p=0.002), in cohabiting or married people (p=0.006), and in bus drivers (p=0.003). No statistically significant association was found between excess weight and the other variables grouped within the general characteristics, i.e., food consumption and healthy and harmful habits (Table 4).

4. DISCUSSION

In accordance with the objectives of the present study, among workers of the public transport service, the frequency of excess bodyweight was very high; 44% were overweight, and 37% were obese. Excess bodyweight had a significant association with age group, marital status, and bus driver position.

In Peru, 60% of people aged 15 and over belong to the excess weight category, reaching 63.5% in urban areas. The frequency of excess weight is greater in women than in men, affecting 62.9% and 57.2%, respectively [4]. Compared with national data [4] and studies conducted in other countries [9-11], the prevalence in the group of workers of the urban transport service is worrying in our study; 8 out of 10 workers belong to the excess weight category.

In the United States, according to the occupational group, transportation workers have the highest prevalence of obesity, irrespective of gender, race, or ethnicity [16]. Among school bus drivers in rural Arkansas, 91% of drivers were overweight or obese, and most did not meet dietary or physical activity guidelines [17].

Mexican drivers who request the revalidation of their license have a higher BMI than those who request it for the first time, suggesting the link between obesity and dedication to transport activity [18].

In our study, the majority of workers consumed the three main meals outside the home. Likewise, during work, the vast majority consumed snacks and sugary drinks. However, no statistically significant differences were found between overweight workers and those with BMI within the normal range. In Peru, workers belonging to the public transport service spend long hours at work. In our study population, they reported a mean of 15 hours of work per day; considering the transport time to return home, they reduce the hours of sleep. On the other hand, a quarter of the workers had dinner at home. According to the workers’ routines, they usually had dinner late at night.

The increase in obesity worldwide seems to be driven mainly by passive overconsumption of energy. This is likely in response to the changes in the global food system, which is producing more processed, affordable, and effectively marketed food than ever before [19]. Individuals who regularly slept less than 7 hours per night were more likely to have higher average body mass indexes and develop obesity compared with those who slept more [20]. People who ate between 11:00 p.m. and 5:00 a.m. (NE) consumed more total calories than the non-NE group. The difference in intake was due to calories ingested at night, with a significant weight gain among the NE [21].

Obesity among public transport service workers is alarming. A significant proportion does not have health insurance, and 80% are not users of health services. Most of the workers also reported the absence of both personal and familial illnesses. The perception that obesity is synonymous with well-being is common (the good life), so it is likely that among carriers, excess weight is not considered a disease. Therefore, they assume that they can do without health services.

One of the limitations of our study is that it was carried out in only two points of Lima and Callao. However, the public transport companies do not circulate within the same jurisdiction but rather move to or from multiple districts of Lima and Callao. Another limitation is that the weight measurement was carried out at different times of the working day, depending on the accessibility of both the workers and the study team. Despite these limitations, the results clearly reflect the problem of public transport workers.

The study has also made it possible to identify other problems for workers in the transport sector, such as access to health insurance and health services. More than 80% of the workers assume that they do not have any disease. However, the findings prove otherwise. The same proportion of workers are overweight, which is a risk factor for a set of long-term health problems [6, 7]. If no action is taken early, subsequent interventions will have fewer benefits. Due to the labor characteristics of the workers of the public transport service, a chain of sanitary interventions [22], preferably in the workplace, are required.

Finally, in our study, we have found unequal access to jobs according to gender. Less than 7% of workers were women. The presence of women in public transport companies is only symbolic [23]. This is far from fulfilling the mandates of the International Labour Organization [24], which promotes equality between women and men in the working world.

CONCLUSION

The workers of the public transport service in Lima have a very high prevalence of excess weight. It is higher than the national average. The factors associated with excess weight were: the age group between 30 and 49 years of age, marital status, and working as a driver. A sanitary intervention in the family and the workplace is required.

REFERENCES