American Journal of Health Studies: 23(2) 2008

WORKERS PERCEPTION: ENVIRONMENTAL FACTORS INFLUENCING

OBESITY AT THE WORKPLACE
Cecilia M. Watkins, PhD, Assistant Professor
CHES, Grace K. Lartey, PhD, Assistant Professor
Vijay Golla, PhD, Assistant Professor
Jagdish Khubchandani, MBBS, MPH, Doctoral Student
Abstract. The present study examines the potential influence perceptions may have on workers
nutritional and exercise behaviors, which could allow for more explicit intervention design.
Surveys were administered in four workplaces in Kentucky to measure workers perceptions of
environmental factors at the workplace and their influence on obesity rates. The majority of
employees perceived that the quality of food and stress influenced their choice of food, while the
lack of a worksite gym prevented them from getting enough exercise at the workplace. Time
affected both their eating and exercise habits at the workplace.

INTRODUCTION

Sedentary lifestyles, decreased physical activity,

and high caloric intake are a few of the many behavioral determinants associated with obesity. The longterm effects associated with obesity are heart disease,
cancer, stroke, and Type II diabetes. These diseases
are included in the top leading causes of death in the
United States (CDC, 2007).
According to the Centers for Disease Control
and Prevention, being overweight or obese increases
the risk of many diseases and health conditions. For
adults, overweight and obesity ranges are determined
by using weight and height to calculate body mass
index (BMI). An adult who has a BMI of 30 or
higher is considered obese (CDC, 2007). Due to
rising rates over the past several years, obesity is now
considered a public health issue.
For many years, obesity was only a self-reported
disease; however, many task forces established internationally, nationally, and locally now obtain raw
data concerning this issue. The global epidemic of
overweight and obesity -- globesity -- is rapidly becoming a major public health problem in many parts
of the world (WHO, 2007). The obesity pandemic
originated in the U.S. and crossed to Europe and the
worlds other rich nations before it penetrated the
worlds poorest countries, especially in their urban
areas (Prentice, 2006). In the United States, obesity
has become prevalent in both urban and rural populations. In 2006, Kentucky, considered a mostly rural

state, ranked fifth highest in the U.S. for adults who

are overweight or obese, eighth for adult diabetes
levels and seventh for rates of hypertension (Trust
for Americans Health Reports, 2006).
Physical and social environmental factors play
a big role in the rising rates of obesity among adults
and children. In the worksite, adults are a captive
audience. In fact, employed adults spend a quarter of their lives at work, and the pressure and demands of work may affect their eating habits and
activity patterns, which may lead to overweight and
obesity (Schulte, Blanciforti, Cutlip, Krajnak, &
Luster, 2007). This could have significant impact
in America, considering that the workforce in the
United States as of February, 2008 is 146,000,000
(U.S. Bureau of Labor Statistics, 2008).
Obesity has a significant financial impact on
employers, communities, and the economy in general. According to a study conducted by the Centers
for Disease Control and Prevention, the national
costs attributed to both overweight and obesity
medical expenses accounted for 9.1% of total U.S.
medical expenditures in 1998, which translate into
$78.5 billion, and has grown to $92.6 billion in
2002 (CDC, 2008). It is estimated that employers
spend more than $75 billion annually on obesityattributable health care (Gates, Brehm, Hutton,
Singler, & Poeppelman, 2006). Increases in obesity
rates have impacted health care providers, especially
among the nursing profession. In Washington State

Cecilia M. Watkins, PhD, CHES, is an Assistant Professor, Department of Public Health, Western Kentucky
University. Grace K. Lartey, PhD, is an Assistant Professor, Department of Public Health, Western Kentucky
University. Vijay Golla, PhD, is an Assistant Professor, Department of Public Health, Western Kentucky
University. Jagdish Khubchandani, MBBS, MPH, is a Doctoral Student, Department of Health and
Rehabilitation Services, University of Toledo. Please address all correspondence to Cecilia M. Watkins,
Department of Public Health, Western Kentucky University, 1906 College Heights Blvd # 11082, Bowling
Green, Ky 42101-1082, Phone: 270-745-4796, Fax: 270-745-4337, Email: cecilia.watkins@wku.edu.
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Watkins, Lartey, Golla & Khubchandani

in 2005, the Bureau of Labor Statistics reported one
in 10 health care employees to have an injury, with
the majority being back injuries, triggered by patient
handling activities. Obesity rates in part, have led
many hospitals to implement zero lift policies in
an attempt to prevent work related back injuries
(Charney, Simmons, Lary, & Metz, 2006).
The business economy, a fast-paced environment that strives to meet the demands of consumers,
places a great deal of stress on manufacturing companies. The stress affects workers and their families.
Employees at manufacturing companies may be at
increased risk for obesity due to the static nature of
many of the jobs, low socioeconomic status, limited
availability of healthy food alternatives, and lack of
available space and time for physical activity (Gates,
Brehm, Hutton, Singler, & Poeppelman, 2006).
Because employees spend the majority of their time
at work, creating a healthy environment for workers
seems like a sensible thing to do. Since employers often bear the financial burden of obesity-related costs,
they often are motivated to offer worksite health
behavior interventions that may prevent negative
obesity-related health outcomes and thus reduce
long-term healthcare costs
(Shimotsu, 2007).
Healthy workplaces prevent occupational disease/
accidents, promote the concept of positive lifestyle
behaviors and facilitate organizational development
(Whitehead, 2006).
Several programs have been implemented in the
workplace to address the obesity pandemic and other
health concerns such as diabetes and cardiovascular
disease, as well as the factors leading to these concerns (i.e., physical inactivity and unhealthy eating
habits). Although these issues are being addressed
through health promotion interventions, researchers
have done little work examining workers perceptions of the environmental factors that affect these
issues, especially with obesity.
In terms of previous research that has gained
insight on perceptions, Lassen, Bruselius-Jensen,
Sommer, Thorsen, and Trolle (2007) conducted a
study that assessed the factors influencing workers
attitudes toward promoting healthy eating among
blue-collar workers. This study was conducted in
Copenhagen with the General Workers Union in
Denmark, an organization of unskilled workers. The
study listed environmental, social, and individual
barriers to participation in health promotion programs. Such barriers include the time to participate,
shift work, resistance to changing bad habits, the
perception that wellness programs have nothing to
do with their work culture (the macho factor), and/
or skepticism about managements commitment to
improve workers health. In addition, they found
that people consider their food intake and overall
health as a personal issue (Lassen, Bruselius-Jensen,

Sommer, Thorsen, & Trolle, 2007). The main factors that were examined included: (a) employees
awareness of current health promotion programs
available at the worksite and to what extent: and (b)
employees attitudes toward promoting healthy eating at the worksite (Lassen, Bruselius-Jensen, Sommer, Thorsen, & Trolle, 2007).
From this study, Lassen and colleagues (2007)
determined that 81% of respondents at baseline reported that they thought their worksite should take
part in promoting healthy eating to at least some extent. In addition, 97% of participants at the conclusion of the study viewed the intervention program,
Food at Work, positively, and 80% agreed that participation among the employees was perceived to be
generally high. Although this study did not assess
the physical environmental factors, it gives insight
to the employees perspective on how they perceive
health promotion programs dealing with obesity. It
suggests that workers are receptive to programs that
would improve their health at the worksite. The
results also provide support for developing interventions that not only focus on adjusting physical
environmental factors, but the social environment as
well.
Other researchers have begun to examine the
levels of intervention in the workplace setting and are
using an ecological approach. The ecological workplace physical activity model developed by Plotnikoff
and colleagues identifies six environment levels in the
workplace including: (a) Individual (i.e., employees
characteristics, skills and knowledge as related to
physical activity); (b) Social (i.e., social peer and supervisor relationships as related to physical activity);
(c) Organizational (i.e., the aspiration of the workplace to promote physical activity); (d) Community
(i.e., how the workplace interacts with the community to promote physical activity); (e) Policy (i.e.,
how the policies in the workplace promote physical
activity); and (f ) Physical Environment (i.e., how
the buildings, grounds and surrounding areas of the
workplace can influence physical activity). The ecological method identifies and considers the environmental interactions between the individuals homes,
workplace, and socio-cultural settings as well as the
climate they live in. With this approach, the environmental factors are assessed at the individual level,
through the relationships between the individual and
co-workers, through the physical environment at the
workplace and through the community of the organization itself and its relation to health promotion
(Prodaniuk, Plotnikoff, Spence, & Wilson, 2004). A
study on self-efficacy and outcome expectations in
the workplace, conducted by Prodaniuk, Plotnikoff,
Spence, and Wilson (2004), found small correlations between the environment and levels of physical
activity among employees. They found that factors
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American Journal of Health Studies: 23(2) 2008

influencing physical activity include biological factors, support in the workplace (physical and social)
for such behaviors, and the employees perception of
the workplace environment (Prodaniuk, Plotnikoff,
Spence, & Wilson, 2004).
In these studies, researchers looked into the
physical environmental factors for methods of interventions to increase physical activity and increase
healthy eating habits. Both studies provide evidence
that interventions that focus on environmental
factors have only modest success in achieving goal
behaviors among employees. Engbers, van Poppel,
Chin, and van Mechelen (2006) offer more insight
in their investigation that significantly changed behavioral determinants towards healthier eating habits through social support, self efficacy and attitude.
These studies offer support that workplaces should
adopt all-encompassing strategies that focus on more
than just environmental factors, including strategies
that recognize the importance of personal health
practices as well as social factors (Makrides, Heath,
Farquharson, & Veinot, 2006).
Environmental factors are important contributors to excessive weight and obesity Gates, Brehm,
Hutton, Singler, and Poeppelman, (2006). Minimal
work, however, has been done to gain insight on
workers perceptions on obesity. Studies have revealed
that workers desire that their employers also participate in worksite wellness programs (Whitehead,
2006). Environmental approaches offer companies
a low-cost option (Gates, Brehm, Hutton, Singler,
& Poeppelman, 2006). Based on current literature,
a multi-faceted ecological approach should be used
to identify environmental, social, and individual
barriers to participation in health promotion programs. Ecological models of change in health behavior provide a conceptual framework for targeting
and measuring environmental variables (Shimotsu,
2007). This approach includes corporate members
from leadership as well as the worksite community,
resources, government bodies that foster physical
activities, and policies regarding physical activity.
Programs to reduce the prevalence of obesity and its
related costs must include environmental (Gates, et
al., 2006) and social approaches aimed at the places
people live, work, and play. The present study observes how workers perceptions of environmental
factors at the workplace can influence behaviors of
eating and exercise. The intent was to compare and
contrast perceptions of employees to identify less favorable environmental factors within the workplace
that contribute to overweight and obesity.

METHOD

SELECTION OF PARTICIPANTS
To increase participation, all employees from
four selected workplaces were invited to participate
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in the study. The number of employees in each

workplace was obtained from the human resources
departments. Industry 1 had 150 employees;
industry 2 had 170; industry 3 had 1,887; and
industry 4 had 800 employees. A total of 3,007
questionnaires were sent out; 1,072 were returned.
INSTRUMENT DEVELOPMENT
An open invitation was sent to all employees
at an industrial workplace (not a participant
workplace in this study) to participate in focus group
discussions. The focus groups were designed to assess
employees perceptions about environmental factors
in the workplace and the influence these factors
have on the prevalence of obesity. Twenty-seven
employees accepted the invitation to participate.
Focus group data were analyzed for common themes.
The identified themes were used in the development
of the instrument. The final instrument was 2
pages and assessed employees perceptions about
environmental factors in the workplace and their
influence on obesity.
PROCEDURES
To ensure complete confidentiality and
anonymity, the questionnaires, which consisted of a
cover letter explaining the purpose of the study and
assuring confidentiality, with prepaid postage were
mailed to the human resource departments to be
distributed to employees. The questionnaires were
coded and employees were encouraged to keep their
codes. Employees had the opportunity to win a $100
gift certificate for participating. Codes were entered
in a raffle and winners codes and gift certificates were
e-mailed to the various human resource departments
to be announced to the employees.
DATA ANALYSIS
SPSS 14.0 was used to analyze the data.
Frequencies, means, and standard deviations were
used to describe the demographic characteristics.
Analysis of variance (ANOVA) tests and t tests were
calculated to determine the relationship between the
independent variable (i.e., the workers perceptions
of environmental factors) and the dependent
variables (i.e., eating and exercise habits). Chi-square
tests were used to analyze the categorical data. Level
of significance was set at p < 0.05.

RESULTS

DEMOGRAPHIC AND BACKGROUND CHARACTERISTICS

A total of 3,007 surveys were sent to the em-

Watkins, Lartey, Golla & Khubchandani

ployees in the four selected workplaces; 1,072 (36%)
were returned. The majority of employees were female (75%) and most of them were between 28 and
57 years old (73%) (Table 1).
TIME CONSTRAINTS
Two items assessed time constraints regarding
exercise and eating habits at the workplace. The majority of employees believed time affected their eating and exercise habits at the workplace. Fifty-seven
percent believed time constraints prevented them
from eating healthy food while 59% of employees
believed it affected their exercise habits.
COST OF FOOD
Two items looked at healthy eating habits in
the workplace. The majority of employees (59%) believed the quality of food at the workplace influenced
their eating habits; however, only 28% of employees
believed the cost of food at the workplace influenced
their eating habits. Chi-square analysis of quality of
food by employees gender found a significant difference (2 = 4.15, df = 1, p < .05). Seventy-eight
percent of female employees believed quality of food
at the workplace influenced their eating habits.

PHYSICAL EXERCISE
Sixty-five percent of employees believed the lack
of a worksite gymnasium prevented them from getting enough exercise at the workplace, while 42% of
employees believed their work assignments prevented them from exercising. A one-way analysis of variance (ANOVA) test was conducted to evaluate the
relationship between physical exercise at the work
place and employees age. Results were significant
for the lack of an exercise facility at the workplace
[F(5, 1066) = 8.3, p < .001]. Compared to other
age groups, the 28-37 year olds exercise habits are
influenced more by the lack of an exercise facility at
the workplace than their work assignments.
STRESS AT THE WORKPLACE
Six items assessed the effects of workplace stress
on employees eating and exercise habits. The majority of employees did not believe workplace stress
influenced their eating or exercise habits (Table 2).
Using t-test analyses, statistically significant differences were found. A significant difference was found
on the hypothesis that workplace stress influenced
employees to eat less. Female employees influenced

Table 1: Demographic and Background Characteristics of Employees (N = 1072)

__________________________________________________________________________
Item
n (%)
__________________________________________________________________________
Gender
Female

808 (75)

Male

264 (25)

Age (years)
18-27

197 (18)

28-37

237 (22)

38-47

293 (27)

48-57

253 (24)

58-67

82 (8)

68+
10 (1)

Type of Workplace
Workplace A
95 (9)
Workplace B

109 (10)

Workplace C

849 (79)

Workplace D

19 (2)

____________________________________________________________________________________________

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American Journal of Health Studies: 23(2) 2008

by workplace stress tend to eat less compared to male
employees [t(395) = -2.960, p <.01]. Using chisquare analysis, workplace stress resulting in eating
less was found to be significant (2 = 10.24, df =
1, p < .01). Sixty-seven percent of female employees believed workplace stress influenced them to eat
less. Male employees on the other hand tend to eat
more junk food when influenced by workplace stress
[t(426) = -5.2, p < .001]. In addition, female employees tended to eat healthier food when influenced
by workplace stress [t(319) = -2.6, p < .01]. Analysis
of variance (ANOVA) tests were conducted to determine the relationship between work place stress and
employees age. Statistically significant differences
were found for eating less [F(5, 1066) = 2.6, p < .05]
and eating more junk food [F(5, 1066) = 3.5, p <

.01]. The 18-27 year olds tended to eat less under

workplace stress compared to the 48-57 year olds.
On the other hand, the 28-37 year olds tended to eat
more junk food compared to the 68+ yr olds.
WORK SHIFT
Employees did not believe their work shift influenced them to exercise more (98%) or eat healthier
foods (96%) (Table 3). Statistically significant differences were found when t-test analyses were conducted to test the influence of work shift on eating
and exercise habits. Work shift influenced female
employees and caused them to eat less compared
to their male counterparts [t(381) = -3.2, p < .01].
Chi-square analysis of work shift by employee eating
habit found a significant difference (2 = 12.84, df =

Table 2: Employees Perceptions of the Influence of Stress on Their Eating and Exercise Habits (N = 1072)
________________________________________________________________________________________
Item
Yes
No

n (%)
n (%)
________________________________________________________________________________________
Does stress at your workplace influence you to:
Eat larger amounts of food

296 (27.6)

776 (72.4)

Eat less food

Eat more junk food

197 (18.4)

875 (81.6)

667 (62.2)

405 (37.8)

Eat healthier food

29 (2.7)

29 (2.7)

Exercise more

44 (4.1)

1028 (95.9)

Exercise less
473 (44.1)
599 (55.9)
________________________________________________________________________________________

Table 3: Employees Perceptions of the Influence of Work Shift on Their Eating and Exercise Habits (N =
1072)
________________________________________________________________________________________
Item
Yes
No

n (%)
n (%)
________________________________________________________________________________________
Does your work shift influence you to:
Eat larger amounts of food

209 (19.5)

863(80.5)

Eat less food

Eat more junk food

162 (15.1)

910 (84.9)

492 (45.9)

580 (54.1)

Eat healthier food

41 (3.8)

1031 (96.2)

Exercise more

25 (2.3)

1047 (97.7)

Exercise less
424 (39.6)
648 (60.4)
________________________________________________________________________________________

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Watkins, Lartey, Golla & Khubchandani

Table 4: Employees Perceptions of the Influence of Coworkers on Their Eating and Exercise Habits (N =
1072)
________________________________________________________________________________________
Item
Yes
No

n (%)
n (%)
________________________________________________________________________________________
Does your coworkers influence you to:
Eat larger amounts of food

262 (24.4)

810(75.6)

Eat less food

Eat more junk food

68 (6.3)

1004 (93.7)

507 (47.3)

565 (52.7)

Eat healthier food

177(16.5)

895 (83.5)

Exercise more

138 (2.3)

934 (87.1)

Exercise less
129(12.0)
943 (88.0)
________________________________________________________________________________________

1, p < .001). Eighty percent of female employees are

influenced by their work shift to eat less. Male employees, on the other hand, tended to eat more junk
food compared to female employees [t(458) = 2.92,
p < .01]. In addition, female employees tended to eat
healthier food when influenced by work shift [t(341)
= -2.4, p < .05]. Female employees exercised more
compared to their male counterparts [t(318) = -2.5,
p < .05]. Analysis of variance (ANOVA) tests were
conducted to determine the relationship between
work shift and employees age. Statistically significant differences were found on eating less food [F(5,
1066) = 2.6, p < .05] and eating junk food [F(5,
1066) = 5.5, p < .001]. Compared to the 58-57 year
olds, 18-27 year olds tended to eat less due to their
work shift. In addition, 18-27 year olds and 28-37
year olds tended to eat more junk food due to their
work shift compared to 38-47 year olds.

CO-WORKERS
The majority of employees did not believe their
co-workers influenced them to eat less food (94%) or
eat larger amounts of food (76%) (Table 4). Statistically significant differences were found when t-test
analyses were conducted. Male employees were more
influenced by their co-workers to eat more [t(488)
= 2.1, p < .05] and eat more junk food [t(470) =
5.4, p < 001]. On the other hand, female employees
were influenced more by their co-workers to exercise
less [t(379) = -2.8, p < .05]. Analysis of variance
(ANOVA) tests were conducted to determine the relationship between the influence of co-workers and
employees age. A statistically significant difference
was found on eating more junk food [F(5, 1066) =
3.9, p < .01]. Compared to the 38-47 year olds, employees between 18 and 27 are influenced by their

co-workers to eat more junk food.

DISCUSSION

Workers perceive that some environmental factors at the workplace can influence their eating and
exercise behaviors. This study reveals that the majority of employees perceived that the quality of food
and stress influenced their choices of food, while the
lack of a worksite gym prevented them from getting
enough exercise at the workplace. Time affected both
their eating and exercise habits at the workplace.
With these significant findings, employers efforts to refine food selections at the workplace would
certainly provide an incentive for workers to eat a
healthier diet. In addition, stress and time management classes could also be utilized to build skills for
workers to cope with challenges found not only at
the workplace, but also at home. The advantage of
having an on-site gym for workers would have to be
considered on a site-to-site situation. Some worksites, due to cost restraints, may consider reduced or
free memberships at a local gym. The advantages of
implementing policies in the workplace for flex time
would encourage workers to either implement or
improve their eating and exercise habits.
All of these health promotion components for
the worksite would focus on the issues that workers perceive as influencing their health behaviors.
These components, while beneficial to the long-term
health of the company, are also an immediate and
costly investment for employers. Many companies
in the U.S. are dealing with sky-rocketing healthcare costs, losing business to foreign enterprises and
struggling to keep above the break-even line. To encourage these companies to invest upfront in their
workforce, the government should offer incentives,
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American Journal of Health Studies: 23(2) 2008

which will support these companies through the initial stages of program setup and maintenance. One
example of government support is a bill introduced
in the Kentucky House of Representatives, which
would establish a wellness project tax credit for employees implementing wellness programs. This is a
progressive step for worksite wellness (Kentucky.gov,
2008).
As noted by Gates, et al. (2006), the increased
risks for obesity at the workplace, which includes
limited healthy food choices and limited time for
exercise, support the findings in this study. Lassen,
et al. (2007) also listed time as a major barrier for
workers to participate in health promotion programs
at the worksite.
Limitations of this study include content validity, the low response rate (36%), and the convenience

sampling. The design of the questionnaire was intended to be short and simple in the anticipation
of a high rate of return. This could contribute to a
question of content validity. The low response rate
can be attributed to the nature of the working environment. Often at work, people are rushed and will
not take time to answer a questionnaire. Also, many
people, despite the assurance of confidentiality, may
believe their answers could be used against them in
their job evaluations. While incentives were offered
to increase participation rates, job type, education
level, low morale or even general antipathy toward
the study may have influenced the response rate.
Finally, the participants were chosen by their willingness to fill out the questionnaire. A large random
sample would have better represented the working
population than a convenience sample.

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