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Behavior and Psychology

Job strain and changes in the body mass index among working women: a prospective study

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The relationship between job strain and weight gain has been unclear, especially for women. Using data from over 52 000 working women, we compare the association between change in job strain and change in body mass index (BMI) across different levels of baseline BMI.


We used data from participants in the Nurses’ Health Study II (n=52 656, mean age=38.4 years), an ongoing prospective cohort study. Using linear regression, we modeled the change in BMI over 4 years as a function of the change in job strain, baseline BMI and the interaction between the two. Change in job strain was characterized in four categories combining baseline and follow-up levels as follows: consistently low strain (low at both points), decreased strain (high strain at baseline only), increased strain (high strain at follow-up only) and consistently high strain (high at both points). Age, race/ethnicity, pregnancy history, job types and health behaviors at baseline were controlled for in the model.


In adjusted models, women who reported high job strain at least once during the 4-year period had a greater increase in BMI (ΔBMI=0.06–0.12, P<0.05) compared with those who never reported high job strain. The association between the change in job strain exposure and the change in BMI depended on the baseline BMI level (P=0.015 for the interaction): the greater the baseline BMI, the greater the BMI gain associated with consistently high job strain. The BMI gain associated with increased or decreased job strain was uniform across the range of baseline BMI.


Women with higher BMI may be more vulnerable to BMI gain when exposed to constant work stress. Future research focusing on mediating mechanisms between job strain and BMI change should explore the possibility of differential responses to job strain by initial BMI.

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  1. Poirier P, Giles TD, Bray GA, Hong YL, Stern JS, Pi-Sunyer FX et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss—an update of the 1997 American Heart Association Scientific Statement on obesity and heart disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 2006; 113: 898–918.

    Article  Google Scholar 

  2. Brunner EJ, Chandola T, Marmot MG . Prospective effect of job strain on general and central obesity in the Whitehall II Study. Am J Epidemiol 2007; 165: 828–837.

    Article  Google Scholar 

  3. Eek F, Östergren P-O . Factors associated with BMI change over five years in a Swedish adult population: results from the Scania Public Health Study. Scand J Public Health 2009; 37: 532–544.

    Article  Google Scholar 

  4. Kouvonen A, Kivimäki M, Cox SJ, Cox T, Vahtera J . Relationship between work stress and body mass index among 45810 female and male employees. Psychosom Med 2005; 67: 577–583.

    Article  Google Scholar 

  5. Overgaard D, Gamborg M, Gyntelberg F, Heitmann BL . Psychological workload is associated with weight gain between 1993 and 1999: analyses based on the Danish Nurse Cohort Study. Int J Obes Relat Metab Disord 2004; 28: 1072–1081.

    Article  CAS  Google Scholar 

  6. Nyberg ST, Heikkilä K, Fransson EI, Alfredsson L, DeBacquer D, Bjorner JB et al. Job strain in relation to body mass index: Pooled analysis of 160 000 adults from 13 cohort studies. J Intern Med 2011; 272: 65–73.

    Article  Google Scholar 

  7. Wardle J, Chida Y, Gibson EL, Whitaker KL, Steptoe A . Stress and adiposity: a meta-analysis of longitudinal studies. Obesity 2011; 19: 771–778.

    Article  Google Scholar 

  8. Hellerstedt WL, Jeffery RW . The association of job strain and health behaviors in men and women. Int J Epidemiol 1997; 26: 575–583.

    Article  CAS  Google Scholar 

  9. Ishizaki M, Nakagawa H, Morikawa Y, Honda R, Yamada Y, Kawakami N et al. Influence of job strain on changes in body mass index and waist circumference: 6-year longitudinal study. Scand J Work Environ Health 2008; 34: 288–296.

    Article  Google Scholar 

  10. Kivimäki M, Head J, Ferrie JE, Shipley MJ, Brunner E, Vahtera J et al. Work stress, weight gain and weight loss: evidence for bidirectional effects of job strain on body mass index in the Whitehall II study. Int J Obes (Lond) 2006; 30: 982–987.

    Article  Google Scholar 

  11. Block JP, He Y, Zaslavsky AM, Ding L, Ayanian JZ . Psychosocial stress and change in weight among US adults. Am J Epidemiol 2009; 170: 181–192.

    Article  Google Scholar 

  12. Rimm EB, Stampfer MJ, Colditz GA, Chute CG, Litin LG, Willett WC . Validity of self-reported waist and hip circumferences in men and women. Epidemiology 1990; 1: 466–473.

    Article  CAS  Google Scholar 

  13. Karasek RA, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B . The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol 1998; 3: 322–355.

    Article  CAS  Google Scholar 

  14. Landsbergis PA, Schnall PL, Schwartz JE, Pickering TG, Warren K . The association of ambulatory blood pressure with alternative forms of job strain. Scand J Work Environ Health 1994; 20: 349–363.

    Article  CAS  Google Scholar 

  15. Willett WC, Sampson L, Stampfer MJ, Rosner B, Bain C, Witschi J et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 1985; 122: 51–65.

    Article  CAS  Google Scholar 

  16. McCullough ML, Feskanich D, Stampfer MJ, Giovannucci EL, Rimm EB, Hu FB et al. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr 2002; 76: 1261–1271.

    Article  CAS  Google Scholar 

  17. Mujahid MS, Diez Roux A, Shen M, Gowda D, Sanchez B, Shea S et al. Relation between neighborhood environment and obesity in the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2008; 167: 1349–1357.

    Article  Google Scholar 

  18. Wolf A, Hunter DJ, Colditz GA, Manson JE, Stampfer MJ, Corsano K . Reproducibility and validity of a self-administered physical activity questionnaire. Int J Epidemiol 1994; 23: 991–999.

    Article  CAS  Google Scholar 

  19. Ainsworth BE, Haskell WL, Leon AS, Jacobs DRJ, Montoye HJ, Sallis JF . Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 1993; 25: 71–80.

    Article  CAS  Google Scholar 

  20. Pinto BM, Borrelli B, King TK, Bock BC, Clark MM, Roberts M et al. Weight control smoking among sedentary women. Addict Behav 1999; 24: 75–86.

    Article  CAS  Google Scholar 

  21. McEwen BS . Protective and damaging effects of stress mediators. N Engl J Med 1998; 338: 171–179.

    Article  CAS  Google Scholar 

  22. Pasquali R, Vicennati V, Gambineri A, Pagotto U . Sex-dependent role of glucocorticoids and androgens in the pathophysiology of human obesity. Int J Obes (Lond) 2008; 32: 1764–1779.

    Article  CAS  Google Scholar 

  23. Champaneri S, Xu X, Carnethon MR, Bertoni AG, Seeman T, DeSantis AS et al. Diurnal salivary cortisol is associated with body mass index and waist circumference: the Multiethnic Study of Atherosclerosis. Obesity 2013; 21: E56–E63.

    Article  CAS  Google Scholar 

  24. Purnell JQ, Kahn SE, Samuels MH, Brandon D, Loriauz DL, Brunzell JD . Enhanced cortisol production rates, free cortisol, and 11β-HSD-1 expression correlate with visceral fat and insulin resistance in men: effect of weight loss. Am J Physiol Endocrinol Metab 2009; 296: E351–E357.

    Article  CAS  Google Scholar 

  25. Epel ES, McEwen BS, Seeman T, Matthews K, Castellazzo G, Brownell KD et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with gentral fat. Psychosom Med 2000; 62: 623–632.

    Article  CAS  Google Scholar 

  26. Kouvonen A, Kivimäki M, Väänänen A, Elovainio M, Ala-Mursula L, Virtanen M et al. Job strain and adverse health behaviors: the Finnish Public Sector Study. J Occup Environ Med 2007; 49: 68–74.

    Article  Google Scholar 

  27. Lallukka T, Lahelma E, Rahkonen O, Roos E, Laaksonen E, Martikainen P et al. Associations of job strain and working overtime with adverse health behaviors and obesity: evidence from the Whitehall II Study, Helsinki Health Study, and the Japanese Civil Servants Study. Soc Sci Med 2008; 66: 1681–1698.

    Article  Google Scholar 

  28. Choi B, Ko S, Landsbergis PA, Dobson M, Schnall PL . Job strain and health-related lifestyle. Am J Public Health 2014; 104: e3.

    Article  Google Scholar 

  29. Smith P . Potentially misleading conclusions: Job strain and health behaviors. Am J Public Health 2014; 104: e4.

    Article  Google Scholar 

  30. Heikkila K, Fransson EI, Nyberg ST, Zins M, Westerlund H, Westerholm P et al. Job strain and health-related lifestyle: findings from an individual-participant meta-analysis of 118 000 working adults. Am J Public Health 2013; 103: 2090–2097.

    Article  Google Scholar 

  31. Lupien SJ, McEwen BS, Cunnar MR, Heim C . Effects of stress throughout the lifespan on the brain, behavior, and cognition. Nat Rev Neurosci 2009; 10: 434–445.

    Article  CAS  Google Scholar 

  32. Zhao I, Bogossian F, Turner C . Does maintaining or changing shift types affect BMI? A longitudinal study. J Occup Environ Med 2012; 54: 525–531.

    Article  Google Scholar 

  33. Leclere A . Shift-work and cardiovascular disease. Eur J Epidemiol 2010; 25: 286–286.

    Google Scholar 

  34. Hattori A, Sturm R . The obesity epidemic and changes in self-report biases in BMI. Obesity 2013; 21: 856–860.

    Article  Google Scholar 

  35. Siegrist J . Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1996; 1: 27–41.

    Article  CAS  Google Scholar 

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The collection of the Nurses’ Health Study II data were supported by the National Institutes of Health (UM1 CA176726). The analysis for this paper was supported by NIH grant P30 DK046200 and the National Institute for Occupational Safety and Health intramural grant (NORA-FY13-927ZKWG).


The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health.

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Fujishiro, K., Lawson, C., Hibert, E. et al. Job strain and changes in the body mass index among working women: a prospective study. Int J Obes 39, 1395–1400 (2015).

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