Introduction
Finland has a universal social security system that includes comprehensive occupational health services (OHS) provided by employers. These services include preventive health examinations, health risk assessments, and lifestyle counseling. Approximately one million occupational health check-ups are conducted annually in Finland. While these examinations primarily focus on work ability and occupational health, they also address general health behaviors such as weight management, physical activity, and smoking.
Asthma is one of the most common chronic diseases among working-age adults, with a prevalence of about 9.6% in Finland. Obesity and smoking are known to be linked to asthma severity, reduced quality of life, and increased work disability. Although trends in health behaviors have been documented in the general population, limited evidence exists regarding whether occupational health interventions influence weight gain and obesity among workers with asthma compared to those without. This prospective study evaluated the impact of occupational health services on obesity over a 5-year period.
Methods
Study Design and Population
This study used data from the prospective, population-based Health and Social Support (HeSSup) Study. The baseline survey was conducted in 1998, with follow-up in 2003. A total of 23,220 participants aged 20–54 years were included. Asthma was defined as self-reported, physician-diagnosed asthma, excluding chronic bronchitis.
Measurements
- Obesity: Defined as BMI ≥30 based on self-reported weight and height.
- Occupational health service use: Participation in occupational health check-ups, receipt of physician advice to change health behavior, and enrollment in health-promoting programs (e.g., weight loss, smoking cessation).
- Covariates: Gender, age group, smoking status (never, former, current), depression (Beck Depression Scale; score ≥10 indicating depression), and physical workload (very light, light, moderate, heavy).
Statistical Analysis
Chi-square tests and t-tests were used for group comparisons. Univariate and multivariate logistic regression models were constructed to identify predictors of obesity in 2003. Correlations between occupational health check-ups and obesity were analyzed using Spearman’s correlation coefficient. All analyses were performed using SPSS Statistics 19.0. The study was approved by the Ethics Committee of Turku University Central Hospital.
Results
Baseline Characteristics
In 1998, 60.7% of participants had undergone an occupational health check-up. The prevalence of asthma was 3.7%. Asthmatic participants were more often female and younger than non-asthmatic participants. Obesity was more prevalent among asthmatics (12%) than non-asthmatics (9%, p=0.014).
Health Service Use
- Asthmatic workers received physician advice to modify health behavior significantly more often (18% vs 14%, p<0.001).
- Participation in health-promoting programs was low overall but slightly higher among participants with asthma.
- Obese individuals were nearly three times more likely to receive behavior change advice and 1.5 times more likely to join weight-loss programs.
Obesity Trends
Obesity increased from 9.1% (1998) to 13.0% (2003). By 2003, 16% of asthmatics and 13% of non-asthmatics were obese (p<0.05). The largest BMI increase occurred among those who did not receive occupational health check-ups and those who participated in health-promoting programs.
Predictors of Obesity
In univariate analysis, asthma was associated with higher obesity risk (OR 1.27, p=0.035). However, after multivariate adjustment, asthma was no longer significant. Independent risk factors for obesity in 2003 were:
- Male gender (OR 1.19)
- Older age (OR 1.25)
- Current smoking (OR 1.08)
- Depression (OR 1.44)
Physical workload was not a significant predictor in the fully adjusted model.
Discussion
The main finding of this 5-year prospective study is that occupational health check-ups, physician advice for health behavior change, and participation in health-promoting programs did not prevent weight gain or reduce obesity among working-age adults. Asthmatic and non-asthmatic workers exhibited similar weight gain trajectories.
Although asthmatic workers received more frequent behavioral advice, this did not translate into lower weight gain. Obesity rates increased similarly in both groups, suggesting that standard occupational health interventions are insufficient to address obesity. Low participation in structured health programs, brief intervention duration, and lack of long-term follow-up likely contributed to the limited effectiveness.
Consistent with previous research, male gender, older age, smoking, and depression were strong predictors of obesity. Depression was particularly predictive of future obesity, highlighting the need for integrated mental health and weight management support. Physical workload was not independently associated with obesity after confounder adjustment.
These findings support the idea that single, short-term occupational health interventions are inadequate for obesity prevention. More effective strategies may include long-term monitoring, motivational counseling, mobile health applications, and multi-component workplace health programs that combine lifestyle support with mental health care.
Conclusions
Occupational health check-ups, physician-provided health behavior advice, and health-promoting programs did not prevent weight gain over 5 years in either asthmatic or non-asthmatic workers. Asthma was not an independent risk factor for obesity after adjustment for confounding variables. Independent predictors of obesity included male gender, older age, current smoking, and depression.
To reduce obesity in working populations, occupational health services should move beyond one-time check-ups to implement sustained, personalized, and multi-disciplinary interventions that address behavioral, psychological, and lifestyle factors simultaneously.
