Original Article
Relationship between weight gain and stress factors among working-age people in Yugawara Town, Kanagawa Prefecture, Japan: a cross-sectional study
2023 年 1 巻 1 号 p. 10-21
詳細
2023 年 1 巻 1 号 p. 10-21
Background: The study aimed to identify the lifestyle factors associated with weight gain among working-age people in Yugawara, Japan.
Methods: A cross-sectional study was conducted among the citizens aged 19–64 years in Yugawara town. Data were obtained between February and March 2015 using a household survey. A bi-variate logistic regression model was used to assess the components associated with overweight status. The level of statistical significance was set at p < 0.05.
Results: There were 717 participants. A body mass index (BMI) ≥18.5 and <25.0 was considered normal weight, and BMI ≥25.0 was considered obese. There were 137 (17.2%) participants with overweight and 580 (72.9%) with either normal weight. Overweight status was positively correlated with ‘being unable to manage stress’ (odds ratio [OR]: 1.66; 95% CI: 1.10, 2.51; p = 0.015), ‘stress relief by eating’ (OR: 1.63; 95% CI: 1.03, 2.57; p = 0.036), ‘stress relief by watching TV’ (OR: 1.70; 95% CI: 1.09, 2.66; p = 0.020), ‘feeling unhealthy’ (OR: 1.95; 95% CI: 1.16, 3.25; p = 0.011), ‘eating dinner alone’ (OR: 1.58; 95% CI: 1.03, 2.44; p = 0.038) and ‘lower frequency of drinking alcohol’ (OR: 2.16; 95% CI: 1.41, 3.32; p < 0.001).
Conclusion: This study found that in working-age Japanese people, weight gain is influenced by stress factors, highlighting the significance of a good stress management approach to avert obesity and related health problems.
Currently, lifestyle-association diseases account for over 80% of all causes of death in Japan1). Obesity is one of the features that cause lifestyle-related diseases.The Ministry of Health, Labour and Welfare’s annual survey of national health and nutrition in Japan shows that obesity among men has been on the rise since 20132). The 2019 results showed that 33.0% of men were considered overweight, with an average body mass index of 25 or more, 4.4 points higher than in 20132). The average was 39.7% for men in their forties and 39.2% for men in their fifties. For women, the overall average was 22.3%, 2.0 points higher than in 2013. A smaller proportion of women than men are obese in all age groups2).
In 2020, the lifestyle diseases associated with the main causes of death were as follows: malignant neoplasm, 27.6%; heart disease, 15.0%; senility, 9.6%; and cerebrovascular disease, 7.5% in Kanagawa Prefecture3).
Factors that are known to lead to weight gain include physical inactivity, irregular eating, an unbalanced diet, overeating, eating too fast, drinking alcohol, smoking and high levels of stress4,5).
In addition, depending on the region, there are a number of factors that contribute to weight gain specifically in obese people6). In particular, there are reports of ‘binge eating’, where people binge on sweets, alcohol and snacks due to stresses7,8).
In traditional family, three generations lived together—grandparents, parents and children—and almost all family members ate together at mealtimes. However, today’s families are almost always two-generational, with each parent and child eating separately. However, there has been little research into how to alleviate the stress of obesity at a local level.
The aim of this study is twofold: 1) to validate the relationship between obesity and lifestyle factors among working-age people in the city of Yugawara, Kanagawa Prefecture, and 2) to identify the stress reduction techniques used. This will be done using data from health surveys.
The questionnaire was part of a survey that informed the creation of a health- and dietary education-promotion plan for the town of Yugawara. The subjects of the survey were men and women of working age, defined as 19 to 64 years of age in the town of Yugawara, in the Kanagawa Prefecture. This survey was conducted from February to March 2015. The questionnaire was self-administered and sent via mail. 2,475 questionnaires in total were delivered. Among these, 835 questionnaires were recovered (33.7%). A body mass index (BMI) was calculated from height and weight. BMI <18.5 was excluded. BMI ≥18.5 and <25.0 was considered normal weight, and BMI ≥25.0 was considered obese. There were 717 eligible participants, and the analysis flowchart for this survey is shown in Fig. 1. The analysis flowchart of this survey is depicted in Fig. 1.
The question items of the Yugawara Town Health Survey were stratified into the following items. There are 38 questions on the questionnaire, including physical characteristics such as height and weight, self-diagnosed health status, who you live with, who you eat with, when you have an anxiety and stress, you are able to manage them, and how you manage anxiety and stress. The questionnaires are shown in Supplementary Table 1.
Statistical analysisMultiple comparisons were used to compare the differences in the average values of age, height and gender by obesity class. Obesity class and the number of responses were examined using fisher’s exact test. Objective variables were: obese body type and normal body type. Explanatory variables were: questionnaire question items including ‘nutrition/diet’, ‘exercise’ and ‘sleep’. A bi-variate logistic regression model was carried out. EZR version 1.53 was employed as the analysis software9). It was determined that a significant difference existed when the upper limit (UL) and lower limit (LL) of the 95% confidence interval had an odds ratio (OR) of 1.0 or more, and the p value was of <0.05.
The characteristics of the subjects by obesity class are shown in Table 1 and Table 2. There were significant differences in sex (p = 0.004), body weight (p < 0.001), employment situation (p = 0.013), self-reported health condition p = 0.009, body shape desires (p < 0.001), having dinner with someone (p = 0.009), eating speed (p = 0.019), perceptions of Shokuiku (p = 0.037), frequency of exercise (p = 0.005), how much exercise would you like to do in the future (p = 0.015), be valued by those around you (p = 0.004). Missing data were addressed listwise deletion.
| Variable (n) | 18.5≤ BMI <25.0 (%) | 25.0≤ BMI (%) | p-value | |
|---|---|---|---|---|
| Sex (716) | Men (318) | 242 (33.8) | 76 (10.6) | 0.004 |
| Women (398) | 337 (47.1) | 61 (8.5) | ||
| Age (years) (644) | Mean (SD) | 43.3 (13.9) | 44.9 (12.8) | 0.727 |
| Height (cm) (717) | Mean (SD) | 163.1 (8.6) | 164.5 (9.5) | 0.227 |
| Body weight (kg) (717) | Mean (SD) | 57.6 (8.4) | 76.7 (11.9) | <0.001 |
| Employment situation (708) | University and vocational students (including gap year) (33) | 33 (4.7) | 0 (0.0) | 0.013 |
| Agriculture, fishing, self-employment (57) | 51 (7.2) | 6 (0.8) | ||
| Employees and officials of enterprises and organisations (284) | 219 (30.9) | 65 (9.2) | ||
| Directors and managers of companies and organisations (27) | 22 (3.1) | 5 (0.7) | ||
| Temporary staff (5) | 3 (0.4) | 2 (0.3) | ||
| Part-time job (130) | 109 (15.4) | 21 (3.0) | ||
| Housewife (85) | 74 (10.5) | 12 (1.7) | ||
| Young people living on part-time work (2) | 2 (0.3) | 0 (0.0) | ||
| Employees of inns, recreation centres, etc. (17) | 13 (1.8) | 4 (0.6) | ||
| Unemployed (51) | 36 (5.1) | 15 (2.1) | ||
| Other (16) | 11 (1.6) | 5 (0.7) | ||
| Availability of family members living with them (716) | Living alone (78) | 57 (8.0) | 21 (2.9) | 0.366 |
| Married life (115) | 94 (13.1) | 21 (2.9) | ||
| Parent-child living (406) | 330 (46.1) | 76 (10.6) | ||
| Lives of parents, children and grandchildren (99) | 84 (11.7) | 15 (2.1) | ||
| Other (18) | 14 (2.0) | 4 (0.6) |
Bold: significant difference, SD:standard deviation
| Variable (n) | 18.5≤ BMI <25.0 (%) | 25.0≤ BMI (%) | p-value | |
|---|---|---|---|---|
| Self-reported health condition (716) | Very healthy (100) | 89 (12.4) | 11 (1.5) | 0.009 |
| Fair to good health (522) | 425 (59.4) | 97 (13.5) | ||
| Rather unhealthy (63) | 45 (6.3) | 18 (2.5) | ||
| Not healthy (31) | 21 (2.9) | 10 (1.4) | ||
| Health awareness (717) | Been thinking about it since before (223) | 191 (26.6) | 32 (4.5) | 0.056 |
| More careful than before (388) | 306 (42.7) | 82 (11.4) | ||
| No more careful than before (36) | 25 (3.5) | 11 (1.5) | ||
| I wasn’t careful before. (70) | 58 (8.1) | 12 (1.7) | ||
| Recognition of metabolic syndrome (710) | Heard a lot (from TV or family) (444) | 354 (49.9) | 90 (12.7) | 0.665 |
| I’ve heard of them, but I’m not sure (256) | 211 (29.7) | 45 (6.3) | ||
| Never heard of it (10) | 8 (1.1) | 2 (0.3) | ||
| Body shape desire (715) | Want to lose a lot of weight (151) | 64 (9.0) | 87 (12.2) | <0.001 |
| Want to lose some weight (364) | 315 (44.1) | 49 (6.9) | ||
| Better leave it the way it is (173) | 173 (24.2) | 0 (0.0) | ||
| Want to gain some weight (27) | 27 (3.8) | 0 (0.0) | ||
| Undergoing cancer screening (706) | At work (56) | 47 (6.7) | 9 (1.3) | 0.689 |
| In the group health checks of the town (60) | 47 (6.7) | 13 (1.8) | ||
| In the town’s institutional health checks (17) | 15 (2.1) | 2 (0.3) | ||
| In private healthcare facilities (98) | 83 (11.8) | 15 (2.1) | ||
| Not received (475) | 378 (53.5) | 97 (13.7) | ||
| Have breakfast (713) | Every day (526) | 425 (59.6) | 101 (14.2) | 0.627 |
| Not eating 1–3 days a week (71) | 60 (8.4) | 11 (1.5) | ||
| Not eating 4–5 days a week (21) | 18 (2.5) | 3 (0.4) | ||
| No (95) | 73 (10.2) | 22 (3.1) | ||
| Having breakfast with (610) | The family (120) | 102 (16.7) | 18 (3.0) | 0.267 |
| Not all together, but eating with the family (177) | 146 (23.9) | 31 (5.1) | ||
| Alone (254) | 205 (33.6) | 49 (8.0) | ||
| Alone (because I live alone) (59) | 43 (7.0) | 16 (2.6) | ||
| Having dinner with (709) | The family (289) | 233 (32.9) | 56 (7.9) | 0.009 |
| Not all together, but eating with the family (232) | 201 (28.3) | 31 (4.4) | ||
| Alone (114) | 89 (12.6) | 25 (3.5) | ||
| Alone (because I live alone) (69) | 48 (6.8) | 21 (3.0) | ||
| No (5) | 3 (0.4) | 2 (0.3) | ||
| Likes and dislikes (713) | A lot (81) | 72 (10.1) | 9 (1.3) | 0.132 |
| A little (210) | 162 (22.7) | 48 (6.7) | ||
| Don’t like them a lot (208) | 171 (24.0) | 37 (5.2) | ||
| No (214) | 172 (24.1) | 42 (5.9) | ||
| Eating speed (712) | Very slow (12) | 10 (1.4) | 2 (0.3) | 0.019 |
| Slightly slow (59) | 53 (7.4) | 6 (0.8) | ||
| Normal speed (264) | 224 (31.4) | 40 (5.6) | ||
| Slightly fast (260) | 205 (28.8) | 55 (7.7) | ||
| Very fast (117) | 85 (11.9) | 32 (4.5) | ||
| Frequency of vegetable consumpti (714) | Every day (251) | 210 (29.4) | 41 (5.7) | 0.139 |
| Twice a day (122) | 105 (14.7) | 17 (2.4) | ||
| Once a day (213) | 165 (23.1) | 48 (6.7) | ||
| Once every two days (98) | 74 (10.4) | 24 (3.4) | ||
| Don’t eat everyday (30) | 24 (3.4) | 6 (0.8) | ||
| Frequency of eating out (714) | At least twice a day (16) | 10 (1.4) | 6 (0.8) | 0.328 |
| Once a day (77) | 60 (8.4) | 17 (2.4) | ||
| 3–6 times a week (130) | 104 (14.6) | 26 (3.6) | ||
| 1–2 times a week (277) | 227 (31.8) | 50 (7.0) | ||
| 1–3 times a month or seldom (214) | 177 (24.8) | 37 (5.2) | ||
| Perceptions of Shokuiku (711) | I know the language and I know the content (317) | 270 (38.0) | 47 (6.6) | 0.037 |
| Have heard of the word but do not know what it means (334) | 259 (36.4) | 75 (10.5) | ||
| Never heard of it (60) | 47 (6.6) | 13 (1.8) | ||
| Awareness of the Japanese Food Guide Spinning Top (708) | I know the language and I know the content (102) | 84 (11.9) | 18 (2.5) | 0.777 |
| Have heard of the word but do not know what it means (207) | 164 (23.2) | 43 (6.1) | ||
| Never heard of it (399) | 324 (45.8) | 75 (10.6) | ||
| Frequency of exercise (701) | 5 days/week or more (50) | 43 (6.1) | 7 (1.0) | 0.005 |
| 3–4 days a week (84) | 77 (11.0) | 17 (2.4) | ||
| 1–2 days a week (130) | 93 (13.3) | 37 (5.3) | ||
| 2–3 days a month (81) | 68 (9.7) | 13 (1.9) | ||
| Less than 1 day per month (30) | 20 (2.9) | 10 (1.4) | ||
| None at all (312) | 265 (37.8) | 47 (6.7) | ||
| Can’t do it for health reasons (14) | 9 (1.3) | 5 (0.7) | ||
| Time of day for exercise (384) | Weekday morning to midday (81) | 65 (16.9) | 16 (4.2) | 0.990 |
| Weekday midday to weekday evening (39) | 30 (7.8) | 9 (2.3) | ||
| Weekday evening and night (67) | 51 (13.3) | 16 (4.2) | ||
| Holiday morning to midday (40) | 32 (8.3) | 8 (2.1) | ||
| Holidays midday to afternoon (27) | 20 (5.2) | 7 (1.8) | ||
| Holidays evening and night (18) | 14 (3.6) | 4 (1.0) | ||
| Not specified (112) | 88 (22.9) | 24 (6.3) | ||
| Exercise with (382) | Alone (226) | 172 (45.0) | 54 (14.1) | 0.720 |
| The family (47) | 35 (9.2) | 12 (3.1) | ||
| Friend (26) | 22 (5.8) | 4 (1.0) | ||
| Worker (20) | 17 (4.5) | 3 (0.8) | ||
| Circle and Club Mates (55) | 46 (12.0) | 9 (2.4) | ||
| Neighbours and community members (4) | 3 (0.8) | 1 (0.3) | ||
| Other (4) | 4 (1.0) | 0 (0.0) | ||
| How much exercise would you like to do in the future (702) | Want to do more (215) | 170 (24.2) | 45 (6.4) | 0.015 |
| continue (156) | 124 (17.7) | 32 (4.6) | ||
| Want to start (190) | 165 (23.5) | 25 (3.6) | ||
| Want to reduce (1) | 1 (0.1) | 0 (0.0) | ||
| Can’t do it for health reasons (11) | 5 (0.7) | 6 (0.9) | ||
| Not particularly thought about (129) | 102 (14.5) | 27 (3.8) | ||
| Bedtime (weekdays) (712) | Before 8 pm (8) | 8 (1.1) | 0 (0.0) | 0.223 |
| 8 pm (7) | 5 (0.7) | 2 (0.3) | ||
| 9 pm (51) | 42 (5.9) | 9 (1.3) | ||
| 10 pm (123) | 104 (14.6) | 19 (2.7) | ||
| 11 pm (227) | 183 (25.7) | 44 (6.2) | ||
| midnight (177) | 146 (20.5) | 31 (4.4) | ||
| After 1 am (75) | 57 (8.0) | 18 (2.5) | ||
| Not decided (44) | 30 (4.2) | 14 (2.0) | ||
| Sleep time (weekdays) (713) | Less than 4 hours (14) | 11 (1.5) | 3 (0.4) | 0.685 |
| 4–5 hours (77) | 57 (8.0) | 20 (2.8) | ||
| 5–6 hours (202) | 165 (23.1) | 37 (5.2) | ||
| 6–7 hours (249) | 204 (28.6) | 45 (6.3) | ||
| 7–8 hours (127) | 105 (14.7) | 22 (3.1) | ||
| 8–9 hours (43) | 33 (4.6) | 10 (1.4) | ||
| More than 9 hours (1) | 1 (0.1) | 0 (0.0) | ||
| Situation on waking (712) | Feeling tired and refreshed (85) | 67 (9.4) | 18 (2.5) | 0.802 |
| Not enough, but some of the fatigue has gone (449) | 366 (51.4) | 83 (11.7) | ||
| Feeling tired (178) | 142 (19.9) | 36 (5.1) | ||
| Stress (709) | Feeling stressed often (194) | 155 (21.9) | 39 (5.5) | 0.911 |
| Sometimes feel stressed (372) | 301 (42.5) | 71 (10.0) | ||
| Feeling less stressed (143) | 117 (16.5) | 26 (3.7) | ||
| Unable to manage anxious or stressed (700) | It’s well-managed (89) | 78 (11.1) | 11 (1.6) | 0.064 |
| It’s managed (389) | 316 (45.1) | 73 (10.4) | ||
| Not very well processed (166) | 132 (18.9) | 34 (4.9) | ||
| Not processed at all (56) | 39 (5.6) | 17 (2.4) | ||
| Sometimes feeling blue or depressed (708) | None at all (274) | 226 (31.9) | 48 (6.8) | 0.661 |
| Very few (208) | 163 (23.0) | 45 (6.4) | ||
| A little (141) | 114 (16.1) | 27 (3.8) | ||
| Often (60) | 51 (7.2) | 9 (1.3) | ||
| Always (25) | 19 (2.7) | 6 (0.8) | ||
| Taking good care of yourself (706) | think so (132) | 114 (16.1) | 18 (2.5) | 0.111 |
| So-so think (369) | 299 (42.4) | 70 (9.9) | ||
| Not too much, I think (162) | 130 (18.4) | 32 (4.5) | ||
| Don’t think so (43) | 30 (4.2) | 13 (1.8) | ||
| Be valued by those around you (710) | think so (178) | 149 (21.0) | 29 (4.1) | 0.004 |
| So-so think (397) | 329 (46.3) | 68 (9.6) | ||
| Not too much, I think (113) | 84 (11.8) | 29 (4.1) | ||
| Don’t think so (22) | 12 (1.7) | 10 (1.4) | ||
| Smoking (708) | Current smoker (170) | 143 (20.2) | 27 (3.8) | 0.350 |
| Former smoker (139) | 108 (15.3) | 31 (4.4) | ||
| Nonsmoker (399) | 323 (45.6) | 76 (10.7) | ||
| Frequency of drinking alcohol (706) | Every day (159) | 138 (19.5) | 21 (3.0) | 0.148 |
| ≥3 days/week (73) | 63 (8.9) | 10 (1.4) | ||
| 1 day/week (108) | 87 (12.3) | 21 (3.0) | ||
| Hardly drink (157) | 124 (17.6) | 33 (4.7) | ||
| Formerly drank (18) | 13 (1.8) | 5 (0.7) | ||
| None (191) | 147 (20.8) | 44 (6.2) | ||
| Alcohol intake amount (338) | <21.6g (259) | 220 (65.1) | 39 (11.5) | 0.695 |
| <43.2 g (66) | 56 (16.6) | 10 (3.0) | ||
| <64.8 g (8) | 6 (1.8) | 2 (0.6) | ||
| ≥64.8 g (5) | 4 (1.2) | 1 (0.3) | ||
| Number of remaining natural teeth (700) | ≥28 (340) | 281 (40.1) | 59 (8.4) | 0.517 |
| 20–27 (245) | 196 (28.0) | 49 (7.0) | ||
| 4–19 (101) | 77 (11.0) | 24 (3.4) | ||
| ≤4 (9) | 7 (1.0) | 2 (0.3) | ||
| No (5) | 5 (0.7) | 0 (0.0) | ||
| Dental advice from a health professional (591) | Yes (231) | 194 (32.8) | 37 (6.3) | 0.491 |
| No (326) | 262 (44.3) | 64 (10.8) | ||
| Not thinking about consulting (34) | 27 (4.6) | 7 (1.2) | ||
| Stress relief methods (Multiple choice) | ||||
| By talking to someone (717) | No (388) | 308 (43.0) | 80 (11.2) | 0.295 |
| Yes (329) | 272 (37.9) | 57 (7.9) | ||
| By exercising (717) | No (598) | 479 (66.8) | 119 (16.6) | 0.252 |
| Yes (119) | 101 (14.1) | 18 (2.5) | ||
| By sleeping (717) | No (434) | 349 (48.7) | 85 (11.9) | 0.699 |
| Yes (283) | 231 (32.2) | 52 (7.3) | ||
| By doing hobbies (717) | No (543) | 436 (60.8) | 107 (14.9) | 0.508 |
| Yes (174) | 144 (20.1) | 30 (4.2) | ||
| By enjoying nature (717) | No (626) | 505 (70.4) | 121 (16.9) | 0.776 |
| Yes (91) | 75 (10.5) | 16 (2.2) | ||
| By bathing (717) | No (558) | 448 (62.5) | 110 (15.3) | 0.493 |
| Yes (159) | 132 (18.4) | 27 (3.8) | ||
| By eating (717) | No (540) | 441 (61.5) | 99 (13.8) | 0.379 |
| Yes (177) | 139 (19.4) | 38 (5.3) | ||
| By drinking (717) | No (568) | 453 (63.2) | 115 (16.0) | 0.160 |
| Yes (149) | 127 (17.7) | 22 (3.1) | ||
| By smoking (717) | No (644) | 516 (72.0) | 128 (17.9) | 0.156 |
| Yes (73) | 64 (8.9) | 9 (1.3) | ||
| By shopping (717) | No (536) | 428 (59.7) | 108 (15.1) | 0.232 |
| Yes (181) | 152 (21.2) | 29 (4.0) | ||
| By watching movies (717) | No (536) | 539 (75.2) | 127 (17.7) | 0.855 |
| Yes (181) | 41 (5.7) | 10 (1.4) | ||
| By meeting friends (717) | No (531) | 421 (58.7) | 110 (15.3) | 0.066 |
| Yes (186) | 159 (22.2) | 27 (3.8) | ||
| By watching TV (717) | No (551) | 454 (63.3) | 97 (13.5) | 0.071 |
| Yes (166) | 126 (17.6) | 40 (5.6) | ||
| By playing video games (717) | No (656) | 533 (74.3) | 123 (17.2) | 0.399 |
| Yes (61) | 47 (6.6) | 14 (2.0) | ||
| Other (717) | No (680) | 553 (77.1) | 127 (17.7) | 0.202 |
| Yes (37) | 27 (3.8) | 10 (1.4) | ||
| No (717) | No (628) | 507 (70.7) | 121 (16.9) | 0.886 |
| Yes (89) | 73 (10.2) | 16 (2.2) | ||
Bold: significant difference.
Table 3 illustrated the OR for each item. The BMI distribution of the subjects was 580 (72.9%) with normal body shape and 137 (17.2%) with obesity.
| Variable | Crude OR | 95% CI | p-value | Adjusted OR | 95% CI | p-value |
|---|---|---|---|---|---|---|
| Self-reported health condition (1 = Feeling unhealthy) | 2.02 | 1.24–3.29 | 0.005 | 1.95 | 1.16–3.25 | 0.011 |
| Having dinner with someone (1 = None) | 1.71 | 1.15–2.55 | 0.009 | 1.58 | 1.03–2.44 | 0.038 |
| Unable to manage anxious or stressed (1 = None) | 1.40 | 0.95–2.07 | 0.093 | 1.66 | 1.10–2.51 | 0.015 |
| Taking good care of yourself (1 = None) | 1.32 | 0.88–1.97 | 0.177 | 1.61 | 1.05–2.46 | 0.027 |
| I am admired by those around me (1 = None) | 2.00 | 1.30–3.08 | 0.002 | 2.31 | 1.47–3.65 | <0.001 |
| Frequency of drinking alcohol (1 = Lower) | 1.60 | 1.09–2.35 | 0.017 | 2.16 | 1.41–3.32 | <0.001 |
| Stress relief by eating (1 = Yes) | 1.22 | 0.80–1.85 | 0.358 | 1.63 | 1.03–2.57 | 0.036 |
| Stress relief by watching TV (1 = Yes) | 1.49 | 0.98–2.26 | 0.063 | 1.70 | 1.09–2.66 | 0.020 |
| Eating speed (1 = Fast) | 1.79 | 1.22–2.64 | 0.003 | 1.90 | 1.26–2.88 | 0.002 |
OR = odds ratio, Adjusted OR: adjusted for sex and age.
Overweight status was positively correlated with ‘health status (1 = worsening)’ (OR: 1.95; 95% CI: 1.16, 3.25; p = 0.011), ‘having dinner with someone (1 = none)’ (OR: 1.58; 95% CI: 1.03, 2.44; p = 0.038), ‘unable to manage anxious or stressed (1 = none)’ (OR: 1.66; 95% CI: 1.10, 2.51; p = 0.015), ‘taking good care of yourself (1 = none)’ (OR: 1.61; 95% CI: 1.05, 2.46; p = 0.027), ‘I am admired by those around me (1 = none)’ (OR: 2.31; 95% CI: 1.47, 3.65; p < 0.001), ‘frequency of drinking alcohol (1 = lower)’ (OR: 2.16; 95% CI: 1.41, 3.32; p < 0.001) and ‘eating speed (1 = lower)’ (OR: 1.90; 95% CI: 1.26, 2.88; p = 0.002).
In the stress relief (multiple answers) section, ‘eat (1 = do)’ has an OR of 1.63 (95% CI: 1.03, 2.57; p = 0.036), ‘watch TV or video (1 = do)’. The OR was 1.70 (95% CI: 1.09, 2.66; p = 0.020)
It was discovered from the outcome of the survey that certain items are significantly correlated with obesity. These were: ‘I am aware I am in poor health’, ‘eating dinner alone’, ‘eat fast’, ‘stress treatment’, ‘not done’, ‘low self-affirmation’, ‘I doubt I’m valued by others’ and ‘infrequent drinking’.
Moreover, ‘eating’ and ‘watching TV and video’ were associated with stress relief methods. Excessive stress can easily lead to gluttony10). The BMI distribution of the subjects was 79 (9.9%) had low body weight, 580 (72.9%) had a normal body shape and 137 (17.2%) had obesity (Table 1). Among them, 10.6% of males and 8.5% of females were obese. Based on the results of the National Health and Nutrition Survey, the obesity rates of Japanese for men and women were 33.0% and 22.3%, respectively, however, these are lower than 15.8% and 13.8% in Yugawara town. There is an area that is surrounded by the sea and the mountains and has a lot of slopes. Lower diabetes mellitus rates were reported in residents living on sloping terrain in Japan11). Diabetes mellitus has a strong relationship to obesity12). It might be thought that a hilly neighborhood environment has a protective effect on overweight.
Obesity has been reported to be associated with low self-affirmation13). Variables such as ‘Unable to deal with stress’ such as low self-affirmation and not thinking that one is valued is cited as psychological factor for obesity. This is supported by our outcomes, where ‘Stress treatment (1 month) (1 = not expected)’ had an OR of 1.66 (95% CI: 1.10, 2.51; p = 0.02). In addition, ‘Do you like me (1 = I don’t think so)’ had an OR of 1.61 (95% CI: 1.05, 2.46; p = 0.03), and ‘Am I cherished by others (1 = I don’t think so)’ had an OR of 2.31, (95% CI: 1.47, 3.65; p < 0.001).
The relationship between obesity, stress and eating behaviour has been reported5,14). Our outcomes support this association. As a means of relieving stress, instead of opting for ‘stress relief: drinking (1 = do)’ (odds ratio [OR]: 0.60; 95% CI: 0.35, 1.02; p = 0.06), participants were more likely to select ‘stress relief: eating’ (OR: 1.63; 95% CI: 1.03, 2.57; p = 0.04) and ‘stress relief: watching TV and video’ (OR: 1.70; 95% CI: 1.09, 2.66; p = 0.02). For this motive, it is necessary to change the stress relief method, such as exercising or consulting with someone.
In recent years, cognitive behavioural therapy (e.g. mindfulness) has been drawing attention as a measure to prevent obesity15). This entails concentrating on the good aspects of eating, which includes relaxing by eating or enjoying a meal with people, etc.), reducing unhealthy eating behaviours and considering the general lifestyle of residents when making suggestions.
People with low self-esteem are more likely to experience stress, which increases their appetite and leads to overeating and unhealthy food choices16,17).‘Do you eat dinner with your family (1 = eat alone)’ (OR: 1.58; 95% CI: 1.03, 2.44; p = 0.04). Those who had dinner alone were at higher risk of obesity regardless of their breakfast companion, because they tend to eat dinner outside of the home, ending up with higher calorie intakes18). In addition, isolated eating has also been identified as a factor in obesity19). This is essential issue considering that the average number of households in 2013 was 235,000 of which 32.3% were single households20). It is considered that this contributes to obesity because it is difficult for a person to eat while considering the nutritional balance in terms of diet21,22). Because single households contribute to obesity because it is difficult for one person to cook meals that are balanced nutritionally.
Limitations and significance of researchGiven the nature of the study methodology, a cross-sectional study, the causal association between obesity and stress cannot be examined. Furthermore, because the findings of this study were limited to the working-age population of Yugawara, Kanagawa Prefecture, they cannot be generalised to other populations. The participant self-reports questions about the presence or absence of stress. As a result, we did not assess it using objective indicators such as saliva amylase and/or cortisol in saliva.
It is evident that the working-age population in Yugawara relieves stress by eating. The following survey items were substantially connected with obesity: ‘I am aware I am in poor health’, ‘eat dinner with my family’, ‘eat fast’, ‘stress treatment’, ‘not done’, ‘low self-affirmation, ‘I don’t think I’m valued by others’ and ‘infrequent drinking’. In terms of stress relief methods, our findings indicate that this population prefers ‘eating’ and ‘watching TV and video’. This study found that in working-age Japanese people, weight gain is influenced by stress factors, highlighting the significance of a good stress management approach to avert obesity and related health problems. Further research is needed to consider measures to alleviate the psychological stress of people of working age and to prevent isolation.
Data Availability & Funding: This study was conducted as part of the Yugawara “Kenko” Plan (Yugawara Town Health Promotion Plan and Dietary Education Promotion Plan in Yugawara Town, Kanagawa, Japan) (The first phase of the plan).
RK developed the statistical analysis plan and performed the statistical analyses. KW contributed to the interpretation of the results. YW implemented the Yugawara Town Health Survey. RH drafted the original manuscript and supervised the conduct of this study. All authors approved the final version of the manuscript for publication.
Study participants were informed of the study’s aims, and those who completed the survey questionnaire were regarded as consenting to participate.
The authors declare no potential conflict of interest.
