Associations between burnout, sociodemographic factors, health behaviors, and obesity indices in Spanish employees

Aina Gabriela Valiente Pizá; Pedro Juan Tárraga López; Ángel Arturo López-González; Irene Coll Campayo; Carla Busquets-Cortés; José Ignacio Ramírez Manent; Aina Gabriela Valiente Pizá; Pedro Juan Tárraga López; Ángel Arturo López-González; Irene Coll Campayo; Carla Busquets-Cortés; José Ignacio Ramírez Manent

doi:10.3934/publichealth.2026009

AIMS Public Health

2026, Volume 13, Issue 1: 135-157. doi: 10.3934/publichealth.2026009

Previous Article Next Article

Research article

Associations between burnout, sociodemographic factors, health behaviors, and obesity indices in Spanish employees

1.
Balearic Islands Health Service, 07010 Palma, Spain
2.
Faculty of Medicine, University of Castilla La Mancha (UCLM), 02008 Albacete, Spain
3.
ADEMA-Health Group of IUNICS, 07009 Palma, Spain
4.
Faculty of Medicine, University of the Balearic Islands, 07120 Palma, Spain

Received: 08 October 2025 Revised: 16 December 2025 Accepted: 07 January 2026 Published: 20 January 2026

Background
Obesity remains a major global health concern, and psychosocial stressors such as burnout may contribute to its development. While lifestyle and sociodemographic factors are recognized determinants, their interaction with burnout has been less studied, especially using advanced adiposity indices. In this study, we assessed the associations between burnout, sociodemographic variables, lifestyle habits, and obesity in a large cohort of Spanish employees.
Methods
We performed a cross-sectional analysis of Spanish workers undergoing occupational health examinations. Burnout was classified into low, moderate, and high levels. Obesity was assessed using body mass index (BMI), waist-to-height ratio (WtHR), the Clínica Universidad de Navarra Body Adiposity Estimator (CUN-BAE), and the Metabolic Score for Visceral Fat (METS-VF). Logistic regression models adjusted for sociodemographic and behavioral variables were applied, including interaction analyses.
Results
Burnout showed a strong and graded association with obesity across all indices. Compared with low burnout, high burnout was associated with up to a 40% higher odds of obesity by BMI, and even stronger associations when using CUN-BAE and METS-VF. Women, older employees, and those from lower social classes were disproportionately affected. Adherence to a Mediterranean diet and engagement in regular physical activity were associated with lower obesity risk among participants with higher burnout levels.
Conclusions
Burnout is a significant and independent correlate of obesity in working populations, particularly when measured with indices capturing visceral fat. Vulnerable groups, women, older workers, and lower social classes, —require targeted interventions. Workplace health programs should integrate stress management with lifestyle promotion as dual strategies to combat obesity. Longitudinal research is needed to confirm causality and assess intervention effectiveness.
- obesity,
- burnout,
- CUN BAE,
- METS-VF,
- mediterranean diet,
- physical activity
Citation: Aina Gabriela Valiente Pizá, Pedro Juan Tárraga López, Ángel Arturo López-González, Irene Coll Campayo, Carla Busquets-Cortés, José Ignacio Ramírez Manent. Associations between burnout, sociodemographic factors, health behaviors, and obesity indices in Spanish employees[J]. AIMS Public Health, 2026, 13(1): 135-157. doi: 10.3934/publichealth.2026009

Related Papers:

Abstract

Background

Obesity remains a major global health concern, and psychosocial stressors such as burnout may contribute to its development. While lifestyle and sociodemographic factors are recognized determinants, their interaction with burnout has been less studied, especially using advanced adiposity indices. In this study, we assessed the associations between burnout, sociodemographic variables, lifestyle habits, and obesity in a large cohort of Spanish employees.

Methods

We performed a cross-sectional analysis of Spanish workers undergoing occupational health examinations. Burnout was classified into low, moderate, and high levels. Obesity was assessed using body mass index (BMI), waist-to-height ratio (WtHR), the Clínica Universidad de Navarra Body Adiposity Estimator (CUN-BAE), and the Metabolic Score for Visceral Fat (METS-VF). Logistic regression models adjusted for sociodemographic and behavioral variables were applied, including interaction analyses.

Results

Burnout showed a strong and graded association with obesity across all indices. Compared with low burnout, high burnout was associated with up to a 40% higher odds of obesity by BMI, and even stronger associations when using CUN-BAE and METS-VF. Women, older employees, and those from lower social classes were disproportionately affected. Adherence to a Mediterranean diet and engagement in regular physical activity were associated with lower obesity risk among participants with higher burnout levels.

Conclusions

Burnout is a significant and independent correlate of obesity in working populations, particularly when measured with indices capturing visceral fat. Vulnerable groups, women, older workers, and lower social classes, —require targeted interventions. Workplace health programs should integrate stress management with lifestyle promotion as dual strategies to combat obesity. Longitudinal research is needed to confirm causality and assess intervention effectiveness.

Authors' contributions

Conceptualization: A.G.V.P., A.A.L.G.; Data collection and analysis: P.J.T.L., I.C.C. and C.B-C; Data curation: C.B-C, P.J.T.L.; Methodology: A.G.V.P., J.I.R.M. and I.C.C.; Validation: J.I.R.M.; Formal analysis: A.G.V.P.; Investigation A.G.V.P.; Draft: A.G.V.P., P.J.T.L., I.C.C., J.I.R.M. and C.B-C; Revision: A.A.L.G., C.B-C and J.I.R.M. All authors have read and agreed to the published version of the manuscript.

Conflict of interest

The authors declare no conflict of interest.

References

[1]	(2023) World Health OrganizationObesity and overweight. Geneva: WHO. [cited 12 November 2025]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
[2]	Hruby A, Hu FB (2015) The epidemiology of obesity: A big picture. Pharmacoeconomics 33: 673-689. https://doi.org/10.1007/s40273-014-0243-x
[3]	NCD Risk Factor Collaboration (NCD-RisC).Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet (2017) 390: 2627-2642. https://doi.org/10.1016/S0140-6736(17)32129-3
[4]	GBD 2019 Risk Factors Collaborators.Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet (2020) 396: 1223-1249. https://doi.org/10.1016/S0140-6736(20)30752-2
[5]	Aranceta-Bartrina J, Pérez-Rodrigo C, Alberdi-Aresti G, et al. (2016) Prevalence of general obesity and abdominal obesity in the Spanish adult population (aged 25–64 years) 2014–2015: the ENPE study. Rev Esp Cardiol (Engl Ed) 69: 579-587. https://doi.org/10.1016/j.rec.2016.02.009
[6]	Torres SJ, Nowson CA (2007) Relationship between stress, eating behavior, and obesity. Nutrition 23: 887-894. https://doi.org/10.1016/j.nut.2007.08.008
[7]	(2019) World Health OrganizationBurn-out an “occupational phenomenon”: International Classification of Diseases (ICD-11). Geneva: WHO. [cited 12 November 2025]. Available from: https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases.
[8]	Schaufeli WB (2017) Burnout: A short socio-cultural history. Burnout, Fatigue, Exhaustion . Cham: Palgrave Macmillan 105-127. https://doi.org/10.1007/978-3-319-52887-8_5
[9]	Melamed S, Shirom A, Toker S, et al. (2006) Burnout and risk of cardiovascular disease: evidence, possible causal paths, and promising research directions. Psychol Bull 132: 327-353. https://doi.org/10.1037/0033-2909.132.3.327
[10]	Armon G, Shirom A, Shapira I, et al. (2008) On the nature of burnout-insomnia relationships: a prospective study of employed adults. J Psychosom Res 65: 5-12. https://doi.org/10.1016/j.jpsychores.2008.01.012
[11]	Ashwell M, Gibson S (2016) Waist-to-height ratio as an indicator of ‘early health risk’: simpler and more predictive than using a ‘matrix’ based on BMI and waist circumference. BMJ Open 6: e010159. https://doi.org/10.1136/bmjopen-2015-010159
[12]	Gómez-Ambrosi J, Silva C, Catalán V, et al. (2012) Clinical usefulness of a new equation for estimating body fat. Diabetes Care 35: 383-388. https://doi.org/10.2337/dc11-1334
[13]	Bello-Chavolla OY, Antonio-Villa NE, Vargas-Vázquez A, et al. (2020) Metabolic Score for Visceral Fat (METS-VF), a novel estimator of intra-abdominal fat content and cardio-metabolic health. Clin Nutr 39: 1613-1621. https://doi.org/10.1016/j.clnu.2019.07.012
[14]	Geda NR, Feng CX, Yu Y (2022) Examining the association between work stress, life stress and obesity among working adult population in Canada: findings from a nationally representative data. Arch Public Health 80: 97. https://doi.org/10.1186/s13690-022-00865-8
[15]	Kivimäki M, Singh-Manoux A, Nyberg S, et al. (2015) Job strain and risk of obesity: systematic review and meta-analysis of cohort studies. Int J Obes (Lond) 39: 1597-1600. https://doi.org/10.1038/ijo.2015.103
[16]	Martínez-González MÁ, Hershey MS, Zazpe I, et al. (2018) Transferability of the mediterranean diet to non-mediterranean countries. What is and what is not the mediterranean diet. Nutrients 9: 1226. https://doi.org/10.3390/nu9111226
[17]	Wahid A, Manek N, Nichols M, et al. (2016) Quantifying the association between physical activity and cardiovascular disease and diabetes: a systematic review and meta-analysis. J Am Heart Assoc 5: e002495. https://doi.org/10.1161/JAHA.115.002495
[18]	Hernáez Á, Zomeño MD, Dégano IR, et al. (2019) Excess weight in Spain: current situation, projections for 2030, and estimated direct extra cost for the Spanish health system. Rev Esp Cardiol (Engl Ed) 72: 916-924. https://doi.org/10.1016/j.rec.2018.10.010
[19]	Alvarez-Alvarez I, Zazpe I, Pérez de Rojas J, et al. (2018) Mediterranean diet, physical activity and their combined effect on all-cause mortality: The Seguimiento Universidad de Navarra (SUN) cohort. Prev Med 106: 45-52. https://doi.org/10.1016/j.ypmed.2017.09.021
[20]	Schaufeli WB, Desart S, De Witte H (2020) Burnout assessment tool (BAT)-development, validity, and rreliability. Int J Environ Res Public Health 17: 9495. https://doi.org/10.3390/ijerph17249495
[21]	de Beer LT, Schaufeli WB, De Witte H, et al. (2020) Measurement invariance of the burnout assessment tool (BAT) across seven cross-national representative samples. Int J Environ Res Public Health 17: 5604. https://doi.org/10.3390/ijerph17155604
[22]	Hadžibajramović E, Schaufeli W, De Witte H (2020) A rasch analysis of the burnout assessment tool (BAT). PLoS One 15: e0242241. https://doi.org/10.1371/journal.pone.0242241
[23]	Schröder H, Fitó M, Estruch R, et al. (2011) A short screener is valid for assessing mediterranean diet adherence among older Spanish men and women. J Nutr 141: 1140-1145. https://doi.org/10.3945/jn.110.135566
[24]	Roman-Viñas B, Serra-Majem L, Hagströmer M, et al. (2010) International physical activity questionnaire: reliability and validity in a Spanish population. Eur J Sport Sci 10: 297-304. https://doi.org/10.1080/17461390903426667
[25]	World Health Organization.Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser (2000) 1-253.
[26]	Ramírez Gallegos A, Valiente Pizà AG, García Pertegaz P, et al. (2025) Multimetric assessment of obesity in manual workers: the impact of age, smoking, diet, and physical activity. Acad J Health Sci 2025 40: 91-104. https://doi.org/10.3306/AJHS.2025.40.06.8
[27]	Marcos PJT, López-González ÁA, Rifá EMA, et al. (2025) Variables associated with overweight and obesity in Spanish healthcare workers. Acad J Health Sci 2025 40: 9-19. https://doi.org/10.3306/AJHS.2025.40.03.9
[28]	López-González AA, Jover AM, Martínez CS, et al. (2022) The CUN-BAE, deurenberg fat mass, and visceral adiposity index as confident anthropometric indices for early detection of metabolic syndrome components in adults. Sci Rep 12: 15486. https://doi.org/10.1038/s41598-022-19343-w
[29]	Lin MF, Lucas HC, Shmueli G (2013) Too big to fail: Large samples and the p-value problem. Inform Syst Res 24: 906-917. https://doi.org/10.1287/isre.2013.0480
[30]	de Souza E Silva D, das Merces MC, Lua I, et al. (2023) Association between burnout syndrome and obesity: A cross-sectional population-based study. Work 74: 991-1000. https://doi.org/10.3233/WOR-210245
[31]	Vasquez-Purí C, Plaza-Ccuno JNR, Soriano-Moreno AN, et al. (2023) Burnout, fat intake, and body mass index in health professionals working in a public hospital: a cross-sectional study. Inquiry 60: 469580231189601. https://doi.org/10.1177/00469580231189601
[32]	Nevanperä NJ, Hopsu L, Kuosma E, et al. (2012) Occupational burnout, eating behavior, and weight among working women. Am J Clin Nutr 95: 934-943. https://doi.org/10.3945/ajcn.111.014191
[33]	Armon G, Shirom A, Berliner S, et al. (2008) A prospective study of the association between obesity and burnout among apparently healthy men and women. J Occup Health Psychol 13: 43-57. https://doi.org/10.1037/1076-8998.13.1.43
[34]	Miao L, Niu X, Huang M, et al. (2024) Association between body mass index and burnout among nurses in China: a cross-sectional study. BMJ Open 14: e081203. https://doi.org/10.1136/bmjopen-2023-081203
[35]	Tosoratto J, Carriedo B, Cantón C (2024) Cardiometabolic risk level in 43,074 Spanish office workers: associated variables. Acad J Health Sci 2024 39: 48-56. https://doi.org/10.3306/AJHS.2024.39.04.48
[36]	Marmot M, Brunner E (2005) Cohort profile: the whitehall II study. Int J Epidemiol 34: 251-256. https://doi.org/10.1093/ije/dyh372
[37]	Nyberg ST, Heikkilä K, Fransson EI, et al. (2012) Job strain in relation to body mass index: pooled analysis of 160,000 adults from 13 cohort studies. J Intern Med 272: 65-73. https://doi.org/10.1111/j.1365-2796.2011.02482.x
[38]	Kivimäki M, Virtanen M, Elovainio M, et al. (2006) Work stress in the etiology of coronary heart disease--a meta-analysis. Scand J Work Environ Health 32: 431-442. https://doi.org/10.5271/sjweh.1049
[39]	Salvagioni DAJ, Melanda FN, Mesas AE, et al. (2017) Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLoS One 12: e0185781. https://doi.org/10.1371/journal.pone.0185781
[40]	Armon G, Melamed S, Shirom A, et al. (2010) Elevated burnout predicts the onset of musculoskeletal pain among apparently healthy employees. J Occup Health Psychol 15: 399-408. https://doi.org/10.1037/a0020726
[41]	Kremers SHM, Beulens JWJ, Strikwerda M, et al. (2025) The association of burnout and vital exhaustion with (measures of) the metabolic syndrome: A systematic review and meta-analysis. Health Psychol 44: 922-935. https://doi.org/10.1037/hea0001498

Reader Comments

Your name:*

Email:*
© 2026 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)