Work engagement and its association with obesity and lifestyle factors in a large working population: a sex-stratified analysis

Lucía Garrido Sepúlveda; Pedro Juan Tárraga López; María Teófila Vicente-Herrero; Lluis Rodas Cañellas; Ángel Arturo López González; José Ignacio Ramírez-Manent; Lucía Garrido Sepúlveda; Pedro Juan Tárraga López; María Teófila Vicente-Herrero; Lluis Rodas Cañellas; Ángel Arturo López González; José Ignacio Ramírez-Manent

doi:10.3934/publichealth.2026017

AIMS Public Health

2026, Volume 13, Issue 1: 306-326. doi: 10.3934/publichealth.2026017

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Research article Special Issues

Work engagement and its association with obesity and lifestyle factors in a large working population: a sex-stratified analysis

1.
Home Hospitalization Unit, Arnau de Vilanova Hospital, Valencia, Spain
2.
Faculty of Medicine, University of Castilla-La Mancha, Albacete, Spain
3.
ADEMA University School, Balearic Islands, Spain
4.
Palma de Mallorca Health Service, Balearic Islands, Spain
5.
Faculty of Medicine, University of the Balearic Islands, Palma, Spain

Received: 10 October 2025 Revised: 29 January 2026 Accepted: 02 February 2026 Published: 05 March 2026

Background
Work engagement, defined as a positive, fulfilling psychological state characterized by vigor, dedication, and absorption, has been proposed as a potential protective factor for cardiometabolic health. However, its relationship with obesity—particularly visceral adiposity—remains poorly understood. This study aimed to examine the association between work engagement and different adiposity indicators and to explore the mediating role of lifestyle behaviors in a large sample of Spanish workers.
Methods
A cross-sectional analysis was conducted among employees attending occupational health evaluations between 2021 and 2022. After applying inclusion and exclusion criteria, 111,612 participants (60.1% men) were included. Work engagement was assessed using the Utrecht Work Engagement Scale (UWES-9) and categorized into very high, high, moderate, and low levels. Obesity and adiposity were evaluated through BMI, waist-to-height ratio (WtHR), CUN-BAE, and METS-VF. Logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) for obesity outcomes across engagement levels, with progressive adjustment for sociodemographic and lifestyle covariates. Mediation analyses evaluated the indirect effects of physical activity, Mediterranean diet adherence, and smoking.
Results
Lower engagement levels were independently associated with higher odds of adiposity across all indices, particularly visceral fat (METS-VF). Participants with low engagement had an adjusted OR = 2.59 (95% CI 2.34–2.85) for high METS-VF compared with those with very high engagement (p-trend < 0.001). Approximately 40% of this association was mediated by lifestyle factors, mainly physical activity. The results remained robust across sensitivity analyses, including nonlinear modeling, imputation, and cluster adjustment.
Conclusions
Lower work engagement is strongly associated with increased visceral adiposity among Spanish workers, partly through behavioral mechanisms. Enhancing engagement may represent an effective psychosocial strategy to improve both psychological well-being and metabolic health in occupational settings.
- work engagement,
- obesity,
- visceral fat,
- life style,
- occupational health,
- psychosocial factors
Citation: Lucía Garrido Sepúlveda, Pedro Juan Tárraga López, María Teófila Vicente-Herrero, Lluis Rodas Cañellas, Ángel Arturo López González, José Ignacio Ramírez-Manent. Work engagement and its association with obesity and lifestyle factors in a large working population: a sex-stratified analysis[J]. AIMS Public Health, 2026, 13(1): 306-326. doi: 10.3934/publichealth.2026017

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Abstract

Background

Work engagement, defined as a positive, fulfilling psychological state characterized by vigor, dedication, and absorption, has been proposed as a potential protective factor for cardiometabolic health. However, its relationship with obesity—particularly visceral adiposity—remains poorly understood. This study aimed to examine the association between work engagement and different adiposity indicators and to explore the mediating role of lifestyle behaviors in a large sample of Spanish workers.

Methods

A cross-sectional analysis was conducted among employees attending occupational health evaluations between 2021 and 2022. After applying inclusion and exclusion criteria, 111,612 participants (60.1% men) were included. Work engagement was assessed using the Utrecht Work Engagement Scale (UWES-9) and categorized into very high, high, moderate, and low levels. Obesity and adiposity were evaluated through BMI, waist-to-height ratio (WtHR), CUN-BAE, and METS-VF. Logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) for obesity outcomes across engagement levels, with progressive adjustment for sociodemographic and lifestyle covariates. Mediation analyses evaluated the indirect effects of physical activity, Mediterranean diet adherence, and smoking.

Results

Lower engagement levels were independently associated with higher odds of adiposity across all indices, particularly visceral fat (METS-VF). Participants with low engagement had an adjusted OR = 2.59 (95% CI 2.34–2.85) for high METS-VF compared with those with very high engagement (p-trend < 0.001). Approximately 40% of this association was mediated by lifestyle factors, mainly physical activity. The results remained robust across sensitivity analyses, including nonlinear modeling, imputation, and cluster adjustment.

Conclusions

Lower work engagement is strongly associated with increased visceral adiposity among Spanish workers, partly through behavioral mechanisms. Enhancing engagement may represent an effective psychosocial strategy to improve both psychological well-being and metabolic health in occupational settings.

Authors' contributions

Conceptualisation: L.G.S., Á.A.L.-G. and J.I.R.-M.; Data collection and analysis: M.T.V.H., L.R.C. and P.J.T.L.; Methodology: L.G.S., M.T.V.H. and L.R.C.; Draft: L.G.S., P.J.T.L., J.I.R.-M. and Á.A.L.-G.; Review L.G.S., M.T.V.H., L.R.C. All authors have read and agreed to the published version of the manuscript.

Ethical considerations

The study adhered strictly to the ethical standards set forth in the Declaration of Helsinki (2013 revision) and complied with all aplicable regulations governing responsible conduct in research. The privacy and anonymity of participants were rigorously maintained throughout the investigation. Ethical clearance was obtained from the Balearic Islands Research Ethics Committee (CEI-IB), with approval granted under protocol number IB 4383/20, dated 23 November 2020. To protect personal information, all participant data were anonymized and encoded, and only the principal investigator retained access to the corresponding identifying information. All members of the research team operated in accordance with Spain's Organic Law 3/2018, dated December 5, which upholds digital rights and data protection standards. This law ensures participants' rights to access, amend, delete, or object to the processing of their personal data at any time.

Data availability

The dataset supporting the findings of this study is stored in a secure and access-restricted database managed by ADEMA University School. The designated Data Protection Officer overseeing this process is Ángel Arturo López González. Due to legal and ethical restrictions associated with occupational health records, the dataset used in this study is not publicly available. However, de-identified data can be made available upon reasonable request to the corresponding author, subject to approval by the Occupational Health Service and compliance with Spanish data protection regulations (GDPR and Ley Orgánica 3/2018).

Conflict of interest

The authors declare no conflicts of interest.

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