The impact of overweight on employment outcomes: a review of the evidence

BACKGROUND: Overweight has been recognised as a significant public health issue. Several hypotheses have been posed to explain the impact of overweight on employment outcomes, including the role of productivity, labour supply, and discrimination. In this review, we provide a systematic synthesis of the evidence on the causal impact of overweight on labour market outcomes worldwide. METHODS: We searched Econ Lit, Medline, and Web of Science databases for relevant studies from 1st Jan 2010 to 20th Jan 2023. Studies were included if they were either longitudinal analysis, pooled cross-sectional or cross-sectional studies if they used Mendelian Randomisation methodology and have been published since 2010. Only those studies with measures of overweight and employment outcomes were included. RESULTS: The number of potentially relevant studies constituted 4,321 hits. A total of 59 studies met the inclusion criteria and were qualitatively reviewed by the authors. Most of the included studies were carried out in the USA (N = 18), followed by the UK (N = 9), Germany (N = 6), Finland (N = 4), and non-EU countries (N = 22). Evidence from the included studies suggests that the overweight effect differs by gender, ethnicity, country, and time period. White women with obesity in the USA, the UK, Germany, Canada, and in the EU (multi-country analyses) are more likely to experience overweight/obesity related labour market penalties such as reduced likelihood of employment, and when employed they also face lower wages compared to non-overweight counterparts. For men there is no evidence of an effect of overweight on employment outcomes or the magnitude of the effect is much smaller or even positive in some cases. CONCLUSIONS: This review has shown that despite ample research on the impact of overweight on employment status and wages, robust causal evidence on the effects of weight status on employment outcomes remains scarce and relies significantly on strong statistical and theoretical assumptions. KEY MESSAGES: • The first study to evaluate the evidence base and the methodology of studies that assessed the economic consequences of overweight. • There is a need for better identification approaches and more recent datasets, especially from low-income countries.