By Michael S. Rosenwald
The Washington Post
HAGERSTOWN, Md. —
With its blue-collar jobs vaporizing by the day, this once proud city of airplane builders, pipe organ laborers and ice cream makers has been wrestling unsuccessfully with stubborn and still-high unemployment.
Now it's confronting one of the side effects: Soaring obesity.
A subject long ignored by policymakers, and one that unemployment counselors are too sheepish to raise with job seekers, the link between bulging waistlines and joblessness is now of intense interest to researchers studying the long-term effects of the country's economic malaise.
Recent studies and surveys have shown a distinct relationship between unemployment and obesity, particularly for lower-skilled workers who struggle to find work - a search made more challenging by their weight.
In Hagerstown, where blue-collar jobs have gone overseas or to cheaper parts of the country, 8.4 percent are unemployed - well above Maryland's 5.9 percent rate. Last month, Gallup identified the area as the third-heaviest place in the United States, with almost 37 percent of its residents obese. Local studies put the number even higher.
Sitting outside a local job resource center and looking at his belly, Eric Steiner was a noticeable example of what public health researchers are worried about. His layoff from a dump truck driving job five years ago coincided with him gaining more than 50 pounds.
"You don't even feel like going outside to take a walk around the block," said Steiner, who hasn't worked a full week in more than a year. "You eat more junk food. You're so depressed you just want to put a gun to your head."
Around the country, high unemployment and high obesity rates are converging. In Texas, the McAllen area suffers from a 38 percent obesity rate and about 10 percent unemployment. In Washington state, Yakima struggles with an almost 36 percent obesity rate and more than 10 percent unemployment. In Toledo: 34 percent obesity, near 7 percent unemployment.
Conversely, some of the areas of lowest unemployment have the lowest rates of obesity. Gallup said the Washington, D.C., region, with a 22 percent obesity rate, is one of the country's healthiest areas. It also boasts a 5 percent unemployment rate, well below the national average.
"A high unemployment rate is a proxy for many economic and socioeconomic determinants of health," said Harry Zhang, an Old Dominion University health economist who recently published a study on obesity and unemployment. "For people living in areas with high unemployment, everything is messed up. You have poverty. High crime. Low education levels. And people rely on food to comfort themselves, to make them feel better."
Some studies even show that employed people in counties with high unemployment are at greater risk of becoming obese. Fearing job loss, they put in longer hours, meaning more sedentary time at work.
For the unemployed, the cycle is wicked.
Unemployment can lead to reduced consumption of healthful foods. Although physical activity sometimes increases for higher-skilled workers out of work - they have savings to pay for the gym - the opposite is often true for lower-skilled workers. They can't afford gyms and, instead of burning calories in physically demanding jobs, they tend to spend more time watching TV.
And even when obese job seekers find openings, studies show that they face discrimination in hiring. In employment categories such as the booming commercial truck-driving sector, obese workers can't pass physicals.
"The problem," Zhang said, "is perpetual."
David Farrell, a 52-year-old Hagerstown resident who had lost his job in retail, saw his weight increase more than 50 pounds recently during a year spent without a job.
"When you're defeated, you get depressed," he said. "When you get depressed, most people have a vice. They either smoke or they eat, whatever." He ate.
"Anything," he said. "Junk food. It didn't matter."
There was a gym in the community where he lives, but Farrell didn't use it.
"You can go to the gym, but you just don't feel like it," he said. "You don't feel like doing anything."
When he finally landed a job stocking commissary shelves, he lost the weight.
"I'm lifting and moving stuff around all day," he said. "You're moving a lot. I burned it off."
Those who work with the jobless said that people desperate for a paycheck often have more urgent issues to address - from home loss to major education gaps - than their weight. And obesity is extremely difficult to explore and address.
"There is only a recent awakening to the issues surrounding the connections" between obesity and unemployment "and the importance of doing something about it," said Peter Thomas, executive director of the Western Maryland Consortium, a job training group. "But it's not an easy problem to bring up."
Weight is personal. "It's such a sensitive issue for so many people," Thomas said. "We're not Weight Watchers. We don't require people to weigh in when they come see us."
Janie Spielman, who works in commercial vehicle education at Hagerstown Community College, feels the awkwardness when dealing with unemployed overweight people trying to enter the long-haul trucking industry. Job training groups push trucking, a booming industry always hiring drivers, as a career option for blue-collar workers displaced by automation or jobs moving overseas.
But there are federal health requirements that the obese can't meet.
"I can't approach someone with their obesity because that's so touch and go," Spielman said. Instead, she simply lays out the requirements: fill out an application, pass a reading test, get a medical evaluation.
"You have to be in good health to pass," she tells applicants. "I'm not a doctor." She never hears from the people who don't pass the physical.
"I think it's embarrassment," she said.
That stigma challenges the obese, who sometimes are passed over by employers in favor of leaner applicants.
Federal law does not protect overweight people from discrimination in the workplace, and studies involving workers in human resources show that it's a daily reality. A 2012 study in the journal BMC Public Health "found a pronounced stigmatization of obese individuals, especially of women, by HR professionals."
A 2010 study titled "Too Big to Hire: Factors Impacting Weight Discrimination" found that "employers' perceptions of applicant weight may lead them to make biased decisions about individuals who are overweight during the hiring process particularly for jobs that are high in visibility and physical demands."
"It's a strike against them," said Thomas, the job training director, adding that being big can be compared with excessive piercings or poor hygiene. "These things send certain messages that employers might not want to send out to their customers and existing workforces."
Hagerstown is not ignoring its obesity problem. Before the recent headlines calling it one of America's "fattest cities," community leaders, led by a local hospital, conducted a study to determine the area's most pressing health concerns.
The report found that 72 percent of county residents were overweight or obese, compared with a national average of 63 percent. Its top recommendation: fight obesity.
"It would appear," said Roderick MacRae, the director of health planning for Washington County, Md., "that our community is particularly beset with this problem."
One of the outgrowths of a community plan to improve life in the county was HEAL, a local group that distributes pedometers and holds weekly walking events. It is open to anyone, but Jenny Fleming, the group's executive director, said to her knowledge all of the participants are employed. Experts say social isolation is another side effect of being unemployed.
The city recently held a contest to get residents to walk 100 miles in 100 days. Last month, about 100 people attended the final rally.
But Steiner, the laid-off dump truck driver, wasn't there. Neither was Farrell, the commissary stocker, who is looking for a better job. And neither was a middle-aged woman who declined to give her name one afternoon outside the downtown job training office. She said that she had gained way too much weight after losing her warehouse job.
She copes this way: "I just want to eat and eat all day. It makes you feel better."
Her primary concern that afternoon was not her weight. What she needs, she said, is a paycheck.