SWIFt Study: Weight-loss strategy aims to prioritise the 'health' of our healthcare workers
While shift workers and essential care workers work around the clock in the fight against COVID-19, the very nature of their work increases their risk of developing COVID-19. But not how you might think.
Close contact with the virus itself increases the chances of catching COVID-19 – data from Melbourne and Victoria clearly shows that, with almost 20% of COVID-19 cases identified in healthcare workers.
But it’s the work schedule that many of our essential workers live by that might create an additional challenge.
Being a shift worker requires people to eat and sleep out of synchronisation with the body clock. On a personal level, these routines can be difficult to adapt to, leading to disrupted eating and sleeping habits. Metabolically, the consequences of “circadian disruption" increase disease risk.
Our research has shown that just by going to work, the risk of weight gain and developing obesity, diabetes and cardiovascular problems are higher in shift workers.
It appears that being obese is associated with all stages of the COVID-19 spectrum, from having a greater risk of testing positive, being hospitalised, requiring critical care, through to death.
We need to look no further than Australia to see clear evidence of this. In a study of English, New Zealand and Australian nurses, 25.5% of Australian nurses surveyed were classified as obese (a body mass index or BMI of 30 or above). This is higher than in non-shift-working populations.
We currently have funding for a four-year National Health and Medical Research Council (NHMRC) project – the SWIFt Study – that is investigating a range of weight-loss strategies for shift-working populations to try to identify one that may be better-suited to their lifestyle.
This study is actively recruiting rotating nightshift workers across Melbourne and Adelaide Now, this study has taken on a greater level of significance, with data emerging linking obesity with poorer COVID-19 outcomes.
In novel data emerging from studies around the world and summarised in a recent review, it appears that being obese is associated with all stages of the COVID-19 spectrum, from having a greater risk of testing positive, being hospitalised, requiring critical care, through to death.
Data from 19 studies that specifically examined the association between weight status and hospitalisation showed that being obese resulted in patients being more than two times more likely to be hospitalised after infection with COVID-19.
So what does this mean for our healthcare workers?
In my opinion, we have a challenge on our hands. The necessity of these workers, in dealing with a pandemic such as COVID-19, puts them at greater risk of exposure through their work environment. The more experienced these workers are, the more valuable they are in the workplace, especially under pandemic conditions.
But longevity in a shift work role is strongly associated with a growing risk of becoming obese and, inadvertently, a compromised ability to deal effectively with the medical challenges COVID-19 poses if exposed.
The reality is that we are asking a lot of our shift-working population, more than perhaps any of us have ever really considered previously.
Our SWIFt Study is a six-month weight-loss intervention for shift workers. It’s the biggest study of its kind in the world. Participants work with research dietitians to follow one of three weight=loss programs. We’ve recruited about 100 participants so far, but are looking to extend that number up to 400.
Interestingly, COVID-19 has caused us to re-examine how we run our clinical trials, and the SWIFt Study now has a much more flexible approach to enrolment and engagement with the study team. Many of our visits have been moved to telehealth, reducing travel time for participants, and increasing our capacity to recruit more widely.
Future-proofing our pandemic response
Our team believes it’s critical to prioritise the “health” of our healthcare workers. While as a population we have, in the past six months, dealt with a number of new lifestyle behaviours with the introduction of compulsory face masks, social distancing and hand washing, prioritising metabolic health seems to have been lost.
Maintaining a focus on the importance of good nutrition will have implications for the management of future pandemics, and not just in healthcare workers. But ensuring we have a well-informed and health-aware workforce is imperative.
Weight-loss as a behaviour change is hard work. We all understand this. In the SWIFt Study, because of this, we’re trialling three different strategies, because it’s not one-size-fits-all.
But COVID-19 has also taught us that we can make behavioural changes to improve health – things such as masks and social distancing. We think it’s time to put the focus back on nutrition, an area that impacts shift workers more than most. We think there’s a greater general understanding now that being overweight is unhealthy. There needs to be much more said about this.
As COVID-19 wanes in Australia but is still out of control elsewhere in the world, the importance of developing weight-loss strategies in this population group is important and timely for healthcare workers and patients.