Obesity among nurses FINAL PAPER!!!

Running head: OBESITY AMONG NIGHT SHIFT NURSES Nursing 1
Obesity Among Night Shift Nurses
Olivia J. Kashuba
Keystone College

Introduction
Obesity is a growing epidemic in the United States raising public health concerns among
third shift workers in the workplace. Employers face new concerns and problems as the rate of
obesity increases. Not only is healthcare a concern employer’s face, absentees and productivity
are also being directly impacted by obesity. According to recent studies the rate of obesity
doubled since 1970 to more than 30% of Americans suffering from being overweight or obese
(Hammond, Levine, 2010).
Recently the American society has changed its work patterns. Society has shifted from a
9-5-work schedule to a 24-hour active society. The American work schedule reflects this shift
and its effects are being felt by this population of workers (Heath, Roach, Dorrian, Ferguson,
Darwent, Sargent, 2012). Working the night shift can be defined as a work schedule between
midnight and five in the morning before the continuation of the day shift. Work now extends to
working hours, which are disruptive to the bodies’ normal diurnal biological rhythm. Obesity,
among other serious health problems, are associated with working the night shift. Several
researchers reported shift workers displaying unhealthy behavioral patterns, are more
overweight, and suffer from other chronic health related problems related with obesity then
compared to those who work the day shift (Atkinson, Fullick, Grindly, Maclaren, Waterhouse,
2008).
Factors
Some factors contributing to the increase of obesity among night shift workers are
unnatural sleep patterns (sleeping during the day), eating habits, and physical activity. Shift
workers tend to develop sleep patterns, which are disruptive to the body’s normal circadian

rhythm. Circadian rhythm is the body’s internal clock. This cycle helps regulate the body’s
hormonal production as well as the body’s metabolism (CNS Drugs, 2001). Circadian rhythm is
prompted by the onset of light or darkness and is coordinated around a 24-hour time period.
Without the pattern of circadian rhythm an individual will have trouble sleeping, which in
essence, will cause a lack of sleep. Shift-related insomnia is a sleep restrictions often faced by
third shift workers (Flo, Pallensen, Akerstedt, Mageroy, Moen, Gronli, Nordhus, Bjorvatn,
2013). Insomnia is the variation in the amount of sleep an individual receives from night to night.
When suffering from insomnia the quality and quantity of sleep may be very minimal’ causing
an individual to have a lack of energy and focus throughout the day (Australian Psychological
Society date). Higher rates of night shift insomnia were recorded compared to those working
during the day shift (Flo, et. al., 2013).
Studies show third shift nurses tend to gravitate toward eating foods that are high in sugar
in order to surpass the feeling of tiredness. Unhealthy food choices were often chosen over
healthy food choices due to easy access. Studies also show night shift workers tend to develop
poor eating habits. These habits include nibbling rather than eating three complete meals, eating
only a few small meals per day and gravitating to quick microwave meals or fast food items.
(Elberly, Feldman, 2010).
One significant cause of obesity in night shift workers is physical activity. According to
Eberly and Feldman, night shift workers can develop vicious cycles of not partaking in physical
activity. Night shift workers often deal with the effects of insomnia and sleeping problems (Flo
et al., 2013). The absence of sleep causes workers to be unmotivated and lack energy to
participate in extra physical activity. This cycle can be difficult to stop if it is not quickly
addressed.

Obesity is often measured by Body mass index (BMI). BMI is the conceptual term used
to determine weight status among individuals. According to the 2012 North American
Association for the Study of Obesity BMI, even with its limitations for higher muscle mass
resulting in a higher BMI, is a commonly used indicator of adiposity. The Nurses’ Health Study
observed 79,000 U.S. female nurses and revealed a trend of nurses who worked the night shift
for a long duration, 1-15 years, and increase in their BMI (Eberly, Fieldman, 2012).
This study seeks to discover whether working the night shift increases BMI,
measurement, and obesity between LPN and RN nurses in the NEPA. A quantitative survey will
be conducted along with research to determine if the height and weight, BMI, of night shift
nurses compared to day shift nurses differs and to see if this difference can be attributed to
higher BMI.
Rationale
Organizations and industries are affected by the dramatic leap the American society is
currently taking toward obesity. Obesity in employees not only affects health care cost but also
decreases productivity, and raises absenteeism in the workplace. Obesity is becoming
detrimental not only to individuals, but also to the companies that they are working for. Studies
show the annual cost of obesity among full-time employees, $73.1 billion in 1998, increased to
$147 billion in 2008. This total accounts for almost 10% of all medical spending. Medicare
spending would decrease by 8.5% and Medicaid by 11.8% in the absence of obesity (Hammond,
Levine, 2010). Employees with a body mass index over 35 represent 37% of the obese
population but are responsible for 61% of excess costs (Finkelstein, Di Bonaventura, Burgess,
and Hale, 2010).

In addition to medical cost, productivity is also affected by obesity. Productivity is
defined as the relationship between output and input in a company or organization (Stefan,
2002). According to Hammond and Levine, obese individuals tend to be less productive because
of their physical and mental conditions and have a greater loss of productive time - LPT. The
estimated loss of productivity in obese workers is $11.7 billion per year. Studies estimate the
correlation between absenteeism - not working your scheduled shift - and obesity make up the
largest area of productivity lost. Obese employees also use more paid off time from work than
employees who are a healthy weight (Hammond, Levine, 2010).
Obesity not only affects an individual’s work life but also their general quality of life.
Many risk factors included with obesity are metabolic syndrome, cardio vascular disease, type 2
diabetes, high levels of triglycerides, low levels of HDL cholesterol, high blood pressure, and
high fasting blood glucose levels (Arheart, Mrtinez, Christ6, Clark III, Clarke, Davila, 2010).
These ailments continue with the person even after they leave the job. These irreversible health
consequences need to be addressed for the greater good of the American workforce.
Nurses play a crucial part in serving our healthcare system. The increase of obesity,
which increases both productivity and increases absenteeism, may be directly affecting the care
and quality nurses are giving to their patients (Narbro, Jonsson, Larrson, Waaler, Wedel,
Sjostrom, 1996). The results of this study will help further the Social Cognitive Theory (SCT)
and conclude whether working the night shift increases BMI among nurses.

Theoretical Framework
Social Cognitive Theory (SCT)
The theoretical model supporting the research is the Social Cognitive Theory. The Social
Cognitive Theory (SCT) describes the influence of personal, environmental, and human
behaviors all have on one another. SCT is composed of three main factors: including self-
efficiency, goals set by an individual, and the expectations of the individual. If an individual is
confident and exercises self-efficiently he or she is able to change harmful behaviors even when
faced with difficult problems. In contrast, when an individual feels as though he or she is unable
to exercise control over their health behavior they will become unmotivated and potentially
create more difficulty when faced with challenges (National Institutes of Health). According to
the U.S. Department of Health and Human Services, SCT was derived from the Social Learning
Theory- SLT. SLT states, individuals not only learn from their own actions and experiences, but
also from observing others and the benefits they receive from their actions.
SCT and Obesity
In order to apply the Social Cognitive Theory to this research, obesity must be recognized
as both a physical and psychological problem. The underlying cause of obesity consists of an
individual’s psychosocial environment and their biological attributes. Individuals who have
difficulty controlling their food consumption and participating in physical activity may be
suffering from distress and anxiety. Obese individuals tend to use food as a coping mechanism to
relieve their anxiety and stress. This perpetual cycle of eating, when in distress, often leads to
overeating and obesity. Distress, which is mental strain or suffering, is inevitable for individuals
working in a high-stress workplace (Collins, Bentz, 2009).

Night eating, a coping mechanism for overeating, is a factor contributing to significant
weight gain. Night eating usually consists of easily accessible foods, which are high in calories.
Individuals tend to snack throughout the night, mindless eating, in replacement of normal meals.
Eating at night also disrupts an individual’s natural circadian rhythm. This disruption causes a
delay of appetite in the morning, which causes an individual to overeat during the night (Collins,
Bentz, 2009). .
Obesity does not only hurt the individual physically but also mentally. Society often
views obese individuals as having a “weak will” and being “unmotivated”. These negative
beliefs may cause feeling of frustration and anxiety. Also, individuals suffering from obesity are
often discriminated at work and have a low self-esteem (Collins, Bentz, 2009).
Behavior and SCT
Obese nurses need to become more cognizant of the behaviors in order to improve their
health and overall quality of life. By adopting the social cognitive theory individuals can
improve their behavior health by taking control of their thoughts and behaviors and exercising
their own self-efficiency or by observing the beneficial actions taken by others. Both methods
will be difficult for the individual, but the end result should overall improve the quality of their
behavior health.
Conceptual Framework
The conceptual framework illustrates the relationship among the dependent variable and
the independent variables. At the core and the outcome of the problem lies BMI.

BMI
Obesity is becoming a serious health problem seen among 30% of the American
population (Heath et. al., 2012). Obesity is measured by an individual’s body mass index (BMI),
which is the core problem faced by nurses working the night shift. Several researchers have
observed a relationship between night shift workers and a higher occurrence of obesity compared
to those working the day shift. The most common differences seen among day shift and night
shift workers are sleep deprivation and changes in the circadian rhythm, eating habits and sleep
deprivation (Eberly, Feldman, 2010). .
SLEEP DISORDERS
Night shift nurses often disrupt the body’s natural circadian cycle, which often times
results in sleep deprivation, sleep disorders and insomnia. Circadian rhythm is the body’s clock
BMI
Physical
Activity
Sleep
Deprivation
/Carcadian
Rhythm
Eating
Habits

that resides in the brain that revolves around a 24 hours period (CNS Drugs, 2001). Research
shows the circadian rhythm has a direct impact on an individual’s energy and metabolism, which
is a plausible factor as to why many night shift nurses suffer from being overweight and obese
(Eberly,Feldman 2010). Also one of the many symptoms seen in insomniacs is a lack of energy
and motivation to enable them to engage in physical activity, thus resulting in an increase in
obesity(Flo et al., 2013).
EATING HABITS
Night shift nurses eat foods during the shift often high in sugar in order to overcome the
feeling of being tired. The desire and easy accessibility to sweets and junk food often override
the alternative choice of a healthy snack. Also, the timing of meals, rather than total caloric
intake, results are most affected by night shift nurses. Night shift nurses are more likely to snack
in place of whole meals, and eat meals and snacks later at night (Atkinson, et. al., 2008).
PHYSICAL ACTIVITY
Night shift nurses often suffer from insomnia and other sleep disorders, which leads to
the lack the energy to engage in physical activity. Physical activity is a major contributor to
weight gain in individuals who work the night shift. The precarious cycle of not getting the daily
amount of exercise because of low energy levels can become very difficult to break. Daily
exercise helps energize and strengthen the body. By not partaking in physical activity an
individual is taking away the body’s natural way of energizing and strengthening the body
(Eberly and Feldman, 2010).

Purpose
The purpose of this study is to find out if working the night shift negatively affects BMI
of Nurses in the Northeast Pennsylvania. The research will determine if working the night shift
impacts lifestyle habits, sleep deprivation and circadian rhythm, eating habits, physical activity,
and increases BMI.
ResearchQuestion
Does sleep restriction, lack of physical activity, and unhealthy eating habits increase the
BMI among night shift nurses?
Hypothesis
Based on the research in the literature review the following hypothesis is established:
Sleep restrictions, lack of physical activity, and unhealthy eating increase the BMI in night shift
nurses.
Null Hypothesis
The null hypothesis of the research is: Sleep restrictions, lack of physical activity,
and unhealthy eating do not increase the BMI in night shift nurses.
Limitations
Limitations in the study are restricted by: the geographical area in which the study is
done, and obtaining surveys from willing participants. Nurses working the night shift have little
time to concentrate and partake in external issues not pertaining to work. In order to gain

efficient responses, additional incentives might have to be made. Also, because the sample size
will be restricted to Northeast Pennsylvania, the study will have geographical constraints.
Significance of Study
According to Healthy People 2010, both physical activity and obesity were included in
the top ten leading health indicators. The two goals designed by the Healthy People 2010 are
increasing the quality and years of a healthy life and to try and diminish health disparities. By
gaining knowledge through this study, night shift nurses will discover how they can improve
their own quality of life, decreasing their BMI, and what steps they need to take to accomplish a
healthy lifestyle.
Literature Review
The purpose of this section is to recognize influences contributing to the growing rate of
obesity among third shift nurses. The literature of the influences will reveal how working the
night shift negatively impacts the quality of life among nurses compared to nurses who work
during the day.
Working the night shift shows much higher BMI’s ratings of obesity compared to day
shift nurses (Eberly, Feldman, 2010). Research shows working the night shift decreases the
opportunity for physical activity. The University Of Maryland School Of Nursing, in Baltimore,
studied 2103 nurses who worked the night shift. Among the nurses studied 55 percent were
recorded as being obese. The study revealed that the sedentary lifestyle of the nurses was the
main cause of increased BMI and obesity (Tarapchak, 2012). Working the night shift also
changes behavior-eating habits and often causes normal meals to be replaced by continual
snacking. Studies have shown that both dietary and timing of meals is most pretentious in night

shift workers (Atkinson, et. al., 2008). Around one-third of the U.S workforce has irregular shift
rotation schedules, which lead to the offset of the natural circadian rhythm. This disruption often
causes obesity and other health related problems when working the night shift (Flo et. al., 2013).
Obesity/BMI
The most commonly used method of measuring obesity is by calculating the
height and weight index of an individual, which is known as body mass index (BMI). According
to the North American Association for the Study of Obesity the formula used to calculate BMI is
BMI = weight (kg) / [height (m)2 (CDC, 2013). Individuals with a BMI in between 18.5 and 24.9
kg/m² are classified as having a normal weight. Whereas individuals with a BMI in between 25
and 29 kg/m² are said to be overweight, over 30 kg/m² are moderately obese, and anything
exceeding 40 kg/m² is considered morbidly obese (Feedman, Thornton, Pi-Snye, Heymsfield,
Wang, Pierson, Blanck, Gallagher, 2012).
Approximately 300 million people suffer from obesity around the world. Of these
300 million, obesity related deaths per year occur in the United States. The National Health
Examination and the National Health and Nutrition Examination conducted a survey on the
American population from 1960-2000. The survey conveyed the alarming growth rates obesity
has taken. The most astonishing of these surveys was during the years 1990-2000. During this
span of ten years, obesity rates tripled among the American population. These studies have
shown that obesity is now an epidemic affecting more than one-third of the American population
(Wiborn, Beckham, Campbell Harvey, Galbreath, Bounty, Nassar, Wismann, Kreider, 2005).
Along with suffering from obesity, an individual is also at risk for type 2 diabetes, hypertension,
coronary heart diseases, gallbladder disease, osteoarthritis, and many types of cancers.

The highest of these risk factors for those suffering from obesity is type 2 diabetes.
Approximately 85% of Americans are currently suffering from type 2 diabetes. Of the 85%, 70%
of these individuals are also suffering from a BMI of 30 or greater. Research shows the risk for
type 2 diabetes is 5 times greater in men and 8.3 times greater in women who suffer from obesity
compared to individuals who have a normal weight. Living a sedentary life, poor nutrition, and
obesity are all factors that greatly contribute increase risk of type 2 diabetes. In addition to being
at a high risk for type 2 diabetes, obese individuals are also at a high risk for cardiovascular
disease, coronary heart disease, hypertension, and congestive heart failure (Wiborn, et. al., 2005).
Not only is an individual at risk for many health factors when sufferings from obesity,
but also the economic costs of obesity have taken a dramatic increase. In 1999, research revealed
the total amount of obesity-related health care cost in the United States was nearly 24 billion
dollars. Research also revealed that obese individuals are 14% and morbidly obese individuals
are 25% more likely to visit their physician than a normal weight individual. Overall over weight
and obese individuals have a 38% higher doctor’s visit record than normal weight individuals.
By the year 2003 the obesity related health care cost sky rocketed to a staggering 75 billion
dollars (Wiborn, et. al., 2005). .
Nurses Working the Night Shift Compared to Day Shift
A study was done to compare the weight gain both day and night shift nurses. The
variables used in the questionnaire were directed to the individual’s weight, eating habits,
physical activity and sleep patterns. The study included a total 85 subjects. Of these subjects 36
worked the day shift and 49 worked the night shift. The mean weight gain of the night shift was
4.3 kg, and the mean weight gain for the day shift was 0.9 kg. Night shift workers reported eating

later and more during their scheduled shift. Many of the nurses also reported eating foods that
were high in sugar and calories in attempts to counteract the feeling of doziness and increase
energy (Eberly, Fieldman, 2012). The average night shift worker ate their last meal at 10:27pm
while the day shift worker ate theirs around 5:52pm. Eating later meals decreases the thermic
effect, which in result causes weight gain (Eberly, Fieldman, 2012). Night shift workers also
found it much more difficult to find time to exercise. Night shift workers were also prone to take
more naps and longer naps throughout the week than compared to the day shift nurses. The
combination of changes in eating habits, lack of physical activity, and the changes in sleep
patterns may have contributed to the rapid weight gain of the night shift workers (Geliebter,
Tanowitz, Aronoff, & Zammit, 2000).
Eating Habits
Studies show that night shift nurses have different eating habits compared to
nurses who work during the day. Some ways in which night shift workers eating behaviors differ
from day shift nurses are: night shift nurses tend to have higher overall caloric intake, are more
likely to snack in place of whole meals, and eat meals and snacks later at night. Results have
revealed the timing of meals, rather than total caloric consumption, is most affected by night
shift (Atkinson, et. al., 2012).
A survey was administered to shift workers over a 5-day period. The survey included
morning afternoon and night shifts. Although the total amount of food ingested within a 24-hour
period did not differ between the three shifts the amount of food did differ during the individual
8-hour shift. The study showed that food intake was much higher for those who worked the

morning shift compared to those who worked the evening and night shift. Night shift workers
tend to have less of an appetite and have limited access to food (Atkinson, et. al., 2012).
The circadian rhythm directly affects an individual’s appetite because the human body is
not designed to intake and digests food during the night, but rather it is naturally designed to
sleep during the night. The body’s glucose tolerance decreases from the morning to the night and
increases cholesterol. This may put an individual at risk of cardiovascular disease (Atkinson, et.
al., 2012).
Night shift workers lean towards foods that are high-energy dense foods to counteract the
feeling of tiredness. These foods are high in calories and have very limited proteins, fat, and
carbohydrates. The differences in eating habits have resulted in lower meal frequency and poorer
meal quality among night shift workers (Atkinson, et. al., 2012).
SleepDeprivation and Circadian Rhythm
Night shift workers often face the risk of insomnia and sleep deprivation due to
the fact that they are constantly upsetting the body’s natural circadian rhythm. Circadian rhythm
is the body’s clock that resides in the brain. It regulates the unique patterns and rhythms
experienced by every individual during both sleep and wakefulness. A person’s endogenous
clock is coordinated around a 24-hour period and is signaled by the day and night (CNS Drugs,
2001). Circadian rhythm not only regulates the body’s behaviors and awake-sleep cycle, it also
affects a person’s feeding behaviors.
Working the late shift has become s disservice to the human performing this work
schedule. Not only are they out of circadian rhythm but they are also affected by a number of
other maladies. They often deal with significant stressors and have few ways of coping with

them. The late shift can become detrimental to an individual's health especially over a prolonged
period of time. The malnutrition can assist in leading to a number of irreversible maladies.
Obesity most often deteriorates an individual's self-efficacy. This loss of drive not only affects
their psyche but also their behavior. The entire wellness of a person is not being addressed when
they work the late shift.
Research shows the circadian rhythm has a direct impact on an individual’s
energy metabolism, which is a plausible factor as to why many night shift nurses suffer from
being overweight and obese (Eberly, Feldman, 2010). Nurses working the night shift get an
average of 5 hours of sleep, which may be the cause of the adverse health effect of obesity.
A study to compare carbohydrate levels and hormone levels during sleep was
performed by Spiegel. Spiegel evaluated 11 men ages 18-27. The studies duration was 16 days
and only allowed the men to sleep four hours a night. The study was performed in a clinical
research center. After 16 days the participants seemed to suffer from both carbohydrate
intolerance and insufficient glucose effectiveness (related to an individual’s hormone levels) due
to lack of sleep, sleep deprivation. That in effect creates a cycle of maladaptive tendencies these
maladies then manifest itself in weight in the continuation of this cycle maladaptation’s become
maladies of the mind and body. The importance of the study was that impaired carbohydrate
metabolism and hormone imbalances can be directly associated with obesity (Eberly Feldman,
2010).
Night shift nurses are constantly defying the body’s natural circadian cycle, which often
times results in sleep deprivation, sleep disorders and insomnia. Insomnia is when an individual
has trouble falling asleep or staying asleep (Member Resource Team, 2013). There are many

types of insomnias, which include delayed sleep phase syndrome, advanced sleep phase
syndrome, irregular sleep-wake cycle, periodic insomnia, and temporary insomnia. Insomnia has
many lifestyle behaviors and risk, which includes both being overweight and diabetes (Sutton,
Moldofsky, Badley, 2001). Night shift nurses suffering from insomnia find it difficult to
overcome its harmful effects. One of the many symptoms seen in insomniacs is a lack of energy
and motivation to enable them to engage in physical activity (Flo et al., 2013).
Physical Activity
According to Eberly and Feldman because nighttime nurses often suffer from insomnia
and other sleep disorders nurses often times lack the energy to engage in physical activity.
Physical activity is a major contributor to weight gain in individuals who work the night shift.
The precarious cycle of not getting the daily amount of exercise because of low energy levels can
become very difficult to break. Daily exercise helps energize and strengthen the body. By not
partaking in physical activity an individual is taking away the body’s natural way of energizing
and strengthening the body (Eberly and Feldman, 2010). A limitation to this study is the lack of
evidence concluding that physical activity is a direct factor in higher obesity ratings among night
shift workers.
An observation performed by Perssons stated many of the night shift nurses included in
the study reported often times choosing sleep over physical activity. The nurses felt as though no
time of the day seemed suitable to part take in physical activity. Many nurses used the time
before their night shift to spend time with family or rest and the time directly after work was
used for sleep. Rest always seemed to be the night shift nurse’s optimal choice when not
working. The lack of strenuous physical activity is one of the main logical factors contributing to

the increase of overweight and obesity seen among night shift nurses (Eberly and Feldman,
2010).
Summary
The literature review discussed the in-depth meaning and relation between
obesity, BMI, and nurses working the night shift. The research highly suggest that eating habits,
sleep deprivation and the circadian rhythm, and physical activity all contribute to the increase in
body mass index among night shift workers. Having a high BMI poses potential health risk
including type 2 diabetes, cardiovascular disease, coronary heart disease, hypertension, and
congestive heart failure. By understanding the effects of bad eating habits, inadequate sleep and
lack of physical activity have on the body the results of the surveys will be more focused and
applicable.
Methodology
ResearchDesign
This research is a quantitative and non-experimental. This research reveals whether
working the night shift effects BMI among nurses. The predictors supporting the research are
eating habits, sleep deprivation, and the circadian rhythm and physical activity.
Sample
My sample will include male and female RN and LPN nurses from Lackawanna,
Wyoming, and Luzerne county hospitals. A consent and survey will be sent out to a total of 18
hospitals included in the three counties. A limitation to the study is the small sample size,
participation and geographical restrictions.

Instrumentation
According to the University of Wisconsin there are several collection methods used in
obtaining reliable research including experiments and clinical trials, observing and recording
events, finding relevant data, administering surveys, and questionnaires. The instruments used in
this research include the equation used to measure BMI and a questionnaire adapted from Nurse
Health Questionnaire and Stanford Disorders research Questionnaire. The Keystone College
Institutional Review Board (IRB) for use approved both questionnaires. The quantitative
questionnaire focuses on the health and measures the BMI of both night shift and day shift
nurses. BMI will be measured using the formula BMI = weight (kg) / [height (m)2 (CDC, 2013).
BMI BMI = weight (kg) / [height (m)2
(CDC, 2013)
Normal Healthy Weight 18.5- 24.9 kg/m²
Over Weight 25 - 29 kg/m²
Moderately Obese 30 -39 kg/m²
Morbidly Obese 40+ kg/m²
Feedman, Thornton, Pi-Snye, Heymsfield, Wang, Pierson,Blanck, Gallagher,2012
Procedure
Approval from the Keystone College IRB will allow the research to be performed. First, a list of
certified male and female LPN and RN nurse information will be collected from hospitals included in
Lackawanna,Luzerne, and Wyoming counties. A letter including the information and the purpose of the
study along with a confidentiality form will be sent to all qualified individuals as well as their place of
employment. To confirm and encourage participants a follow up letter will be sent to each individual.
This letter will include the same information as the first time along with the website location of the
questionnaire. Two weeks after the second letter is mailed the individuals will receive a phone call
encouraging them to participate, the importance of the study, and the potential to win either a $125 dollar

gift certificate to Olive Garden or four day passes to Hershey Park. The survey will be located at
SurveyMonkey.com and listed under NEPA night shift nurses and obesity Keystone College Study. After
the survey is completed an e-mail will be sent confirming the participant is entered into the drawing to
win one of the two prizes listed above.
Analysis ofData
The rate of BMI among night shift nurses will be analyzed using the social cognitive theory and
life-style behaviors. The predictors eating habits sleep deprivation and circadian rhythm, and physical
activity will be analyzed and completed using the SPSS version 22.
Conclusion
Obesity is a growing epidemic in the United States raising public health concerns among third
shift workers in the workplace. The research and completed surveys will confirm or deny if sleep
restrictions, circadian rhythm, physical activity, and eating habits increase the BMI of night shift nurses.
By validating the hypothesis of the research,precaution, preventatives, and solutions will be available in
order to improve the quality of health among night shift nurses with high BMI.

Obesity Rates Among Night Shift Nurses Questionnaire
1. What shift do you currently work? 1. Day 2. Night 3. Rotating
2. Average total hours of sleep per day?
3. How often do you exercise?
A. Sedentary (No Exercise)
B. Mild Exercise (play golf, climb stairs, go for a walk)
C. Occasional exercise (work out less then 4xs a week for 30min)
D. Regular vigorous exercise (more then 4x a week for 1 hour or more)
4. What is your gender? Male Female
5. What is your age?
6. What is your current weight?
7. What is your current height?
Are you dieting? Yes No
Are you on a Physician prescribed diet? Yes No
Do you use artificial sweetener? Yes No
Do you have breakfast everyday? Yes No
Do you eat all three meals a day? Yes No
Do you have problems with eating or your appetite? Yes No
Do you eat fried foods more then three times per week? Yes No
Do you take food from home to work? Yes No
Are you concerned about your weight? Yes No
Have you tried to lose weight? Yes No

8. What percentage of your meals are made at home?
9. What types of snacks do you most often eat at work?
10. Please list all medical problems that currently affect you, including narcolepsy and other sleep
disorders. Please indicate whether each condition has or has not been diagnosed by a physician.
_____________________________________________________________________
_________________________________________________________________________________
_____________________________________________________________________
11. Please list all medications and doses that you are currently taking, including those for narcolepsy
and other sleep disorders.
_________________________________________________________________________________
_________________________________________________________________________________
_______________________________________________________________
12. Please list all significant medical problems that you had in the past including narcolepsy and
other sleep disorders.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________
13. At what time do you usually get into bed on a work night?
14. At what time do you usually get out of bed on a work morning?
15. How long, on average, does it take you to get out of bed?
16. Once you are out of bed on a work morning, how long does it take you to feel fully awake?

17. At what time do you usually get into bed on a non-work night? __________AM / PM
18. At what time do you usually get out of bed on a non-work morning __________AM / PM 19.
On a non-work morning, how long does it take you to get out of bed? _____ hr _____ min
20. Once you are out of bed on a non-work morning, how long does it take you to feel fully awake?
_____ hr _____ min -OR- ⁯ Never feel fully awake
20. How many hours of sleep do you think you need to feel fully rested? _____ hr _____ min -OR-
⁯ Never feel fully rested
21. Do you consider yourself to be a morning person or an evening person? ⁯ Morning person ⁯
Evening person ⁯ No preference
22. At what time would you ideally like to go to sleep? __________AM / PM
23. What time would you ideally like to wake up? __________AM / PM
24. In general, do you sleep well at night? ⁯ Yes ⁯ No
25. How long does it usually take you to fall asleep after the lights are off? _____ hr _____ min
26. How often do you wake up too early in the morning and cannot get back to sleep?
⁯ Always ⁯ Usually ⁯ Rarely ⁯ Never
27. How often do you feel refreshed after a typical night of sleep?
⁯ Always ⁯ Usually) ⁯ Rarely ⁯ Never
28. How often do you sleep restlessly?
29 Always ⁯ Usually ⁯ Rarely ⁯ Never
30. How often do you have difficulty falling asleep at night?
⁯ Always ⁯ Usually ⁯ Rarely ⁯ Never
31. How often do you have difficulties maintaining sleep?
⁯ Always ⁯ Usually⁯ Rarely ⁯ Never
32. How often do you have difficulty falling asleep and maintaining sleep?
⁯ Always ⁯ Usually⁯ Rarely ⁯ Never

33. How often do you wake up during a typical night's sleep and have a difficult time falling back asleep?
__________ times
34. If you have difficulties with sleeping well at night using a scale from 0 to 10 please rate how much
this problem affects you (0 = no distress/impairment; 10 = severe distress/impairment):
A. In general, how much distress does sleep cause?
B. How much does it affect your social life/relationship with friends?
C. How much does it affect your relationship with your spouse/family members?
D. How much does it affect your relationships with your coworkers and employers?
35.How often do you have difficulty staying awake during the day?
⁯ Once,or more, per day ⁯ Several times per week ⁯ Once per month ⁯ Once per year, or less
37. How often do you experience sudden sleep attacks (nightmares) that are so intense that you must stop
what you are doing? ⁯ Once, or more, per day ⁯ Several times per week ⁯ Once per month ⁯ Once per
year, or less
Thank you for you participation to help further this research
Questions were taken from a research document by Reham Abdulkkarim Halawani, and the Sleep
Disorder Research Questionnaire by Stanford University Center for Narcolepsy and Related Disorders.

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