Fat and fitness – in for the long haul

Long-distance lorry driving is predominantly a male profession that necessitates prolonged absences from home and family. This dislocation often results in an inability to access health services and lifestyle information, maintain a healthy diet and participate in regular physical activity.

Certainly, the research literature portrays long-distance lorry driving as a stressful and hazardous occupation,1 associated with fatigue and physical strain,2,3 poor diet,1,4,5 high levels of tobacco smoking,1,4 inactivity,6 and prolonged exposure to vehicle exhaust fumes.4 Invariably, such factors may contribute to higher levels of fatality through road traffic accidents,7,8 and also other health-related problems including respiratory disorders,9 cancer,4,9-14 spinal disorders,15 and cardio-vascular disease.1,16

This survey aimed to collect data on the lifestyles of long-distance lorry drivers visiting the Port of Liverpool, in Merseyside, to inform the development of appropriate health promotion initiatives to encourage them to be health aware, access services and attain a healthier lifestyle.

Methods

Lifestyle data was obtained from 170 lorry drivers over a two-month period, starting on 22 January 2004, via a structured questionnaire administered by one of two interviewers: a male nurse specialising in men’s health and a female health promotion specialist.

Both interviewers asked all the questions to minimise the variation in the interpretation of the questions, and to overcome any problems posed by the potential illiteracy of participants.

Completion of the questionnaire was prefaced with a short discussion outlining the purpose of the study. The interviewers also stressed its voluntary and confidential nature, adding an assurance that anonymity would be preserved since neither the participant’s name nor date of birth was recorded.

Data analysis was conducted, using the Statistical Package for the Social Sciences, version 10.0, on all completed questionnaires.

RESULTS

Sample characteristics

The survey was completed by 168 men and two women. All participants described themselves as white, and their ages ranged from 23 to 74 years, with an average of 44 years. Nearly two-fifths of the respondents (38.2%) lived in Merseyside, a quarter resided in the North West region (27.1%), and the remaining 34.7% lived in other areas of the UK.

Fruit and vegetable consumption

Daily intake of fruit and vegetables by the drivers was low. On average, participants consumed one portion of fruit and vegetables each day (range 0-7), with nearly a third (28.8%) totally excluding such produce from their diets.

Moreover, only 7.1% of drivers consumed the minimum daily intake of five portions of fruit and vegetables, recommended by the World Health Organisation, to protect against the risk of developing coronary heart disease (CHD), common cancers and micro-nutrient deficiencies.17
Although drivers realised the health benefits of including fruit and vegetables in their diets, low intake was attributed to problems in acquiring and eating fruit and vegetables during the working week.

When on the road, drivers could only buy fruit and vegetables at motorway service areas and other roadside outlets (owing to restricted parking in supermarkets and shops), where fresh produce was often unavailable, expensive or of a poor quality. In line with the findings of previous research,5 drivers also highlighted the difficulties in storing fruit, which has a shorter shelf life, and was considered messier to eat than other snacks, such as chocolate bars and crisps.

Fat intake

More than half of drivers (51.7%) regularly used ‘unhealthy’ spreads, such as butter or saturated margarine, and only one in 15 used margarines containing plant stenols, such as Flora Proactive and Benecol, which can reduce cholesterol levels.

As table 1 (above) demonstrates, the drivers’ weekly consumption of fried food, takeaway meals, biscuits, chocolate and crisps, was also high. This reflects the lack of suitable parking for lorries at many supermarkets and food outlets, and the drivers’ subsequent reliance on motorway service areas and transport caf menus.5 Indeed, the provision of healthier food at roadside facilities was identified as a key issue by 75.2% of drivers.

Physical activity

Physical activity lowers the risk of developing CHD, Type 2 diabetes, stroke, osteoporosis, and obesity.18,19 However, long-distance lorry driving is primarily a sedentary profession, characterised by long and irregular work schedules, which inhibits regular participation in physical exercise.6

Only 28.2% of drivers reported taking moderate exercise, such as brisk walking, cycling or gardening, two or more times a week, and nearly half (44.1%) never exercised at all. Participation in more energetic activities, such as jogging, football or working out at a gym, was equally low.

Nearly three-quarters of drivers (71.2%) never took part in vigorous exercise, and a meagre 10% undertook vigorous exercise three times a week or more.

Drivers were asked what sports facilities they would like to be offered to increase their levels of physical activity. On-site access to gym equipment at the docks was identified as the most favoured option by an overwhelming 82.1% of participants. This was valued above all other activities because of the ability to co-ordinate physical exercise with loading schedules.

Body mass index (BMI)

Within the UK, the prevalence of obesity in the adult population has trebled over the past 20 years, and data suggests that about two-thirds of men in this country are classified as overweight or obese.20

This rise has been attributed to changes in lifestyle behaviour, such as diet, and diminishing levels of physical activity. This poses a significant public health problem in terms of its impact on future levels of CHD, Type 2 diabetes, respiratory and musculoskeletal problems.21
Unfortunately, the detrimental combination of a high-fat diet and physical inactivity is reflected in the BMI levels of the drivers, with more than three-quarters (76.6%) classified as overweight or obese.

Smoking

More than two-thirds of drivers (68.8%) had smoked at some point, and, on average, had started smoking at 15 years of age. Although 52 drivers had successfully quit smoking, more than a third (38.2%) were still smoking, which is considerably higher than rates reported among adult males either locally in Sefton (21.4%), or regionally in the North West (28%).22 Respondents smoked an average of 20 cigarettes per day (range six to 60 cigarettes), and three-quarters (76.9%) had tried to give up smoking in the past without success.

Conclusion and recommendations

This study illustrates that lorry drivers report unhealthy lifestyle behaviour, characterised by diets high in fat and low in fruit and vegetables, physical inactivity and excessive rates of smoking.

Such lifestyle factors are compounded by the sedentary nature of long-distance lorry driving, which is typified by irregular work schedules, limited availability of healthy food at port and roadside establishments, inadequate leisure time, and restricted access to health services and advice.

However, unless this behaviour is addressed soon, in the long-term, this population will remain at greater risk of developing chronic disease, such as CHD, diabetes and cancer.

We propose the following recommendations to improve key lifestyle behaviour among lorry drivers:

– In line with the findings of previous research,5,23 OH and health improvement teams should work in partnership with port and roadside catering outlets to increase the availability of reasonably-priced, healthy food options. Staff could be educated on the provision of nutritious low-fat options via on-site cooking demonstrations and recipe cards, while financial assistance could be given to purchase equipment, such as ovens to cook jacket potatoes, and subsidise fruit distribution.

– Haulage companies should be encouraged to provide drivers with cool boxes to aid the storage and prolong the shelf life of healthier food items, including fruit, salad, and unsaturated margarine.

– Consideration should be given to situating gyms in UK ports to facilitate increased physical activity levels in the driver population.

– A lifestyle brochure should be developed for lorry drivers to provide advice specifically tailored to life on the road. In particular, the booklet should include information regarding healthy dietary habits, and examples of exercises that can be undertaken when away from home, as well as smoking cessation advice. Provision of telephone helpline numbers is also essential to facilitate access to health information while on the road.
– Lifestyle information could be recorded onto cassette tapes, in addition to written material, so that drivers can interpret advice when on the road, and ensure that all drivers, regardless of their literacy level, understand the message.

– Pilot mentoring schemes with peers should be developed to offer advice and a social support network to drivers to reduce social isolation,24 increase health awareness, and sustain lifestyle behavioural change, such as healthier eating, participation in physical activity and smoking cessation.

Jo McCullagh is senior health promotion specialist, Sefton Health Improvement Support Service

Acknowledgements

We would like to acknowledge South Sefton Primary Care Trust, and express our thanks to O’Connor Transport (Widnes), and The Mersey Docks and Harbour Company for supporting this initiative

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