Around the world, 650 million adults, 340 million adolescents, and 39 million children are obese. This estimation is still rising. According to the WHO, 167 million adults and children will experience deteriorating health by 2025 as a result of being overweight or obese (1). Obesity is a significant contributor to poor health, including type 2 diabetes, cardiovascular disease, cancer, decreased life expectancy, and mortality (2), which could impact all classes of communities.

Most body systems, including the endocrine, gastrointestinal, neurological, and cardiovascular systems, are severely impacted by overweight and obesity, increasing a person's risk of contracting infectious diseases (3). Obesity-related complications increase the number of morbidities that need to be managed by the declining number of healthcare professionals (4). Healthcare workers (HCWs) who have direct contact with patients and often influence their behaviors ought to have a healthy physique to show a good role model in front of patients, and this revealed the importance of a healthy physique toward disease prevention (5). Overweight and obese HCWs might have difficulty counseling the patients even if the patients clinically state with weight increase (6), which could be one of the barriers that can affect the patient consultation due to the same health issue.

Obesity and overweight rates are rapidly rising in developed and developing countries, including Palestine (7). Overweight [body mass index (BMI) of 25.0–29.9 kg/m²] and obesity (BMI ≥ 30 kg/m²) increases the risk of non-communicable diseases (NCDs) (8). A meta-analysis study in Middle East countries found that the prevalence of obesity and overweight was 21.17 and 33.14%, respectively (9). A recent survey conducted in Palestine concluded that the prevalence of overweight and obesity is 23.6 and 19.5% in the Gaza Strip and 26.1% in the West Bank (10).

Due to the Israeli siege, people in Gaza live in unfavorable and dangerous conditions. The political events there, where Palestinian refugees, in particular, and Palestinian lives, in general, are concerned, have contributed to widespread unemployment, malnutrition, food insecurity, a lack of income, and a continuous decline in the quality of care for all patient categories (11, 12). These factors undoubtedly could have an impact on people with NCDs. Healthcare workers are exposed to a wide range of difficulties that prevent the provision of health services as required, including lack of human resources, lack of medical supplies, workload, and financial burden, and these factors may negatively affect the health of health sector workers and lead to the development of work-related illness (13).

Understanding the viewpoints of healthcare professionals is crucial before creating a successful healthcare intervention (14). A healthy society depends on the efforts of an important set of professionals, the HCWs (15). Unfortunately, little health research has been done on managing NCDs. Previous studies revealed that sedentary jobs, long periods of sitting, and shift work all greatly raise the risk of obesity (16). Healthcare providers include certified medical personnel (e.g., doctors, nurses, medical scientists, pharmacists, and technicians) and non-clinical support staff (e.g., the administrative class) (17). Because of their specialized training, healthcare professionals are supposed to have a high level of knowledge and awareness of their health condition and the effects of lifestyle changes on their health (18, 19). In addition, HCWs are responsible for promoting appropriate lifestyle changes that affect disease prevention and serve as role models for the general population by leading healthy lifestyles (20).

Therefore, few studies have been conducted to evaluate overweight, obesity, and the risk factors linked to these conditions among Palestinian HCWs working in the Gaza Strip. Because they are overlooked in research studies while being identified as high-risk populations, this study was done to evaluate the prevalence of overweight and obesity and its associated factors among HCWs.

Obesity among HCWs is an important issue as it impacts the morbidity of HCWs. In the present study, the overall prevalence of overweight and obesity among HCWs was 65% (39.3% overweight and 25.7% obesity). These findings are comparable with the meta-analysis in the Middle Eastern countries, which reported the prevalence of overweight and obesity were 33.14 and 21.17%, respectively (9). Moreover, a previous study conducted in the Gaza Strip said the prevalence of obesity was 19.5% (10). The current research has found a higher prevalence of overweight and obesity among HCWs than the prevalence of overweight and obesity reported in the previous study. When compared to the overall adult population, healthcare workers have a higher prevalence of obesity. This may be because they are more susceptible to the disease due to irregular and extended work hours, poor food, and workplace stress.

There is a significant association between the elevation of the anthropometric measure (Height, weight, WC, HC, SBP, and DBP) and being overweight or obese. It was also noted that the participant's elevation in anthropometric measurements had a significant positive association with being overweight and obese. The higher prevalence of overweight and obesity among HCWs might be influenced by sedentary behaviors, which might be contributed to the work environments and the socioeconomic status that may encourage the adaption of less physical activity and eating habits (31, 32). One of the contributing factors may be eating a poor diet while watching TV, especially sugary snacks. Other researchers have discovered a link between screen time and sugary, high-energy snacks (33). Due to the work environment, the HCW's low frequency of intake of meals, low intake of fruits and vegetables, and low physical activity increased overweight and obesity. Further research is needed to investigate dietary habits and socioeconomic status and their association with overweight and obesity among HCWs.

Furthermore, the prevalence of overweight and obesity increased with age. Similar results were reported by Low et al. (34), Addo et al. (35), Kishawi et al. (36), and Firouzbakht et al. (37), that the prevalence of overweight and obesity increased as age increased. This places a future load of illness on the medical workforce. In addition, the previous study found that the estimated peak increase in the prevalence of overweight and obesity as age increased was 40–50 years in developing countries while it was 50–60 years in developed countries (34), which is in line with the current study. The peak increase in the prevalence of obesity with age was 30–39 years. In the present study, the peak age is lower than in the previous study. Most of the studies confirmed the association between age increasing and susceptibility to non-communicable diseases and overweight and obesity as one of the risk factors of illness. Overweight and obesity are associated with increased age due to decreased physical activity, routine daily activities, comorbidities, and dietary habits. Therefore, the high ratio of youth and the predominance of the HCWs category found in this study represent the actual age and job category distribution among HCWs in the Gaza Strip.

In addition, the findings from this study show that married participants had a higher prevalence of overweight and obesity than single participants. The results support the findings reported by Dagen et al. (38) and Tzotzas et al. (39) that married adults had a higher prevalence of being overweight and obese than single adults and hypothesized that the increase in BMI among married couples is due to the increased social support, along with regularly eating dense food that increases the risk of being overweight or obese (39).

Our results revealed that the prevalence of overweight and obese increased among patients who had hypertension and type 2 diabetes. In addition, participants with a positive family history of NCDs had a higher prevalence of overweight and obesity than those without a family history of NCDs, in which similar findings have been found in previous studies (40–43).

Similar to the findings of our investigation, numerous studies have shown that nurses had a higher risk of obesity than workers in other occupations. In their academic careers in Scotland and England (44, 45), it is covered that the risk of obesity was lower for different HCW job categories than for nurses. Unfortunately, Hegde et al. in their studies in Tamil Nadu, India, found results that contradicted our study, suggesting that the burden of obesity was greater among physicians than nurses (46). All the studies mentioned earlier agree that different job categories were associated with obesity among HCWs. However, the aforementioned studies did not share comparable sociodemographic populations to that of the Gaza Strip. Most studies among HCWs did not specifically analyze different types of HCW occupations and obesity. Hazmi et al. (47) only mentioned the overall prevalence of obesity without further analysis according to job category, while Mustafa et al. (48) and Ramli (49) only divided the occupations of HCWs into professional vs. ancillary jobs. In contrast, our study is the first in the Gaza Strip to work with HCWs and determine the prevalence of overweight and obesity and classify HCW occupations into four main groups, doctors, nurses, paramedical, and non-medical categories, with the prevalence of overweight and obesity. Thus, we know nurses are at a greater risk of becoming obese than doctors and other job categories in the Gaza Strip.

Our findings reported that eating behavior was significantly associated with increased overweight and obesity, thus, the participants <3 meals per day had increased the prevalence of overweight and obesity in other groups (Table 2). Incomparable to previous studies, eating behavior was reported as one of the leading factors in the development of overweight and obesity with carried gender and age differences (50–53). In addition, no local studies reported an association between eating behavior and the prevalence of obesity.

In addition, physical inactivity is identified as a risk factor for overweight and obesity (54, 55). However, the current study revealed that all healthcare workers with low or moderate activity had no significant association between physical activity and overweight and obesity. A similar result was reported by Firouzbakht et al. (37) and El Kishawi et al. (36). These previous studies recognized the low physical activity due to the working shift of HCWs, limited availability of exercise facilities, and workload.

However, the current study showed significant predictors associated with an increase in the prevalence of overweight and obesity among HCWs. These associated factors included gender, age, marital status, monthly income, known hypertension, type 2 diabetes, family history of NCDs, and elevation of anthropometric measurements. On the other hand, the current study did not find any significant associations between educational level, smoking status, physical activity, and fruit and vegetable consumption.

This study has several strengths. The first study estimated the prevalence of overweight and obesity among HCWs in the Gaza Strip. This study defined the associated factors with an increase in the prevalence of overweight and obesity; therefore, this study will be a baseline for subsequent studies among HCWs. There are some limitations in the study that need to be considered. First, cross-sectional data do not explore the causal pathways that underlie the reported association. Second, no availability of previous studies about the prevalence of overweight and obesity to interpret our results. Third, recall bias is also possible by using food frequency. Fourth, the majority of our participants were nurses compared with other professions.

This study showed a high prevalence of overweight and obesity among HCWs. Age, monthly income, marital status, known hypertension, type 2 diabetes, and eating habits were associated with the prevalence of overweight and obesity. These findings appear to show an emerging problem in HCWs. A wellness program should be developed by decision-makers throughout mass-level educational awareness campaigns for HCWs to prevent and manage the modifiable risk factors that increase overweight or obesity.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

The studies involving human participants were reviewed and approved by Palestinian Health Research Committee at the Directorate General of Human Resources Development, Ministry of Health, Gaza (PHRC/HC/663/19). The patients/participants provided their written informed consent to participate in this study.

LM, JY, and MaM generated the idea for the study and formulated a research plan. JY wrote the original draft preparation and reviewed and edited. MJ, HJ, YF, LW, ZL, ZH, and MeM revised the manuscript and interpreted the data and editing. LM and MaM supervised the study. All authors acquired, analyzed, and interpreted the data. All authors contributed to the article and approved the submitted version.