DOI: 10.1177/10519815261473912 ISSN: 1051-9815

Shift work and BMI in nursing professionals: A cross-sectional mediation analysis through psychological distress and irregular eating patterns

Eva Urbón, Carlos Salavera
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Background

Shift work is a well-established occupational risk factor for psychological strain in healthcare professionals, yet its association with physical health outcomes such as body mass index (BMI) remains inconsistent. Drawing on a biopsychosocial and occupational health psychology framework, this study examined the psychological and behavioral pathways that may underlie the association between shift work and BMI in nursing professionals.

Objective

To examine, using a cross-sectional structural equation modeling approach, whether psychological distress and irregular eating patterns were associated with the relationship between shift work with night shifts and body mass index (BMI) among nursing professionals.

Methods

A cross-sectional design was employed with a sample of 194 actively employed nurses (78.4% women; M age = 38.7 years). Psychological distress was modeled as a latent construct comprising anxiety, stress, and emotional exhaustion, assessed using the Depression Anxiety Stress Scales–21 (DASS-21) and the Maslach Burnout Inventory–Human Services Survey (MBI–HSS) . Irregular eating patterns were operationalized through meal skipping and between-meal snacking. BMI was calculated from self-reported weight and height. Structural equation modeling with bootstrap confidence intervals was used to test a sequential mediation model while controlling for age and sex.

Results

Shift work was positively associated with psychological distress, which in turn was associated with irregular eating patterns. These eating behaviors were directly associated with higher BMI. The total indirect association between shift work and BMI was statistically significant (95% bootstrap confidence interval excluding zero), particularly through irregular eating patterns, whereas the sequential pathway involving psychological distress did not reach statistical significance, suggesting that organizational constraints related to shift work may exert a more direct influence on eating behaviors than psychological distress alone.

Conclusions

The findings are broadly consistent with a biopsychosocial model in which the association between shift work and BMI is linked to intermediate psychological and behavioral processes. Although the cross-sectional design precludes causal inference, the results highlight the importance of addressing both psychological strain and eating-related self-care behaviors within occupational health interventions aimed at nurses working rotating night shifts.

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