Abstracts

Introduction

The work-family interface refers to the interaction between domains considered essential in adult life; difficulties in reconciling these domains subject workers to challenges that can affect their health and well-being ¹1. Bilodeau J, Marchand A, Demers A. Work, family, work-family conflict and psychological distress: a revisited look at the gendered vulnerability pathways. Stress Health 2020; 36:75-87.. Women workers often experience such challenges due to the unequal division of childcare and domestic chores. Although these activities are essential for the well-being of the family and for society as a whole, this often invisible and undervalued workload can be a burden for women ²2. Gálvez-Muñoz L, Rodríguez-Modroño P, Domínguez-Serrano M. Work and time use by gender: a new clustering of European welfare systems. Fem Econ 2011; 17:125-57.^,33. Agénor P-R, Canuto O. Gender equality and economic growth in Brazil: a long-run analysis. J Macroecon 2015; 43:155-72.^,44. Hirata H. Mudanças e permanências nas desigualdades de gênero: divisão sexual do trabalho numa perspectiva comparativa. Friedrich-Ebert-Stiftung 2015; (7):4-9.^,55. Heise L, Greene ME, Opper N, Stavropoulou M, Harper C, Nascimento M, et al. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet 2019; 3393:2440-54.^,66. Sorj B, Fraga A. Leave policies and social inequality in Brazil. Int J Sociol Soc Policy 2020; 40:515-26.. In fact, time-use studies in 29 European countries showed that unpaid domestic work is “at the core of gender inequality”, even in countries with strong social support systems ²2. Gálvez-Muñoz L, Rodríguez-Modroño P, Domínguez-Serrano M. Work and time use by gender: a new clustering of European welfare systems. Fem Econ 2011; 17:125-57.. In Brazil, challenges of reconciling work and family domains are aggravated because of the country’s high gender inequality and incipient public social policies aimed to reduce conflicts between work and family, especially for women in lower-wage jobs ³3. Agénor P-R, Canuto O. Gender equality and economic growth in Brazil: a long-run analysis. J Macroecon 2015; 43:155-72.^,44. Hirata H. Mudanças e permanências nas desigualdades de gênero: divisão sexual do trabalho numa perspectiva comparativa. Friedrich-Ebert-Stiftung 2015; (7):4-9.^,55. Heise L, Greene ME, Opper N, Stavropoulou M, Harper C, Nascimento M, et al. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet 2019; 3393:2440-54.^,66. Sorj B, Fraga A. Leave policies and social inequality in Brazil. Int J Sociol Soc Policy 2020; 40:515-26.^,77. Mulheres dedicam mais horas aos afazeres domésticos e cuidado de pessoas, mesmo em situações ocupacionais iguais a dos homens. Agência IBGE Notícias 2019; 26 apr. https://agenciadenoticias.ibge.gov.br/agencia-sala-de-imprensa/2013-agencia-de-noticias/releases/24266-mulheres-dedicam-mais-horas-aos-afazeres-domesticos-e-cuidado-de-pessoas-mesmo-em-situacoes-ocupacionais-iguais-a-dos-homens.
https://agenciadenoticias.ibge.gov.br/ag... .

Difficulties in the work-family interface are also caused by drastic changes in several occupations, including increased workload and the feeling that free time is decreasing ⁸8. Jabs J, Devine CM. Time scarcity and food choices: an overview. Appetite 2006; 47:196-204.^,99. Roberts K. Work-life balance - the sources of the contemporary problem and the probable outcomes. A review and interpretation of the evidence. Employee Relations 2007; 29:334-51.. Advanced information and communication technologies mean that people can work anytime, anywhere, allowing them to work outside regular office hours more often. The expansion of work beyond traditional spaces and schedules hinders maintaining boundaries between professional and family life ⁹9. Roberts K. Work-life balance - the sources of the contemporary problem and the probable outcomes. A review and interpretation of the evidence. Employee Relations 2007; 29:334-51..

This article addresses two aspects of the work-family interface related to health and well-being: work-family conflict and lack of time due to professional and domestic demands. Work-family conflict is defined as “a form of inter-role conflict in which the role pressures from the work and family domains are mutually incompatible in some respect” ¹⁰10. Greenhaus JH, Beutell NJ. Sources of conflict between work and family roles. Acad Manage Rev 1985; 10:76-88. (p. 77). Its resulting conflicts can affect two directions: work-to-family conflicts caused by interferences of work demands in family life; family-to-work conflicts caused by interferences of family demands in work performance ¹⁰10. Greenhaus JH, Beutell NJ. Sources of conflict between work and family roles. Acad Manage Rev 1985; 10:76-88.^,1111. Frone MR, Russell M, Cooper ML. Antecedents and outcomes of work-family conflict: testing a model of the work-family interface. J Appl Psychol 1992; 77:65-78.. Several studies have reported associations between work-family conflict and physical ¹²12. Borgmann LS, Rattay P, Lampert T. Health-related consequences of work-family conflict from a European perspective: results of a scoping review. Front Public Health 2019; 9:189.^,1313. Versey HS, Tan M. Work-family spillover and metabolic syndrome indicators: findings from a national sample. J Health Psychol 2020; 25:1771-83. and psychological consequences ¹1. Bilodeau J, Marchand A, Demers A. Work, family, work-family conflict and psychological distress: a revisited look at the gendered vulnerability pathways. Stress Health 2020; 36:75-87.^,1414. Carvalho VS, Chambel MJ, Neto M, Lopes S. Does work-family conflict mediate the associations of job characteristics with employees' mental health among men and women? Front Psychol 2018; 13:966. Work-family conflict has also been associated with factors that contribute to weight gain, including unhealthy eating habits ¹⁵15. Shukri M, Jones F, Conner M. Relationship between work-family conflict and unhealthy eating: does eating style matter? Appetite 2018: 123:225-32.^,1616. Rocco PTP, Bensenor IM, Griep RH, Barreto SM, Moreno AB, Alencar AP, et al. Work-family conflict and ideal cardiovascular health score in the ELSA-Brasil baseline assessment. J Am Heart Assoc 2019; 15:e012701. and lower levels of physical activity ¹⁶16. Rocco PTP, Bensenor IM, Griep RH, Barreto SM, Moreno AB, Alencar AP, et al. Work-family conflict and ideal cardiovascular health score in the ELSA-Brasil baseline assessment. J Am Heart Assoc 2019; 15:e012701.^,1717. Allen T, Armstrong J. Further examination of the link between work-family conflict and physical health: the role of the health-related behaviors. Am Behav Scientist 2006; 49:1204-21.^,1818. Roos E, Sarlio-Lähteenkorva S, Lallukka T, Lahelma E. Associations of work-family conflicts with food habits and physical activity. Public Health Nutr 2007; 10:222-9.^,1919. Lee B, Lawson KM, Chang PJ, Neuendorf C, Dmitrieva NO, Almeida DM. Leisure-time physical activity moderates the longitudinal associations between work-family spillover and physical health. J Leis Res 2015; 47:4680..

Time scarcity, also referred to as “lack of time”, is described as people’s perception of having insufficient time to complete necessary tasks ²⁰20. Godbey G, Lifset R, Robinson JP. No time to waste: an exploration of time use, attitudes toward time, and the generation of municipal solid waste. Social Research 1998; 65:101-40.. It is associated with unhealthy behaviors, including consumption of ultra-processed foods ²¹21. Djupegot IL, Nenseth CB, Bere E, Bjørnarå HBT, Helland SH, Øverby NC, et al. The association between time scarcity, sociodemographic correlates and consumption of ultra-processed foods among parents in Norway: a cross-sectional study. BMC Public Health 2017; 17:447., unhealthy food choices ⁸8. Jabs J, Devine CM. Time scarcity and food choices: an overview. Appetite 2006; 47:196-204.^,2222. Venn D, Strazdins L. Your money or your time? How both types of scarcity matter to physical activity and healthy eating. Soc Sci Med 2017; 172:98-106., lack of meal planning and diet quality ²³23. Ducrot P, Méjean C, Aroumougame V, Ibanez G, Allès B, Kesse-Guyot E, et al. Meal planning is associated with food variety, diet quality and body weight status in a large sample of French adults. Int J Behav Nutr Phys Act 2017; 14:12., and reduced physical activity ²²22. Venn D, Strazdins L. Your money or your time? How both types of scarcity matter to physical activity and healthy eating. Soc Sci Med 2017; 172:98-106.. Venn & Strazdins ²²22. Venn D, Strazdins L. Your money or your time? How both types of scarcity matter to physical activity and healthy eating. Soc Sci Med 2017; 172:98-106. analyzed the relationship between time (or the lack of it) and health, defining time as a finite resource for health since we need time to exercise, work, care, consume, and to build close relationships. The authors also suggested that time scarcity is socially patterned and, thus, a potential mechanism for generating health inequalities.

Difficulties in reconciling professional and domestic demands can trigger stress, and exposure to chronic psychological stressors might cause weight gain during adulthood ²⁴24. Park S, Sung E. You gotta have something to chew on': perceptions of stress-induced eating and weight gain among office workers in South Korea. Public Health Nutr 2021; 24:499-511.. Some studies have analyzed body mass index (BMI) and other variables related to weight gain regarding the life cycle (partnership, parenthood) ¹³13. Versey HS, Tan M. Work-family spillover and metabolic syndrome indicators: findings from a national sample. J Health Psychol 2020; 25:1771-83.^,2525. McMunn A, Lacey RE, Kumari M, Worts D, McDonough P, Sacker A. Work-family life courses and metabolic markers in mid-life: evidence from the British National Child Development Study. J Epidemiol Community Health 2016; 70:481-7.^,2626. Lacey RE, Sacker A, Bell S, Kumari M, Worts D, McDonough P, et al. Work-family life courses and BMI trajectories in three British birth cohorts. Int J Obes (Lond) 2017; 41:332-9.; however, we found no studies on work-family conflict or lack of time related to weight gain. Similarly, studies have associated time scarcity with unhealthy food choices ⁸8. Jabs J, Devine CM. Time scarcity and food choices: an overview. Appetite 2006; 47:196-204.^,2121. Djupegot IL, Nenseth CB, Bere E, Bjørnarå HBT, Helland SH, Øverby NC, et al. The association between time scarcity, sociodemographic correlates and consumption of ultra-processed foods among parents in Norway: a cross-sectional study. BMC Public Health 2017; 17:447.^,2727. Celnik D, Gillespie L, Lean MEJ. Time-scarcity, ready-meals, ill-health and the obesity epidemic. Trends Food Sci Technol 2012; 27:4-11., but not directly with weight gain.

Most studies on the relationship between health and work-family conflict or time scarcity have been conducted in Western Europe and North America. Because work and non-work are no longer separate domains in several occupations, simultaneously affecting time dedicated to self-care and leisure, the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) was a pioneer in combining work-family conflict with lack of time for leisure and self-care. Previous cross-sectional results from ELSA-Brasil showed that time scarcity was associated with overweight and obesity among women who worked over 40 hours per week ²⁸28. Pinto KA, Griep RH, Rotenberg L, Almeida MCCA, Barreto RS, Aquino EML. Gender, time use and overweight and obesity in adults: results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). PLoS One 2018; 13:e194190. and lower lifestyle ideal cardiovascular health scores among men and women. Both work-to-family and family-to-work conflicts were also associated with lower lifestyle ideal cardiovascular health scores among women ¹⁶16. Rocco PTP, Bensenor IM, Griep RH, Barreto SM, Moreno AB, Alencar AP, et al. Work-family conflict and ideal cardiovascular health score in the ELSA-Brasil baseline assessment. J Am Heart Assoc 2019; 15:e012701..

Understanding the various causes for weight gain among workers is essential to the national public health agenda. This study therefore aimed to analyze the effect of work-to-family conflict, family-to-work conflict, and lack of time for self-care and leisure due to professional and domestic demands on the incidence of weight gain and increase in waist circumference by gender in the ELSA-Brasil cohort.

Methods

Study design and population

The study sample consisted of participants of ELSA-Brasil, a multicenter prospective cohort study ²⁹29. Schmidt MI, Duncan BB, Mill JG, Lotufo PA, Chor D, Barreto SM, et al. Cohort profile: Longitudinal Study of Adult Health (ELSA-Brasil). Int J Epidemiol 2015; 44:68-75.. The ELSA-Brasil participants at baseline (2008-2010) included 15,105 active or retired civil servants (aged 35-74 years) from five universities and one research institute from six Brazilian state capitals [Salvador (Bahia State), Belo Horizonte (Minas Gerais State), Rio de Janeiro, São Paulo, Vitória (Espírito Santo State), and Porto Alegre (Rio Grande do Sul State)] ²⁹29. Schmidt MI, Duncan BB, Mill JG, Lotufo PA, Chor D, Barreto SM, et al. Cohort profile: Longitudinal Study of Adult Health (ELSA-Brasil). Int J Epidemiol 2015; 44:68-75.. These participants were invited to a follow-up visit (2012-2014) after a mean of 3.9 years (standard deviation - SD = 0.4 years), which 14,014 attended. After excluding retired participants (n = 3,885), participants who received bariatric surgery (n = 267), and those with missing data on any of the included variables (n = 703), our analytical sample included 9,159 participants (4,413 men and 4,746 women) who attended both baseline and the follow-up visit (Figure 1). The final sample had similar numbers to the eligible population: women (51.8% vs. 51.3%), < 55 years old (80.9% vs. 80.6%), with a university degree (55.1% vs. 54.6%).

The research protocol was approved by the Ethics Research Committee of each participating institution and by the Brazilian National Ethics Research Committee: Federal University of Minas Gerais (UFMG: 186/06); University of São Paulo (USP: 669/06); Federal University of Rio Grande do Sul (UFRGS: 194/06); Federal University of Espírito Santo (UFES: 041/06); Federal University of Bahia (UFBA: 027/06) and Oswaldo Cruz Foundation (Fiocruz: 343/06). All participants signed an Informed Consent Form.

Baseline and follow-up measurements

In both baseline and follow-up measurements, standardized protocol were used to collect data during in-person visits by standardized, certified teams to the study sites ³⁰30. Schmidt MI, Griep RH, Passos VM, Luft VC, Goulart AC, Menezes GMS, et al. Estratégias e desenvolvimento de garantia e controle de qualidade no ELSA-Brasil. Rev Saúde Pública 2013; 47 Suppl 2:105-12..

Outcome: annual gains in weight and waist circumference

At both visits (baseline and follow-up), body weight was measured (in kg) using an electronic scale whereas waist circumference was measured (in cm) at the midpoint between the lowest rib margin and the iliac crest using an inelastic anthropometric tape. Measurements were taken after overnight fasting following a standardized protocol ²⁹29. Schmidt MI, Duncan BB, Mill JG, Lotufo PA, Chor D, Barreto SM, et al. Cohort profile: Longitudinal Study of Adult Health (ELSA-Brasil). Int J Epidemiol 2015; 44:68-75.^,3030. Schmidt MI, Griep RH, Passos VM, Luft VC, Goulart AC, Menezes GMS, et al. Estratégias e desenvolvimento de garantia e controle de qualidade no ELSA-Brasil. Rev Saúde Pública 2013; 47 Suppl 2:105-12.. Annual gains in weight and increase in waist circumference were calculated as the difference in baseline and follow-up measurements divided by the time elapsed in years. Weight gain and increase in waist circumference were then defined as an annual gain ≥ 75th percentile, i.e., ≥ 1.21kg/year and ≥ 1.75cm/year respectively in women and ≥ 0.96kg/year and ≥ 1.41cm/year respectively in men.

Exposure: work-family conflict

Work-family conflict at baseline was based on three items from a four-item questionnaire created by Frone et al. ¹¹11. Frone MR, Russell M, Cooper ML. Antecedents and outcomes of work-family conflict: testing a model of the work-family interface. J Appl Psychol 1992; 77:65-78.: (i) time-based work-to-family conflict (demands from work keep you from spending enough time with your family), (ii) strain-based work-to-family conflict (work demands hinder fulfilling domestic responsibilities), and (iii) family-to-work conflict (family demands affect work responsibilities). An additional item was also included, considering the effect of both domains (work and family) on leisure time and self-care: lack of time for leisure and self-care (family and work demands keep you from spending enough time under your own care and on leisure activities) ²⁸28. Pinto KA, Griep RH, Rotenberg L, Almeida MCCA, Barreto RS, Aquino EML. Gender, time use and overweight and obesity in adults: results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). PLoS One 2018; 13:e194190.^,3131. Pinto KA, Menezes GM, Griep RH, Lima KT, Santos TR, Almeida MC, et al. Work-family conflict and time use: psychometric assessment of an instrument in ELSA-Brazil. Rev Saúde Pública 2016; 50:39.. Response options for all four items (never to almost never, rarely, sometimes, frequently, and very frequently) were categorized as never to rarely (reference category), sometimes, and frequently. The psychometric properties of the Brazilian version of these four items have been shown previously ³¹31. Pinto KA, Menezes GM, Griep RH, Lima KT, Santos TR, Almeida MC, et al. Work-family conflict and time use: psychometric assessment of an instrument in ELSA-Brazil. Rev Saúde Pública 2016; 50:39..

Covariates

Covariates collected at baseline were: sex, age (continuous and categorized as < 45 years or ≥ 45 years), schooling level (secondary education or lower, tertiary education), self-reported skin color/race (black, brown, white, of Asian-descendant, Indigenous), marital status (married/cohabiting, not married/not cohabiting), takes care of a sick person or a person with disability (yes, no), has children aged 5 years or younger (yes, no), hired a full-time domestic worker (yes, no), number of work hours per week (≤ 40, > 40), and per capita income (USD; < 466.8, 466.8-933.5, ≥ 933.6).

Statistical analyses

Descriptive analyses were performed to characterize the study population. Categorical variables are presented as absolute and relative frequencies whereas continuous variables are described by means and SD. Chi-square tests were performed. Crude and adjusted associations between work-family conflict and weight gain and increase in waist circumference were estimated by Poisson regression applying robust variance with R software version 3.5.1 (http://www.r-project.org). Analyses were adjusted for age, schooling level, and self-reported skin color/race and stratified by gender.

Results

Mean age of the analytical sample at baseline was 47.9 (SD = 6.6) for women and 48.4 (SD = 6.9) years for men. Most participants had complete secondary or tertiary education , self-reported as white, and were married/cohabiting. Around 10% of participants had children aged 5 years or younger, and a quarter of all participants hired a full-time domestic worker. More men (39.5%) than women (29.4%) worked over 40 hours per week. About 33.2% women and 26.8% men reported frequent time-based work-to-family conflict; 25.8% women and 16.4% men reported frequent strain-based work-to-family conflict; 6.6% women and 7.3% men reported frequent family-to-work conflict; and 35.4% women and 24.9% men reported frequent lack of time for self-care (Table 1).

Weight gain and increase in waist circumference were prevalent among the youngest participants, participants with a high school degree or lower schooling level, and unmarried/cohabiting men. Women with a full-time domestic worker showed lower weight gain and men with a full-time domestic worker showed lower increase in waist circumference. Finally, women who reported family-to-work conflict had higher weight gain and men who reported strain-based work-to-family conflict had higher weight gain and increase in waist circumference (Table 1).

Among women, adjusted models showed that family-to-work conflict reported as “sometimes” and “frequently” were associated with a higher risk of weight gain (relative risk - RR = 1.12; 95% confidence interval - 95%CI: 1.00-1.25 and RR = 1.37; 95%CI: 1.16-1.62, respectively). Lack of time for self-care and leisure reported as “sometimes” and “frequently” was also associated with weight gain, but with no gradient, dose-response relationship (RR = 1.15; 95%CI: 1.02-1.31 and RR = 1.13; 95%CI: 1.10-1.28, respectively) (Table 2). Among men, frequent time-based and strain-based work-to-family conflict was associated with a higher incidence of weight gain (RR = 1.17; 95%CI: 1.03-1.32 and RR = 1.24; 95%CI: 1.09-1.41, respectively). No associations between work-family conflict and increase in waist circumference were observed among participants, except among women who reported “sometimes” time-based work-to-family conflict (RR = 1.13; 95%CI: 1.01-1.28) (Table 3).

Discussion

This large multicenter study brought new insights about work-family conflict and lack of time for self-care and leisure and their association with weight gain, showing different trends for men and women. Among men, only work-to-family conflict affected weight gain. Among women, family-to-work conflict affected weight gain and lack of time for self-care and leisure.

The direction of the conflict (work-to-family or family-to-work) and its effects are seemingly influenced by the cultural roles attributed to men and women. Thus, although our sample includes professional men and women workers, the different conflict directions reflect traditional gender roles, in which women are responsible for the home and family while men are responsible for providing financial support ⁴4. Hirata H. Mudanças e permanências nas desigualdades de gênero: divisão sexual do trabalho numa perspectiva comparativa. Friedrich-Ebert-Stiftung 2015; (7):4-9.. The culture of ideal work, which usually divides work and family problems, can be particularly challenging for women, who still perceive themselves as the main responsible for the family’s well-being. Some women could thus feel a widening gap between their work and family or feel guilty about neglecting work ³²32. Korabik K. The intersection of gender and work-family guilt. In: Mills M, editor. Gender and the work-family experience: an intersection of two domains. Cham: Springer; 2015. p. 141-57.. Offer ³³33. Offer S. The costs of thinking about work and family: mental labor, work-family spillover, and gender inequality among parents in dualearner families. Sociol Forum (Randolph N J) 2014; 29:916-36. found that while men thought about labor-related matters more often than women, their concerns did not result in unpaid labor, whereas women’s labor-related thoughts tended to involve unpaid labor and leisure activities. According to the author ³³33. Offer S. The costs of thinking about work and family: mental labor, work-family spillover, and gender inequality among parents in dualearner families. Sociol Forum (Randolph N J) 2014; 29:916-36., both women and men think about family-related concerns at work, but these thoughts are more harmful to women’s health. Moreover, distress from family-to-work conflicts was seemingly prevalent among women, whereas long working hours, conflict at work, and low career perspectives ¹1. Bilodeau J, Marchand A, Demers A. Work, family, work-family conflict and psychological distress: a revisited look at the gendered vulnerability pathways. Stress Health 2020; 36:75-87. especially affected men. Some authors ¹⁵15. Shukri M, Jones F, Conner M. Relationship between work-family conflict and unhealthy eating: does eating style matter? Appetite 2018: 123:225-32. have supposed that family-to-work issues could be more stressful than work-to-family ones, leading to unhealthier food choices, especially in circumstances of greater emotional engagement (for example, while taking care of family members). Previous cross-sectional results from ELSA-Brasil found that family interference was associated with work, physical activity, and lifestyle ideal cardiovascular health score (including diet, physical activity, smoking, and BMI) only among women ¹⁶16. Rocco PTP, Bensenor IM, Griep RH, Barreto SM, Moreno AB, Alencar AP, et al. Work-family conflict and ideal cardiovascular health score in the ELSA-Brasil baseline assessment. J Am Heart Assoc 2019; 15:e012701., which could explain part of the observed effects of family-to-work conflict on weight gain.

We observed gender differences in the effect of lack of time for self-care and leisure on weight gain, similarly to a previous cross-sectional ELSA-Brasil investigation, in which both overweight and obesity were associated with such lack of time but only among women who worked over 40 hours per week ³¹31. Pinto KA, Menezes GM, Griep RH, Lima KT, Santos TR, Almeida MC, et al. Work-family conflict and time use: psychometric assessment of an instrument in ELSA-Brazil. Rev Saúde Pública 2016; 50:39.. Together, these results indicate gender differences in the relationship between time scarcity and weight-related variables, which require more public attention. Gender differences in lack of time for self-care and leisure can be analyzed from the number of hours spent on professional and domestic tasks (total working hours). Although our study sample had no information on total working hours, recent Brazilian statistics suggest that women have higher total working hours ³⁴34. Bandeira LM, Preturlan RB. As pesquisas sobre uso do tempo e a promoção da igualdade de gênero no Brasil. In: Fontoura N, Araújo C, editors. Uso do tempo e gênero. Rio de Janeiro: Universidade do Estado do Rio de Janeiro; 2016. p. 43-61., thus leaving less time for self-care and leisure. On the other hand, a simple analysis of work duration does not consider the complexity involved in organizing this work each day. Chatzitheochari & Arber ³⁵35. Chatzitheochari S, Arber S. Class, gender and time poverty: a time-use analysis of British workers' free time resources. Br J Sociol 2012; 63:451-71. proposed an innovative complementary approach to time-use studies, showing subtle aspects of time perception that could help interpret our results. The authors analyzed the quality of free time (daily time not occupied by professional work and self-care) based on its fragmentation, that is, the number of interruptions ³⁵35. Chatzitheochari S, Arber S. Class, gender and time poverty: a time-use analysis of British workers' free time resources. Br J Sociol 2012; 63:451-71.. They observed that women had greater fragmentation of time since their free time often coincided with domestic chores (i.e., two activities at the same time), which happened much less among men. For the authors ³⁵35. Chatzitheochari S, Arber S. Class, gender and time poverty: a time-use analysis of British workers' free time resources. Br J Sociol 2012; 63:451-71., dealing with various constraints during free time is another obstacle to women’s leisure. These results, which affect the “free” character of time, corroborate Pereira et al. ³⁶36. Pereira AV, Oliveira SS, Rotenberg L. The self-confrontation with own time as an analytical perspective in the study of relations between time and health. Ciênc Saúde Colet 2018; 23:2393-401. regarding too much time for the others linked to too little time for oneself.

Regarding care activities, compared to men, many women participants of ELSA-Brasil were single, widowed, or divorced; they more often cared for a sick person or a person with a disability; and many also reported having children aged 5 years and younger. Therefore, many single women participants in our study could be raising children and caring for older adults. Women who were responsible for working and being the primary caregiver reported intensified time pressure and were more likely to complain about insufficient time for themselves than other women. This context and the aging of the population affirm the importance of thinking about a new division of care work in which both women and men are responsible for care for dependent people ³⁷37. Hirata H. O trabalho de cuidado: comparando Brasil, França e Japão. Sur, Rev Int Direitos Human 2016; 13:53-64.. Women are also traditionally more responsible for family commitments such as food preparation and household chores, which can affect their available time for leisure and physical activity ³3. Agénor P-R, Canuto O. Gender equality and economic growth in Brazil: a long-run analysis. J Macroecon 2015; 43:155-72.. Perceptions of time scarcity caused by these commitments could also increase consumption of convenience foods, ready meals, and fast food ⁸8. Jabs J, Devine CM. Time scarcity and food choices: an overview. Appetite 2006; 47:196-204.. These results emphasize the unequal experience of men and women regarding lack of time and its possible association with rising levels of obesity ³⁸38. Banwell C, Hinde S, Dixon J, Sibthorpe B. Reflections on expert consensus: a case study of the social trends contributing to obesity. Eur J Public Health 2005; 15:564-8..

According to the literature, causes for the effect of time scarcity on weight gain in women may involve both the type of diet and physical activity. In dual-earner families, household tasks are shortly completed in the early evening, favoring the replacement of traditional family meals with more convenient options ²⁷27. Celnik D, Gillespie L, Lean MEJ. Time-scarcity, ready-meals, ill-health and the obesity epidemic. Trends Food Sci Technol 2012; 27:4-11.. Some studies have attributed the feeling of time scarcity to the increased prevalence of employed parents. Moreover, employed mothers often complain of a general lack of time, which can influence their food choices ⁸8. Jabs J, Devine CM. Time scarcity and food choices: an overview. Appetite 2006; 47:196-204.^,2121. Djupegot IL, Nenseth CB, Bere E, Bjørnarå HBT, Helland SH, Øverby NC, et al. The association between time scarcity, sociodemographic correlates and consumption of ultra-processed foods among parents in Norway: a cross-sectional study. BMC Public Health 2017; 17:447.. In fact, several conceptual models recognize the availability of time as essential regarding food choice, especially time for food preparation and home cooking ³⁸38. Banwell C, Hinde S, Dixon J, Sibthorpe B. Reflections on expert consensus: a case study of the social trends contributing to obesity. Eur J Public Health 2005; 15:564-8.^,3939. Chen P-J, Antonelli M. Conceptual models of food choice: influential factors related to foods, individual differences, and society. Foods 2020; 9:1898.^,4040. Sullivan O. Changing gender practices within the household. A theoretical perspective. Gend Soc 2004; 18:207-22., whereas time scarcity favors physical inactivity ²²22. Venn D, Strazdins L. Your money or your time? How both types of scarcity matter to physical activity and healthy eating. Soc Sci Med 2017; 172:98-106..

The question used to analyze lack of time in this study mentions “lack of time for self-care and leisure due to professional and domestic demands”. Thus, since self-care and leisure are knowingly related to health, an association between lack of time and health outcomes is expected. Moreover, this question limits the possibility of direct comparisons with other Brazilian and international studies which are based on questions directly linked to the perception of time per se, such as: “How often do you feel rushed and pressed for time?” ²²22. Venn D, Strazdins L. Your money or your time? How both types of scarcity matter to physical activity and healthy eating. Soc Sci Med 2017; 172:98-106. (p. 3). These do not specify lack of time for what or because of what. Though the unavailable comparability can be a limitation, it is also a strength since our specific question allows for analyzing perceived lack of time due to both professional and domestic demands while considering time for self-care and leisure. Our study also has other important strengths. This is the first large, contemporary cohort study with small losses to follow-up to investigate how work-to-family conflict, family-to-work conflict, and the influence of both types of conflict on lack of time for self-care and leisure affect the incidence of weight gain in a large Brazilian sample by gender. Studies on the possible influence of these factors on weight gain are still incipient, especially in less-developed countries. Furthermore, we performed highly standardized measurements, including waist circumference, with strict quality control.

However, this study has limitations. Firstly, the work-family conflict indicators used might only partly represent the whole work-life conflict model since isolated items were used to measure complex dimensions of a higher construct. Secondly, since civil servants are a specific population, our results might only reflect the middle-class, employed individuals, or civil servants who live in the largest cities of Brazil. Moreover, since our sample population is aged over 35 years, our data might not represent possible gender differences in the younger generations. Finally, our outcome was assessed over a relatively short time (four years), which could explain the predominant lack of association between measures of work-family conflict and changes in waist circumference.

Overall, the asymmetric relationships between men and women in professional and domestic domains result in differences in the direction of the work-family conflict, in the lack of time for self-care and leisure, and their effects on weight gain. Such asymmetry reflects the socially-produced gender system, which creates expectations of what it means to be a man and to be a woman, causing pervasive health inequalities between the genders ⁵5. Heise L, Greene ME, Opper N, Stavropoulou M, Harper C, Nascimento M, et al. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet 2019; 3393:2440-54.. Women, for example, see themselves as responsible for managing their home and family ³⁴34. Bandeira LM, Preturlan RB. As pesquisas sobre uso do tempo e a promoção da igualdade de gênero no Brasil. In: Fontoura N, Araújo C, editors. Uso do tempo e gênero. Rio de Janeiro: Universidade do Estado do Rio de Janeiro; 2016. p. 43-61.. Thus, gender is not caused by a dichotomy based on sex, but by a complex system that structures the lives of human beings through the process of socialization ⁵5. Heise L, Greene ME, Opper N, Stavropoulou M, Harper C, Nascimento M, et al. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet 2019; 3393:2440-54., a process that should be (re)built in daily negotiations ⁴⁰40. Sullivan O. Changing gender practices within the household. A theoretical perspective. Gend Soc 2004; 18:207-22..

To conclude, balancing work and family domains has become a challenge for many contemporary workers. This study results suggest that occupational and social health promotion programs are essential to help workers balance work and family life to reduce weight gain. In countries with high social and gender inequalities, future research should consider the influence of social determinants on health and the effect of work-family conflict on lifestyle (e.g., diet, physical activity, and stress) and weight gain among women and men to better understand their association. Ultimately, closing gender gaps in labor market will benefit both women and men and their households and also the global economy.

Acknowledgments

The authors thank the staff and participants of the ELSA-Brasil for their significant contributions. ELSA-Brasil baseline study and the four-year follow-up were supported by the Brazilian Ministry of Health (Science and Technology Department) and the Brazilian Ministry of Science and Technology (Financier of Studies and Projects and Brazilian National Research Council - CNPq); grants of baseline: 01 06 0010.00 (Rio Grande do Sul State), 01 06 0212.00 (Bahia State), 01 06 0300.00 (Espírito Santo State), 01 06 0278.00 (Minas Gerais State), 01 06 0115.00 (São Paulo State), 01 06 0071.00 (Rio de Janeiro State); grants of four-year follow-up: 01 10 0643-03 (Rio Grande do Sul State), 01 10 0742-00 (Bahia State), 01 12 0284-00 (Espírito Santo State), 01 10 0746-00 (Minas Gerais State), 01 10 0773-00 (São Paulo State), 01 11 0093-01 (Rio de Janeiro State). This study was partly supported by the Rio de Janeiro State Carlos Chagas Filho Research Foundation (FAPERJ). R. H. Griep, D. Chor, M. J. M. Fonseca, and L. Rotenberg are fellow of the CNPq. This article is part of the Joint Brazilian-Swedish Research Collaboration Social determinants of health and aging: occupational and contextual factors in Sweden and Brazil funded by the Graduate Studies Coordinating Board (CAPES; 88881.155651/2017-0) and STINT (BRA2017-7135). A. S. Cardoso was supported by CAPES (Post-doctoral scholarship: 88887.463964/2019-00).

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