Acta Med. Nagasaki 61: 105−110−

MS#AMN 07210

Type A Behavior Pattern and Obesity in Japanese Workers: A Cross-Sectional
Study
Sayaka Ogawa1, 2, Jun Tayama2, 3, Tatsuo Saigo1, 2, Atsushi Takeoka2, Masaki Hayashida1, 2, Hironori Yamasaki  4,
Yuji Shimizu  5, Susumu Shirabe1, 21Unit of Preventive Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan

2

Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan

3

Graduate School of Education, Nagasaki University, Nagasaki, Japan

4

Department of Endocrinology, Diabetes and Metabolism, Sasebo City General Hospital, Sasebo, Japan

5

Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan

Obesity is associated with personality. The Type A behavior pattern (TABP), which is characterized by hostility and competitive
behavior, is related to psychological stress. However, the relationship between obesity and the TABP has not been examined.
This study aimed to examine the relationship between obesity and the Type A behavior pattern in 3,099 Japanese workers.
The Type A behavior pattern was measured via the Maeda Type A Behavior Checklist. Data were analyzed using multivariate
logistic regression adjusted for age, being current smokers, heavy drinker, lack of exercise, occupation, and rapid eating. The
multivariate odds ratio (95% confidence interval) for obesity associated with TABP was 1.55 (1.13 to 2.13) in men. Regarding
other variables, age, lack of exercise, and rapid eating were associated with obesity in men. The multivariate odds ratio (95%
confidence interval) for obesity associated with TABP was 1.27 (0.81 to 2.02) in women. Regarding other variables, age andrapid eating were associated with obesity in women. The findings suggest that the Type A behavior pattern was associatedwith increased obesity prevalence in Japanese men. People with TABP tend to eat larger portions during mealtimes repeatedly
by rapid eating; it is possible that eating large portions may lead to an increase weight in men with TABP.
ACTA MEDICA NAGASAKIENSIA 61: 105−110, 2018
Key words: obesity, Type A behavior pattern, eating behavior, psychological stress

Introduction
Obesity has recently become a serious, global medical andsocial issue. Because of the health-related damage caused byobesity, there is a need for psychosomatic treatment in generalinternal medicine. Obesity is a major cause of lifestyle-relateddiseases, such as diabetes, dyslipidemia, and hypertension,and it has been found to lead to heart diseases and stroke.1-2
The Japan Society of the Study of Obesity deﬁned a bodymass index (BMI) ≥25kg/m2 as a criterion for obesity, whichis considered to be excessive accumulation of adipose tissue.3

Psychosocial factors, which includes eating behavioral
abnormalities and personality, is considered to be one of thecauses of obesity. Previous studies have reported that obesity
is associated with personality.4-5 Shim et al. examined theassociation between BMI and personality in Korean men
and women; the results showed that obese men exhibited
higher scores on openness to experience and lower scores on
conscientiousness, while obese women exhibited higherscores on agreeableness and lower scores on neuroticism
and openness to experience, relative to their counterparts ofnormal weight.4 Kakizaki et al. examined the association

Address correspondence: Jun TAYAMA, PhD
Graduate School of Education, Nagasaki University, Nagasaki-shi, Bunkyou 1-14, Nagasaki 852-8521, Japan.
Tel.: +81-95-819-2397, Fax: +81-95-819-2397, Email: jtayama@nagasaki-u.ac.jp
Received August 7, 2017; Accepted November 2, 2017

106

between obesity and personality in Japanese people aged
40–60 years.5 The results that showed extraversion andpsychoticism were signiﬁcantly and positively associatedwith being overweight in both men and women.5
A previous study reported that people with the Type A
behavior pattern (TABP) have high stress.6 The TABP has
been associated with drive, competitive behavior, hostility,
time urgency, self-conﬁdence, nervousness, scrupulosity,and aggression.7 According to a meta-analysis, the relationships between TABP characteristics including hostility as apersonality trait promoted metabolic syndrome;8 therefore,
the hostility component of the TABP is related to metabolic
syndrome. Furthermore, hostility is associated with lifestyle
traits such as sedentary behavior, smoking, and drinking.9
These behaviors increase the risk for the metabolic syndrome.10
In a survey of Japanese people living in Hawaii, the TABP
was associated with BMI in men.11 However, no studies haveexamined the association between the TABP and obesity inJapanese workers.
We conducted a cross-sectional study that aimed to examine
the relationship between obesity and the TABP in Japanese
workers. We hypothesized that the TABP would be associated with increased obesity prevalence among Japanese
workers.

Materials and methods
Participants and procedure
This cross-sectional study was conducted between Augustand September 2009. Employees of Nagasaki university
who underwent a comprehensive health check-up wereenrolled. In total, 3,099 potential participants were assessed
for eligibility during periodical health examinations. Of
these, 140 individuals with missing data were excluded. We
therefore analyzed data from 2,959 participants (1,437 men,
1,522 women). The study was approved by the ethics committee of Nagasaki University (No. 12053007). All participants provided written informed consent to participate in the
study. The dataset was anonymized appropriately prior to theinitiation of the statistical analysis.
Measurements
Height and weight were measured by a nurse at a healthcheckup venue using height and weight measurement scales.
Obesity was deﬁned according to the deﬁnition provided by
The Japan Society of the Study of Obesity, wherein individuals
with a BMI ≥25 kg/m2 are considered obese.3

Jun Tayama et al.: Type A Behavior Pattern and Obesity

Questionnaires
Demographic variables. The questionnaire cover sheet
contained items pertaining to participantsʼ demographic
characteristics (i.e., age, sex, and occupation). Occupation
was classiﬁed into three categories: (a) engineer, researcher,or teacher; (b) clerical staff; and (c) other. Those whose
occupation was experimental assistant staff, clerical assistantstaff, or service industry staff selected (c) “other”.
The TABP. The TABP was measured using the Maeda
Type A Behavior Checklist,12 which comprises 12 items(Table 1). The total score on this measurement tool was
positively correlated with the Type A scale score on the
Jenkins Activity Survey (r = 0.72).12 Furthermore, Kojima et
al. reported the scaleʼs Cronbachʼs α to be 0.80, demonstrating
good internal consistency.13 For items 5, 6, and 9, responsesof “always,” “often,” and “never” were given four, two, andzero points, respectively. For the remaining items, responsesof “always,” “often,” and “never” were given two, one, andzero points, respectively. The cutoff point was 17.
Lifestyle habits (drinking, smoking, and exercise habits). Participants were asked if they consume alcohol (every
day, sometimes, hardly, or never). Further, the frequency ofalcohol consumption (less than 20 g/day, 20-40 g/day, 40-60
g/day and more than 60 g/day).14 Heavy drinker was deﬁned
as ethanol intake of at least 40 g/day in men and 20 g/day inwomen.15-17 Participants were also asked if they smoke(habitually smoking/never) and if they exercise at least 30
minutes no more than twice per week (yes/no).14
Rapid eating. Participants were asked about their eating
speed (slow, normal, or fast). Those who answered "fast"
were considered to eat rapidly.14
Data Analysis
We used χ2 and t tests to examine the differences between
the obesity and non-obesity groups. The multivariate logistic
regression was performed, with the presence or absence ofobesity as the dependent variable and various psychologicaland behavioral variables as independent variables according
to sex. In addition, we calculated the odds ratio (OR) and
95% conﬁdence interval (Cl) for obesity. The analyses were
performed to examine the following factors: age (≤29, 30–
39, 40–49, 50–59, and 60–69 years), being a current smoker(yes, no), heavy drinker (yes, no), lack of exercise (yes, no),occupation (engineer, researcher, or teacher; clerical staff;
and other) and rapid eating (yes, no). Covariates included
age,18-19 smoking habits,20-21 drinking habits,22-23 exercise
habits,24-25 occupation,17, 26 and rapid eating,27-28 which were107

Jun Tayama et al.: Type A Behavior Pattern and Obesity

Table 1. Items of Maeda Type A Behavior Checklist
No

Items

1

Do you have a busy daily life?

2

Do you feel being pressed for time in your daily life?

3

Do you easily become enthusiastic over your job or other things?

4

When you are absorbed in your job, do you ﬁnd it difﬁcult to change your mind?

5

Are you a perfectionist?

6

Do you have conﬁdence in yourself?

7

Do you easily feel tense?

8

Do you easily feel irritated or angry?

9

Are you punctual with everything?

10

Are you unyielding?

11

Do you have an intense temper?

12

Do you easily become competitive about job or other things?

Note. For items 5, 6, and 9, responses of “always,” “often,” and “never” were given four, two, and zero points,
respectively. For the remaining items, responses of “always,” “often,” and “never” were given two, one, andzero points, respectively.

Table 2. Demographic characteristics of the obesity and the non-obesity group
All

Non-Obesity group

Obesity group(n = 2959)(n = 2408)(n = 551)

22.09 ± 3.48

20.83 ± 2.16

27.62 ± 2.68

< .0001

TABP score11.79 ± 5.76

11.58 ± 5.62

12.72 ± 6.23

< .0001Age (Mean ± SD)

39.11 ± 11.20

38.23 ± 11.10

42.88 ± 10.84< .0001

1437/1522

1028/1380

409/142< .0001

14.80

13.33

21.23

< .0001

6.42

6.42

6.80

0.7777

78.67

79.10

76.77

0.2316

35.69

35.51

36.48

0.6677

Clerical (%)

13.11

14.00

9.26

< .001Other (%)

51.20

50.50

54.26

0.1103

Rapid eating (%)

28.89

25.96

41.74

< .0001

Variable
BMI ab

Men/Women
Current smoker (%)
Heavy drinker (%)

c

Lack of exercise (%)

dp value

Occupation
Engineer, researcheror teacher (%)

Note. a body mass index; b Type A behavior pattern; c heavy drinking was deﬁned as ethanol intake of at least 40 g/day in men and
20 g/day in women; d exercise of at least 30 min no more than twice per week.

strongly related to obesity in the previous studies. In theunivariate and multivariate logistic regression, we deﬁned
the group that answered “no” as a reference to the items of
being a current smoker, heavy drinker, lack of exercise, andrapid eating. We set below the TABP cutoff score, under 29

years old, others in occupation as reference. All statisticalanalyses were performed using SPSS ver. 22.0 (IBM InstituteInc.), and p values of < 0.05 were considered statisticallysigniﬁcant.

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Jun Tayama et al.: Type A Behavior Pattern and Obesity

Results
1. Demographic characteristics of the obesity and the nonobesity group
Table 2 shows the demographic characteristics of the obesity and the non-obesity groups as well as the results of theχ2 and t tests, indicating differences between the groups.
The proportions of participants in the obesity group who
reported BMI ≥ 25kg/m2, TABP score, age, being current
smoker, and rapid eating were signiﬁcantly higher comparedto those observed in the non-obesity group (p < 0.0001). The
number of participants in the obesity group who reported
clerical staff as occupation was signiﬁcantly lower comparedto those observed in the non-obesity group (p < 0.001). The
number of men was higher than women in the obesity group,
while the number of men was lower than women in the nonobesity group (p < 0.001).
2. Relationship between obesity and the TABPWe examined the relationship between obesity and the
TABP by multivariate analysis adjusted for age, being a cur-Table 3. Multivariate analysis of the associations between obesity (body mass index of ≥ 25kg/m2) and demographic characteristics,
drinking and smoking habits, exercise habits, and rapid eating
Men

Women

No. of persons
with obesity/
No. ofparticipantsMultivariate OR d
(95%CI e)

No. of persons
with obesity/
No. ofparticipantsMultivariate OR d
(95%CI e)

Non-TABP

281/805

1.00 (referent)

115/1178

1.00 (referent)

TABP

128/223

1.55 (1.13-2.13)

27/202

1.27 (0.81-2.02)

Variables

TABP aAge≤ 29

38/1731.00 (referent)

30/4941.00 (referent)

30-39

120/303

1.54 (0.90-2.64)

43/4601.44 (0.88-2.36)

40-49

125/2652.01 (1.18-3.41)

35/2601.98 (1.17-3.36)

50-59

89/2092.26 (1.31-3.91)

32/1453.45 (2.00-5.94)

60-69

37/78

2.83 (1.43-5.59)

2/21

1.37 (0.30-6.32)

Current smoker
No

306/780

1.00 (referent)

128/13071.00 (referent)Yes

103/2480.97 (0.68-1.36)

14/73

1.70 (0.91-3.17)

396/983

1.00 (referent)

127/1292

1.00 (referent)

13/45

0.66 (0.34-1.28)

15/88

1.45 (0.79-2.66)

No

107/3141.00 (referent)

21/1901.00 (referent)Yes

302/714

1.59 (1.15-2.21)

121/1190

1.09 (0.66-1.80)

158/419

1.03 (0.76–1.40)

43/4360.87 (0.59–1.30)

Clerical staff

34/93

1.03 (0.60-1.77)

17/2440.56 (0.32-0.98)

Other

217/5161.00 (referent)

82/7001.00 (referent)

Heavy drinker bNo
YesLack of exercisec

Occupation
Engineer, researcher or teacher

Rapid eatingNo

229/692

1.00 (referent)

92/1091

1.00 (referent)Yes

180/336

1.66 (1.23-2.23)

50/2891.92 (1.32-2.80)

Note. a Type A behavior pattern; b heavy drinking was deﬁned as ethanol intake of at least 40 g/day in men and 20 g/day in women; c exercise of at least
30 min no more than twice per week; d odds ratio; e conﬁdence interval.

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Jun Tayama et al.: Type A Behavior Pattern and Obesity

rent smoker, heavy drinker, lack of exercise, occupation, andrapid eating. Tables 3 show the results of the multivariate
analysis of the associations between obesity (BMI of ≥ 25kg/m2) and demographic characteristics, drinking and smoking
habits, exercise habits, and eating behavior in men andwomen. The multivariate OR (95%CI) for obesity associatedwith TABP was 1.55 (1.13 to 2.13) in men. Other variables,
associated with increased risk of obesity in men were 40-49
years (OR = 2.01, 95% CI = 1.18 to 3.41), 50-59 years (OR= 2.26, 95% CI = 1.31 to 3.91), 60-69 years (OR = 2.83, 95%
CI = 1.43 to 5.59), lack of exercise (OR = 1.59, 95% CI =1.15 to 2.21), and rapid eating (OR = 1.66, 95% CI = 1.23 to2.23). The multivariate OR (95%CI) for obesity associatedwith TABP was 1.27 (0.81 to 2.02) in women. Other variables
associated with an increased risk of obesity in women were40-49 years (OR = 1.98, 95% CI = 1.17 to 3.36), 50-59 years(OR = 3.45, 95% CI = 2.00 to 5.94), and rapid eating (OR =1.92, 95% CI = 1.32 to 2.80).

Discussion
The ﬁndings suggest that the TABP could be associatedwith increased obesity prevalence, particularly among men
Japanese workers. However, the TABP was not associatedwith obesity in Japanese women. Therefore, the hypothesisthat the TABP would increase the risk of obesity was partially
supported. Moreover, in Japanese men, the factors related toobesity were found to be age, lack of exercise, and rapid eating.
In Japanese women, the factors related to obesity were foundto be age and rapid eating.
The TABP as a risk factor of obesity in men might berelated to eating large portions of food rapidly. Previous
studies have reported that rapid eating is associated with current obesity.27-29 In addition, rapid eating does not lead to afeeling of satiety; 28 therefore, it is possible that the TABP in
men leads to overeating and increased risk of obesity. People
with TABP tend to eat larger portions during mealtimes
repeatedly by rapid eating; it is possible that eating large
portions may lead to an increase weight in men with TABP.
In this study, the TABP was related to obesity in men;
however, in women, there was no association between the
TABP and obesity. The TABP in women may not increase
eating portions by rapid eating. Moreover, in women, lack of
exercise was not a risk of obesity. In this study, lack of exercise was observed in 71% of men and 86% of women (p <0.0001); in this study, women tended to exercise less frequently. Since women have a low basal metabolism, it isconsidered that lack of exercise was not related to obesity inwomen. In addition, the factors related to obesity in men
were found to be age, lack of exercise, and rapid eating. The
factors related to of obesity in women were found to be age
and rapid eating. In the previous studies, age,18-19 exercise
habits,24-25 and eating behavior 27-28 were associated withobesity, and similar results were observed in the Japanese
workers in the current study. It is known that obesity in men
and women is prevalent in the middle age. 18-19 Obesity inwomen in their 40s to 50s is related to menopause.30 In thisstudy, the relationship between obesity and age were alsosimilar.
This study involved four limitations. First, it was a crosssectional study; therefore, we could not infer a causal relationship between the TABP and obesity. Second, the researchtargeted workers from only one workplace; therefore, theresults are not generalizable to all workers. Third, the TABP
could not be accurately grasped because we used a self- report questionnaire; therefore, it is difﬁcult to determine
which elements of the TABP affected obesity. Fourth, endocrine diseases including thyroid diseases,31-32 metabolic
diseases such as diabetes,33-34 diseases requiring steroids,35-36
psychiatric diseases37-38 are associated with obesity. However,in this study, the participants were not inquired in detailregarding these diseases, and we did not exclude them fromthe analysis. Therefore, there is a limitation to the interpretation of the result of this study. Fifth, this study was targetedat university staff; the university staffʼs speciﬁc stress may
have inﬂuenced this outcome.
The study has two clinical implications. First, the identiﬁcation of TABP as a risk factor for obesity could contributeto obesity prevention. Second, reducing the tendency to eat
rapidly could increase the effectiveness of efforts to lose
weight.
We plan to conduct a longitudinal study to determine
whether the TABP is a risk factor for obesity. Moreover, it isnecessary to examine weight-loss programs that focus on the
TABP, to verify the effects observed in the present study.

Acknowledgments
This study was supported by Grants-Aid for ScientiﬁcResearch form Japan Society for the Promotion of Science,
26870437. This paper received English proofread by Editage.
We would like to express our gratitude to the participants inthe present study. This study was supported by the Center for
Health and Community Medicine at Nagasaki University.

110

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