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Automated Behavioral Workplace Intervention to Prevent Weight Gain and Improve Diet: The ChooseWell 365 Randomized Clinical Trial.
Thorndike, AN, McCurley, JL, Gelsomin, ED, Anderson, E, Chang, Y, Porneala, B, Johnson, C, Rimm, EB, Levy, DE
JAMA network open. 2021;(6):e2112528
Abstract
IMPORTANCE Personalized interventions that leverage workplace data and environments could improve effectiveness, sustainability, and scalability of employee wellness programs. OBJECTIVE To test an automated behavioral intervention to prevent weight gain and improve diet using employee cafeteria purchasing data. DESIGN, SETTING, AND PARTICIPANTS This individual-level randomized clinical trial of a 12-month intervention with 12 months of follow-up was conducted among employees of a hospital in Boston, Massachusetts, who purchased food at on-site cafeterias that used traffic-light labels (ie, green indicates healthy; yellow, less healthy; red, unhealthy). Participants were enrolled September 2016 to February 2018. Data were analyzed from May to September 2020. INTERVENTIONS For 12 months, participants in the intervention group received 2 emails per week with feedback on previous cafeteria purchases and personalized health and lifestyle tips and 1 letter per month with peer comparisons and financial incentives for healthier purchases. Emails and letters were automatically generated using survey, health, and cafeteria data. Control group participants received 1 letter per month with general healthy lifestyle information. MAIN OUTCOMES AND MEASURES The main outcome was change in weight from baseline to 12 months and 24 months of follow-up. Secondary outcomes included changes in cafeteria purchases, including proportion of green- and red-labeled purchases and calories purchased per day, from baseline (12 months preintervention) to the intervention (months 1-12) and follow-up (months 13-24) periods. Baseline Healthy Eating Index-15 (HEI-15) scores were compared to HEI-15 scores at 6, 12, and 24 months. RESULTS Among 602 employees enrolled (mean [SD] age, 43.6 [12.2] years; 478 [79.4%] women), 299 were randomized to the intervention group and 303 were randomized to the control group. Baseline mean (SD) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) was 28.3 (6.6) and HEI-15 score was 60.4 (12.4). There were no between-group differences in weight change at 12 (0.2 [95% CI, -0.6 to 1.0] kg) or 24 (0.6 [95% CI, -0.3 to 1.4] kg) months. Compared with baseline, the intervention group increased green-labeled purchases by 7.3% (95% CI, 5.4% to 9.3%) and decreased red-labeled purchases by 3.9% (95% CI, -5.0% to -2.7%) and calories purchased per day by 49.5 (95% CI, -75.2 to -23.9) kcal more than the control group during the intervention period. In the intervention group, differences in changes in green (4.8% [95% CI, 2.9% to 6.8%]) and red purchases (-3.1% [95% CI, -4.3% to -2.0%]) were sustained at the 24-month follow-up. Differences in changes in HEI-15 scores were not significantly different in the intervention compared with the control group at 6 (2.2 [95% CI, 0 to 4.4]), 12 (1.8 [95% CI, -0.6 to 4.1]), and 24 (1.6, 95% CI, -0.7 to 3.8]) months. CONCLUSIONS AND RELEVANCE The findings of this randomized clinical trial suggest that an automated behavioral intervention using workplace cafeteria data improved employees' food choices but did not prevent weight gain over 2 years. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02660086.
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Influence of Nutrition, Food and Diet-Related Interventions in the Workplace: A Meta-Analysis with Meta-Regression.
Melián-Fleitas, L, Franco-Pérez, Á, Caballero, P, Sanz-Lorente, M, Wanden-Berghe, C, Sanz-Valero, J
Nutrients. 2021;(11)
Abstract
OBJECTIVE To review the scientific literature on the influence of verified nutrition, food and diet interventions on occupational health. METHOD This study involved a critical analysis of articles retrieved from MEDLINE (via PubMed), Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS) and Medicina en Español (MEDES) using the descriptors "Diet, Food, and Nutrition" and "Occupational Health" and applying the filters "Clinical Trial", "Humans" and "Adult: 19+ years"; the search was conducted on 29 May 2021. RESULTS A total of 401 references were retrieved from the bibliographic databases, with an additional 16 identified through a secondary search; among the studies retrieved, 34 clinical trials were selected after applying the inclusion and exclusion criteria. The interventions were grouped into seven categories: (1) dietary interventions associated with exercise or educational programs; (2) individual environmental interventions or other educational actions; (3) educational interventions oriented toward lifestyle, dietetics, physical activity and stress management; (4) economic incentives; (5) multicomponent interventions (combination of mindfulness, e-coaching and the addition of fruits and vegetables); or dietary interventions (facilitating greater food supply in cafeterias); or interventions focused on physical exercise. CONCLUSIONS Given that most people spend a large part of their time in the workplace and, therefore, eat at least one of their daily meals there, well-planned interventions-preferably including several strategies-have been demonstrated, in general, as useful for combating overweight and obesity. From the meta-regression study, it was observed that the interventions give better results in people who presented high Body Mass Index (BMI) values (obesity). In contrast, intervention 2 (interventions related to workplace environment) would not give the expected results (it would increase the BMI).
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Effectiveness of Combining Antiobesity Medication With an Employer-Based Weight Management Program for Treatment of Obesity: A Randomized Clinical Trial.
Pantalone, KM, Smolarz, BG, Ramasamy, A, Baz Hecht, M, Harty, BJ, Rogen, B, Griebeler, ML, Borukh, E, Young, JB, Burguera, B
JAMA network open. 2021;(7):e2116595
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IMPORTANCE The clinical efficacy of antiobesity medications (AOMs) as adjuncts to lifestyle intervention is well characterized, but data regarding their use in conjunction with workplace wellness plans are lacking, and coverage of AOMs by US private employers is limited. OBJECTIVE To determine the effect of combining AOMs with a comprehensive, interdisciplinary, employer-based weight management program (WMP) compared with the WMP alone on weight loss, treatment adherence, and work productivity and limitations. DESIGN, SETTING, AND PARTICIPANTS This 1-year, single-center, open-label, parallel-group, real-world, randomized clinical trial was conducted at the Cleveland Clinic's Endocrinology and Metabolism Institute in Cleveland, Ohio, from January 7, 2019, to May 22, 2020. Participants were adults with obesity (body mass index [BMI; calculated as weight in kilograms divided by height in meters squared] ≥30) enrolled in the Cleveland Clinic Employee Health Plan. INTERVENTIONS In total, 200 participants were randomized 1:1, 100 participants to WMP combined with an AOM (WMP+Rx), and 100 participants to WMP alone. The WMP was the Cleveland Clinic Endocrinology and Metabolism Institute's employer-based integrated medical WMP implemented through monthly multidisciplinary shared medical appointments. Participants in the WMP+Rx group initiated treatment with 1 of 5 US Food and Drug Administration-approved medications for chronic weight management (orlistat, lorcaserin, phentermine/topiramate, naltrexone/bupropion, and liraglutide, 3.0 mg) according to standard clinical practice. MAIN OUTCOMES AND MEASURES The primary end point was the percentage change in body weight from baseline to month 12. RESULTS The 200 participants were predominately (177 of 200 [88.5%]) women, had a mean (SD) age of 50.0 (10.3) years, and a mean (SD) baseline weight of 105.0 (19.0) kg. For the primary intention-to-treat estimand, the estimated mean (SE) weight loss was -7.7% (0.7%) for the WMP+Rx group vs -4.2% (0.7%) for the WMP group, with an estimated treatment difference of -3.5% (95% CI, -5.5% to -1.5%) (P < .001). The estimated percentage of participants achieving at least 5% weight loss was 62.5% for WMP+Rx vs 44.8% for WMP (P = .02). The rate of attendance at shared medical appointments was higher for the WMP+Rx group than for the WMP group. No meaningful differences in patient-reported work productivity or limitation measures were observed. CONCLUSIONS AND RELEVANCE Clinically meaningful superior mean weight loss was achieved when access to AOMs was provided in the real-world setting of an employer-based WMP, compared with the WMP alone. Such results may inform employer decisions regarding AOM coverage and guide best practices for comprehensive, interdisciplinary employer-based WMPs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03799198.
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Effects of a Workplace Wellness Program on Employee Health, Health Beliefs, and Medical Use: A Randomized Clinical Trial.
Reif, J, Chan, D, Jones, D, Payne, L, Molitor, D
JAMA internal medicine. 2020;(7):952-960
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IMPORTANCE Many employers use workplace wellness programs to improve employee health and reduce medical costs, but randomized evaluations of their efficacy are rare. OBJECTIVE To evaluate the effect of a comprehensive workplace wellness program on employee health, health beliefs, and medical use after 12 and 24 months. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial of 4834 employees of the University of Illinois at Urbana-Champaign was conducted from August 9, 2016, to April 26, 2018. Members of the treatment group (n = 3300) received incentives to participate in the workplace wellness program. Members of the control group (n = 1534) did not participate in the wellness program. Statistical analysis was performed on April 9, 2020. INTERVENTIONS The 2-year workplace wellness program included financial incentives and paid time off for annual on-site biometric screenings, annual health risk assessments, and ongoing wellness activities (eg, physical activity, smoking cessation, and disease management). MAIN OUTCOMES AND MEASURES Measures taken at 12 and 24 months included clinician-collected biometrics (16 outcomes), administrative claims related to medical diagnoses (diabetes, hypertension, and hyperlipidemia) and medical use (office visits, inpatient visits, and emergency department visits), and self-reported health behaviors and health beliefs (14 outcomes). RESULTS Among the 4834 participants (2770 women; mean [SD] age, 43.9 [11.3] years), no significant effects of the program on biometrics, medical diagnoses, or medical use were seen after 12 or 24 months. A significantly higher proportion of employees in the treatment group than in the control group reported having a primary care physician after 24 months (1106 of 1200 [92.2%] vs 477 of 554 [86.1%]; adjusted P = .002). The intervention significantly improved a set of employee health beliefs on average: participant beliefs about their chance of having a body mass index greater than 30, high cholesterol, high blood pressure, and impaired glucose level jointly decreased by 0.07 SDs (95% CI, -0.12 to -0.01 SDs; P = .02); however, effects on individual belief measures were not significant. CONCLUSIONS AND RELEVANCE This randomized clinical trial showed that a comprehensive workplace wellness program had no significant effects on measured physical health outcomes, rates of medical diagnoses, or the use of health care services after 24 months, but it increased the proportion of employees reporting that they have a primary care physician and improved employee beliefs about their own health. TRIAL REGISTRATION American Economic Association Randomized Controlled Trial Registry number: AEARCTR-0001368.
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Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol.
Seeberg, KGV, Andersen, LL, Bengtsen, E, Sundstrup, E
Systematic reviews. 2019;(1):219
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) are the leading cause of work disability and sickness absence worldwide. The prevalence of MSDs increases with age, consequently challenging sustainable employability among the growing ageing workforce. Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted. This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks, respectively. METHODS We will search the following bibliographic databases: PubMed (including the database 'MEDLINE') and Web of Science Core Collection (including the databases 'Science Citation Index Expanded', 'Social Sciences Citation Index' and 'Arts & Humanities Citation Index'). Manual searches will also be performed. We will include randomised controlled trials (RCTs) and non-RCTs reported in English in which (1) participants are adult workers with MSD, (2) interventions are aiming at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and (3) interventions are initiated and/or carried out at the workplace. The review will adhere to the 'Preferred Reporting Items for Systematic reviews and Meta-Analyses' (PRISMA) guidelines for reporting systematic reviews and the Institute for Work and Health (IWH) guidelines for workplace-based interventions. For the primary evaluation of the review, the quality assessment and evidence synthesis will conform to the IWH guidelines. Secondary evaluation will include a meta-analysis (unless the included studies do not allow this due to heterogeneity) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach on the studies with pain intensity as an outcome. DISCUSSION This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD. RCTs are considered the most powerful experimental design in clinical trials, but solely including these may be too restrictive to understand effective workplace-based interventions where randomised and carefully controlled trials (RCTs) are not always possible. In order to maximize practical relevance, the selection process will, therefore, include both RCTs and non-RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders. The result of this work will form the basis for industry-specific evidence-based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) number CRD42018116752 .
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Successful Implementation of a Mediterranean Weight Loss Program to Prevent Overweight and Obesity in the Workplace.
San Mauro Martin, I, Sanz Rojo, S, Becerra, X, Garicano Vilar, E
Journal of occupational and environmental medicine. 2019;(8):e329-e332
Abstract
OBJECTIVE Reducing obesity is a priority for employers seeking to lower the incidence and severity of chronic illness and associated health services. The aim was to identify if a workplace-based dietary intervention monitored by health professionals is effective at reducing obesity, as part of an obesity-control-program at work. METHODS A 12-week dietary intervention was designed for 102 overweight/obese Spanish employees in Madrid. Dietary and anthropometric (height, weight, body mass index [BMI], fat mass, and waist circumference) assessment was conducted at baseline, follow-up, and final. Six 20-minute counseling sessions were undertaken by participants. RESULTS Significant post-intervention reductions were observed in all anthropometric measures. 77.5% of the participants were considered respondents to the intervention, while 22.5% remaining were not. A higher proportion of women responded positively to the treatment compared with men. However, higher decrease in anthropometric measures were observed in men. CONCLUSION The workplace is deemed to be effective for providing guided dietary intervention and behavioral support based on the proximity of health professionals to the employee.
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Evaluation of a Brief Intervention for Promoting Mental Health among Employees in Social Enterprises: A Cluster Randomized Controlled Trial.
Deforche, B, Mommen, J, Hublet, A, De Roover, W, Huys, N, Clays, E, Maes, L, De Bourdeaudhuij, I, Van Cauwenberg, J
International journal of environmental research and public health. 2018;(10)
Abstract
Evidence on the effectiveness of workplace mental health promotion for people with disabilities is limited. This study aimed to evaluate the effectiveness of a brief mental health promotion intervention in social enterprises. It had a non-blinded cluster randomized controlled trial design with follow-up one and four months after the intervention. In total 196 employees agreed to participate (86 intervention and 110 control). Empowerment was the main outcome; secondary outcomes were resilience, palliative behavior, determinants of four coping strategies of mental health, quality of life, and life satisfaction. A brief participant satisfaction survey was conducted after the intervention. No significant intervention effect on empowerment was found. However, at one month follow-up, significant favorable effects were found on perceived social support for coping strategies for mental health and on palliative behavior. At four months follow-up, favorable intervention effects were found on quality of life, but unfavorable effects were found on unjustified worrying. In addition, the intervention was well received by the employees. This brief intervention might be a promising first step to improve mental health in people with disabilities working in social enterprises. Nevertheless, additional monitoring by professionals and managers working in the organizations might be needed to maintain these effects.
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Using the CDC's Worksite Health ScoreCard as a Framework to Examine Worksite Health Promotion and Physical Activity.
Gutermuth, LK, Hager, ER, Pollack Porter, K
Preventing chronic disease. 2018;:E84
Abstract
INTRODUCTION Worksite health promotion programs are emerging as an effective approach for addressing the adult obesity epidemic and improving the overall health of employees. METHODS We conducted a scoping review to identify articles that described a physical activity component (eg, promoted increased physical or reduced sitting time) of a worksite health promotion intervention. Our search specified full-length articles published in English from January 2000 through July 2015. We used the Centers for Disease Control and Prevention's Worksite Health ScoreCard, a validated tool, as a framework to summarize information on organizational supports strategies (18 questions) and physical activity strategies (9 questions) implemented by worksite health promotion programs. We also determined whether or not the included studies reported significant (P < .05) improvements in physical activity. RESULTS We identified 18 worksite health promotion programs; 11 produced significant improvements in physical activity. Incentives, health risk assessments, health promotion committees, leadership support, marketing, and subsidies or discounts for use of exercise facilities were the most effective organizational supports strategies cited, and physical activity seminars, classes, and workshops were the most effective physical activity strategies cited. CONCLUSION The use of the Health ScoreCard allowed for a practical interpretation of our findings, which can inform next steps for the field. Future research should explore the relationships between components of worksite health promotion programs and their outcomes to further develop best practices that can improve worker health and promote physical activity.
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A 30-month worksite-based lifestyle program to promote cardiovascular health in middle-aged bank employees: Design of the TANSNIP-PESA randomized controlled trial.
Coffeng, JK, van der Ploeg, HP, Castellano, JM, Fernández-Alvira, JM, Ibáñez, B, García-Lunar, I, van der Beek, AJ, Fernández-Ortiz, A, Mocoroa, A, García-Leal, L, et al
American heart journal. 2017;:121-132
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BACKGROUND Cardiovascular disease (CVD) is the leading cause of death worldwide. With atherosclerosis as the underlying cause for many CVD events, prevention or reduction of subclinical atherosclerotic plaque burden (SAPB) through a healthier lifestyle may have substantial public health benefits. OBJECTIVE The objective was to describe the protocol of a randomized controlled trial investigating the effectiveness of a 30-month worksite-based lifestyle program aimed to promote cardiovascular health in participants having a high or a low degree of SAPB compared with standard care. METHODS We will conduct a randomized controlled trial including middle-aged bank employees from the Progression of Early Subclinical Atherosclerosis cohort, stratified by SAPB (high SAPB n=260, low SAPB n=590). Within each stratum, participants will be randomized 1:1 to receive a lifestyle program or standard care. The program consists of 3 elements: (a) 12 personalized lifestyle counseling sessions using Motivational Interviewing over a 30-month period, (b) a wrist-worn physical activity tracker, and (c) a sit-stand workstation. Primary outcome measure is a composite score of blood pressure, physical activity, sedentary time, body weight, diet, and smoking (ie, adapted Fuster-BEWAT score) measured at baseline and at 1-, 2-, and 3-year follow-up. CONCLUSIONS The study will provide insights into the effectiveness of a 30-month worksite-based lifestyle program to promote cardiovascular health compared with standard care in participants with a high or low degree of SAPB.
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Improving cardiovascular health in Spanish seafarers.
Romero-Paredes, Mdel C, Reinoso-Barbero, L, González-Gómez, MF, Bandrés-Moya, F
International maritime health. 2016;(1):3-8
Abstract
BACKGROUND AND AIM There is a high prevalence in the Spanish general population of some cardiovascular risk factors like overweight, obesity and hypercholesterolaemia. But there is lack of research on Spanish seafarers. On the other hand, there is strong evidence of the cardiovascular risk predictive value of some biomarkers. The purpose of this work was to study the convenience of the introduction of detailed diet questionnaires and the measurement of some biomarkers in the pre-embarkation medical examination. MATERIALS AND METHODS Seafarers undergoing medical checkup during 2011 in Madrid, Spain (n = 334). Overweight and obese subjects received general advice on healthy diet and physical activity. Seventy-four of them were followed up in 2012 and 2013. Glycated haemoglobin (HbA1c), high-sensitivity C-reactive protein (hs-CRP), thyrotropin (TSH) and microalbuminuria were measured in two selected groups of patients in 2011. RESULTS Overweight and obesity were present in 207 (62%) individuals of the studied population. Those followed up in 2012 and 2013 showed a reduction of body mass index, waist circumference and total cholesterol values. We observed risk value of HbA1c in 60 (35.5%) individuals with significant association to other cardiovascular risk factors. Microalbuminuria appeared in subjects with high blood pressure. High TSH and hs-CRP were not significantly present in our population. CONCLUSIONS 1. Measurement of HbA1c during medical checkups improves early detection of cardiovascular risk in seafarers. 2. Individuals with overweight and obesity responded positively to medical advice and diminished their risk factors, thus it may be more effective to introduce detailed questionnaires on this issue.