Workplace Interventions to Reduce Obesity and Cardiometabolic Risk

Racial and Ethnic Differences in Awareness and Prevalence of Unidentified Cardiovascular Risk Factors Among Health System Employees

PURPOSE

To evaluate awareness about cardiovascular (CVD) risk among a racially and ethnically diverse cohort of health system employees.

DESIGN

Cross-sectional study.

SETTING

Voluntary survey of health system employees during an annual CVD awareness and screening event.

SUBJECTS

759 health system employees.

MEASURES

We performed initial CVD screening measurements (blood pressure, body mass index) and collected patient-reported answers to questions about their own CVD risk factors (hypertension, high cholesterol, diabetes, overweight, smoking, physical inactivity and family history of CVD) and whether or not they believed that CVD is preventable. Subjects were offered in-depth follow-up CVD screening (lipid panel, hs-CRP, hemoglobin A1c), if interested.

ANALYSIS

Continuous measures were compared across sex and racial/ethnic subsets using a t test and analysis of variance technique. Univariable and multivariable logistic regression models were used to estimate the employee's willingness to undergo further comprehensive screening.

RESULTS

African American, Hispanic, and Asian employees were younger than white employees (P < .0001). More than one-quarter of African Americans reported a history of hypertension, a higher rate than for other subgroups (P = .001). The rate of self-reported diabetes was highest in African American and Asian employees (P = .001). African Americans had a 54% reduced odds of electing to pursue follow-up CVD screening (odds ratio: .46, 95% confidence interval = .24-.91, P = .025).

CONCLUSION

Presence of CVD risk factors and knowledge of their importance differ among racial and ethnic groups of health system employees in our cohort as does interest in pursuing follow-up screening once risk factors are identified. Development of evidence-based customization strategies by racial and ethnic group may improve understanding of and interest in CVD risk factors and advance prevention. The data from this study will inform future research and strategies for employee health promotion.

Pragmatic Evaluation of a Health System-Based Employee Weight Management Program

Objective: We aimed to evaluate the fidelity and estimate the effectiveness of a novel health system employee weight-management program. Methods: Employees participating in a weight loss program consisting of self-monitoring, health coaching and meal replacements optionally enrolled in the 12-month study. Longitudinal, single-arm analyses were conducted evaluating change over time via survey, claims and programmatic data. Token participation incentives were offered for survey completion. Results: In total, 140 participants enrolled (51.2 ± 9.8 years; BMI = 33.2 ± 6.5 kg/m2; 89.3% female). During 1 year, participants attended 18.0 ± 12.2 coaching appointments and self-reported significant improvements in weight (-8.2 ± 10.5% body weight), BMI (-3.9 ± 6.5 kg/m2), fruit/vegetable intake, home food preparation, added sugar, sugar sweetened beverages and life satisfaction (all p < 0.05). No significant changes were reported in physical activity, weight-related social support, self-efficacy or healthcare utilization (all p > 0.05). Conclusions: The findings from this evaluation establish implementation fidelity. Clinically significant self-reported weight loss, coupled with improvements in many weight-related behaviors, suggest the program is an effective weight management tool when offered as an employee well-being program.

Cardioprotective effects of resistance training add to those of total activity in Americans

BACKGROUND

Resistance training is cardioprotective independent of total activity in experimental research and is prescribed to clinical populations, but is often largely neglected at population scale. Here we determine whether these benefits are relevant to general practice.

METHODS

A total of 6947 Americans over 20 years old (51% male) from NHANES 2003-2006 reported resistance training and objectively tracked 1-week total activity. Activity measures were modeled as five-level predictors of objectively measured binary heart-disease risks (hypertension, dyslipidemia, overweight, and diabetes) corrected for age, ethnicity, gender, and smoking. Significance was defined as Pfor trend less than .10 that the lowest activity category differed from the average of all others. If both activity measures predicted the same risk, mutually corrected models were run.

RESULTS

Average total activity was 20 minutes/day (SD 24). About 30% of subjects had resistance trained in the past month, reporting up to 7 sessions/day. Prevalences of hypertension, dyslipidemia, overweight, and diabetes were 32%, 46%, 68%, and 7.2%, respectively. All significant associations for resistance training (but not total activity) exhibited a threshold in dose-response curve, with comparable benefits from any dose above "none." Resistance trainers had significantly lower odds of hypertension (ORs, 0.55-0.85), overweight (ORs, 0.55-0.74), and diabetes (ORs, 0.51-0.80), but not dyslipidemia (ORs, 0.55-0.74). For total activity there was no significant trend in risk of either hypertension or dyslipidemia, but there were for overweight (ORs for each quintile above the lowest 1.04, 0.89, 0.78, and 0.49) and diabetes (ORs, 0.83, 0.68, 0.50, and 0.23; all Pfor trend <.01). Associations of resistance training with diabetes and obesity attenuated only slightly after correction for total activity, and vice versa.

CONCLUSIONS

Cardioprotective associations of resistance training were comparable to those of total activity and clinically relevant at low doses. Largest benefits accrued to those who combined any dose of resistance training with high total activity.

A self-management programme for work ability and quality of life in nurses aged 45 years and over: A randomized controlled trial

BACKGROUND

Nurses are exposed to declining work ability and quality of life because of biological and environmental factors.

AIM

The aim of the study was to investigate the effect of a self-management programme based on an attitude-social influence-self-efficacy model on work ability and quality of life for nurses aged 45 years and over.

METHODS

A parallel group trial design was used. Nurses who fitted the eligibility criteria of being aged 45 years and over were randomly assigned to an intervention or a control group. Data were collected between October 2017 and June 2018 at the hospital. The participants were blinded to group allocation. The primary outcome in the study was the impact of age on work ability.

RESULTS

Each group consisted of 30 nurses. There were no dropouts, so all subjects were analysed. Compared with the baseline, the intervention group's work ability was higher. There was a statistically significant difference between the groups in terms of the amount of changes in Work Ability Index scores at the third month compared the baseline.

CONCLUSION

The self-management programme was effective in increasing the nurses' work ability and healthy lifestyle behaviours affecting their quality of life.

The Efficacy of Workplace Interventions on Improving the Dietary, Physical Activity and Sleep Behaviours of School and Childcare Staff: A Systematic Review

There is a need for effective interventions that improve the health and wellbeing of school and childcare staff. This review examined the efficacy of workplace interventions to improve the dietary, physical activity and/or sleep behaviours of school and childcare staff. A secondary aim of the review was to assess changes in staff physical/mental health, productivity, and students’ health behaviours. Nine databases were searched for controlled trials including randomised and non-randomised controlled trials and quasi-experimental trials published in English up to October 2019. PRISMA guidelines informed screening and study selection procedures. Data were not suitable for quantitative pooling. Of 12,396 records screened, seven articles (based on six studies) were included. Most studies used multi-component interventions including educational resources, work-based wellness committees and planned group practice (e.g., walking groups). Multiple outcomes were assessed, findings were mixed and on average, there was moderate risk of bias. Between-group differences in dietary and physical activity behaviours (i.e., fruit/vegetable intake, leisure-time physical activity) favoured intervention groups, but were statistically non-significant for most outcomes. Some of the studies also showed differences favouring controls (i.e., nutrient intake, fatty food consumption). Additional robust studies testing the efficacy of workplace interventions to improve the health of educational staff are needed.

Sugar-free Workplace: A Step for Fighting Obesity

Currently, there is a worldwide obesity pandemic with an incidence that has increased progressively over the last few decades. Obesity is considered a global health hazard and is associated with a significant economic impact on the healthcare system. It has been linked to several serious medical conditions, including heart disease, hypertension, stroke, diabetes mellitus, and cancer. Obesity is also related to social and psychological problems such as anxiety and depression. Several factors predispose the population to obesity, including decreased physical activity and non-healthy dietary habits. Sugar is the most important key contributor to the pandemic of obesity, and implementing a sugar-free workplace policy will provide a promising strategy for fighting obesity.

Qualitative Exploration of the Feasibility and Acceptability of Workplace-Based Microgrants to Improve Physical Activity: The 10,000 Steps Pedometer Microgrant Scheme

OBJECTIVE

Despite the benefits associated with workplace health programs, many organizations are unable to offer them due to financial constraints. To address this barrier, the existing 10,000 Steps program trialed the 10,000 Steps Pedometer Microgrant Scheme. This study assessed the feasibility and acceptability of the Microgrant Scheme.

METHODS

Semi-structured interviews with employee representatives (n = 19) were used to explore perceptions of the Microgrant Scheme. Thematic inductive analysis was conducted.

RESULTS

Three main themes emerged: 1) the need for workplace initiatives to address health promotion issues (The Need); 2) the factors associated with the application and implementation process (The Process); and 3) employee and employer benefits associated with the Microgrant Scheme (The Outcomes).

CONCLUSION

These findings highlight the potential utility of a Microgrant Scheme to extend the reach and long-term sustainability of workplace health promotion activities.

Predictors of Weight Change: Findings From an Employee Wellness Program

Introduction: Employers are instituting employee wellness programs that include educational, lifestyle coaching, and weight and other condition management components to address obesity-related issues in the workplace. However, the findings of such wellness initiatives have been mixed. The purpose of this exploratory study is to determine whether the readiness for change measures are important predictors of weight loss in an employee wellness program. Methods: Retrospective data analysis of an employee wellness program conducted in the United States was conducted using data collected between 2014 and 2015 for people with BMI ≥ 30. These participants were assigned to one of two subprograms: weight management or condition management. We assessed the weight change within each program. Further, the relationship between weight change and readiness for change variables for weight, diet, and physical activity were examined by applying multiple linear regression and logistic regression models. The multivariable model included subprogram; gender; age; systolic and diastolic blood pressure; risk factor count; readiness for change for weight, activity, and diet; and stress level as covariates. Results: There were 209 participants in the weight management program and 243 participants in the condition management program who met the criteria for obesity, resulting in a final sample of 452 participants. On average, the weight change for these participants was -0.28 pounds (SD = 15.55) and there was no statistical difference between the weight change in the two programs. When compared to the reference group (maintenance), participants at the action stage of physical activity, on average, lost weight (b = -4.59, p = 0.02). Likewise, participants at the pre-contemplation stage of physical activity lost weight when compared to the maintenance group (b = -26.24, p = 0.000). Participants at the pre-contemplation stage of physical activity had higher odds of achieving at least 5% weight loss than participants at the maintenance stage (OR = 5.80, p = 0.053). Conclusion: Readiness for change for activity may be a predictor of weight change, and may predict the likelihood of achieving clinically significant weight loss. These findings can assist in targeting subjects for participation in such programs. The findings regarding the relationship between readiness for change and weight loss are counterintuitive, and further research is warranted in this area.

Association of hyperuricemia with metabolic syndrome among university workers: sex and occupational differences

BACKGROUND

The relationship between metabolic syndrome (MetS) and hyperuricemia is not fully understood.

OBJECTIVE

To examine the association of hyperuricemia with MetS and the component of MetS that is mostly influenced by hyperuricemia among university workers.

METHODS

Anthropometric measurements, blood pressure, glucose, lipid profiles, renal function tests were measured in 1198 male and 1075 female (22-60 years old) workers on annual medical examination.

RESULTS

Hyperuricemia was 3-fold higher in males (odds ratio, OR, 2.938, 95% confidence interval, CI, 1.909-4.522, P<0.01) than females after adjustment for age, body mass index (BMI) and renal function. Overall, individuals with hyperuricemia were 3.9-fold likely to have MetS OR, 3.903; CI (2.439-6.245), P<0.01, and dyslipidemia, 2.5 times (OR, 2.501; 95% CI, 1.776-3.521, P<0.01) after adjustment for age, BMI, sex and renal function. However, no associations were found in individuals with hypertension (OR, 1.427; 95% CI, 0.996-2.205, P=0.052) and hyperglycemia (OR, 1.476; 95% CI, 0.989-2.202, P=0.057). Administrative work positively associated (OR, 1.895; 95% CI, 1.202-2.925, P<0.05) with hyperuricemia in males and not females.

CONCLUSION

Male workers with hyperuricemia, especially those working in administration were at risk of metabolic syndrome. It is important to screen, prevent and treat metabolic syndrome in individuals diagnosed with hyperuricemia at the workplace.

Design of ChooseWell 365: Randomized controlled trial of an automated, personalized worksite intervention to promote healthy food choices and prevent weight gain

BACKGROUND/AIMS

Behavioral nudges in the food environment increase healthy choices, but it is unknown if they improve diet and health. The ChooseWell 365 study will determine if an automated, personalized worksite intervention to nudge healthier choices improves overall diet and cardiometabolic health.

DESIGN

Randomized controlled trial of 602 hospital employees who regularly use on-site cafeterias and pay with an employee ID.

INTERVENTION

The intervention combines an environmental strategy (traffic-light labeling) with objective feedback and personalized nudges (health/lifestyle tips, social norms, incentives) to promote healthy food choices. The ChooseWell 365 software platform automatically generates personalized emails and letters that integrate employees' weight goals with health, lifestyle, and cafeteria purchasing data. Over one year, the intervention group receives two weekly emails. One provides a log of daily purchases; the second provides personalized health/lifestyle tips. The intervention group receives monthly mailed letters with social norm comparisons and financial incentives for healthier purchases. The one-year intervention will be completed in February 2019; all follow-up will be completed March 2020.

OUTCOMES

Weight, cardiometabolic risk factors, and dietary intake at one and two-year follow-up. Other outcomes include worksite food purchases by study participants and other non-participant employees who are socially connected (inferred from purchasing data) to participants.

CONCLUSIONS

ChooseWell 365 tests a novel strategy to deliver a scalable worksite prevention program that is integrated into the workday. The intervention is personalized but automated and therefore does not require costlier individual counseling. In the future, this program could be applied broadly in other worksite settings.

Insights into the Role of Employers Supporting Obesity Management in People with Obesity: Results of the National ACTION Study

Lack of both awareness and application of evidence-based principles for obesity care for people with obesity (PwO) limit employers' role in supporting effective obesity management among employees with obesity (EwO). The aim of the ACTION (Awareness, Care, and Treatment In Obesity maNagement) study was to explore the current state of employer wellness programs related to obesity management, evaluate the impact of obesity in the workplace, assess attitudes regarding the role of employers in managing obesity, and identify challenges in implementing workplace wellness programs as perceived by employer representatives (ERs) and EwO. An online survey was conducted among ERs and adult PwO (BMI ≥30 by self-reported height and weight) using a cross-sectional, US-based stratified sample design. There were 153 ER respondents and 3008 adult PwO respondents; 1478 PwO were employed full-time, part-time, or were self-employed. ERs recognize the seriousness of obesity and its negative impact on work productivity; however, wellness programs tend to fall short of addressing specific needs of EwO, evidenced by low participation and success rates reported by EwO. This study highlights the need for programs that address the complexities of obesity and the specific needs of EwO, which currently are inadequately addressed according to EwO.

Cardiovascular disease prevention at the workplace: assessing the prognostic value of lifestyle risk factors and job-related conditions

Objectives

The prognostic utility of lifestyle risk factors and job-related conditions (LS&JRC) for cardiovascular disease (CVD) risk stratification remains to be clarified.

Methods

We investigated discrimination and clinical utility of LS&JRC among 2532 workers, 35–64 years old, CVD-free at the time of recruitment (1989–1996) in four prospective cohorts in Northern Italy, and followed up (median 14 years) until first major coronary event or ischemic stroke, fatal or non-fatal. From a Cox model including cigarette smoking, alcohol intake, occupational and sport physical activity and job strain, we estimated 10-year discrimination as the area under the ROC curve (AUC), and clinical utility as the Net Benefit.

Results

N = 162 events occurred during follow-up (10-year risk: 4.3%). The LS&JRC model showed the same discrimination (AUC = 0.753, 95% CI 0.700–0.780) as blood lipids, blood pressure, smoking and diabetes (AUC = 0.753), consistently across occupational classes. Among workers at low CVD risk (n = 1832, 91 CVD events), 687 were at increased LS&JRC risk; of these, 1 every 15 was a case, resulting in a positive Net Benefit (1.27; 95% CI 0.68–2.16).

Conclusions

LS&JRC are as accurate as clinical risk factors in identifying future cardiovascular events among working males. Our results support initiatives to improve total health at work as strategies to prevent cardiovascular disease.

Utilizing Standard Data Transactions and Public-Private Partnerships to Support Healthy Weight Within the Community

CONTEXT

Obesity is a significant health issue in the United States that both clinical and public health systems struggle to address. Electronic health record data could help support multi-sectoral interventions to address obesity. Standards have been identified and created to support the electronic exchange of weight-related data across many stakeholder groups.

CASE DESCRIPTION

The Centers for Disease Control and Prevention initiated a public-private partnership including government, industry, and academic technology partners to develop workflow scenarios and supporting systems to exchange weight-related data through standard transactions. This partnership tested the transmission of data using this newly-defined Healthy Weight (HW) profile at multiple health data interoperability demonstration events.

FINDINGS

Five transaction types were tested by 12 partners who demonstrated how the standards and related systems support end-to-end workflows around managing weight-related issues in the community. The standard transactions were successfully tested at two Integrating the Healthcare Enterprise (IHE) Connectathon events through 86 validated tests encompassing 38 multi-partner transactions.

DISCUSSION

We have successfully demonstrated the transactions defined in the HW profile with a public-private partnership. These tested IT products and HW standards could be used to support a continuum of care around health related issues encompassing both health care and public health functions.

CONCLUSION

The use of the HW profile, including a set of transactions and identified standards to implement those transactions, in IT products is a helpful first step in leveraging health information technology to address weight-related issues in the United States. Future work is needed to expand the use of these standards and to assess their use in real world settings.

Workplace Interventions to Prevent Type 2 Diabetes Mellitus: a Narrative Review

PURPOSE OF REVIEW

This study aims to summarize the recent peer-reviewed literature on workplace interventions for prevention of type 2 diabetes mellitus (T2DM), including studies that translate the Diabetes Prevention Program (DPP) curriculum to workplace settings (n = 10) and those that use different intervention approaches to achieve the specific objective of T2DM prevention among employees (n = 3).

RECENT FINDINGS

Weight reduction was achieved through workplace interventions to prevent T2DM, though such interventions varied substantially in their effectiveness. The greatest weight loss was reported among intensive lifestyle interventions (i.e., at least 4 months in duration) that implemented the structured DPP curriculum (n = 3). Weight reduction was minimal among less intensive interventions, including those that substantially modified the DPP curriculum (n = 2) and those that used non-DPP intervention approaches to prevent T2DM (n = 3). Most studies (n = 12) reported increased levels of physical activity following the intervention. Implementation of the DPP in workplaces may be an effective strategy to prevent T2DM among employees.

A cost-analysis of complex workplace nutrition education and environmental dietary modification interventions

BACKGROUND

The workplace has been identified as a priority setting to positively influence individuals' dietary behaviours. However, a dearth of evidence exists regarding the costs of implementing and delivering workplace dietary interventions. This study aimed to conduct a cost-analysis of workplace nutrition education and environmental dietary modification interventions from an employer's perspective.

METHODS

Cost data were obtained from a workplace dietary intervention trial, the Food Choice at Work Study. Micro-costing methods estimated costs associated with implementing and delivering the interventions for 1 year in four multinational manufacturing workplaces in Cork, Ireland. The workplaces were allocated to one of the following groups: control, nutrition education alone, environmental dietary modification alone and nutrition education and environmental dietary modification combined. A total of 850 employees were recruited across the four workplaces. For comparison purposes, total costs were standardised for 500 employees per workplace.

RESULTS

The combined intervention reported the highest total costs of €31,108. The nutrition education intervention reported total costs of €28,529. Total costs for the environmental dietary modification intervention were €3689. Total costs for the control workplace were zero. The average annual cost per employee was; combined intervention: €62, nutrition education: €57, environmental modification: €7 and control: €0. Nutritionist's time was the main cost contributor across all interventions, (ranging from 53 to 75% of total costs).

CONCLUSIONS

Within multi-component interventions, the relative cost of implementing and delivering nutrition education elements is high compared to environmental modification strategies. A workplace environmental modification strategy added marginal additional cost, relative to the control. Findings will inform employers and public health policy-makers regarding the economic feasibility of implementing and scaling dietary interventions.

TRIAL REGISTRATION

Current Controlled Trials: ISRCTN35108237 . Date of registration: The trial was retrospectively registered on 02/07/2013.

Community factors related to healthy eating & active living in counties with lower than expected adult obesity rates

Background

Adult obesity rates in the United States have reached epidemic proportions, yet vary considerably across states and counties. We sought to explore community-level factors that may be associated with reduced adult obesity rates at the county level.

Methods

We identified six U.S. counties that were positive deviants for adult obesity and conducted semi-structured interviews with community leaders and government officials involved in efforts to promote healthier lifestyles. Using site visits and in-depth qualitative interviews, we identified several recurrent themes and strategies.

Results

Participants: 1) developed a nuanced understanding of their communities; 2) recognized the complex nature of obesity, and 3) implemented a county-wide strategic approach for promoting healthy living. This county-wide approachwas used to a) break down silos and build partnerships, b) access community resources and connections, and c) transfer ownership to community members.

Conclusions

We found that county leaders focused on establishing a county-wide structure to connect and support community-led initiatives to promote healthy living, reduce obesity, and foster sustainability. Findings from this study can help inform county-level efforts to improve healthy living and combat the multi-faceted challenges of adult obesity across the U.S.

Employment and professional outcomes in 803 patients undergoing bariatric surgery in a French reference center for obesity

Background:

Very few studies have been performed on small populations about the links between employment and bariatric surgery.

Objective:

To determine if rates of employment are increased among patients who have undergone bariatric surgery, to assess their post-operative health consequences (post-prandial weakness, diarrhea), and patients' ability to maintain post-operative advice (ie, 30 minutes of daily physical activity, 6 small meals daily) compared to non-employed post-surgical patients.

Methods:

This cross-sectional study was performed in the Regional Reference Centre for Obesity, which is a partnership between the University Hospital and a clinic in Angers, France during 2012 using a self-administrated questionnaire completed by patients hospitalized for post-operative follow-ups after bariatric surgery. Issues investigated were their professional situation before and after the surgery, compliancy to post-operative advice, and any postoperative side effects.

Results:

Employment rates were 64.4% before and 64.7% after the surgery (p=0.94). Of these, 30.6% maintained 30 minutes of daily physical activity vs. 41.0% of non-workers (p=0.02). 50.5% of employed patients and 57.3% of non-workers maintained 6 small meals a day after surgery (p=0.09). 8% of working patients reported post-prandial weaknesses and 8% reported diarrhea that caused problems at work.

Conclusion:

Employment rate remained stable after surgery. Having a job seemed to be an obstacle to managing 30 minutes of daily exercise, especially among women, but not maintaining 6 small meals a day. Therefore, working environment needs to be assessed to improve job quality and retention for patients who have undergone bariatric surgery.

Effectiveness of a health promotion program among employees in a western United States school district

OBJECTIVES

To evaluate the effectiveness of a worksite wellness program in decreasing health risk.

METHODS

Analyses were based on 2411 employees from a school district in the western United States that participated in the WellSteps wellness program for 12 months.

RESULTS

The numbers of high-risk employees at baseline were 683 for body mass index, 360 for systolic blood pressure, 242 for diastolic blood pressure, 72 for blood glucose, and 216 for total cholesterol. Among participants, 46.0% lowered body mass index, 34.7% lowered systolic blood pressure, 56.3% lowered diastolic blood pressure, 65.6% lowered blood glucose, and 38.6% lowered total cholesterol. The percentages moving out of the high-risk categories after 1 year were 11.6%, 39.4%, 70.7%, 38.9%, and 40.7%, respectively.

CONCLUSIONS

The worksite wellness program effectively lowered risk measures among those identified in high-risk categories at baseline.

Worksite Environmental Interventions for Obesity Prevention and Control: Evidence from Group Randomized Trials

Worksites provide multiple advantages to prevent and treat obesity and to test environmental interventions to tackle its multiple causal factors. We present a literature review of group-randomized and non-randomized trials that tested worksite environmental, multiple component interventions for obesity prevention and control paying particular attention to the conduct of formative research prior to intervention development. The evidence on environmental interventions on measures of obesity appears to be strong since most of the studies have a low (4/8) and unclear (2/8) risk of bias. Among the studies reviewed whose potential risk of bias was low, the magnitude of the effect was modest and sometimes in the unexpected direction. None of the four studies describing an explicit formative research stage with clear integration of findings into the intervention was able to demonstrate an effect on the main outcome of interest. We present alternative explanation for the findings and recommendations for future research.

Weight gain prevention in the school worksite setting: results of a multi-level cluster randomized trial

OBJECTIVE

To describe the effectiveness, reach and implementation of a weight gain prevention intervention among public school employees.

METHOD

A multi-level intervention was tested in a cluster randomized trial among 782 employees in 12 central Massachusetts public high schools from 2009 to 2012. The intervention targeted the nutrition and physical activity environment and policies, the social environment and individual knowledge, attitudes and skills. The intervention was compared to a materials only condition. The primary outcome measures were change in weight and body mass index (BMI) at 24-month follow-up. Implementation of physical environment, policy and social environment strategies at the school and interpersonal levels, and intervention participation at the individual level were assessed.

RESULTS

At 24-month follow-up, there was a net change (difference of the difference) of -3.03 pounds (p=.04) and of -.48 BMI units (p=.05) between intervention and comparison conditions. The majority of intervention strategies were successfully implemented by all intervention schools, although establishing formal policies was challenging. Employee participation in programs targeting the physical and social environment was maintained over time.

CONCLUSION

This study supports that a multi-level intervention integrated within the organizational culture can be successfully implemented and prevent weight gain in public high school employees.

Promoting health and wellness in the workplace: a unique opportunity to establish primary and extended secondary cardiovascular risk reduction programs

Given the burden of cardiovascular disease (CVD), increasing the prevalence of healthy lifestyle choices is a global imperative. Currently, cardiac rehabilitation programs are a primary way that modifiable risk factors are addressed in the secondary prevention setting after a cardiovascular (CV) event/diagnosis. Even so, there is wide consensus that primary prevention of CVD is an effective and worthwhile pursuit. Moreover, continual engagement with individuals who have already been diagnosed as having CVD would be beneficial. Implementing health and wellness programs in the workplace allows for the opportunity to continually engage a group of individuals with the intent of effecting a positive and sustainable change in lifestyle choices. Current evidence indicates that health and wellness programs in the workplace provide numerous benefits with respect to altering CV risk factor profiles in apparently healthy individuals and in those at high risk for or already diagnosed as having CVD. This review presents the current body of evidence demonstrating the efficacy of worksite health and wellness programs and discusses key considerations for the development and implementation of such programs, whose primary intent is to reduce the incidence and prevalence of CVD and to prevent subsequent CV events. Supporting evidence for this review was obtained from PubMed, with no date limitations, using the following search terms: worksite health and wellness, employee health and wellness, employee health risk assessments, and return on investment. The choice of references to include in this review was based on study quality and relevance.