Preventing Diabetes in the Workplace

Descriptive Study of Employee Engagement With Workplace Wellness Interventions in the UK

OBJECTIVE

To explore sequential steps of employee engagement in wellness interventions and the impact of wellness interventions on employee health.

METHODS

Using previously collected survey data from 23,667 UK employees, we tabulated intervention availability, awareness, participation, and associated health improvement and compared engagement by participation and risk status.

RESULTS

Employees' awareness of wellness interventions at their workplaces was often low (mean 43.3%, range 11.6%-82.3%). Participation was highest in diet/nutrition initiatives (94.2%) and lowest in alcohol counseling and smoking cessation interventions (2.1%). Employees with health risks were less likely than lower-risk employees to report awareness, participation, and health improvements from wellness interventions addressing the relevant health concern.

CONCLUSION

Employers and policymakers should consider variation in intervention engagement as they plan and implement wellness interventions. Engaging employee populations with higher health risks requires a more targeted approach.

Effectiveness of workplace wellness programmes for dietary habits, overweight, and cardiometabolic health: a systematic review and meta-analysis

Background

The workplace offers a unique opportunity for effective health promotion. We aimed to comprehensively study the effectiveness of multicomponent worksite wellness programmes for improving diet and cardiometabolic risk factors.

Methods

We did a systematic literature review and meta-analysis, following PRISMA guidelines. We searched PubMed-MEDLINE, Embase, the Cochrane Library, Web of Science, and Education Resources Information Center, from Jan 1, 1990, to June 30, 2020, for studies with controlled evaluation designs that assessed multicomponent workplace wellness programmes. Investigators independently appraised the evidence and extracted the data. Outcomes were dietary factors, anthropometric measures, and cardiometabolic risk factors. Pooled effects were calculated by inverse-variance random-effects meta-analysis. Potential sources of heterogeneity and study biases were evaluated.

Findings

From 10 169 abstracts reviewed, 121 studies (82 [68%] randomised controlled trials and 39 [32%] quasi-experimental interventions) met the eligibility criteria. Most studies were done in North America (57 [47%]), and Europe, Australia, or New Zealand (36 [30%]). The median number of participants was 413·0 (IQR 124·0–904·0), and median duration of intervention was 9·0 months (4·5–18·0). Workplace wellness programmes improved fruit and vegetable consumption (0·27 servings per day [95% CI 0·16 to 0·37]), fruit consumption (0·20 servings per day [0·11 to 0·28]), body-mass index (−0·22 kg/m² [−0·28 to −0·17]), waist circumference (−1·47 cm [−1·96 to −0·98]), systolic blood pressure (−2·03 mm Hg [−3·16 to −0·89]), and LDL cholesterol (−5·18 mg/dL [−7·83 to −2·53]), and to a lesser extent improved total fat intake (−1·18% of daily energy intake [−1·78 to −0·58]), saturated fat intake (−0·70% of daily energy [−1·22 to −0·18]), bodyweight (−0·92 kg [−1·11 to −0·72]), diastolic blood pressure (−1·11 mm Hg [−1·78 to −0·44]), fasting blood glucose (−1·81 mg/dL [−3·33 to −0·28]), HDL cholesterol (1·11 mg/dL [0·48 to 1·74]), and triglycerides (−5·38 mg/dL [−9·18 to −1·59]). No significant benefits were observed for intake of vegetables (0·03 servings per day [95% CI −0·04 to 0·10]), fibre (0·26 g per day [−0·15 to 0·67]), polyunsaturated fat (−0·23% of daily energy [−0·59 to 0·13]), or for body fat (−0·80% [−1·80 to 0·21]), waist-to-hip ratio (−0·00 ratio [−0·01 to 0·00]), or lean mass (1·01 kg [−0·82 to 2·83]). Heterogeneity values ranged from 46·9% to 91·5%. Between-study differences in outcomes were not significantly explained by study design, location, population, or similar factors in heterogeneity analyses.

Interpretation

Workplace wellness programmes are associated with improvements in specific dietary, anthropometric, and cardiometabolic risk indicators. The heterogeneity identified in study designs and results should be considered when using these programmes as strategies to improve cardiometabolic health.

Influence of Incentive Design and Organizational Characteristics on Wellness Participation and Health Outcomes

OBJECTIVE

To explore how changing incentive designs influence wellness participation and health outcomes.

METHODS

Aggregated retrospective data were evaluated using cluster analysis to group 174 companies into incentive design types. Numerous statistical models assessed between-group differences in wellness participation, earning incentives, and over-time differences in health outcomes.

RESULTS

Four incentive design groups based on requirements for earning incentives were identified. The groups varied in support for and participation in wellness initiatives within each company. All four design types were associated with improved low density lipoprotein (LDL) (P < 0.01), three with improved blood pressure (P < 0.001), and two with improved fasting glucose (P < 0.03). No incentive plan types were associated with improved body mass index (BMI), but designs predominantly focused on health outcomes (eg, Outcomes-Focused) exhibited a significant increase over time in BMI risk.

CONCLUSION

Incentive design and organizational characteristics impact population-level participation and health outcomes.

Evaluating a pragmatic estimate of insulin sensitivity in Latino youth with obesity

The whole-body insulin sensitivity index (WBISI) is a widely used surrogate of insulin sensitivity estimated from glucose and insulin concentrations during an oral glucose tolerance test (OGTT). The original WBISI uses five timepoints but reduced sampling models have been proposed. These reduced models have not been applied to the paediatric population. The purpose of this study is to compare cross-sectional agreement and changes in response to lifestyle intervention between the original WBISI and the WBISI₁₂₀ using fasting and 2-hour glucose and insulin concentrations from OGTT among Latino adolescents with obesity. We also examined the cost-differential between the two measures. Secondary analyses were conducted with data from Latino adolescents (14-16 years) with obesity (BMI ≥ 95th percentile) who were recruited for a randomized controlled lifestyle intervention trial. Baseline data in youth (n = 148) who underwent a 2-hour OGTT was used to analyse agreement between WBISI and WBISI₁₂₀ . Data from 65 participants who completed a 12-week lifestyle intervention were used to assess changes and the rate of change between WBISI and WBISI₁₂₀ . Research costs to determine both measures were compared. WBISI₁₂₀ showed good cross-sectional agreement (ICC_agreement = 0.88) with the full WBISI. Following intervention, WBISI₁₂₀ increased 62.5% (M ± SD, 1.6 ± 1.2 to 2.6 ± 1.7, P < .001) while WBISI increased by 25.0% (1.6 ± 1.0 to 2.0 ± 1.0, P < .001) but the rate of change for WBISI and WBISI₁₂₀ was not significantly different (P = .11). WBISI₁₂₀ costs ~70% less than WBISI. WBISI₁₂₀ may offer a cost-effective surrogate estimate of insulin sensitivity in Latino youth with obesity.