Visceral Fat-Reducing Effect of Novel Dietary Intervention Program: A Randomized Controlled Trial in Japanese Males

Background/Objectives: Reducing visceral fat is a critical factor in preventing obesity-related health complications. In this study, we evaluated the effectiveness of our previously reported novel dietary intervention program, "Optimized Nutri-Dense Meals", designed according to the Dietary Reference Intakes (DRIs) in Japan in reducing visceral fat. Method: This open-label, randomized controlled trial included 100 Japanese males with obesity or overweight. In total, 50 participants were assigned to a control group that continued their usual diets, and the other 50 consumed test meals twice per week for four weeks (test group). Result: The primary outcome, visceral fat area, significantly decreased in the test group compared to that in the control group (-7.5 cm2, confidence interval [CI]: -14.3 to -0.6). In addition, we measured the changes in gut flora and work productivity. The abundance of Bifidobacterium (+1.5%, CI: 0.3-2.7) and Christensenellaceae (+0.4%, CI: 0.01-0.8) increased significantly in the test group compared with those in the control group. Work Limitation Questionnaire Japanese version scores representing presenteeism also significantly increased in the test group (+1.2 points, CI: 0.2-2.3) compared with the control group. Conclusions: These findings suggest that dietary interventions based on Japanese DRIs can effectively decrease visceral fat and improve health outcomes over the short term without the need for a complete dietary overhaul.

Do worksite health promotion programs (WHPP) influence presenteeism among employees? A systematic review1

BACKGROUND

Worksite health promotion programs (WHPP) aiming to reduce presenteeism are rapidly increasing. However, program-efficacy seems impaired by lack of conceptual understanding and theoretical frameworks related to presenteeism.

OBJECTIVES

To study (1) the concept of presenteeism, (2) the causes of the phenomenon and (3) which WHPP affect presenteeism.

METHODS

We followed the PRISMA 2020 guidelines for mapping relevant literature in seven databases. The main search-terms were "worksite", "WHPP", "presenteeism", "employee productivity" and "interventions". Reviews and review of reviews were included and analysed according to research questions and ecological theory.

RESULTS

Of 2196 studies identified, 14 reviews were included, comprising 1390 single studies. Conceptually, presenteeism was poorly defined, mostly related to productivity/performance limitations due to ill health. Factors causing presenteeism addressed individual health or lifestyle (78%), and, to a lesser extent work and organisational factors (management/job stress) (22%). Forty-five highly diverse WHPP were identified, about 90% focusing health outcomes. 22/45 WHPP affected presenteeism/productivity positively. Multi-component WHPP implemented at multi levels accounted for 55%. Single-component programs, implemented at individual level, were mostly targeting health-risk subgroups. No specific WHPP seems preferable. Methodological quality seems highly associated with worksite intervention-efficacy.

CONCLUSION

Increased telework opportunities due to COVID-19 experiences has affected working conditions worldwide, for better and worse, requiring adaptions at employee, management, organisational and socio-cultural levels. Our results showed high program diversity, several adaptable to future needs (e.g., digital solutions), however hampered by narrow focus on individual health. Future research should focus on theory-based high quality multilevel WHPP comprising contextual, work, and organisational factors.

Assessing the Fiscal Burden of Obesity in Canada by Applying a Public Economic Framework

INTRODUCTION

Rising obesity prevalence is a health priority for many governments because of its impact on population health and economic consequences. We sought to estimate the broader consequences of obesity in Canada by applying a government perspective framework that captures lost tax revenues and increased government spending on social benefit programs.

METHODS

An age-specific prevalence-based model was built to quantify the fiscal burden of disease for government attributed to people living with obesity. The model was populated with age-specific wages, employment activity and government benefits received to estimate taxes and transfer costs. A targeted literature search was conducted to identify modifiers of employment status, wages and disability status attributed to people with obesity, and applied to employment and epidemiological projections which enabled us to estimate government costs and tax losses. Government tax revenue and costs attributed to obesity were projected over a 10-year period and discounted at 3%.

RESULTS

The fiscal burden of obesity in Canada is estimated at CAD$22,974 million (2021). This figure consists of obesity-attributed revenue losses of CAD$9404 million from direct taxes due to decreased employment activity and CAD$2374 million from indirect tax revenue losses due to reduced consumption taxes. Healthcare costs are estimated at CAD$7881 million annually and disability costs of CAD$3686 million annually. This fiscal burden of disease distributed amongst taxpayers in 2021 is estimated to be CAD$752 per capita. We estimate for every 1% reduction in obesity prevalence, CAD$229.7 million net fiscal gains can be achieved annually.

CONCLUSIONS

Obesity is associated with substantial clinical and economic burden not only to the healthcare system but also to wider government budgets as demonstrated using fiscal analysis. Reductions in obesity prevalence are likely to have positive fiscal gains for government from reduced spending on public benefits and increased tax revenue attributed to employment changes.

Lower Intakes of Key Nutrients Are Associated with More School and Workplace Absenteeism in US Children and Adults: A Cross-Sectional Study of NHANES 2003-2008

The influence of individual macro- and micronutrients on absenteeism in the United States is largely unknown. The objective of this study was to determine whether nutritional status or nutrient intake were associated with absenteeism from school and work due to illness or injury. Data from NHANES 2003-2008 were used to assess nutrient intake from food and food plus supplements, nutritional biomarker levels, and school and work absenteeism per year in children and adults. Negative binomial regression models were used to predict mean days of missed work per year and to estimate incidence rate ratios (IRRs) of absenteeism by nutrient biomarker status. Of 7429 children, 77% reported missing school days (mean 4.0 days). Of 8252 adults, 51% reported missing work days (mean 4.9 days). Children and adults who reported more absent days had a significantly lower intake of protein and several essential micronutrients from the diet. When nutrients from supplements were included, this negative association was retained for protein, selenium, choline, and DHA in children and for protein, selenium, vitamin K, choline, potassium, fiber, octadecatrienoic acid, and lycopene in adults. Future studies are needed to ascertain whether dietary interventions, such as access to healthier food options and/or dietary supplements, can reduce absenteeism.

The Effect of Pythagorean Self-Awareness Intervention on Stress and Mental Health Characteristics of Civil Servants in Crete, Greece

Evidence is limited regarding the effects of holistic programs on work-related stress, anxiety, and depressive symptomatology. This study aimed to evaluate the effects of the Pythagorean Self-Awareness Intervention (PSAI) on stress and mental health characteristics of civil servants in Crete, Greece. This was a single arm interventional study with PSAI outcome evaluation. Validated, self-reported scales were used to assess stress and mental health characteristics (PSS, DASS, UCLA, RSE, and STAXI). Hair samples were obtained to measure cortisol concentrations as a biological stress marker. Paired-samples t-test or Wilcoxon tests were used to evaluate pre- and post-intervention measures. Overall, 48 civil servants (56.3% women, mean age 51 years) participated in the study. Statistically significant reductions were observed in all self-reported stress scales (p < 0.05). Although hair cortisol decreased, this difference was not statistically significant (p = 0.109). Statistically significant improvements were also observed on depressive symptomatology (p < 0.001), self-esteem (p < 0.001), loneliness (p < 0.001), self-efficacy (p = 0.002), and anger (p = 0.017). The PSAI appeared beneficial with respect to all self-reported outcomes. Larger studies including control groups and further follow-up evaluations are needed to ascertain these findings.

Estimating the benefits of obesity prevention on productivity: an Australian perspective

Background/objectives

Obesity poses one of the biggest public health challenges globally. In addition to the high costs of obesity to the healthcare system, obesity also impacts work productivity. We aimed to estimate the benefits of preventing obesity in terms of years of life, productivity-adjusted life years (PALYs) and associated costs over 10 years.

Subjects/methods

Dynamic life table models were constructed to estimate years of life and PALYs saved if all new cases of obesity were prevented among Australians aged 20–69 years from 2021 to 2030. Life tables were sex specific and the population was classified into normal weight, overweight and obese. The model simulation was first undertaken assuming currently observed age-specific incidences of obesity, and then repeated assuming all new cases of obesity were reduced by 2 and 5%. The differences in outcomes (years of life, PALYs, and costs) between the two modelled outputs reflected the potential benefits that could be achieved through obesity prevention. All outcomes were discounted by 5% per annum.

Results

Over the next 10 years, 132 million years of life and 81 million PALYs would be lived by Australians aged 20–69 years, contributing AU$17.0 trillion to the Australian economy in terms of GDP. A 5% reduction in new cases of obesity led to a gain of 663 years of life and 1229 PALYs, equivalent to AU$262 million in GDP.

Conclusions

Prevention of obesity is projected to result in substantial economic gains due to improved health and productivity. This further emphasises the need for public health prevention strategies to reduce this growing epidemic.

Blue Zones-Based Worksite Nutrition Intervention: Positive Impact on Employee Wellbeing

“Blue Zones” are geographical regions where people live to be non-agenarians and centenarians with significantly better rates of mental wellness when compared to the average American. It was discovered that these areas have nine unique evidenced-based lifestyle principles, with one of their main principles being the consumption of a plant-based diet. With this in mind, we performed a worksite intervention with the objective of understanding the relationships among Blue Zones knowledge, a plant-based lifestyle, and improvements in overall mental wellness during the COVID-19 pandemic. During spring 2021, we recruited 52 employees from a public, mid-sized university in the southwestern United States to participate in an 8-week virtual intervention that included weekly topic presentations, cooking demonstrations, and Blue Zones education. Participants were also assigned to weekly wellness counseling groups integrating Motivational Interviewing based principles that included additional, relevant conversation topics and support. The final sample (n = 52 participants) had a mean age of 45.6 ± 10.6 years. Participants were predominantly women (84.6%) and nearly half were married (44.2%). The majority attended graduate school (59.6%) and identified as White (84.6%). Paired-samples t-tests indicated significant improvements in all mental wellness outcomes and Healthy Eating Index-2015 (HEI-2015) scores over time (p's &lt; 0.001 to 0.02). Multiple linear regression models revealed that Blue Zones knowledge (β = −0.037, p = 0.010) significantly negatively predicted Patient Health Questionnaire-9 (PHQ-9) scores at 8-weeks. Additionally, multiple linear regression models indicated small group attendance (β = −1.51, p = 0.003) and Blue Zones knowledge (β = −0.81, p = 0.012) significantly negatively predicted sleep scores at 8-weeks. When HEI-2015 total scores were also included at baseline and 8-weeks (post-intervention), Blue Zones knowledge (β = −0.031, p = 0.049) was a borderline significant predictor of PHQ-9 at 8-weeks. Additionally, small group sessions (β = −1.52 p = 0.005) were a significant predictor of sleep at 8-weeks. The intervention illustrated that virtual intervention strategies can improve nutrition and mental wellness for future advancement in life quality and wellbeing.

The effectiveness of nutrition and health intervention in workplace setting: a systematic review

Health status of workers are crucial to maintain their productivity and it will impact on output per capita. This systematic review aims to evaluate the effectiveness of nutrition and health intervention in workplace setting and implication for further research. Articles were searched from PubMed, PMC, Cochrane Library (Trial), Science-direct, and Google scholar published from 2005-2020. Inclusion criteria were the intervention subject aged 19-64 years old with experimental randomized control trial (RCT) or non-RCT study design. Several keywords used for literature searching including “nutrition education in workplace”, “nutrition intervention in workplace”, and “workplace intervention”. Data were narratively described. Eleven studies were meet inclusion and exclusion criteria and further be reviewed. Five studies focused on intervene food environment in the workplace, four studies focused on nutrition education using different channels i.e., workplace visiting and emails, the other two interventions were objected to decrease health risk regarding occupational health. Positive outcomes were recorded for all workplace intervention, including increase in nutrition knowledge, self-efficacy, reduce risky behavior, and also improved body mass index and blood biomarkers. Workplace nutrition and health intervention proved to be an effective way to enhanced balanced nutrition behavior and improve health status. This study implies an urgency of nutrition and health intervention in a workplace.

A Network-Based Analysis of a Worksite Canteen Dataset

The provision of wellness in workplaces gained interest in recent decades. A factor that contributes significantly to workers’ health is their diet, especially when provided by canteen services. The assessment of such a service involves questions as food cost, its sustainability, quality, nutritional facts and variety, as well as employees’ health and disease prevention, productivity increase, economic convenience vs. eating satisfaction when using canteen services. Even if food habits have already been studied using traditional statistical approaches, here we adopt an approach based on Network Science that allows us to deeply study, for instance, the interconnections among people, company and meals and that can be easily used for further analysis. In particular, this work concerns a multi-company dataset of workers and dishes they chose at a canteen worksite. We study eating habits and health consequences, also considering the presence of different companies and the corresponding contact network among workers. The macro-nutrient content and caloric values assessment is carried out both for dishes and for employees, in order to establish when food is balanced and healthy. Moreover, network analysis lets us discover hidden correlations among people and the environment, as communities that cannot be usually inferred with traditional or methods since they are not known a priori. Finally, we represent the dataset as a tripartite network to investigate relationships between companies, people, and dishes. In particular, the so-called network projections can be extracted, each one being a network among specific kind of nodes; further community analysis tools will provide hidden information about people and their food habits. In summary, the contribution of the paper is twofold: it provides a study of a real dataset spanning over several years that gives a new interesting point of view on food habits and healthcare, and it also proposes a new approach based on Network Science. Results prove that this kind of analysis can provide significant information that complements other traditional methodologies.

Employee experiences in underground workplaces: a qualitative investigation

Underground workplaces (UWS) are increasingly being recognised as a sustainable solution to concerns regarding lack of space facing megacities. UWS can multiply available space by reducing urban sprawl thereby improving quality of life in cities. However, developing workplaces that respond to the needs and preferences of occupants will be a crucial factor in determining the success of this concept. We examine the experiences of existing full-time employees of a large underground facility in North America and analyse how these are related to company policies and other organisational factors. From in-depth interviews of 73 participants, three predominant themes emerged from the analyses: environmental effects (e.g. lack of sunlight), design (e.g. the unique working environment), and organisational factors and social dynamics (e.g. policies regarding breaks). We discuss these themes in relation with interventions that may improve employee comfort and retention and suggest that many factors are within organisational control. Practitioner Summary: Underground workplaces are a sustainable solution to lack of urban space. However, developing effective workplaces is crucial to their success. We examine the experiences of existing employees of an underground facility in North America. We suggest that most negative attitudes towards underground spaces can be mitigated through simple organisational interventions. Abbreviations: UWS: underground workplaces; IRB: institutional review board.

Impact of nutrition interventions and dietary nutrient density on productivity in the workplace

The global spread of diet-related noncommunicable diseases represents a threat to public health and national economies alike. The elimination of poverty and the eradication of hunger, two key United Nations Sustainable Development Goals, cannot be accomplished without a well-nourished labor force. Easy access to low-cost diets that are energy dense but nutrient poor has resulted in hidden hunger, in which micronutrient deficiencies coexist with obesity or overweight. Workplace interventions in low- and middle-income countries have addressed nutrient adequacy and micronutrient deficiencies, often using fortified foods. Workplace interventions in high-income countries have largely focused on weight loss, smoking cessation, stress reduction, and physical activity. Even though improvement of productivity may have been the ultimate goal, relatively few interventions in high-income countries have explored the likely impact of improved dietary nutrient density on workplace performance. Given that optimal nutrition benefits both physical and mental health, interventions to improve diet quality ought to have a measurable impact on the productivity of the labor force. The present review examines the evidence linking workplace dietary interventions with workplace productivity measures.

Rate of inappropriate energy and micronutrient intake among the Korean working population

OBJECTIVE

Adequate energy and nutrient intakes are important for workers who spend at least one-third of their day working. We investigated differences in these intakes among Korean workers because few studies have reported on energy or nutrient intakes, related to working conditions (long working hours, shift work and non-standard work).

DESIGN

Dietary intake was assessed using 1-d 24-h recall. Energy and nutrient intakes were evaluated using age- and sex-specific dietary reference intakes for Korean citizens. Occupational characteristics were obtained from self-reported Korean National Health and Nutritional Examination Survey (KNHANES) data (occupational classification, working hours, shift work and non-standard workers). An age, education and household income-adjusted logistic regression model was applied to investigate differences in inappropriate energy and nutrient intakes, by sex and occupation.

SETTING

Cross-sectional study.

PARTICIPANTS

From KNHANES (2007-2016), 11 145 participants (5401 males; 5744 females) were included, finally.

RESULTS

Males with long working hours had higher inappropriate carbohydrate, protein, water, vitamin B2 and phosphate intakes than those who worked ≤60 h/week. Long working hours among females were significantly associated with total energy and nutrient 'under-intake'. Male shift and non-standard workers had higher inappropriate protein, water, mineral and vitamin intakes. Multivariate logistic regression revealed that white- and male pink-collar workers had significantly increased risks of water and vitamins A, C, B1 and niacin 'under-intake'.

CONCLUSIONS

We found different rates of inappropriate energy and micronutrient intakes according to working conditions. Younger workers with long hours and shift work schedules were vulnerable to inappropriate energy and nutrient intakes.

Is food insecurity related to health-care use, access and absenteeism?

OBJECTIVE

Food insecurity (FI) is defined as uncertain access to healthy food in quantity and quality. We hypothesize that FI may be associated with greater health-care use and absenteeism because it may amplify the effect of diseases; also, FI may be associated with reduced health-care access because it reflects economic vulnerability. The present study estimates the association between FI and health-care use and access, and absenteeism.

DESIGN

Cross-sectional data collected in 2015-2016. Health-care use was measured as the number of consultations, taking any drug and having been hospitalized in the past year. Health-care access was measured by the suspension of medication and having fewer consultations due to financial constraints. Absenteeism was measured by the weeks of sickness leave. Binary variables were modelled as a function of FI using logistic regressions; continuous variables were modelled as a function of FI using negative binomial and zero-inflated negative binomial regressions. Covariates were included sequentially.

SETTING

Portugal.

PARTICIPANTS

Non-institutionalized adults from the EpiDoc3 cohort (n 5648).

RESULTS

FI was significantly associated with health-care use before controlling for socio-economic conditions and quality of life. Moderate/severe FI was positively related to the suspension of medicines (adjusted OR = 4·68; 95 % CI 3·11, 6·82) and to having fewer consultations (adjusted OR = 3·98; 95 % CI 2·42, 6·37). FI and absenteeism were not significantly associated.

CONCLUSIONS

Our results support the hypothesis that FI reflects precariousness, which hinders access to health care. The greater use of health care among food-insecure people is explained by their worse quality of life and lower socio-economic condition, so that the specific role of poor nutrition is unclear.

Effects of a multi-behavioral health promotion program at worksite on smoking patterns and quit behavior

BACKGROUND

Tobacco use is associated with various severe health risks. Therefore, the need to decrease smoking rates is a great public health concern. The workplace has capability as a setting through which large groups of smokers can be reached to encourage smoking cessation.

OBJECTIVE

The aim of the present study was to evaluate effects of a multi behavioral worksite health promotion intervention. The primary outcome was the change of smoking rate. Secondary outcomes were changes in smoking attitudes and readiness to stop smoking among employees over an intervention period of 12 months.

METHOD

112 and 110 employees were enrolled in the intervention and control arm respectively. The intervention group received a 12-month multicomponent health promotion intervention. One of the main elements of the multicomponent intervention was a smoking cessation and counseling program. During the pilot year, participants completed a self-evaluation questionnaire at baseline and again after 12 months to related outcomes and changes.

RESULTS

Results showed that participants' quit behavior and smoking behavior changed over time in the intervention group (IG). Readiness to quit smoking also increased in the IG compared to the comparison group (CG). Some positive intervention effects were observed for cognitive factors (e.g., changes attitudes towards smoking). Baseline willingness to change smoking behavior was significantly improved over time.

CONCLUSIONS

This study showed initial results of a long-term multicomponent worksite health promotion program with regard to changes in smoking behavior, attitudes towards smoking and readiness to quit smoking. The evaluation suggests that a worksite health promotion program may lead to improvements in smoking behavior for a number of workers.

Impact of a 6-Month Micronutrient-Dense Plant-Rich Nutrition Intervention on Health and Well-Being at the Worksite

This nonrandomized pilot study utilized the health belief model and the theory of planned behavior to assess the effectiveness of perceived behavioral control to determine the impact of a micronutrient-dense plant-rich (mNDPR) dietary intervention on employee health and wellness at the worksite. Seventy-one employees and/or spouses (≥18 years) who met the inclusion criteria were recruited from a regional medical center and a local university. Participants were provided more than 14 hours of in-person lecture combined with take-home materials, and electronic resources to support participants in their transition and adherence to the dietary plan. The study consisted of a 6-hour introductory session followed by weekly 1-hour meetings for 7 consecutive weeks and then monthly 1-hour meetings, for 4 consecutive months over the span of 6 months. Retention of participants was approximately 55 percent. Participants were assessed for measures of weight, waist circumference, and blood pressure; physiological measures of blood cholesterol, triglycerides, blood glucose, and hemoglobin A1c; and well-being measures of gastroesophageal reflux disease, depression, sleep, pain, and worksite productivity, pre-, mid-, and post-intervention. A significant reduction was seen in weight (F(2, 78) = 19.81, p < 0.001) with a mean reduction of 6.65 lb., waist circumference (F(2, 72) = 40.914, p < 0.001) with a mean reduction of 2.8 inches, total cholesterol (F(2, 70) = 19.09, p < 0.001) with a mean reduction of 17.81 mg/dL, HDL (F(2, 70) = 4.005, p=0.023) with a mean reduction of 3.61 mg/dL, LDL (F(2, 56) = 10.087, p < 0.001) with a mean reduction of 13.1 mg/dL, blood glucose (F(2, 70) = 6.995, p=0.002) with a mean reduction of 3.7 mg/dL, hemoglobin A1c (paired samples t (39) = 2.689, p=0.01) with a mean reduction of 0.118%, GERD (F(2, 72) = 7.940, p=0.001, MSE = 4.225) with a mean reduction of 1.4, depressive symptoms as measured by the PHQ 9 (F(2, 72) = 10.062, p < 0.001, MSE = 5.174) with a mean reduction of 2.0, and an improvement in sleep quality was seen as measured by the PSQI (F(2, 74) = 11.047, p < 0.001, MSE = 2.269) with a mean improvement of 1.3. In most cases, improvement occurred across the first two time periods and then leveled off. Blood pressure, triglycerides, pain measurements, and WPAI did not change over time. Effect sizes for significant pairwise comparisons indicated medium to large effects of practical significance. This intervention was therefore effective at improving employee health and well-being. Widespread worksite implementation should be considered to improve the overall wellness of employees.

Predictors of Health Self-Management Program Preference Among Lower-to-Middle Wage Employed Adults With Chronic Health Conditions

PURPOSE

We examined the extent to which demographic, chronic disease burden, and financial strain characteristics were associated with a preference for engaging in the Chronic Disease Self-Management Program (presented as a "health self-management program" [HSMP]) over a financial self-management program (FSMP) and a no program preference (NPP) group among employed adults.

DESIGN

Cross-sectional, correlation design using baseline data from a randomized controlled trial (RCT).

SUBJECTS

The analytic sample included 324 workers aged 40 to 64 years with 1 or more chronic disease conditions recruited into the RCT from 2015 to 2017.

MEASURES

Chronic disease burden measures included the number of chronic conditions, body mass index (BMI), and the 8-item and 15-item Patient Health Questionnaire (PHQ-8 and PHQ-15). Financial strain was measured as the inability to purchase essentials and food assistance receipt. Both individual and household measures of income were assessed.

ANALYSES

Multinomial logistic regression and post-hoc marginal effects models.

RESULTS

Moderate-to-severe depressive symptoms increased the likelihood of having an HSMP preference when compared with those preferring the FSMP (RR = 4.2, P < .05) but not those having NPP; while higher BMI marginally increased HSMP preference over FSMP preference, but not NPP groups (RR = 1.04, P < .05). Financial strain differentially, but significantly, reduces the likelihood of HSMP preference at varying levels of household poverty, depressive symptom severity, and financial strain.

CONCLUSION

Middle-aged, lower-to-middle income workers with moderate-to-severe depressive symptoms opt for HSMPs over FSMPs, but preference for HSMPs significantly diminished when they are experiencing financial strain.

The effectiveness of dietary workplace interventions: a systematic review of systematic reviews

Objective

To summarise findings of systematic reviews that distinctively report dietary intervention components and their effects on diet-, health- and economic-related outcomes in the workplace setting.

Design

MEDLINE, Embase, CINAHL, Web of Science, Cochrane Library and Google Scholar were searched in December 2014 and the search was updated in August 2017.

Results

The search identified 1137 titles, of which nineteen systematic reviews from the initial search and two systematic reviews from the updated search met the inclusion criteria (twenty-one systematic reviews, published in twenty-two papers). Most systematic reviews were of moderate quality and focused on dietary behaviour change outcomes and some health-related biomarkers. Evidence was strongest for interventions to increase fruit and vegetable intake, reduce fat intake, aid weight loss and reduce cholesterol. Few reported workplace-related and evaluation outcomes.

Conclusions

These findings suggest that workplace dietary interventions can positively influence diet and health outcomes. Suggestions for effective interventions components have been made.

Working Health Services Scotland: a 4-year evaluation

Background

Working Health Service Scotland (WHSS) supports the self-employed and employees of small and medium-sized enterprises (SMEs) in Scotland with a health condition affecting their ability to work, who are either absent or at risk of becoming absent due to it.

Aims

To evaluate the impact on health and work outcomes of WHSS clients over a 4-year period.

Methods

Data were collected at enrolment, entry, discharge and follow-up at 3 and 6 months after discharge. Clients completed up to three validated health questionnaires at entry and discharge-EuroQol five dimensions (EQ-5D) and visual analogue scale (VAS); Hospital Anxiety and Depression Scale (HADS); and Canadian Occupational Performance Measure (COPM).

Results

A total of 13463 referrals occurred in the 4-year period; 11748 (87%) were eligible and completed entry assessment and 60% of the latter completed discharge paperwork. The majority of referrals were due to musculoskeletal conditions (84%) while 12% were referred with mental health conditions. Almost a fifth (18%) of cases were absent at entry and back at work at discharge. Work days lost while in WHSS was associated with age, length of absence prior to entering WHSS, primary health condition and time in programme. All health measures showed significant improvements from entry to discharge. Improvement in general health was sustained at 3- and 6-month follow-up.

Conclusions

The WHSS evaluation findings indicate that participation was associated with positive changes to health and return-to-work. The extent of the positive change in health measures and work ability can be highly important economically for employees and employers.

The Nutritional Quality of Lunch Meals Eaten at Danish Worksites

Monitoring the nutritional environment is important to help inform future initiatives to improve access to healthy foods. The objective was to examine the nutritional quality of lunch meals eaten at 15 worksite canteens and then to compare with results from a study conducted 10 years before. The duplicate-portion-technique with subsequent chemical analysis was used to quantify 240 customers' lunch intake. Estimated mean energy intake was 2.1 MJ/meal (95% confidence interval (CI): 1.9 to 2.4 g/meal) and estimated energy density 599 kJ/100 g (95% CI 550 to 653 kJ/100 g). Energy density of the male participants' meals were significantly higher compared with the female participants' meals (+55 kJ/100 g, 95% CI: +12 to +98 kJ/100 g, p = 0.012), whereas no gender differences were found in macronutrient distribution or fruit and vegetable intake. Compared to the study conducted 10 years before several significant changes were observed, including an increase in mean estimated intake of fruit and vegetables (+38 g/meal, 95% CI: 19 to 57 g/meal, p < 0.001) and a decrease in energy density (-76 kJ/100 g, 95% CI: -115, -37 kJ/100 g, p < 0.001). In conclusion, this study suggests an equalization of gender differences in fruit and vegetable intake and a possible improvement in the nutritional quality of canteen lunch meals over a 10-year period.

Group-based healthy lifestyle workplace interventions for shift workers: a systematic review

Objective

Shift work is a risk factor for many chronic diseases and has been associated with unhealthy lifestyle behaviors. Workplaces have great potential for promoting and supporting behavior change. We conducted a systematic review of group-based lifestyle workplace interventions for shift workers to (i) identify adaptations and intervention components that accommodate shift working and (ii) assess their impact on weight, physical activity, sedentary behavior and healthy eating.

Methods

A systematic search was conducted in Scopus, Web of Knowledge, EBSCO and Ovid databases. Using pre-established criteria, independent pairs of researchers conducted the study selection, quality appraisal and data extraction.

Results

In total, 22 studies on group-based workplace interventions for shift workers were included. Many demonstrated organizational level adaptations, such as flexible delivery times and paying employees’ time for their involvement. Delivery locations near the workplace and management support were other key features. Common intervention components included competitive group activities, individualized goal setting, self-monitoring and feedback, staff involvement in intervention delivery, and incentives. There was moderate evidence for effectiveness on weight and physical activity outcomes, but insufficient evidence for healthy eating outcomes. No interventions focusing on sedentary behavior among shift workers were found.

Conclusion

Current evidence demonstrates that group-based workplace interventions can be effective for supporting shift workers to lose weight and increase physical activity, while further research is needed to change healthy eating and sedentary behaviors. Our findings offer decision support on organizational-level adaptations and intervention components that are important to make interventions that promote healthy lifestyles more accessible to shift workers.

The impact of worksite interventions promoting healthier food and/or physical activity habits among employees working 'around the clock' hours: a systematic review

We conducted a systematic review of randomised studies on the impact of worksite interventions to promote healthier food and/or physical activity among people who work irregular hours ‘around the clock’, that is, outside of ordinary daytime working hours. The population–intervention–comparator–outcomes–study (PICOS) design format was used. Data sources were PubMed and CINAHL. An updated search was conducted on October 2017 using Google Scholar and the related articles function in PubMed on initially included studies to identify additional studies. Risk of bias was used to assess study quality. A total of seven studies (reports published in 14 papers) were included in the systematic review: Two interventions with a broader lifestyle approach, three focusing on physical exercise and two on providing healthier food or meal options. The studies had sample sizes from 30 to 1,000 and targeted a mixture of occupations, including both male- and female-dominated occupational groups. The interventions lasted from 2 to 12 months. Only one had an extended follow-up. In general, the studies showed small-to-moderate effect sizes on several measures, including dietary and/or physical activity measures, suggesting acceptable effectiveness for interventions involving community-level behaviour change. Our findings highlight a need to further develop and implement well-designed health promotion interventions with comparable outcome measures and effect size reports. A mixture of health promotion strategies is recommended for future practice in this target population, including individually tailored programmes, improving the food and physical activity environment and using broader lifestyle approaches including the use of participatory and empowerment strategies. While more research is needed in this field, the existing knowledge base on effective approaches awaits translation into practice.

Nutra-ergonomics: influence of nutrition on physical employment standards and the health of workers

The importance of ergonomics across several scientific domains, including biomechanics, psychology, sociology, and physiology, have been extensively explored. However, the role of other factors that may influence the health and productivity of workers, such as nutrition, is generally overlooked. Nutra-ergonomics describes the interface between workers, their work environment, and performance in relation to their nutritional status. It considers nutrition to be an integral part of a safe and productive workplace that encompasses physical and mental health as well as the long-term wellbeing of workers. This review explores the knowledge, awareness, and common practices of nutrition, hydration, stimulants, and fortified product use employed prior to physical employment standards testing and within the workplace. The influence of these nutra-ergonomic strategies on physical employment standards, worker safety, and performance will be examined. Further, the roles, responsibilities, and implications for the applicant, worker, and the employer will be discussed within the context of nutra-ergonomics, with reference to the provision and sustainability of an environment conducive to optimize worker health and wellbeing. Beyond physical employment standards, workplace productivity, and performance, the influence of extended or chronic desynchronization (irregular or shift work) in the work schedule on metabolism and long-term health, including risk of developing chronic and complex diseases, is discussed. Finally, practical nutra-ergonomic strategies and recommendations for the applicant, worker, and employer alike will be provided to enhance the short- and long-term safety, performance, health, and wellbeing of workers.

Outcomes Across the Value Chain for a Comprehensive Employee Health and Wellness Intervention: A Cohort Study by Degrees of Health Engagement

OBJECTIVE

Evaluate a large employer's wellness intervention by studying outcomes across the value chain, and testing Health Engagement's (HE) dose-response relationship to outcomes.

METHODS

Evaluation included 37 measures across eight outcomes domains (OD) using repeated measures, analysis of variance and logistic regression.

RESULTS

Participants with higher HE had better pre-post percent changes than control: 1.7% higher for Motivation (OD1), 3.4% for Behavior (OD2), 1.0% for Emotion (OD3), 5.8% for Biometrics (OD4), 6.3% for Compliance (OD5), and 5.2% for Claims (OD6). They also had 0.5% less Productivity loss (OD7), and odds of Turnover (OD8) one-quarter to one-half that of control. A dose-response relationship with degrees of HE was also shown.

CONCLUSIONS

Three outcomes domains (OD6 to OD8) can be monetized for cost-benefit analysis. Authors recommend, however, staying focused on driving HE and using metrics from all OD to assess value.

Increasing public support for food-industry related, obesity prevention policies: The role of a taste-engineering frame and contextualized values

BACKGROUND

Support for policies to combat obesity is often undermined by a public sense that obesity is largely a matter of personal responsibility. Industry rhetoric is a major contributor to this perception, as the soda/fast food/big food companies emphasize choice and individual agency in their efforts to neutralize policies that are burdensome. Yet obesity experts recognize that environmental forces play a major role in obesity. We investigate whether exposure to a taste-engineering frame increases support for food and beverage policies that address obesity. A taste-engineering frame details strategies used by the food industry to engineer preferences and increase the over-consumption of processed foods and sugary beverages. We also examine the effects of exposure to two contextualized values that have recently been promoted in expert discourse-consumer knowledge and consumer safety - on public support of policies. Our research shows how causal frames and contextualized values may effectively produce support for new obesity policies.

METHODS

We use an online survey experiment to test the effects of exposure to a taste-engineering frame (TEF), the value of consumer knowledge (CK), or the value of consumer safety (CS), on level of support for a range of policies. A random sample of adults, age 18 + living in the United States was included in the study (N = 2580). Ordered logistic regression was used to measure the effects of treatment exposure. The primary outcome was level-of-support for four (4) food-industry related, obesity prevention policies (aka food and beverage policies): 1) require food-manufacturers to disclose the amount of additives in food products on food packaging; 2) require food-manufacturers to advertise food products in accordance with their actual nutritional value; 3) prohibit all high-fat, high-sugar food advertising on television programming watched primarily by children; and 4) increase healthy food availability in work sites, schools, and hospitals.

FINDINGS

These data suggest that a taste-engineering frame and contextualized values significantly increase public support for many of the food and beverage policies tested.

CONCLUSIONS

Applying a taste-engineering frame and/or contextualized values to address obesity advances a population-based policy agenda to counteract the effects of food-industry strategies.

Eating Together at the Firehouse: How Workplace Commensality Relates to the Performance of Firefighters

Cooperative activities among coworkers can provide valuable group-level benefits; however, previous research has often focused on artificial activities that require extraordinary efforts away from the worksite. We investigate organizational benefits that firms might obtain through various supports for coworkers to engage in commensality (i.e., eating together). We conducted field research within firehouses in a large city to explore the role that interacting over food might have for work-group performance. Using a mix of qualitative and quantitative methods, our field research shows a significant positive association between commensality and work-group performance. Our findings establish a basis for research and practice that focuses on ways that firms can enhance team performance by leveraging the mundane and powerful activity of eating.

Worksite Health Program Promoting Changes in Eating Behavior and Health Attitudes

Background. The aim of the present study was to evaluate the effectiveness of a worksite multicomponent health promotion intervention on eating behavior and attitudes, changes in body weight, and readiness to make eating behavior changes among workers over a 12-month intervention period. Method. A total of 3,095 workers of a logistic company participated in a quasi-experimental comparison group study design. The intervention group received a multicomponent health training. Two of the main elements of the multicomponent intervention were physical exercise training and nutrition counseling/training. During the pilot year, participants completed a survey at baseline and again after 12 months to assess physical activity–, health-, and diet-related factors. Results. Results showed that participants’ body weight did not significantly decrease in the intervention group. Mean weight loss in the intervention groups was 0.5 kg (body mass index = 0.1 kg/m2). Eating behaviors in the intervention group improved more than in the comparison group. Some positive intervention effects were observed for the cognitive factors (e.g., changes in eating attitudes). Baseline readiness to change eating behavior was significantly improved over time. Conclusions. We demonstrated initial results of a long-term multicomponent worksite health promotion program with regard to changes in body weight, eating behavior, and attitudes. This evaluation of a 12-month pilot study suggests that a worksite health promotion program may lead to improvements in nutritional health behaviors for a number of workers. An investigation of long-term effects of this multicomponent intervention is strongly recommended.

Health risk factors associated with presenteeism in a Chinese enterprise

BACKGROUND

Chronic health problems are prevalent in China and may lead to loss of work productivity through presenteeism.

AIMS

To investigate the prevalence of potential risk factors for presenteeism in Chinese workers and the strength of their association with reported presenteeism.

METHODS

A cross-sectional survey of employees in a Chinese petrochemical corporation included a medical examination report and questionnaire data on demographic characteristics, potential risk factors for presenteeism and presenteeism evaluation. Data were analysed using Pearson's chi-square tests, t-tests and logistic regression modelling.

RESULTS

There were 1506 responses available for analysis; response rate 92%. The prevalence of presenteeism was 15%. Univariate analysis indicated a significantly higher prevalence of presenteeism in employees who were male, age ≤35 years, single, divorced or widowed and overweight or obese. Higher presenteeism was found in participants with high blood pressure, hypertriglyceridemia, hypercholesterolemia, insufficient physical activity, cigarette smoking, alcohol use, insufficient cereal intake, life dissatisfaction and job dissatisfaction. The prevalence of presenteeism was significantly associated with the number of potential risk factors. Logistic regression disclosed six independent risk factors associated with presenteeism: hypercholesterolemia, high blood pressure, insufficient physical activity, alcohol drinking, insufficient cereal intake and life dissatisfaction.

CONCLUSIONS

Chronic conditions, health risk factors and presenteeism were prevalent in employees of a Chinese petrochemical corporation. Risk factors for other health conditions were associated with presenteeism. Health management programmes should be implemented to reduce risk factors and promote the health of employees in an effort to reduce presenteeism.

Reducing Health Risk Factors in Workplaces of Low and Middle-Income Countries

OBJECTIVE

To reduce risk factors in workplace settings in low- and middle-income countries.

DESIGN AND SAMPLE

Workplace interventions were utilized as part of the Community Interventions for Health program, a nonrandomized, controlled study undertaken in three communities in China, India, and Mexico. Exactly, 45 industrial, 82 health and 101 school workplace settings with a target population of 15,726. Two independent cross-sectional surveys of workers were conducted at baseline and follow-up, after 18-24 months of intervention activities.

MEASURES

Culturally appropriate interventions to reduce tobacco use, increase physical activity, and improve dietary intake were delivered in the intervention areas.

RESULTS

Exactly, 12,136 adults completed surveys at baseline, and 9,786 at follow-up. In the intervention group, the prevalence of tobacco use reduced significantly in men (-6.0%, p < .001) and the proportion eating five portions of fruit and vegetables daily increased (+6.9%, p < .001) compared with the control group. There were no significant differences between the groups for changes in physical activity or prevalence of overweight.

CONCLUSIONS

Workplace interventions improved risk factors in China, India, and Mexico.

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.

Sick leave days and costs associated with overweight and obesity in Germany

OBJECTIVE

To analyze the impact of body mass index on sick leave days and related costs in Germany.

METHODS

Cross-sectional analysis of German Socio-Economic Panel data (n = 7990). The relationship between body mass index class and sick leave days was analyzed via analyses of variance (ANOVA) (bivariate) and zero-inflated negative binomial regression models (multivariate).

RESULTS

Body mass index was positively associated with annual sick leave days in the bivariate analysis (P < 0.001). In the fully adjusted zero-inflated negative binomial, overweight women had 3.64, obese women 5.19, and obese men 3.48 excess sick leave days in 2009 (vs normal weight), while excess sick leave days of overweight men were not statistically significant. The extrapolated excess costs in the German working population amount to &OV0556;2.18 billion (base case).

CONCLUSIONS

The absenteeism-related lost productivity costs associated with excess weight are formidable and emphasize the persistent need for health promotion efforts in Germany.

An evaluation of a comprehensive, incentivized worksite health promotion program with a health coaching component

Purpose

– The use of lifestyle coaches in a worksite setting to improve weight, nutrition, physical activity, and smoking behavior among at risk individuals is a relatively new area of research in the field of health promotion. The purpose of this paper is to assess the effectiveness of an accountability-based worksite telephonic health coaching program that incorporates financial incentives, a personal wellness profile (PWP) assessment tool, and biometric testing.

Design/methodology/approach

– A retrospective cohort study was conducted based on data from four midsize companies in Utah (USA), 2007-2010. Individuals with high-risk biometric scores were required to work with a health coach.

Findings

– Participants had fewer healthcare claims and lower costs than nonparticipants, which became more pronounced over the study period. Health risks and PWP results significantly improved, more so in those in poorer health at baseline that worked with a health coach. Mean difference between health age and potential achievable age significantly decreased, more so for men than women and among those with the greatest need for improvement.

Originality/value

– Health coaching effectively improved biometric scores among high-risk individuals and narrowed the difference between current health age and achievable age, more so among those with the greatest health risks at baseline who worked with a health coach.

Evidence-based lifestyle interventions in the workplace--an overview

BACKGROUND

Lifestyle-related health issues affect the economic position of organizations and contribute to reduced productivity, increased absenteeism and health care costs.

AIMS

To summarize the effectiveness of different workplace health interventions for promoting healthy lifestyle, preventing diseases and reducing health care costs.

METHODS

We searched MEDLINE via Pubmed, EMBASE, Cochrane Library, NelH, HighWire Press and Google Scholar in March 2012. Systematic reviews and meta-analyses of workplace interventions aimed at promoting physical activity, healthy weight and good nutrition were included. Three authors assessed the quality of the reviews and extracted data on methods, interventions, outcomes, results and effect sizes.

RESULTS

We identified 15 publications covering a total of 379 original studies. Three systematic reviews found beneficial effects of workplace nutrition interventions on employees' dietary behaviour. Three reviews found multi-component physical activity interventions to be effective in increasing employees' physical activity and fitness. The other activity promotion interventions were less effective regarding physical activity and weight-related outcomes. In terms of weight management, our findings favour multi-component interventions that focus on both physical activity and nutrition over single dietary programmes.

CONCLUSIONS

Workplace health promotion interventions may improve physical activity, dietary behaviour and healthy weight. There is no evidence of increased efficacy associated with specific intervention types. Workplace health promotion should focus on either physical activity or weight or nutrition behaviour to maximize effectiveness. Best evidence is available for multi-component interventions.

Social marketing and breastfeeding: a literature review

Aims:

Through the review of relevant literature this study illuminates the concepts of social marketing and breastfeeding. It specifically discusses the positioning of the link between social marketing and breastfeeding within different fields of study and develops a theoretical framework that tries to bridge the gap between those disciplines.

Method:

Various electronic databases were used and through systematic selection 11 scientific articles were identified that this literature review is based on.

Results:

The review indicates that the relationship between social marketing and breastfeeding is complex. There are indications that this relationship is being investigated within three distinct fields of research: psychology/education, public health and marketing. Depending on the research field the emphasis is put on either breastfeeding or social marketing as well as on the other concepts that were discovered to be of importance within this relationship. Namely, group and individual demography as well as behaviour were revealed to be important elements of the link between social marketing and breastfeeding.

Conclusions:

Based on the results this study concludes that a more multidimensional view on the relationship between the concepts under study is needed since the focus of previous studies is very one-sided and limited to just one element when all elements should be integrated equally.

Healthy snacks at the checkout counter: a lab and field study on the impact of shelf arrangement and assortment structure on consumer choices

Background

The essence of nudging is to adapt the environment in which consumers make decisions to help them make better choices, without forcing certain outcomes upon them. To determine how consumers can effectively be guided to select healthier snacks, we examine the effect of manipulating the assortment structure and shelf layout of an impulse display including both healthy and unhealthy snacks near the checkout counter of a canteen.

Methods

Both a lab and field study applied a two-factor experimental design manipulating snack offerings both in an on-screen choice environment and a natural environment (hospital staff restaurant). Shelf arrangement (i.e. accessibility) was altered by putting healthy snacks at higher shelves versus lower shelves. Assortment structure (i.e. availability) was altered by offering an assortment that either included 25% or 75% healthy snacks. Participants in the lab study (n = 158) made a choice from a shelf display. A brief survey following snack selection asked participants to evaluate the assortment and their choice. The field experiment took place in a hospital canteen. Daily sales data were collected for a period of four weeks. On completion of the field study, employees (n = 92) filled out a questionnaire about all four displays and rated their attractiveness, healthiness and perceived freedom of choice.

Results

The lab study showed a higher probability of healthy snack choice when 75% of the assortment consisted of healthy snacks compared to conditions with 25% healthy snack assortments, even though choices were not rated less satisfying or more restrictive. Regarding shelf display location of healthy snacks, no significant differences were observed. There was also no significant shelf arrangement by assortment structure interactive effect. The field study replicated these findings, in that this assortment structure led to higher sales of healthy snacks. Sales of unhealthy and total snacks were not impacted by manipulations (no main or interaction effects). Employees preferred shelf displays including a larger healthy snack assortment located at top shelves. Employees also felt more freedom in choice when healthy snacks were displayed at top shelves compared to lower shelves.

Conclusions

Overall, results suggest that increasing the prominence of healthy snacks by enlarging their availability, while permitting access to unhealthy snacks, is a promising strategy to promote sales. These results point to the importance of nudging strategies to encourage healthier snack patterns.

Presenteeism according to healthy behaviors, physical health, and work environment

The objective of this study is to identify the contribution that selected demographic characteristics, health behaviors, physical health outcomes, and workplace environmental factors have on presenteeism (on-the-job productivity loss attributed to poor health and other personal issues). Analyses are based on a cross-sectional survey administered to 3 geographically diverse US companies in 2010. Work-related factors had the greatest influence on presenteeism (eg, too much to do but not enough time to do it, insufficient technological support/resources). Personal problems and financial stress/concerns also contributed substantially to presenteeism. Factors with less contribution to presenteeism included physical limitations, depression or anxiety, inadequate job training, and problems with supervisors and coworkers. Presenteeism was greatest for those ages 30-49, women, separated/divorced/widowed employees, and those with a high school degree or some college. Clerical/office workers and service workers had higher presenteeism. Managers and professionals had the highest level of presenteeism related to having too much to do but too little time to do it, and transportation workers had the greatest presenteeism because of physical health limitations. Lowering presenteeism will require that employers have realistic expectations of workers, help workers prioritize, and provide sufficient technological support. Financial stress and concerns may warrant financial planning services. Health promotion interventions aimed at improving nutrition and physical and mental health also may contribute to reducing presenteeism.