Obesity trends by industry of employment in the United States, 2004 to 2011

A Digitally Enabled Combined Lifestyle Intervention for Weight Loss: Pilot Study in a Dutch General Population Cohort

BACKGROUND

Overweight and obesity rates among the general population of the Netherlands keep increasing. Combined lifestyle interventions (CLIs) focused on physical activity, nutrition, sleep, and stress management can be effective in reducing weight and improving health behaviors. Currently available CLIs for weight loss (CLI-WLs) in the Netherlands consist of face-to-face and community-based sessions, which face scalability challenges. A digitally enabled CLI-WL with digital and human components may provide a solution for this challenge; however, the feasibility of such an intervention has not yet been assessed in the Netherlands.

OBJECTIVE

The aim of this study was two-fold: (1) to determine how weight and other secondary cardiometabolic outcomes (lipids and blood pressure) change over time in a Dutch population with overweight or obesity and cardiometabolic risk participating in a pilot digitally enabled CLI-WL and (2) to collect feedback from participants to guide the further development of future iterations of the intervention.

METHODS

Participants followed a 16-week digitally enabled lifestyle coaching program rooted in the Fogg Behavior Model, focused on nutrition, physical activity, and other health behaviors, from January 2020 to December 2021. Participants could access the digital app to register and track health behaviors, weight, and anthropometrics data at any time. We retrospectively analyzed changes in weight, blood pressure, and lipids for remeasured users. Surveys and semistructured interviews were conducted to assess critical positive and improvement points reported by participants and health care professionals.

RESULTS

Of the 420 participants evaluated at baseline, 53 participated in the pilot. Of these, 37 (70%) were classified as overweight and 16 (30%) had obesity. Mean weight loss of 4.2% occurred at a median of 10 months postintervention. The subpopulation with obesity (n=16) showed a 5.6% weight loss on average. Total cholesterol decreased by 10.2% and low-density lipoprotein cholesterol decreased by 12.9% on average. Systolic and diastolic blood pressure decreased by 3.5% and 7.5%, respectively. Participants identified the possibility of setting clear action plans to work toward and the multiple weekly touch points with coaches as two of the most positive and distinctive components of the digitally enabled intervention. Surveys and interviews demonstrated that the digital implementation of a CLI-WL is feasible and well-received by both participants and health care professionals.

CONCLUSIONS

Albeit preliminary, these findings suggest that a behavioral lifestyle program with a digital component can achieve greater weight loss than reported for currently available offline CLI-WLs. Thus, a digitally enabled CLI-WL is feasible and may be a scalable alternative to offline CLI-WL programs. Evidence from future studies in a Dutch population may help elucidate the mechanisms behind the effectiveness of a digitally enabled CLI-WL.

Dietary Patterns, Occupational Stressors and Body Composition of Hospital Workers: A Longitudinal Study Comparing before and during the COVID-19 Pandemic

This longitudinal study aimed to evaluate the association between dietary patterns and the body composition of hospital workers subjected to occupational stressors before and during the COVID-19 pandemic. Data on sociodemographic, occupational, lifestyle, anthropometric, food consumption and occupational stress were collected before and during the COVID-19 pandemic. A total of 218 workers from a private hospital in Santo Antônio de Jesus, Bahia, Brazil were included in the study. After evaluating the normality of the data, parametric or non-parametric tests were used to characterize the sample. Dietary pattern was defined with Exploratory Factor Analysis and Structural Equation Modeling was used to test the desired association. During the pandemic, work per shift increased by 8.2% (p = 0.004) and working hours > 40 h/week increased by 9.2% (p = 0.006). Despite the higher prevalence of low occupational stress (85.8% vs. 72.1%), high stress increased by 13.7% from 2019 to 2020 (p < 0.001) and 30.3% reported a positive mediating effect on the variables of body composition, body mass index (b = 0.478; p < 0.001), waist circumference (b = 0.395; p = 0.001), fat-free mass (b = 0.440; p = 0.001) and fat mass (b = -0.104; p = 0.292). Therefore, a dietary pattern containing high-calorie foods was associated with changes in the body composition of hospital workers, including occupational stressors as mediators of this relationship.

Generalizability and accuracy of IBM MarketScan health risk assessment instrument data for augmentation of commercial claims data

PURPOSE

We evaluated the generalizability and accuracy of the IBM® MarketScan® Health Risk Assessment (HRA) data to assess its suitability as supplement to linked claims data.

METHODS

We identified adult private insurance enrollees in the IBM® MarketScan® Commercial Claims & Encounters (CC&E) and HRA databases between 2012 and 2017. In the claims data, for each enrollee, we sampled the first calendar year with continuous enrollment indicating full capture of claims data and extracted linked HRA survey data if available. We compared HRA participants and non-participants considering demographics, prevalences of chronic conditions, and healthcare utilization. Including the subsample with HRA data only, we estimated the negative predictive value (NPV) of obesity and smoking reported in the HRA against diagnosis code in the claims data.

RESULTS

Between 2012 and 2017, 2 693 444 and 31 450 000 of HRA and non-HRA participants were included in the study, respectively. Chronic diseases were similarly distributed between the two populations, with hypertension and hyperlipidemia representing the highest prevalence difference (1.4%). The two samples showed similar healthcare utilization. The proportion of false-negatives for obesity and smoking information when relying on the HRA data compared to patients with positive diagnosis based on claims data was low (<1%). Prevalence estimates of both variables were similar to national estimates.

CONCLUSION

Our findings suggest that the overall HRA population may represent the overall claims population and HRA provides certain data elements with satisfactory accuracy.

Vending Machines in Australian Hospitals: Are They Meeting the Needs of the Consumer?

The current report explores how well vending machines are meeting the needs of health care organizations and their staff and visitors in Australia. Hospital vending machines often provide the only source of food through the night to staff and visitors and traditionally offer less-healthy options. Findings presented in this report suggest that vending machines are not meeting current statewide policies and guidelines for healthier food environments in health care. This is despite widespread support for healthier refreshments in hospitals by staff, visitors, and patients. Alternatives to traditional vending and opportunities for nutrition educators and researchers are discussed.

Self-Efficacy, Social-Support, and Physical Activity Measures Among Hospital Employees: A Multisite Cross-Sectional Study

INTRODUCTION

Associations across self-efficacy, social support, and multiple measures of physical activity (PA) have not been thoroughly explored in hospital employees.

METHODS

Validated surveys assessed psychosocial factors; the IPAQ-long assessed PA, and mixed-effects analyses examined relations between psychosocial variables and PA in 920 employees from 6 Texas hospitals.

RESULTS

At P <.05, self-efficacy was significantly associated with light (β = 1.67), moderate (β = 1.63), and vigorous (β = 2.78) leisure PA; with domestic PA (β = 1.64); and with moderate commute PA (β = 0.03). At P < .05, family social-support was significantly associated with light (β = 0.94), moderate (β = 0.63), and vigorous (β = .74) leisure PA; with moderate (β = 0.46) and vigorous (β = 1.24) occupation PA; with light (β = 0.58) and moderate (β = 0.20) commute PA; and with domestic PA (β = 1.18). At P < .05, social support from friends was significantly associated with light (β = 0.74), moderate (β = 0.58), and vigorous (β = .91) leisure PA; with moderate commute (β = 0.21); and with domestic PA (β = 0.82).

CONCLUSION

Interventions must emphasize self-efficacy-building strategies and the role of family support to meaningfully impact PA behaviors in this unique population.

Impact of Obesity on Work Productivity in Different US Occupations: Analysis of the National Health and Wellness Survey 2014 to 2015

Objective:

The aim of this study was to quantify the relationship between workers’ body mass index and work productivity within various occupations.

Methods:

Data from two administrations (2014 and 2015) of the United States (US) National Health and Wellness Survey, an Internet-based survey administered to an adult sample of the US population, were used for this study (n = 59,772). Occupation was based on the US Department of Labor's 2010 Standardized Occupation Codes. Outcomes included work productivity impairment and indirect costs of missed work time.

Results:

Obesity had the greatest impact on work productivity in Construction, followed by Arts and Hospitality occupations. Outcomes varied across occupations; multivariable analyses found significant differences in work productivity impairment and indirect costs between normal weight and at least one obesity class.

Conclusion:

Obesity differentially impacted productivity and costs, depending upon occupation.

Increase in Obesity Among Women of Reproductive Age in Zambia, 2002-2014

Objective: To describe trends in obesity in Zambian women of reproductive age and to identify factors that may have contributed to changes in trends and nutrition outcomes. Materials and Methods: We obtained data on body mass index and individual factors of women from the Zambia Demographic and Health Survey for the period 2002 to 2014. From these data, we calculated descriptive statistics and examined the extent to which factors link to the odds of obesity over time. We also reviewed primary and secondary data sources, such as government documents, theses, and search engines to identify factors that may have contributed to trends and changes in nutrition outcomes. Results: The proportion of obesity doubled from 2002 (12.5%) to 2014 (22.3%). The odds were higher among educated, currently married and wealthy women, and it increased with age. Rural residence and working in agricultural-related jobs were linked to lower odds for obesity. This disparity varies by province. In addition, despite the presence of many nutrition policies and strategies, the increase in obesity occurred within the past two decades when urbanization and other factors (e.g., sedentary work, a proliferation of fast food restaurants, and advertisements) may have affected changes in nutrition outcomes for women. Conclusions: We identified increasing trends in obesity in women of reproductive age over time. The rapid urbanization and other factors that occurred in Zambia during this period are significant risk factors for obesity in Zambian women. The findings will be of interest to countries that are undergoing a nutrition transition.

Calories Purchased by Hospital Employees After Implementation of a Cafeteria Traffic Light-Labeling and Choice Architecture Program

IMPORTANCE

Nearly one-third of the 150 million US adults who are employed are obese. A workplace program that reduces employees' caloric intake could help prevent obesity.

OBJECTIVE

To determine if implementation of a hospital workplace cafeteria healthy eating program was associated with reduction in calories purchased by employees over 2 years.

DESIGN, SETTING, AND PARTICIPANTS

A longitudinal cohort study of 5695 employees who purchased food with their employee identification card before and after implementation of a workplace cafeteria healthy eating program was conducted from December 1, 2009, to February 29, 2012, in a hospital in Boston, Massachusetts. Statistical analysis was conducted from April 6, 2018, to May 14, 2019.

EXPOSURE

After a 3-month baseline period, "traffic light" food labels (in which green indicates healthy, yellow indicates less healthy, and red indicates least healthy) and choice architecture (product placement) changes were implemented permanently.

MAIN OUTCOME AND MEASURES

Main outcomes were changes in calories of employees' purchases from baseline (December 1, 2009, to February 28, 2010) to the same quarter 1 year (December 1, 2010, to February 28, 2011) and 2 years (December 1, 2011, to February 29, 2012) later. Purchases were obtained from sales data linked to employee identification cards. The hypothesized association of estimated changes in daily calories consumed with employees' weight was calculated using a dynamic model of weight change. Analyses were adjusted for age, sex, race/ethnicity, and job type.

RESULTS

Among the 5695 employees in the study, 4057 were women and 1638 were men, and the mean (SD) age was 40 (12) years. Baseline purchases had a mean of 565 kcal per transaction (95% CI, 558-572 kcal) and decreased 19 kcal per transaction (95% CI, -23 to -15 kcal) at 1 year and 35 kcal per transaction (95% CI, -39 to -31 kcal) at 2 years (-6.2%; P < .001) relative to baseline. The largest reduction was from red-labeled items, decreasing 42 kcal per transaction at 2 years (95% CI, -45 to -39 kcal) from a mean of 183 kcal per transaction (95% CI, 177-188 kcal) at baseline (-23.0%; P < .001). Calories from green-labeled items increased 6 kcal per transaction (95% CI, 3-9 kcal) from a mean of 152 kcal per transaction (95% CI, 149-155 kcal) (4.0%; P < .001), and calories from yellow-labeled items did not change. Among frequent purchasers (≥36 transactions per quarter; n = 453), total kilocalories per quarter at baseline was 41 784, which, averaged over the entire follow-up, decreased a mean of 4275 kcal/quarter (95% CI, -5325 to -3224 kcal) over 2 years. Assuming no compensatory changes in diet or activity, this equated to a reduction of 47 kcal per day and estimated a 2.0-kg weight loss over 3 years.

CONCLUSIONS AND RELEVANCE

A workplace cafeteria traffic light-labeling and choice architecture program was associated with a sustained decrease in calories purchased, particularly from unhealthy foods. Point-of-purchase programs could help improve dietary intake and prevent obesity in employees.

Association of Worksite Food Purchases and Employees' Overall Dietary Quality and Health

INTRODUCTION

Most Americans spend half their waking hours at work and consume food acquired there. The hypothesis was that the healthfulness of worksite food purchases was associated with employees' overall diet and health.

METHODS

Participants were 602 hospital employees who regularly used worksite cafeterias and enrolled in a health promotion study in 2016-2018. All cafeterias used traffic-light labels (green=healthy, yellow=less healthy, red=unhealthy). A Healthy Purchasing Score was calculated for each participant by summing weighted proportions of cafeteria items purchased over a 3-month observation period (red=0, yellow=0.5, green=1; range, 0-1). Healthy Eating Index scores (range, 0-100) were calculated based on two 24-hour dietary recalls. BMI, blood pressure, and HbA1c were measured. Hypertension and prediabetes/diabetes diagnoses were determined by self-reported and clinical data. Regression analyses examined dietary quality and diagnoses by tertile of Healthy Purchasing Score (T1=least healthy purchases, T3=most healthy), adjusting for demographics. All data were collected before the start of the intervention and were analyzed in 2018.

RESULTS

Mean age was 43.6 years (SD=12.2), 79% were female, and 81% were white. Mean BMI was 28.3 kg/m² (SD=6.5); 21% had hypertension, and 27% had prediabetes/diabetes. Mean Healthy Eating Index was 60.4 (SD=12.5); mean Healthy Purchasing Score was 0.66 (SD=0.15). Healthier purchases were associated with healthier Healthy Eating Index scores (T1=55.6, T2=61.0, T3=64.5, p<0.001) and lower obesity prevalence (T1=38%, T2=29%, T3=24%, p<0.001); similar patterns were observed for hypertension and prediabetes/diabetes.

CONCLUSIONS

Worksite food purchases were associated with overall dietary quality and cardiometabolic risk. Interventions to increase healthfulness of food choices at work may improve employees' health.

Excesso de peso e fatores associados entre profissionais de saúde da Estratégia Saúde da Família

Resumo Introdução Há aumento global na prevalência da obesidade, importante fator de risco para as doenças crônicas não transmissíveis. Objetivo Avaliar a prevalência de excesso de peso e os fatores associados entre profissionais de saúde da Estratégia Saúde da Família. Método Estudo transversal, com 215 profissionais de saúde de Montes Claros, MG, em 2015. Investigaram-se informações demográficas, laborais, comportamentais e de hábitos alimentares. Os profissionais foram classificados quanto à presença de um perfil de saúde - concomitância de índice de massa corporal normal, não fumar, consumir frutas e verduras diariamente, praticar atividade física e não adicionar sal às refeições. Análise estatística com modelo de regressão logística para identificar os fatores associados ao excesso de peso. Resultados Participaram agentes comunitários de saúde (58,0%), enfermeiros (27,0%), técnicos de enfermagem (9,0%) e médicos (6,0%). A maioria do sexo feminino (87%) e idade média de 35,92 (±8,98). Possuíam excesso de peso 53,5% (36,7% com sobrepeso; 16,8% com obesidade). A idade avançada, outro vínculo de trabalho, consumo de frutas e verduras irregular e ausência do perfil de saúde apresentaram associação com excesso de peso. Conclusão Houve alta prevalência de excesso de peso entre os profissionais de saúde, associado ao estilo de vida e trabalho.

Measures of Physical Activity and Body Mass Index in Hospital Workers: A Multisite Cross-Sectional Study

OBJECTIVE

This study examined physical activity (PA) profiles of hospital employees and evaluated associations between PA domains (occupation, commute, leisure, and domestic) and intensity levels (light, moderate, and vigorous) with body mass index (BMI).

METHODS

Nine hundred twenty employees across six Texas hospitals were enrolled in the multisite study, 2012 to 2013. Analysis of covariance tests assessed equality of means (minutes) across PA measures, and mixed effects analyses evaluated associations between PA measures and BMI, while controlling for covariates.

RESULTS

Over 78% of participants were overweight or obese. Mixed effects models showed significant inverse associations with BMI: light leisure PA (β = -0.0183|P = 0.003), moderate leisure PA (β = -0.0182|P = 0.005), vigorous leisure PA (β = -0.0248|P = 0.000), moderate commute PA (β = -0.0315|P = 0.02), moderate domestic PA (β = -0.0087|P = 0.018), and vigorous occupation PA (β = -0.0158|P = 0.001).

CONCLUSION

Delivery of effective interventions in this population must consider the nature of the work environment as well as employees' PA profiles.

Association of statin therapy with incidence of type 2 diabetes among US Veterans

AIMS

While some but not all trial data have suggested an elevated risk of type 2 diabetes with statin use, limited data are available on the relation of statin treatment with glycaemia and risk of type 2 diabetes among Veterans. We examined whether statin use was associated with a higher incidence of type 2 diabetes and secondarily, if statin use was associated with high plasma glucose.

METHODS

Prospective analysis based on electronic health records of 3,390,799 US Veterans from 2000 to 2012. We used the Veteran Administration Corporate Data Warehouse to obtain information on random plasma glucose. Statin use was captured using the pharmacy database. type 2 diabetes was defined as having at least one inpatient diagnosis or at least two outpatient diagnoses of type 2 diabetes using International Classification of Disease version 9 codes 250.xx, or the use of hypoglycemic agents. We used multi-level derived propensity score and inverse probability weighting to address confounding by indication and Cox regression to estimate relative risk of type 2 diabetes.

RESULTS

The mean age was 62±11.9 years; 93.3% were men and 82.7% were white. During a median follow-up of 3.0 years, 443,104 new cases of type 2 diabetes occurred. Compared to no statin use, multivariable adjusted hazard ratio (95% CI) for type 2 diabetes was 1.21 (1.19-1.24) for low statin potency, 1.22 (1.21-1.23) for medium statin potency, and 1.34 (1.32-1.36) for high statin potency (p linear trend <0.0001). In secondary analysis, statin use was not associated with higher plasma glucose.

CONCLUSIONS

Our data show a positive association between statin use and incidence of type 2 diabetes among US Veterans.

Determinants of racial/ethnic disparities in disordered sleep and obesity

Racial/ethnic minorities experience a disproportionate risk of both suboptimal sleep and obesity, and the relationship between sleep and obesity may differ by race/ethnicity for modifiable and non-modifiable reasons. Because many people of color have historically lived and continue to largely live in disadvantaged, obesogenic physical and social environments, these greater adverse exposures likely negatively affect sleep, resulting in physiological dysregulation. Physiological dysregulation may, in turn, lead to increased obesity risk and subsequent health consequences, which are likely more influential than potential genetic differences in race, a social construct. The purpose of this article is to describe potential environmental, genetic, and epigenetic determinants of racial/ethnic differences in the sleep-obesity relationship and to review current epidemiological findings regarding either racial/ethnic minority specific estimates of the association or disparities in the relationship. Using the socioecological framework as a conceptual model, I describe sleep and obesity as socially patterned and embedded in modifiable physical and social contexts with common causes that are influenced by upstream social conditions. I also provide examples of sleep and obesity-related studies that correspond with the downstream, intermediate, and upstream factors that likely contribute to commonly observed racial/ethnic disparities in the sleep-obesity relationship. The review concludes with broad recommendations for (1) advancing research methodology for epidemiological studies of disparities in the link between sleep and obesity, (2) future research topics, as well as (3) several broad policies and structures needed to address racial/ethnic disparities in sleep health and obesity.