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Bensa K, Širok K. Is It Time to Re-Shift the Research Agenda? A Scoping Review of Participation Rates in Workplace Health Promotion Programs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032757. [PMID: 36768121 PMCID: PMC9916376 DOI: 10.3390/ijerph20032757] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 06/12/2023]
Abstract
Workplace health promotion programmes (WHPPs) are among the most important measures to improve the health and motivation of the ageing workforce. However, they are accompanied with certain challenges, such as low participation rates and higher participation levels of the more health-conscious workers, often failing to engage those who need such interventions the most. Following the PRISMA guidelines, this scoping review examined participation rates reported in articles on WHPPs to identify potential knowledge gaps. The results are worrying: participation rates are not only infrequently reported, but also low. Of the 58 articles, 37 report participation rates, with the majority (20) reporting an average participation rate of less than 50%. Reported participation rates refer either to different target groups, the type of intervention, or to single points in time, which makes it difficult to establish consistent criteria for comparison. We argue that despite the importance of WHPP efficacy, research focus should shift to the determinants of participation, as well as the issue of standardising the reporting of participation rates, alongside the potential problem of reporting bias.
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Affiliation(s)
- Katarina Bensa
- Faculty of Management, University of Primorska, 6000 Koper, Slovenia
| | - Klemen Širok
- Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia
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Nikniaz L, Tabrizi JS, Farhangi MA, Pourmoradian S, Allameh M, Hoseinifard H, Tahmasebi S, Nikniaz Z. Community-Based Interventions to Reduce Fat Intake in Healthy Populations: A Systematic Review and Meta-Analysis. CURRENT NUTRITION & FOOD SCIENCE 2022. [DOI: 10.2174/1573401318666220308125105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Reducing fat intake is a major focus of most dietary recommendations aiming to prevent chronic diseases. Thus, this study aimed to summarize community-based interventions for reducing fat consumption among healthy people.
Methods:
According to PRISMA guidelines, in this systematic review and meta-analysis databases including PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science, ProQuest, and Google Scholar were searched up to January 2021. Randomized clinical trials (RCTs) or quasi-experimental studies reporting the effect of community-based interventions to reduce fat intake in a healthy populations were included. The quality of studies was assessed using the Cochrane Collaboration tool and The Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis was performed using CMA2 software.
Results:
Our search strategy resulted in a total of 1,621 articles, 43 of which were included in the study after screening. Of the 43 included studies, 35 studies reported a significant decrease in fat intake using educational and multiple intervention methods. About 82% of studies using the technology were effective (significant decrease in fat intake) in reducing fat intake. Moreover, studies specifically designed to change fat intake were more effective than multicomponent interventions. The meta-analysis of high-quality studies showed that the differences in total fat (-0.262 g/d) and saturated fat (-0.350 g/d) intake between the intervention and control groups were statistically significant (P<0.05).
Conclusion:
Based on the high-quality studies, educational and multiple interventions are suggested in the community settings to decrease fat intake. For a concise conclusions, long-term and high frequency interventions focusing on reducing fat intake are desirable.
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Affiliation(s)
- Leila Nikniaz
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Center, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Samira Pourmoradian
- Nutrition research center, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Motahareh Allameh
- Adolescent, Youth and Schools Health Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Hosein Hoseinifard
- MSc in biostatistics, Iranian Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanaz Tahmasebi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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The Effects of Two Workplace Weight Management Programs and Weight Loss on Health Care Utilization and Costs. J Occup Environ Med 2016; 58:162-9. [PMID: 26849260 DOI: 10.1097/jom.0000000000000586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of this study was to compare the impact of two worksite weight management (WM [education] and WM+ [education plus counseling]) programs, on health care utilization and costs. Secondarily, compare the intervention groups to an observational control group of obese workers. Finally, evaluate the impact of actual weight loss on these outcomes. METHODS Estimate the change in the WM and WM+ intervention groups. Using propensity score adjustment compare the two intervention groups with the observational control group; and compare those who lost weight with those who did not. RESULTS No significant differences between the two intervention groups, or between these intervention groups and the observational control group. Those who lost weight reduced their overall health care costs. CONCLUSIONS To achieve weight loss and associated morbidity reductions, more extensive and intensive interventions, with more attention to motivation and compliance, are required.
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Østbye T, Stroo M, Eisenstein EL, Peterson B, Dement J. Is overweight and class I obesity associated with increased health claims costs? Obesity (Silver Spring) 2014; 22:1179-86. [PMID: 24796000 DOI: 10.1002/oby.20669] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Evaluate the relationship between body mass index (BMI) and health claims costs over the last decade, assess the strength and nature of the relationship between BMI and costs, and identify comorbidities that may drive any increased costs. METHODS Using 2001-2011 claims data for employees participating in annual health appraisals, annual paid claims costs were calculated. One-part negative binomial models were fit to evaluate the relationship between BMI and costs, controlling for age, gender, race/ethnicity, and calendar year period. RESULTS The relationship between increasing BMI and increasing health claims costs is gradual and starts already at a BMI of 19. The nature of the relationship did not change notably over time. The most important obesity-related comorbidities, expressed as percent increase in cost per BMI unit, was cardiovascular disease (males 10.53, 95% CI [6.46, 14.77], females 4.27, 95% CI [1.25, 7.38), while cardiovascular agents (7.23, 95% CI [6.08, 8.39]) were the most important driver of pharmacy costs. CONCLUSION In contrast to recent evidence relating to effects on mortality, we observed a gradual increase in health claims costs starting at the low end of the recommended BMI range.
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Leon B, Miller BV, Zalos G, Courville AB, Sumner AE, Powell-Wiley TM, Walter MF, Waclawiw MA, Cannon RO. Weight Loss Programs May Have Beneficial or Adverse Effects on Fat Mass and Insulin Sensitivity in Overweight and Obese Black Women. J Racial Ethn Health Disparities 2014; 1:140-147. [PMID: 25110634 PMCID: PMC4125812 DOI: 10.1007/s40615-014-0006-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/17/2013] [Accepted: 01/02/2014] [Indexed: 12/20/2022]
Abstract
Objective Weight loss interventions have produced little change in insulin sensitivity in black women, but mean data may obscure metabolic benefit to some and adverse effects for others. Accordingly, we analyzed insulin sensitivity relative to fat mass change following a weight loss program. Design and Methods Fifty-four black women (BMI range 25.9 to 54.7 kg/m2) completed the 6-month program that included nutrition information and worksite exercise facilities. Fat mass was measured by dual-energy X-ray absorptiometry, and insulin sensitivity index (SI) was calculated from an insulin-modified intravenous glucose tolerance test using the minimal model. Results Baseline SI (range 0.74 to 7.58 l/mU−1•min−1) was inversely associated with fat mass (r = −0.516, p < 0.001), independent of age. On average, subjects lost fat mass (baseline 40.8 ± 12.4 to 39.4 ± 12.6 kg [mean ± SD], P < 0.01), but 17 women (32 %) actually gained fat mass. SI for the group was unchanged (baseline 3.3 ± 1.7 to 3.2 ± 1.6, P = 0.67). However, the tertile with greatest fat mass loss (−3.6 kg, range −10.7 to −1.7 kg) improved insulin sensitivity (SI +0.3 ± 1.2), whereas the tertile with net fat mass gain (+0.9 kg, range −0.1 to +3.8 kg) had reduced insulin sensitivity (SI −0.7 ± 1.3) from baseline values (P < 0.05 by ANOVA). Conclusions Black women in a weight loss program who lose fat mass may have improved insulin sensitivity, but fat mass gain with diminished sensitivity is common. Additional support for participants who fail to achieve fat mass loss early in an intervention may be required for success.
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Affiliation(s)
- Benjamin Leon
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, Building 10-CRC Room 5-3330, 10 Center Drive, Bethesda, MD 20892 USA
| | - Bernard V. Miller
- Diabetes, Endocrinology and Obesity Branch, Clinical Center; National Institutes of Health, Bethesda, MD USA
| | - Gloria Zalos
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, Building 10-CRC Room 5-3330, 10 Center Drive, Bethesda, MD 20892 USA
| | - Amber B. Courville
- Nutrition Department, Clinical Center; National Institutes of Health, Bethesda, MD USA
| | - Anne E. Sumner
- Diabetes, Endocrinology and Obesity Branch, Clinical Center; National Institutes of Health, Bethesda, MD USA
| | - Tiffany M. Powell-Wiley
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, Building 10-CRC Room 5-3330, 10 Center Drive, Bethesda, MD 20892 USA
| | - Mary F. Walter
- Core for Clinical Laboratory Services, Clinical Center; National Institutes of Health, Bethesda, MD USA
| | - Myron A. Waclawiw
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, MD USA
| | - Richard O. Cannon
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, Building 10-CRC Room 5-3330, 10 Center Drive, Bethesda, MD 20892 USA
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Lemon SC, Wang ML, Wedick NM, Estabrook B, Druker S, Schneider KL, Li W, Pbert L. Weight gain prevention in the school worksite setting: results of a multi-level cluster randomized trial. Prev Med 2014; 60:41-7. [PMID: 24345602 PMCID: PMC3933312 DOI: 10.1016/j.ypmed.2013.12.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/03/2013] [Accepted: 12/07/2013] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Stephenie C Lemon
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Monica L Wang
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Nicole M Wedick
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Barbara Estabrook
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Susan Druker
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Kristin L Schneider
- Rosalind Franklin University of Medicine and Science, Department of Psychology, 3333 Green Bay Road, North Chicago, IL 60064, USA.
| | - Wenjun Li
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Lori Pbert
- University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Department of Medicine, 55 Lake Avenue North, Worcester, MA 01655, USA.
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Carnie A, Lin J, Aicher B, Leon B, Courville AB, Sebring NG, de Jesus J, DellaValle DM, Fitzpatrick BD, Zalos G, Powell-Wiley TM, Chen KY, Cannon RO. Randomized trial of nutrition education added to internet-based information and exercise at the work place for weight loss in a racially diverse population of overweight women. Nutr Diabetes 2013; 3:e98. [PMID: 24366370 PMCID: PMC3877430 DOI: 10.1038/nutd.2013.39] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/03/2013] [Accepted: 10/27/2013] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Obesity in the United States is highly prevalent, approaching 60% for black women. We investigated whether nutrition education sessions at the work place added to internet-based wellness information and exercise resources would facilitate weight and fat mass loss in a racially diverse population of overweight female employees. METHODS A total of 199 (average body mass index 33.9±6.3 kg m(-2)) nondiabetic women (57% black) at our institution were randomized to a 6-month program of either internet-based wellness information (WI) combined with dietitian-led nutrition education group sessions (GS) weekly for 3 months and then monthly with shift in emphasis to weight loss maintenance (n=99) or to WI alone (n=100). All were given access to exercise rooms convenient to their work site. Fat mass was measured by dual-energy X-ray absorptiometry. RESULTS WI+GS subjects lost more weight than WI subjects at 3 months (-2.2±2.8 vs -1.0±3.0 kg, P>0.001). Weight (-2.7±3.9 vs -2.0±3.9 kg) and fat mass (-2.2±3.1 vs -1.7±3.7 kg) loss at 6 months was significant for WI+GS and WI groups (both P<0.001), but without significant difference between groups (both P>0.10); 27% of the WI+GS group achieved 5% loss of initial weight as did 18% of the WI group (P=0.180). Blacks and whites similarly completed the study (67 vs 74%, P=0.303), lost weight (-1.8±3.4 vs -3.3±5.2 kg, P=0.255) and fat mass (-1.6±2.7 vs -2.5±4.3 kg, P=0.532), and achieved 5% loss of initial weight (21 vs 32%, P=0.189), irrespective of group assignment. CONCLUSION Overweight women provided with internet-based wellness information and exercise resources at the work site lost weight and fat mass, with similar achievement by black and white women. Additional weight loss benefit of nutrition education sessions, apparent at 3 months, was lost by 6 months and may require special emphasis on subjects who fail to achieve weight loss goals to show continued value.
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Affiliation(s)
- A Carnie
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - J Lin
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - B Aicher
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - B Leon
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - A B Courville
- Nutrition Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - N G Sebring
- Nutrition Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - J de Jesus
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - D M DellaValle
- Nutrition Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - B D Fitzpatrick
- Nutrition Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - G Zalos
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - T M Powell-Wiley
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - K Y Chen
- Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - R O Cannon
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Østbye T, Stroo M, Brouwer RJN, Peterson BL, Eisenstein EL, Fuemmeler BF, Joyner J, Gulley L, Dement JM. The steps to health employee weight management randomized control trial: rationale, design and baseline characteristics. Contemp Clin Trials 2013; 35:68-76. [PMID: 23648394 DOI: 10.1016/j.cct.2013.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 04/18/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The workplace can be an important setting for addressing obesity. An increasing number of employers offer weight management programs. PURPOSE Present the design, rationale and baseline characteristics of the Steps to Health study (STH), a randomized trial to evaluate the effectiveness of two preexisting employee weight management programs offered at Duke University and Medical Center. METHODS 550 obese (BMI ≥30) employee volunteers were randomized 1:1 to two programs. Baseline data, collected between January 2011 and July 2012, included height/weight, accelerometry, workplace injuries, health care utilization, and questionnaires querying socio-cognitive factors, perceptions of health climate, physical activity, and dietary intake. In secondary analyses participants in the two programs will also be compared to a non-randomized observational control group of obese employees. RESULTS At baseline, the mean age was 45 years, 83% were female, 41% white, and 53% black. Mean BMI was 37.2. Participants consumed a mean of 2.37 servings of fruits and vegetables per day (in the past week), participated in 11.5 min of moderate-to-vigorous physical activity, and spent 620 min being sedentary. CONCLUSION STH addresses the need for evaluation of worksite interventions to promote healthy weight. In addition to having direct positive effects on workers' health, worksite programs have the potential to increase productivity and reduce health care costs.
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Affiliation(s)
- Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Miller PSJ, Biddle EA, van Dongen JM, van Tulder MW, Tompa E, Shemilt I. Economic incentives to enhance safety behaviour in workers for preventing occupational injuries. Hippokratia 2013. [DOI: 10.1002/14651858.cd010474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Paul SJ Miller
- University of Nottingham; School of Community Health Sciences; Nottingham UK
| | - Elyce A Biddle
- National Institute of Occupational Safety and Health; Division of Safety Research; 1095 Willowdale Road Morgantown West Virginia USA 26505
| | - Johanna Maria van Dongen
- VU University; Department of Health Sciences, Faculty of Earth and Life Sciences; De Boelelaan 1085 Amsterdam Netherlands 1081HV
| | - Maurits W van Tulder
- VU University; Department of Health Sciences, Faculty of Earth and Life Sciences; De Boelelaan 1085 Amsterdam Netherlands 1081HV
| | - Emile Tompa
- Institute for Work and Health; 481 University Avenue, Suite 800 Toronto Ontario Canada M5G 2E9
| | - Ian Shemilt
- University of Cambridge; The Primary Care Unit; Institute of Public Health Forvie Site, Robinson Way Cambridge Cambridgeshire UK CB2 0SR
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Salinardi TC, Batra P, Roberts SB, Urban LE, Robinson LM, Pittas AG, Lichtenstein AH, Deckersbach T, Saltzman E, Das SK. Lifestyle intervention reduces body weight and improves cardiometabolic risk factors in worksites. Am J Clin Nutr 2013; 97:667-76. [PMID: 23426035 PMCID: PMC3607649 DOI: 10.3945/ajcn.112.046995] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Worksites are potentially effective locations for obesity control because they provide opportunities for group intervention and social support. Studies are needed to identify effective interventions in these settings. OBJECTIVE We examined the effects of a multicomponent lifestyle intervention on weight loss and prevention of regain in 4 worksites (2 intervention and 2 control sites). DESIGN Overweight and obese employees (n = 133) enrolled in this pilot worksite-randomized controlled trial with a 0-6-mo weight-loss phase and a 6-12-mo structured weight-maintenance phase. The intervention combined recommendations to consume a reduced-energy, low-glycemic load, high-fiber diet with behavioral change education. Outcome measurements included changes in body weight and cardiometabolic risk factors. RESULTS The mean ± SEM weight loss was substantial in intervention participants, whereas control subjects gained weight (-8.0 ± 0.7 compared with +0.9 ± 0.5 kg, respectively; P < 0.001), and 89% of participants completed the weight-loss phase. Intervention effects were not significant at the 0.05 level but would have been at the 0.10 level (P = 0.08) in a mixed model in which the worksite nested within group was a random factor. There were also significant improvements in cardiometabolic risk factors in intervention compared with control subjects regarding fasting total cholesterol, glucose, systolic blood pressure, and diastolic blood pressure (P ≤ 0.02 for each). No significant weight regain was observed in participants who enrolled in the structured weight-maintenance program (0.5 ± 0.7 kg; P = 0.65), and overweight and obese employees in intervention worksites who were not enrolled in the weight-loss program lost weight compared with subjects in control worksites (-1.3 ± 0.5 compared with +0.7 ± 0.2 kg, respectively; P = 0.02). CONCLUSION Worksites can be effective for achieving clinically important reductions in body weight and improved cardiometabolic risk factors. This trial was registered at clinicaltrials.gov as NCT01470222.
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Affiliation(s)
- Taylor C Salinardi
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA
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A "small-changes" workplace weight loss and maintenance program: examination of weight and health outcomes. J Occup Environ Med 2013; 54:1230-8. [PMID: 22995814 DOI: 10.1097/jom.0b013e3182480591] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the effect of "small-changes" and "usual care" workplace interventions on weight loss and to investigate the effect of small changes with or without maintenance on weight and health outcomes. METHODS Overweight/obese employees at two New Zealand worksites received a 12-month usual-care intervention (n = 53), followed by a 12-month small-changes intervention (n = 102). Small changes comprised a 12-week component, followed by 9 months of maintenance, implemented at only one worksite. Magnitudes of effects were assessed via a threshold of -5% (weight loss) and standardization (health outcomes). RESULTS Small changes showed beneficial weight loss relative to usual care in both worksites. For small-changes interventions, worksites reduced weight (12 weeks) and maintained lost weight (12 months). One in every three participants lost 5% or more weight. Some improvements in health outcomes were shown. CONCLUSION Regardless of maintenance, the small-changes intervention was successful in sustaining weight loss.
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Dennis EA, Potter KL, Estabrooks PA, Davy BM. Weight Gain Prevention for College Freshmen: Comparing Two Social Cognitive Theory-Based Interventions with and without Explicit Self-Regulation Training. J Obes 2012; 2012:803769. [PMID: 22778919 PMCID: PMC3384957 DOI: 10.1155/2012/803769] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 03/07/2012] [Accepted: 04/02/2012] [Indexed: 11/23/2022] Open
Abstract
The college transition represents a critical period for maintaining a healthy weight, yet intervention participation and retention represent significant challenges. The objective of this investigation was to evaluate the preliminary efficacy and acceptability of two interventions to prevent freshman weight gain. One intervention provided opportunities to improve outcome expectations and self-efficacy within a social cognitive theory framework (SCT), while the other targeted the same variables but focused on explicit training in self-regulation skills (SCTSR). Methods. Freshmen (n = 45) aged >18 years were randomized to a 14-week intervention, SCT or SCTSR; both included online modules and in-class meetings. Of the 45 students randomized, 5 withdrew before the classes began and 39 completed pre- and posttesting. Primary outcomes included body weight/composition, health behaviors, and program acceptability. Analyses included independent sample t-tests, repeated measures ANOVA, and bivariate correlational analyses. Results. Body weight increased over the 14-week period, but there was no group difference. Percent body fat increased in SCTSR but not SCT (mean difference: SCTSR, +1.63 ± 0.52%; SCT, -0.25 ± 0.45%; P = 0.01). Class attendance was 100% (SCTSR) and 98% (SCT); SCTSR students (>50%) remarked that the online tracking required "too much time." Conclusions. The intervention was well received, although there were no improvements in weight outcomes.
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Affiliation(s)
- Elizabeth A. Dennis
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, 221 Wallace Hall (0430), Blacksburg, VA 24061, USA
| | - Kerry L. Potter
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, 221 Wallace Hall (0430), Blacksburg, VA 24061, USA
| | - Paul A. Estabrooks
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, 221 Wallace Hall (0430), Blacksburg, VA 24061, USA
| | - Brenda M. Davy
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, 221 Wallace Hall (0430), Blacksburg, VA 24061, USA
- *Brenda M. Davy:
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Combining environmental and individual weight management interventions in a work setting: results from the Dow chemical study. J Occup Environ Med 2011; 53:245-52. [PMID: 21346636 DOI: 10.1097/jom.0b013e31820c9023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the comparative effectiveness of environmental weight loss interventions alone versus in combination with an individual intervention. METHODS A quasi-experimental design compared outcomes for two levels of environmental interventions and for participants who did or did not simultaneously self-select into an individually focused weight loss intervention (YW8). Analysis of covariance and logistic regression techniques were used to examine risk outcomes. RESULTS Employees who participated in YW8 were no more successful at losing weight than those exposed to only the environmental interventions. Approximately, 13.5% of each group lost at least 5% of their body weight; overall changes in mean body weight and body mass index were negligible in both groups. CONCLUSIONS Simple worksite environmental modifications may help with weight maintenance, but are not likely to result in substantial weight reductions even when combined with low-intensity individual interventions.
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Effectiveness of Phone and E-Mail Lifestyle Counseling for Long Term Weight Control Among Overweight Employees. J Occup Environ Med 2011; 53:680-6. [DOI: 10.1097/jom.0b013e31821f2bbb] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Quintiliani L, Poulsen S, Sorensen G. Healthy Eating Strategies in the Workplace. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2010; 3:182-196. [PMID: 23935706 PMCID: PMC3737584 DOI: 10.1108/17538351011078929] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE There is a clear link between dietary behavior and a range of chronic diseases, and overweight and obesity constitute an indirect risk in relation to these diseases. The worksite is a central venue for influencing dietary behavior. The purpose of this paper is to provide an overview of workplace influences on worker dietary patterns. DESIGN/METHODOLOGY/APPROACH The paper reviews the evidence of the effectiveness of dietary health promotion, and provides a brief overview of appropriate theoretical frameworks to guide intervention design and evaluation. The findings are illustrated through research examples. FINDINGS Through case studies and published research, it is found that workplace dietary interventions are generally effective, especially fruit and vegetable interventions. There is less consistent evidence on the long term effectiveness of workplace weight management interventions, underscoring the need for further research in this area. This paper also reports evidence that changes in the work environment, including through health and safety programs, may contribute to enhancing the effectiveness of workplace health promotion, including dietary interventions. Organizational factors such as work schedule may also influence dietary patterns. The social ecological model, the social contextual model and political process approach are presented as exemplar conceptual models that may be useful when designing or assessing the effects of workplace health promotion. ORIGINALITY/VALUE Using the worksite as setting for influencing health by influencing dietary patterns holds considerable promise and may be instrumental in reducing workers' risk of chronic diseases.
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Affiliation(s)
- Lisa Quintiliani
- Boston University Medical Center, General Internal Medicine, Boston MA USA,
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Abstract
OBJECTIVE Evaluate innovative, evidence-based approaches to organizational/supportive environmental interventions aimed at reducing the prevalence of obesity among Dow employees after 2 years of implementation. METHODS A quasi-experimental study design compared outcomes for two levels of intervention intensity with a control group. Propensity scores were used to weight baseline differences between intervention and control subjects. Difference-in-differences methods and multilevel modeling were used to control for individual and site-level confounders. RESULTS Intervention participants maintained their weight and body mass index, whereas control participants gained 1.3 pounds and increased their body mass index values by 0.2 over 2 years. Significant differences in blood pressure and cholesterol values were observed when comparing intervention employees with controls. At higher intensity sites, improvements were more pronounced. CONCLUSIONS Environmental interventions at the workplace can support weight management and risk reduction after 2 years.
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Kim Y, Pike J, Adams H, Cross D, Doyle C, Foreyt J. Telephone intervention promoting weight-related health behaviors. Prev Med 2010; 50:112-7. [PMID: 20006642 DOI: 10.1016/j.ypmed.2009.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 11/19/2009] [Accepted: 12/06/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Recent national surveys have documented that the majority of adults in the United States do not meet the recommended levels of healthy lifestyle-related behaviors. The Nutrition and Physical Activity (NuPA) study was designed to promote fruit and vegetable consumption, physical activity, and weight management for a working population. METHOD Data were collected nationwide, USA, from 2005 to 2007 and analyzed in 2008. A total of 2470 employed participants were randomized into the self-help (SH: n=1191) or self-help plus telephone counseling (SH+C: n=1279) group. The SH+C group received nine structured telephone counseling sessions in addition to the print materials. RESULTS A series of hierarchical regression analyses for each of the health behavior outcomes in the present-at-follow-up subsample (n=1098-1148) revealed that the SH+C was effective in increasing fruit and vegetable consumption. Among the overweight and obese participants, weight loss was significant in both the SH and SH+C groups. CONCLUSION Using a theory-based behavioral change counseling technique and targeting multiple health behaviors among employed individuals, our findings demonstrate that the addition of telephone counseling to mailed self-help materials is effective in promoting healthy diet and weight management.
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Affiliation(s)
- Youngmee Kim
- Behavioral Research Center, American Cancer Society, Atlanta, GA, USA.
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Application of the Environmental Assessment Tool (EAT) as a Process Measure for a Worksite Weight Management Intervention. J Occup Environ Med 2010; 52 Suppl 1:S42-51. [DOI: 10.1097/jom.0b013e3181ca3b37] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Racette SB, Deusinger SS, Inman CL, Burlis TL, Highstein GR, Buskirk TD, Steger-May K, Peterson LR. Worksite Opportunities for Wellness (WOW): effects on cardiovascular disease risk factors after 1 year. Prev Med 2009; 49:108-14. [PMID: 19576927 PMCID: PMC4399499 DOI: 10.1016/j.ypmed.2009.06.022] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 06/24/2009] [Accepted: 06/25/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors. METHODS In St Louis, Missouri from 2005 to 2006, 151 employees (134 F, 17 M, 81% overweight/obese) participated in a cohort-randomized trial comparing assessments + intervention (worksite A) with assessments only (worksite B) for 1 year. All participants received personal health reports containing their assessment results. The intervention was designed to promote physical activity and favorable dietary patterns using pedometers, healthy snack cart, WeightWatchers(R) meetings, group exercise classes, seminars, team competitions, and participation rewards. Outcomes included BMI, body composition, blood pressure, fitness, lipids, and Framingham 10-year coronary heart disease risk. RESULTS 123 participants, aged 45+/-9 yr, with BMI 32.9+/-8.8 kg/m(2) completed 1 year. Improvements (P< or =0.05) were observed at both worksites for fitness, blood pressure, and total-, HDL-, and LDL-cholesterol. Additional improvements occurred at worksite A in BMI, fat mass, Framingham risk score, and prevalence of the metabolic syndrome; only the changes in BMI and fat mass were different between worksites. CONCLUSION A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors, but many of the improvements were achieved with worksite health assessments and personalized health reports in the absence of an intervention.
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Affiliation(s)
- Susan B Racette
- Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Avenue, St. Louis, MO 63108-2212, USA.
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Sternfeld B, Block C, Quesenberry CP, Block TJ, Husson G, Norris JC, Nelson M, Block G. Improving diet and physical activity with ALIVE: a worksite randomized trial. Am J Prev Med 2009; 36:475-83. [PMID: 19460655 DOI: 10.1016/j.amepre.2009.01.036] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 12/09/2008] [Accepted: 01/31/2009] [Indexed: 11/28/2022]
Abstract
CONTEXT Healthy diets and regular physical activity confer many health benefits, but the prevalence of these behaviors is relatively low. BACKGROUND Cost-effective strategies are needed to increase healthy eating and physical activity in the population. DESIGN An RCT, conducted in 2006, of a 16-week e-mail program offered individually tailored, small-step goals; a personal homepage with tips; educational materials; and tracking and simulation tools. SETTING/POPULATION Seven hundred eighty-seven employees in the administrative offices of a large healthcare organization volunteered to participate. MAIN OUTCOME MEASURES Changes were self-reported for total physical activity; moderate physical activity (MPA); vigorous physical activity (VPA); walking; sedentary behavior; and intake of fruits and vegetables, saturated and trans fats, and added sugars in the intervention group compared to the control group. RESULTS In intent-to-treat analyses (conducted in 2007 and 2008) that set change in nonresponders to the follow-up questionnaire to zero, the intervention group reported increases of 28.0 minutes/week (min/wk) of MPA (SE=7.4, p=0.0002); 12.5 min/wk of VPA (SE=5.7, p=0.03); and 21.5 min/wk of walking (SE=5.5, p=0.0003) relative to the control group. Intake of both saturated and trans fats (grams/day [g/day]) declined (beta=-0.95, SE=0.36, p=0.01; beta=-0.29, SE=0.12, p=0.02, respectively). The consumption of fruits and vegetables increased significantly (p=0.03), and the consumption of added sugars decreased marginally (p=0.08). The largest changes were in participants who did not meet behavioral recommendations at baseline (increase of 55.4 min/wk of MPA and decrease of 1.15 g/day of trans fats, relative to the control group). Differences between the intervention and control groups were still observed 4 months after the intervention ended. CONCLUSIONS ALIVE is an effective program for achieving significant improvement in diet and physical activity. TRIAL REGISTRATION NCT00607009.
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Affiliation(s)
- Barbara Sternfeld
- Division of Research, Kaiser Permanente, Oakland, California 94612, USA.
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Goetzel RZ, Baker KM, Short ME, Pei X, Ozminkowski RJ, Wang S, Bowen JD, Roemer EC, Craun BA, Tully KJ, Baase CM, DeJoy DM, Wilson MG. First-year results of an obesity prevention program at The Dow Chemical Company. J Occup Environ Med 2009; 51:125-38. [PMID: 19209033 PMCID: PMC2877035 DOI: 10.1097/jom.0b013e3181954b03] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine first-year results from a workplace environmental obesity prevention program at The Dow Chemical Company. METHODS A quasi-experimental cohort study was conducted among employees at nine treatment worksites (n = 8013) who received environmental weight management interventions and three control worksites (n = 2269). Changes in employees' weight, body mass index (BMI), and other health risks were examined using chi2 and t-tests. RESULTS After 1 year, a modest treatment effect was observed for weight and BMI largely because the control group subjects gained weight; however, no effect was observed for overweight and obesity prevalence. Other risk factors (tobacco use, high blood pressure, and systolic and diastolic blood pressure values) decreased significantly, although blood glucose (high risk prevalence and values) increased. CONCLUSIONS Environmental changes to the workplace can achieve modest improvements in employees' health risks, including weight and BMI measures, in 1 year.
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Affiliation(s)
- Ron Z Goetzel
- Institute for Health and Productivity Studies, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Abstract
OBJECTIVE To evaluate an employee Internet-based weight management program. METHODS Changes in eating habits, stage of change, body weight, and weight categories were compared between enrollment and 6 months after enrollment. Weights and weight categories were compared among a subset of participants and non-participants at 12 months. RESULTS Seven thousand seven hundred forty-three International Business Machines employees enrolled in the program between December 2004 and February 2006, and 74% were overweight or obese (body mass index > or =25). At 6 months, follow-up survey respondents (1639) had significantly increased most healthy eating habits (eg, 20% decrease in junk foods) and the frequency of healthy foods eaten (eg, 12% increase in fruits). The percentage of participants in the normal weight category had increased from 27.0% to 29.8%, while average weight decreased from 182.6 to 180.2 lbs (P < 0.05). Increased web site usage was associated with increased weight loss and stage of change improvements. At 12 months, a higher percentage of participants had moved into the normal weight category compared with the percentage of non-participants (+2.0% points; P < 0.05), although there were no differences in average weight change. CONCLUSIONS Despite issues of limited penetration and potential self-selection, this Internet-based program had utility in reaching a large number of employees in dispersed work settings, and it led to improved eating habits and improved stage of change at 6 months and more individuals moving into the normal weight category at 6 and 12 months.
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Lemmens VEPP, Oenema A, Klepp KI, Henriksen HB, Brug J. A systematic review of the evidence regarding efficacy of obesity prevention interventions among adults. Obes Rev 2008; 9:446-55. [PMID: 18298429 DOI: 10.1111/j.1467-789x.2008.00468.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the past, interventions aimed at reducing obesity have mainly targeted at weight loss treatment in obese adults, with limited long-term effects. With the increasing number of people being obese and being at risk for obesity, there has been a shift in focus towards prevention of obesity. We conducted a systematic review of the peer-reviewed literature on the efficacy of obesity prevention interventions in adults in order to identify effective interventions and intervention elements. Pubmed, OVID, and Web of Science databases were searched from January 1996 to June 2006. Interventions aimed at primary prevention of weight gain among adults achieved by focusing on dietary intake, physical activity or the combination of both were included. The outcome measure had to be difference in change in body mass index or body weight between the intervention and the control groups. Nine studies were included, five long-term studies (at least 1 year) and four short-term (3 months to 1 year). Seven studies evaluated an intervention that focused on a combination of diet and physical activity to prevent weight gain, one on diet only and one on physical activity only. One dietary intervention (long-term), and three combined dietary and physical activity interventions (one long-term and two short-term) produced significantly positive results at end of follow-up. The two long-term, effective interventions consisted of intensive and long-term intervention implementation, including groups sessions designed to promote behavioural changes. The current evidence of efficacy of obesity prevention interventions is based on a very small number of studies. Some studies showed a positive impact on body mass index or weight status, but there was too much heterogeneity in terms of study design, theoretical underpinning and target population to draw firm conclusions about which intervention approaches are more effective than others. More research is urgently needed to extend the body of evidence.
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Affiliation(s)
- V E P P Lemmens
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands.
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Using a Return-On-Investment Estimation Model to Evaluate Outcomes From an Obesity Management Worksite Health Promotion Program. J Occup Environ Med 2008; 50:981-90. [DOI: 10.1097/jom.0b013e318184a489] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Makrides L, Dagenais GR, Chockalingam A, LeLorier J, Kishchuk N, Richard J, Stewart J, Chin C, Alloul K, Veinot P. Evaluation of a workplace health program to reduce coronary risk factors. ACTA ACUST UNITED AC 2008. [DOI: 10.1108/14777270810867294] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dejoy DM, Wilson MG, Goetzel RZ, Ozminkowski RJ, Wang S, Baker KM, Bowen HM, Tully KJ. Development of the Environmental Assessment Tool (EAT) to measure organizational physical and social support for worksite obesity prevention programs. J Occup Environ Med 2008; 50:126-37. [PMID: 18301169 PMCID: PMC2917629 DOI: 10.1097/jom.0b013e318161b42a] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the development, reliability, and validity of the Environmental Assessment Tool (EAT) for assessing worksite physical and social environmental support for obesity prevention. METHODS The EAT was developed using a multistep process. Inter-rater reliability was estimated via Kappa and other measures. Concurrent and predictive validity were estimated using site-level correlations and person-level multiple regression analyses comparing EAT scores and employee absenteeism and health care expenditures. RESULTS Results show high inter-rater reliability and concurrent validity for many measures and predictive validity for absenteeism expenditures. CONCLUSIONS The primary use of the EAT is as a physical and social environment assessment tool for worksite obesity prevention efforts. It can be used as a reliable and valid means to estimate relationships between environmental interventions and absenteeism and medical expenditures, provided those expenditures are for the same year that the EAT is administered.
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Affiliation(s)
- David M Dejoy
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA 30602-6522, USA.
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Culos-Reed SN, Doyle-Baker PK, Paskevich D, Devonish JA, Reimer RA. Evaluation of a community-based weight control program. Physiol Behav 2007; 92:855-60. [PMID: 17619026 DOI: 10.1016/j.physbeh.2007.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 05/31/2007] [Accepted: 06/11/2007] [Indexed: 01/22/2023]
Abstract
Overweight and obesity result from a complex interaction of behavioral, environmental, and genetic factors. The present study reports on the efficacy of a community-based weight control program in 31 overweight and obese adults. TrymGym is a multi-dimensional lifestyle behavior change program for improving both diet and physical activity (PA) related behavior with education and cognitive behavioral training. The program was evaluated using nutritional, physiological, and physical activity-related psychological factors before and after the 12 week program. Paired sample t-tests were conducted to identify significant changes. Body weight (BW) and diastolic blood pressure decreased by 3.6 and 6.4% respectively in completers of the study. Waist and hip circumferences decreased by 4.1 and 5.7% respectively. Caloric intake decreased from 1994+/-146 at baseline to 1768+/-144 in completers of the study. There was also a significant 5.2% decrease in the percentage of calories derived from fat and a 4% increase in percent of calories from protein. Although intake of vitamin C was increased at the end of the study, intake of several other micronutrients at baseline did not meet Dietary Reference Intake recommendations and were further compromised at week 12. Despite a trend toward increased participation in leisure-time and strenuous PA there was a decrease in behavioral intention to participate in future PA. Overall, this community-based weight control program was effective in fostering a significant improvement in BW, anthropometric measurements, participation in PA, and nutritional intake.
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Affiliation(s)
- S Nicole Culos-Reed
- University of Calgary, Faculty of Kinesiology, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
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Beresford SAA, Locke E, Bishop S, West B, McGregor BA, Bruemmer B, Duncan GE, Thompson B. Worksite study promoting activity and changes in eating (PACE): design and baseline results. Obesity (Silver Spring) 2007; 15 Suppl 1:4S-15S. [PMID: 18073337 DOI: 10.1038/oby.2007.383] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Based on previous worksite-wide intervention studies and an ecological framework, we created a behavioral intervention program to maintain or reduce weight through healthy eating and physical activity. The design and evaluation plan of the group-randomized trial and the recruitment of worksites are described. Preliminary results regarding the dietary and physical activity behaviors associated with BMI are discussed. RESEARCH METHODS AND PROCEDURES The intervention used an ecological framework modified by qualitative methods that identified salient barriers and facilitators of behavioral change. Approximately 30 transportation, manufacturing, utilities, personal, household, and miscellaneous service companies in the greater Seattle area are being recruited to the trial. The study population for the present analysis consists of 18 worksites from the first two randomization waves. Dietary behavior was assessed, not by calories, but by behavioral measures related to BMI. Physical activity behaviors were surveyed. BMI is derived from reported height and weight at baseline. RESULTS The intervention has been developed with a specified minimum suite of strategies within the defined framework. Response rates to the baseline survey among the 18 worksites are 81% on average. After adjusting for age, gender, race, and education, BMI was associated with frequency of intensity-adjusted physical activity, sweat-inducing exercise, fast food meals, soft drinks, eating while doing another activity, and fruit and vegetable intake. DISCUSSION Worksite-wide intervention strategies can be adapted to target obesity prevention. Employees are willing to participate in surveys at high rates. Several measures of physical activity and eating choices are associated with baseline BMI.
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Affiliation(s)
- Shirley A A Beresford
- Department of Epidemiology, University of Washington, Box 357236, Seattle, WA 98195-7236, USA.
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Vargas PA, Perry TT, Robles E, Jo CH, Simpson PM, Magee JM, Feild CR, Hakkak R, Carroll PA, Jones SM. Relationship of body mass index with asthma indicators in head start children. Ann Allergy Asthma Immunol 2007; 99:22-8. [PMID: 17650825 DOI: 10.1016/s1081-1206(10)60616-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the relationship of body mass index (BMI) and asthma indicators on children with asthma in a Head Start (HS) program. METHODS In this cross-sectional study (November 18, 2000, to December 12, 2003) of children aged 3 to 5 years with asthma, we compared the BMI data of HS asthmatic patients (n = 213) with the data of peer control subjects from a sample (n = 816) of the National Health and Nutrition Examination Survey aged 3 to 5 years and with children in prekindergarten in Arkansas public schools (n = 1,024). Parental reports of asthma symptoms, health care use, medication use, school days missed, and quality of life were used as indicators of asthma morbidity. Categorical analysis and chi2 tests were performed to examine the relationship between BMI and asthma morbidity. RESULTS The prevalence of overweight (> or =95th percentile) was significantly higher in HS children with asthma compared with the National Health and Nutrition Examination Survey children (P < .001) and Arkansas prekindergarten children (P = .05). Compared with HS asthmatic children with a BMI less than the 85th percentile, HS asthmatic patients with a BMI of the 85th percentile or greater reported significantly more school days missed (P = .02), lifetime hospitalizations (P = .04), emergency department visits (P = .02), and activity limitations (P = .03) and fewer oral corticosteroid bursts (P = .04). There was also a trend for more daytime symptoms (P = .05) and lower quality of life (P = .06). No differences were observed in rescue (P = .28) or controller (P = .47) medications, environmental tobacco smoke exposure (P = .47), positive allergy test results (P = .85), and nighttime symptoms (P > .99). CONCLUSIONS Having an increased BMI was associated with more asthma morbidity in this group of HS asthmatic patients. Despite the lack of a clear explanation for the link between asthma and BMI, our data suggest that an increased BMI significantly affects the well-being of young asthmatic patients and should be further addressed.
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Affiliation(s)
- Perla A Vargas
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock 72202-3591, USA.
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Pratt CA, Lemon SC, Fernandez ID, Goetzel R, Beresford SA, French SA, Stevens VJ, Vogt TM, Webber LS. Design characteristics of worksite environmental interventions for obesity prevention. Obesity (Silver Spring) 2007; 15:2171-80. [PMID: 17890484 DOI: 10.1038/oby.2007.258] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This paper describes the design characteristics of the National Heart, Lung, and Blood Institute (NHLBI)-funded studies that are testing innovative environmental interventions for weight control and obesity prevention at worksites. RESEARCH METHODS AND PROCEDURES Seven separate studies that have a total of 114 worksites ( approximately 48,000 employees) across studies are being conducted. The worksite settings include hotels, hospitals, manufacturing facilities, businesses, schools, and bus garages located across the U.S. Each study uses its own conceptual model drawn from the literature and includes the socio-ecological model for health promotion, the epidemiological triad, and those integrating organizational and social contexts. The interventions, which are offered to all employees, include environmental- and individual-level approaches to improve physical activity and promote healthful eating practices. Environmental strategies include reducing portion sizes, modifying cafeteria recipes to lower their fat contents, and increasing the accessibility of fitness equipment at the workplace. Across all seven studies about 48% (N = 23,000) of the population is randomly selected for measurements. The primary outcome measure is change in BMI or body weight after two years of intervention. Secondary measures include waist circumference, objective, and self-report measures of physical activity, dietary intake, changes in vending machines and cafeteria food offerings, work productivity, healthcare use, and return on investment. DISCUSSION The results of these studies could have important implications for the design and implementation of worksite overweight and obesity control programs.
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Affiliation(s)
- Charlotte A Pratt
- National Heart, Lung, and Blood Institute, Division of Epidemiology and Clinical Applications, 6701 Rockledge Drive, MSC 7936, Room 10118, Bethesda, MD 20892, USA.
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Arena VC, Padiyar KR, Burton WN, Schwerha JJ. The impact of body mass index on short-term disability in the workplace. J Occup Environ Med 2007; 48:1118-24. [PMID: 17099447 DOI: 10.1097/01.jom.0000241050.26059.2b] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to assess the association between body mass index and short-term disability in a working "white collar" population. METHODS The authors collected cross-sectional data from 19,061 health risk appraisals completed by employees of a large financial services corporation from 2000-2002. The self-reported information for demographics and job satisfaction was combined with personnel and detailed information from short-term disability events (STD) taken during the same time period. RESULTS After adjusting for multiple covariates, body mass index is an independent predictor for STD events. Body mass index categories of overweight and obese have odds ratios of 1.26 and 1.76 compared with normal weight (P < 0.0001). CONCLUSIONS The improvement of employee health and wellness should be pursued by the employer in an effort to promote healthier weight among their workers. This in turn should reduce STD events that result in the loss of worker productivity and a major cost to companies.
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Affiliation(s)
- Vincent C Arena
- Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
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Windyga P, Kim K, White V, Leon M, Bag A, Chen W. Cost-return prediction in morbidly obese employees following weight loss interventions: a study framework. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2007; 2007:1766-1769. [PMID: 18002319 DOI: 10.1109/iembs.2007.4352653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Obesity and its many complications potentially can collapse most medical plans, unless attempts at prevention and therapy become more effective and widespread. An important incentive for providing effective treatment is proper reimbursement. We present here an evaluation of the feasibility, constrains and requirements for comparative cost-effectiveness evaluation of weight loss intervention from the payer's and employer's points of view, and propose a general framework for this type of studies toward decision making.
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Affiliation(s)
- Piotr Windyga
- School of Electrical Engineering and Computer Science, University of Central Florida, Orlando, FL, USA.
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Kwak L, Kremers SPJ, van Baak MA, Brug J. Participation rates in worksite-based intervention studies: health promotion context as a crucial quality criterion. Health Promot Int 2005; 21:66-9. [PMID: 16339773 DOI: 10.1093/heapro/dai033] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Recently, a set of specific quality evaluation criteria for health promotion research has been proposed in this journal. One of the quality criteria identified is the 'health promotion context'. With this paper we would like to contribute to the dialogue by specifying the importance of this criterion on the basis of our on experience with worksite-based obesity prevention interventions. We advocate the reporting of participation rates among approached worksites in publications on worksite intervention effects. Such information will help to draw conclusions on the practical relevance of the shown effectiveness of the intervention. Health promotion practice is advised to adopt and disseminate evidence-based interventions, accompanied by a diffusion study with a minimal research burden for participants.
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Serxner S, Anderson DR, Gold D. Building program participation: strategies for recruitment and retention in worksite health promotion programs. Am J Health Promot 2004; 18:1-6, iii. [PMID: 15011935 DOI: 10.4278/0890-1171-18.4.tahp-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Building program participation is vital for all health promotion programs. There are a large variety of strategies that have been used to enhance recruitment and retention in worksite health promotion programs. Many of these strategies are examined and their significance in the design and operation of health promotion programs in worksite settings is reviewed.
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Hoke CN, Franks S. Work site, physician's office, or medical university clinic: the effect of setting on success in a multidisciplinary weight-loss program. Eat Behav 2004; 3:93-100. [PMID: 15001023 DOI: 10.1016/s1471-0153(01)00053-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The effect of treatment setting on success in a 16-week multidisciplinary cognitive-behavioral weight-management program was examined. Twenty-seven women and six men with an average initial weight of 198.13 lb (+/-39.10) participated in the program at a medical university (MU), their primary care physician's office (PCP), or their work site (WS). The average amount of weight lost, body mass index (BMI) decrement, and number of sessions attended were compared as measures of success between programs. Results supported the hypothesis that treatment setting affects program success [F(6,40)=0.54, P<.05]. WS was more effective than PCP [Wilk's lambda=0.59, P<.05] in promoting weight loss [F(1,2)=5.22, P<.05]. Results indicate that the ongoing contingencies in the WS environment promote weight loss through more consistent adherence to suggested weight-loss strategies.
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Affiliation(s)
- Cassandra N Hoke
- Department of Psychology, University of North Texas, Terrill Hall, P.O. Box 311280, Denton, TX 76203-1280, USA.
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McKeown E, Barkauskas V, Quinn A, Kresowaty J. Occupational nursing service in a small manufacturing plant: interventions and outcomes. INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATIONS : THE OFFICIAL JOURNAL OF NANDA INTERNATIONAL 2003; 14:125-35. [PMID: 14768128 DOI: 10.1111/j.1744-618x.2003.00125.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
PURPOSE To describe the health needs presented by workers in a small industrial setting, describe the occupational health nursing (OHN) services provided, and examine the effectiveness of these services. METHODS Data were abstracted from 491 employee records accumulated over a 7-year service period. Standardized nursing languages were used to describe employee needs and nursing interventions. FINDINGS Data revealed 1,368 needs were identified and 3,193 nursing interventions were administered. Health-seeking behaviors, knowledge deficit, collaborative problems, risk of infection, and impaired tissue integrity seemed most amenable to change in the context of OHN services. Altered health maintenance was the problem that seemed least amenable to change. CONCLUSIONS Findings present a dynamic picture of OHN services provided in an OHN program and their effectiveness. Standardized nursing languages were effective and appropriate in describing the health issues managed and interventions applied. PRACTICE IMPLICATIONS Further use of standardized nursing languages in occupation health can establish core functions and knowledge base.
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Affiliation(s)
- Elaine McKeown
- St. Joseph Mercy Health System, Washtenaw Community College, Ann Arbor, MI, USA.
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Leslie WS, Lean MEJ, Baillie HM, Hankey CR. Weight management: a comparison of existing dietary approaches in a work-site setting. Int J Obes (Lond) 2002; 26:1469-75. [PMID: 12439649 DOI: 10.1038/sj.ijo.0802153] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2001] [Revised: 06/11/2002] [Accepted: 06/14/2002] [Indexed: 11/09/2022]
Abstract
OBJECTIVES (1). To compare the effectiveness a 2512 kJ (600 kcal) daily energy deficit diet (ED) with a 6279 kJ (1500 kcal) generalized low-calorie diet (GLC) over a 24 week period (12 weeks weight loss plus 12 weeks weight maintenance). (2). To determine if the inclusion of lean red meat at least five times per week as part of a slimming diet is compatible with weight loss in comparison with a diet that excludes lean red meat. DESIGN Randomized controlled trial. SETTING Large petrochemical work-site. PARTICIPANTS One-hundred and twenty-two men aged between 18 and 55 y. MAIN OUTCOME MEASURES Weight loss and maintenance of weight loss. INTERVENTION Eligible volunteers were randomized to one of the four diet/meat combinations (ED meat, ED no meat, GLC meat, GLC no meat). One-third of subjects in each diet/meat combination were randomized to an initial control period prior to receiving dietary advice. All subjects attended for review every 2 weeks during the weight loss period. For the 12 week structured weight maintenance phase, individualized energy prescriptions were re-calculated for the ED group as 1.4 (activity factor) x basal metabolic rate. Healthy eating advice was reviewed with subjects in the GLC group. All subjects were contacted by electronic mail at 2 week intervals and anthropometric and dietary information requested. RESULTS No difference was evident between diet groups in mean weight loss at 12 weeks (4.3 (s.d. 3.4) kg ED group vs 5.0 (s.d. 3.5) kg GLC group, P=0.34). Mean weight loss was closer to the intended weight loss in the 2512 kJ (600 kcal) ED group. The dropout rate was also lower than the GLC group. The inclusion of lean red meat in the diet on at least five occasions per week did not impair weight loss. Mean weight gain following 12 weeks weight maintenance was +1.1 (s.d. 1.8) kg, P<0.0001. No differences were found between groups. CONCLUSIONS This study has shown that the individualized 2512 kJ (600 kcal) ED approach was no more effective in terms of weight loss than the 6279 kJ (1500 kcal) GLC approach. However the ED approach might be considered preferable as compliance was better with this less demanding prescription. In terms of weight loss the elimination of red meat from the diet is unnecessary. The weight maintenance intervention was designed as a low-input approach, however weight regain was significant and weight maintenance strategies require further development.
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Affiliation(s)
- W S Leslie
- University of Glasgow Department of Human Nutrition, Glasgow Royal Infirmary, Glasgow, UK.
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Hagihara A, Tarumi K, Nobutomo K. Grouping participants for tailored work-site weight loss programs: a signal detection approach. Am J Ind Med 2002; 41:269-78. [PMID: 11920970 DOI: 10.1002/ajim.10059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although work-site obesity prevention programs have been widely promoted, they have a high rate of attrition and participants find it very difficult to maintain the decreased weight. It is necessary to develop effective work-site programs that match the type of intervention to the participants and offer the necessary support. To this end, higher-order interaction of the causal factors of obesity needs to be analyzed. METHODS The subjects were male, white-collar workers (20-64 years of age), in Osaka, Japan. Since conventional methods, such as regression analysis or analysis of variance, cannot deal with the interaction of many variables, signal detection analysis by Kraemer was used to identify the higher-order interaction of multiple predictors of obesity. RESULTS Out of 15 independent variables, a higher-order interaction consisting of 8 significant variables was identified. Consequently, the subjects were categorized into nine subgroups. It was revealed that the obesity of two groups of workers, 40 or more years old with a high degree of obesity, had different causes: one was related to working conditions, and one was related to smoking cessation. For the other terminal groups, further factors related to obesity were revealed. CONCLUSION Although the applicability of the findings is limited, the methodology using signal detection analysis might be applicable to other weight loss programs as a way of facilitating the matching of the type of intervention and the target group.
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Affiliation(s)
- Akihito Hagihara
- Kyushu University Graduate School of Medicine, Department of Health Services Management and Policy, Higashi-ku, Fukuoka 812-8582, Japan.
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National Health Expenditure Account of Korea: Sources and Estimation Methods. HEALTH POLICY AND MANAGEMENT 2002. [DOI: 10.4332/kjhpa.2002.12.1.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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A Review for the Factors Affecting the Effects of Health Promotion Programs. HEALTH POLICY AND MANAGEMENT 2002. [DOI: 10.4332/kjhpa.2002.12.1.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Muto T, Yamauchi K. Evaluation of a multicomponent workplace health promotion program conducted in Japan for improving employees' cardiovascular disease risk factors. Prev Med 2001; 33:571-7. [PMID: 11716652 DOI: 10.1006/pmed.2001.0923] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The long-term effectiveness of multicomponent worksite health promotion programs targeting cardiovascular disease risk factors remains unclear in Japan. This study was conducted to evaluate the effectiveness of such a health promotion program consisting of a main program provided over 4 days and a follow-up program provided over 1 year. METHODS The subjects of this randomized controlled trial were male employees working for a building maintenance company in Japan. The intervention group (n = 152) and the control group (n = 150) consisted of employees having abnormal findings in at least one of the following items at baseline health examination: body mass index (BMI), systolic (SBP) or diastolic blood pressure, total cholesterol, HDL cholesterol, triglycerides, and fasting blood glucose. Evaluation was conducted at 18 months after the main program. RESULTS BMI, SBP, total cholesterol, and triglycerides improved significantly in the intervention group compared with the control group (P < 0.05). When comparisons were limited to those who showed abnormality at baseline, BMI, total cholesterol, and triglycerides improved significantly in the intervention group (P < 0.05). CONCLUSIONS The multicomponent health promotion program provided to employees was shown to be effective in improving obesity, high blood pressure, and hyperlipidemia when evaluated 18 months after the main intervention program.
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Affiliation(s)
- T Muto
- Department of Public Health, Juntendo University School of Medicine, Tokyo, 113-8421, Japan.
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Heetderks-Cox MJ, Alford BB, Bednar CM, Heiss CJ, Tauai LA, Edgren KK. CD-ROM nutrient analysis database assists self-monitoring behavior of active duty Air Force personnel receiving nutrition counseling for weight loss. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2001; 101:1041-6. [PMID: 11573756 DOI: 10.1016/s0002-8223(01)00255-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study observed the effect of using a computerized vs manual method of self-monitoring among Air Force personnel receiving nutrition counseling for weight loss. Subjects who enrolled during the first 2 weeks of the 4-week recruitment period completed food records for 6 weeks using a CD-ROM nutrient database (intervention group) whereas those who enrolled during the last 2 weeks used a food record booklet (comparison group). Of the 42 subjects (n = 23 intervention group and n = 19 comparison group), only 113 intervention and 11 comparison group subjects (57% of study enrollees) submitted at least 1 food record during the study and were included in the analysis, which included review of pre- and poststudy questionnaires, food records, and focus group data. There were no significant differences between the number of days per week documented or average number of items recorded daily. All 9 intervention as compared to 2 comparison group subjects who completed a poststudy questionnaire searched for lower-energy and lower-fat items and reported changing their dietary intake as a result. All intervention group subjects who participated in a focus group (n=6) had favorable comments about using the CD-ROM for monitoring and changing eating habits, indicating that it is a beneficial self-monitoring tool. Participants enjoyed the immediate dietary feedback, and computerized food records may be easier to interpret by nutrition counselors. A number of computerized nutrient databases are available to assist patients and consumers in managing nutritional concerns.
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Affiliation(s)
- M J Heetderks-Cox
- Department of Nutrition and Food Sciences, Texas Woman's University, Denton, USA
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Leutzinger JA, Ozminkowski RJ, Dunn RL, Goetzel RZ, Richling DE, Stewart M, Whitmer RW. Projecting future medical care costs using four scenarios of lifestyle risk rates. Am J Health Promot 2000; 15:35-44. [PMID: 11184117 DOI: 10.4278/0890-1171-15.1.35] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study predicts medical care expenditures over 10 years for Union Pacific Railroad (UPRR) under alternative health risk factor scenarios for the UPRR workforce. DESIGN This paper describes the development of an economic forecasting model to predict medical care expenditures assuming four different scenarios of population risk. The variables used to predict medical care expenditures are employee demographics and health risk profiles. SETTING UPRR is a transportation company with more than 56,000 employees in 25 states west and south of the Mississippi River. SUBJECTS Employees of UPRR. MEASURES Intermediate outcomes included health risk measures related to exercise patterns, body weight, eating habits, smoking, alcohol consumption, total cholesterol, blood glucose, blood pressure, stress, and depression. Major outcome measures included projected total annual payments by UPRR for medical care services for the decade following 1998. RESULTS The UPRR work force is projected to grow by 500 employees per year over the 10-year study period. The average age is expected to increase from 44 to 48 years. Without further health promotion intervention, 7 of the 11 risk factors assessed would likely worsen among UPRR's workforce. Medical care cost increases are projected to range from $22.2 million to $99.6 million in constant 1998 dollars over the next decade, depending on the effectiveness of risk factor modification programs. With an expected health promotion budget averaging $1.9 million annually over 10 years, health risks must decline at least 0.09% per year for the program to pay for itself. CONCLUSIONS Estimating various risk and cost scenarios can facilitate program planning and produce an economic justification for worksite health programs.
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Abstract
Managed care has become the predominant form of health insurance in the United States. With its features of capitation, provider monetary risk, and population perspective, managed care represents a huge growth opportunity for advocates of disease prevention and health promotion, including those in the field of health education. In reality, however, health education's role has fallen far short of expectations. This article is presented to initiate a dialogue on the role of health education and its subset, worksite health promotion, within managed care. The worksite is emphasized because of its attractiveness as a site in delivering population-based medicine. Furthermore, employers exercise considerable influence in shaping the health care marketplace. A list of recommendations is presented, offering suggestions on what health education needs to do to increase its impact in the managed care movement. These arguments are posed to better position this profession in a changing health care environment.
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Affiliation(s)
- T Golaszewski
- Department of Health Science, SUNY Brockport, New York 14420, USA.
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Schmitz MK, Jeffery RW. Public health interventions for the prevention and treatment of obesity. Med Clin North Am 2000; 84:491-512, viii. [PMID: 10793654 DOI: 10.1016/s0025-7125(05)70233-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Epidemic obesity is one of the few undesirable consequences of humanity's mastery of the environment. This article reviews public health approaches to preventing and treating obesity. The most encouraging efforts to date have been interventions targeting children in both medical and community surroundings. Treating and preventing obesity in adults has been less successful. It is suggested that taking an environmental health perspective on the obesity problem may facilitate the advancement of scientific understanding of this important health issue.
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Affiliation(s)
- M K Schmitz
- Division of Epidemiology, University of Minnesota, School of Public Health, Minneapolis, USA
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Steinhardt MA, Bezner JR, Adams TB. Outcomes of a traditional weight control program and a nondiet alternative: a one-year comparison. THE JOURNAL OF PSYCHOLOGY 1999; 133:495-513. [PMID: 10507139 DOI: 10.1080/00223989909599758] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The purpose of this study was to evaluate the effectiveness of a traditional weight control program and nondiet alternative in improving behavioral (e.g., restrained, emotional, and external eating), psychological (e.g., body preoccupation, physical self-esteem), and biomedical (e.g., body weight, blood pressure, cholesterol) outcomes. There were 2 intervention groups--traditional weight control (TWC) and Diet Free Forever (DFF); a nonvolunteer comparison group; and a control group, all made up of employees of 3M (N = 357). The 2 intervention groups participated in 10-week eating programs. Outcome variables were assessed at baseline, at 10 weeks for the intervention groups only, and again at 1 year. At baseline, the 2 intervention groups had higher restrained, external, and emotional eating scores, greater body preoccupation, and lower physical self-esteem than the comparison and control groups. They also weighed more. At 1 year, both intervention groups had decreased their body preoccupation and increased their physical self-esteem. Participants in the DFF program reduced their restrained eating, whereas those in the TWC program increased their restrained eating. Neither eating program had an impact on the biomedical outcomes.
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Affiliation(s)
- M A Steinhardt
- Department of Kinesiology and Health Education, University of Texas, USA
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Buller DB, Morrill C, Taren D, Aickin M, Sennott-Miller L, Buller MK, Larkey L, Alatorre C, Wentzel TM. Randomized trial testing the effect of peer education at increasing fruit and vegetable intake. J Natl Cancer Inst 1999; 91:1491-500. [PMID: 10469751 DOI: 10.1093/jnci/91.17.1491] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The National Cancer Institute recommends that Americans eat at least five daily servings of fruits and vegetables. National strategies to increase consumption may not reach minority and lower socioeconomic populations. In a randomized trial, peer education was tested for effectiveness at increasing fruit and vegetable intake among lower socioeconomic, multicultural labor and trades employees. METHODS Employees (n = 2091) completed a baseline survey and received an 18-month intervention program through standard communication channels (e.g., workplace mail, cafeteria promotions, and speakers). Ninety-three social networks (cliques) of employees were identified, which were pair matched on intake. At an interim survey (during months 8 and 9), 11 cliques no longer existed and 41 matched pairs of cliques containing 905 employees remained, with one clique per pair being randomly assigned to the peer education intervention. Employees who were central in the communication flow of the peer intervention cliques served as peer educators during the last 9 months of the intervention program. Fruit and vegetable intake was measured with 24-hour intake recall and with food-frequency questions in baseline, outcome (i.e., at 18 months), and 6-month follow-up surveys. All P values are two-sided. RESULTS By use of multiple regression, statistically significant overall effects of the peer education program were seen in the intake recall (increase of 0.77 total daily servings; P<.0001) and the food-frequency (increase of 0.46 total daily servings; P =.002) questions at the outcome survey. The effect on the total number of servings persisted at the 6-month follow-up survey when measured by the intake recall (increase of 0.41 total daily servings; P =.034) but not the food-frequency (decrease of 0.04 total daily servings; P =.743) questions. CONCLUSIONS Peer education appears to be an effective means of achieving an increase in fruit and vegetable intake among lower socioeconomic, multicultural adult employees.
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Affiliation(s)
- D B Buller
- D.B. Buller, AMC Cancer Research Center, Denver, CO, USA.
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Pelletier KR. A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: 1995-1998 update (IV). Am J Health Promot 1999; 13:333-45, iii. [PMID: 10557506 DOI: 10.4278/0890-1171-13.6.333] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The fourth in a series of critical reviews, this study examines the clinical and cost outcome evaluations of 10 worksite health promotion programs that were comprehensive, multifactorial, and directed at risk management. The studies, conducted between 1994 and 1998, indicate favorable clinical and cost outcomes and suggest characteristics of worksite interventions that may be critical for effectiveness.
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Affiliation(s)
- K R Pelletier
- Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, CA 94304-1583, USA
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Pelletier KR. Clinical and cost outcomes of multifactorial, cardiovascular risk management interventions in worksites: a comprehensive review and analysis. J Occup Environ Med 1997; 39:1154-69. [PMID: 9429168 DOI: 10.1097/00043764-199712000-00009] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This paper is a critical review of the clinical and cost outcome evaluation studies of multifactorial, comprehensive, cardiovascular risk management programs in worksites. A comprehensive international literature search conducted under the auspices of the National Heart, Lung and Blood Institute identified 17 articles based on 12 studies that examined the clinical outcomes of multifactorial, comprehensive programs. These articles were identified through MEDLINE, manual searches of recent journals, and through direct inquiries to worksite health promotion researchers. All studies were conducted between 1978 and 1995, with 1978 being the date of the first citation of a methodologically rigorous evaluation. Of the 12 research studies, only 8 utilized the worksite as both the unit of assignment and as the unit of analysis. None of the studies analyzed adequately for cost effectiveness. Given this limitation, this review briefly considers the relevant worksite research that has demonstrated cost outcomes. Worksite-based, multifactorial cardiovascular intervention programs reviewed for this article varied widely in the comprehensiveness, intensity, and duration of both the interventions and evaluations. Results from randomized trials suggest that providing opportunities for individualized, cardiovascular risk reduction counseling for high-risk employees within the context of comprehensive programming may be the critical component of an effective worksite intervention. Despite the many limitations of the current methodologies of the 12 studies, the majority of the research to date indicates the following: (1) favorable clinical and cost outcomes; (2) that more recent and more rigorously designed research tends to support rather than refute earlier and less rigorously designed studies; and (3) that rather than interpreting the methodological flaws and diversity as inherently negative, one may consider it as indicative of a robust phenomena evident in many types of worksites, with diverse employees, differing interventions, and varying degrees of methodological sophistication. Results of these studies reviewed provide both cautious optimism about the effectiveness of these worksite programs and insights regarding the essential components and characteristics of successful programs.
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Affiliation(s)
- K R Pelletier
- Stanford Corporate Health Program, Stanford University School of Medicine, Calif., USA
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