Weight-inclusive, intuitive eating-based workplace wellness program associated with improvements in intuitive eating, eating disorder symptoms, internalized weight stigma, and diet quality

INTRODUCTION

The use of weight-inclusive programming within a workplace wellness context remains understudied.

METHODS

The present study is a pilot/feasibility study of a 3-month, virtual, weight-inclusive, intuitive eating-based workplace wellness program. Program participants (n = 114), who were all employees at a large public university in the Midwest, received weekly emails with a link to an instructional video related to intuitive eating and were encouraged to meet virtually with their health coach. Participants provided self-report data on behavioral and psychological outcomes including intuitive eating, internalized weight stigma, eating disorder symptoms, and diet quality at baseline, post-intervention (3 months from baseline), and follow-up (6 months from baseline). Changes in behavioral and psychological outcomes from baseline to post-intervention and follow-up were examined using paired t-tests, with Cohen's d effect sizes reported. Generalized linear models were used to examine whether participant characteristics and program engagement were associated with program outcomes.

RESULTS

Increases in intuitive eating and decreases in internalized weight stigma and eating disorder symptoms were seen from baseline to post-intervention (Cohen's d = 1.02, -0.47, and -0.63, respectively) and follow-up (Cohen's d = 0.86, -0.31, and -0.60). No changes in dietary quality were seen at post-intervention, but a significant reduction in intake of added sugars, fast food, and sugar sweetened beverages were observed at follow-up (Cohen's d = -0.35, -0.23, -0.25).

CONCLUSIONS

This study provide preliminary support for the acceptability and potential impact of a weight-inclusive workplace wellness program that should be tested in a rigorous randomized trial.

Employees' Baseline Food Choices and the Effect of a Workplace Intervention to Promote Healthy Eating: Secondary Analysis of the ChooseWell 365 Randomized Controlled Trial

BACKGROUND

Little is known about whether the effectiveness of workplace wellness programs differs by employees' baseline health behaviors.

OBJECTIVE

This study examined the association of baseline cafeteria food choices with the effect of a workplace intervention on cafeteria food choices, dietary quality, and body mass index (BMI).

DESIGN

This was a secondary analysis of the ChooseWell 365 randomized controlled trial, testing a set of behavioral interventions to improve diet and prevent weight gain.

PARTICIPANTS/SETTING

Participants were 602 employees of a Boston, MA, hospital who had purchased food from cafeterias, which used traffic-light food labeling. Data were collected in 2016-2020.

INTERVENTION

The 12-month intervention (plus 12 months' follow-up) involved financial incentives and personalized feedback on cafeteria purchases. The control group received monthly letters with generic healthy eating and exercise tips.

MAIN OUTCOME MEASURES

Healthy purchasing scores (HPS) were calculated by weighting color categories (red = 0, yellow = 0.5, green = 1) and scaling from 0 to 100 (healthiest); employees were categorized into baseline (pre-intervention) HPS tertiles (T1 = least healthy, T3 = healthiest). Healthy eating index (HEI-2015) scores were calculated from two 24-hour dietary recalls. Intervention effects on 12- and 24-month changes in HPS (primary outcome), HEI-2015 score, and BMI were compared among tertiles. Subgroup analyses examined whether changes by tertile varied with financial rewards received.

STATISTICAL ANALYSES

Adjusting for baseline characteristics, multivariable linear regression assessed intervention effects across baseline HPS tertiles.

RESULTS

Compared with T3, T1 employees had lower education; higher obesity, hypertension, and pre-diabetes; and lower HEI-2015 scores. The intervention increased HPS, but no change was observed in HEI-2015 scores or BMI; the intervention effect did not differ among tertiles at 12 or 24 months. Financial incentives were associated with a larger effect on 12-month HPS changes for T1 than for T2/T3 (P-interaction < 0.001).

CONCLUSION

Compared with employees with healthier baseline food choices, employees with the least healthy food choices and highest cardiometabolic risk had similar improvements in the nutritional quality of cafeteria purchases as a result of the behavioral intervention, and they appeared to be more responsive to financial incentives.

Cost-Effectiveness Of A Workplace Ban On Sugar-Sweetened Beverage Sales: A Microsimulation Model

Sugar-sweetened beverages (SSBs) increase chronic disease risk. We estimated the impact on employee health and health care spending of banning SSB sales in California-based health care organizations. We used survey data from a large, multisite health care organization in California, sampling 2,276 employees three months before and twelve months after a workplace SSB sales ban was imposed. We incorporated the survey data into a simulation model to estimate chronic disease incidence and costs. We estimated that an SSB ban as effective as the one observed would save about $300,000 per 10,000 people over ten years among similar employers, as a result of averted health care and productivity spending—after both SSB sales losses and non-SSB beverage sales gains were accounted for. Sales bans would typically need to reduce SSB consumption by 2.2 ounces per person per day for lost revenue to be fully offset if there were no increase in non-SSB beverage sales.

A systematic review of randomized controlled trials examining workplace wellness interventions

BACKGROUND

One of the influencing factors associated with weight gain is overeating as a maladaptive coping strategy to process or avoid the emotional impact of psychological stress. Psychological stress is chronically and pervasively associated with stress stemming from the workplace environment. Workplace wellness interventions have a unique opportunity to change environmental factors impacting psychological stress, which can improve individual food choice and weight management efforts.

AIM

To synthesize evidence from randomized controlled trials on workplace wellness interventions that impact employee psychological stress and food choice or weight management.

METHODS

A systematic review was completed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Selected studies were limited to English-language articles exploring randomized interventions at workplaces among adult employees and included measurements of psychometric stress and food choice (qualitative or quantitative) or biometric weight management. From the search, 10 studies were included in the final review.

RESULTS

Results were inconsistent across studies. There was no observable association between psychological stress reduction and food choice or weight management. Mid-length interventions (ranging from 6 to 9 months) had more consistent associations between intervention program implementation, reduced psychological stress, and improved food choice or weight management.

CONCLUSIONS

The studies examining employee food choices and weight management efforts remained very heterogeneous, indicating that more research is needed in this specific area of employee wellness program planning and measurement. Consistent research methodology and assessment tools are needed to measure dietary intake.

Four-year review of presenteeism data among employees of a large United States health care system: a retrospective prevalence study

BACKGROUND

Historically, in an effort to evaluate and manage the rising cost of healthcare employers assess the direct cost burden via medical health claims and measures that yield clear data. Health related indirect costs are harder to measure and are often left out of the comprehensive overview of health expenses to an employer. Presenteeism, which is commonly referred to as an employee at work who has impaired productivity due to health considerations, has been identified as an indirect but relevant factor influencing productivity and human capitol. The current study evaluated presenteeism among employees of a large United States health care system that operates in six locations over a four-year period and estimated loss productivity due to poor health and its potential economic burden.

METHODS

The Health-Related Productivity Loss Instrument (HPLI) was included as part of an online Health Risk Appraisal (HRA) administered to employees of a large United States health care system across six locations. A total of 58 299 HRAs from 22 893 employees were completed and analyzed; 7959 employees completed the HRA each year for 4 years. The prevalence of 22 specific health conditions and their effects on productivity areas (quantity of work, quality of work, work not done, and concentration) were measured. The estimated daily productivity loss per person, annual cost per person, and annual company costs were calculated for each condition by fitting marginal models using generalized estimating equations. Intra-participant agreement in reported productivity loss across time was evaluated using κ statistics for each condition.

RESULTS

The health conditions rated highest in prevalence were allergies and hypertension (high blood pressure). The conditions with the highest estimated daily productivity loss and annual cost per person were chronic back pain, mental illness, general anxiety, migraines or severe headaches, neck pain, and depression. Allergies and migraines or severe headaches had the highest estimated annual company cost. Most health conditions had at least fair intra-participant agreement (κ ≥ 0.40) on reported daily productivity loss.

CONCLUSIONS

Results from the current study suggested a variety of health conditions contributed to daily productivity loss and resulted in additional annual estimated costs for the health care system. To improve the productivity and well-being of their workforce, employers should consider presenteeism data when planning comprehensive wellness initiatives to curb productivity loss and increase employee health and well-being during working hours.

A qualitative study of facilitators and barriers to implementing worksite policies that support physical activity

BACKGROUND

Physical inactivity is associated with several chronic diseases that are costly to society, employers, and individuals. Workplaces are a common location for physical activity (PA) initiatives because of the amount of time individuals who are employed full time spend at work. This research examined a statewide worksite wellness program, the Healthiest Maryland Businesses (HMB) program, to fill an important gap regarding the facilitators for and barriers to implementing workplace policies that support PA.

METHODS

Individual telephone interviews were conducted in December 2015 with six HMB Coordinators and their supervisor, and from August through October 2016 with a purposeful sample of 15 businesses of various sizes from across Maryland, to learn about the role of leadership, and successes and challenges of implementing PA programs and policies. The sample of businesses was intentionally selected to capture perspectives from a range of businesses. Interviews were recorded and professionally transcribed. Descriptive coding was used to identify dominant themes that addressed the study aims and research questions.

RESULTS

PA was not described as a priority for several large and small businesses. To garner more support for PA, interviewees emphasized associating PA initiatives with measures the businesses care about, such as health care costs from claims data. Small businesses also described having a need for PA programming yet reported having significant resource constraints. There was a strong interest in developing guidance for implementing PA break policies, which was mentioned as a critical support for workplace PA promotion. More commitment and investment of resources from leadership, and an engaged wellness committee with company representation at all levels and roles, were identified as vital for impactful programs.

CONCLUSIONS

Most businesses are implementing PA programs with limited policy supports, which was mentioned as a barrier. Successful implementation of workplace wellness programs broadly, and PA initiatives specifically, are achievable through leadership buy-in, employee input, and policy supports, along with highlighting the economic benefits for businesses.

Workplace wellness: industry associations are well placed and some are ready to take a more active role in workplace health

Background

Investments in settings-based health interventions can include workplaces, however, engaging with businesses and convincing them to take a role can be difficult. Our research investigated the potential for trade or industry associations (IAs) to have a role in promoting workplace health initiatives to their members.

Methods

Seventeen semi-structured interviews were undertaken with senior executives from IAs representing industries in the mining, transport, agriculture, manufacturing, farming, hospitality, and construction sectors. Analysis of interviews identified themes around attitudes to workplace health promotion programs and the perceived, actual and potential role/s of IAs in promoting workplace wellness.

Results

IA representatives believed workplaces had potential to be promoting the health and wellbeing of workers through their member organisations; however for some the extent of their role was unclear and for others there was confusion between government-mandated safety initiatives and non-mandated health and wellbeing initiatives. All reported that their IA could have a role in promoting worker health and wellbeing initiatives to member organisations. IAs with larger companies as members were more likely to recognise the importance of workplaces promoting workers’ health; however, the degree of involvement considered appropriate varied. Most IAs had not discussed the topic with their member organisations although they identified resources and support that could assist them in encouraging members to undertake workplace health programs. Resources included industry-relevant business cases outlining the benefits of workplace health, and industry-appropriate worker health information.

Conclusions

Our research suggests that across many industry sectors, larger IAs in particular are ready to take a more active role in workplace health initiatives and are well placed to promote these to member organisations.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3364-7) contains supplementary material, which is available to authorized users.

Healthy and productive workers: using intervention mapping to design a workplace health promotion and wellness program to improve presenteeism

Background

Presenteeism is a growing problem in developed countries mostly due to an aging workforce. The economic costs related to presenteeism exceed those of absenteeism and employer health costs. Employers are implementing workplace health promotion and wellness programs to improve health among workers and reduce presenteeism. How best to design, integrate and deliver these programs are unknown. The main purpose of this study was to use an intervention mapping approach to develop a workplace health promotion and wellness program aimed at reducing presenteeism.

Methods

We partnered with a large international financial services company and used a qualitative synthesis based on an intervention mapping methodology. Evidence from systematic reviews and key articles on reducing presenteeism and implementing health promotion programs was combined with theoretical models for changing behavior and stakeholder experience. This was then systematically operationalized into a program using discussion groups and consensus among experts and stakeholders.

Results

The top health problem impacting our workplace partner was mental health. Depression and stress were the first and second highest cause of productivity loss respectively. A multi-pronged program with detailed action steps was developed and directed at key stakeholders and health conditions. For mental health, regular sharing focus groups, social networking, monthly personal stories from leadership using webinars and multi-media communications, expert-led workshops, lunch and learn sessions and manager and employee training were part of a comprehensive program. Comprehensive, specific and multi-pronged strategies were developed and aimed at encouraging healthy behaviours that impact presenteeism such as regular exercise, proper nutrition, adequate sleep, smoking cessation, socialization and work-life balance. Limitations of the intervention mapping process included high resource and time requirements, the lack of external input and viewpoints skewed towards middle and upper management, and using secondary workplace data of unknown validity and reliability.

Conclusions

In general, intervention mapping was a useful method to develop a workplace health promotion and wellness program aimed at reducing presenteeism. The methodology provided a step-by-step process to unravel a complex problem. The process compelled participants to think critically, collaboratively and in nontraditional ways.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3843-x) contains supplementary material, which is available to authorized users.

A case study of a workplace wellness program that offers financial incentives for weight loss

Employers are increasingly adopting workplace wellness programs designed to improve employee health and decrease employer costs associated with health insurance and job absenteeism. This paper examines the outcomes of 2635 workers across 24 worksites who were offered financial incentives for weight loss that took various forms, including fixed payments and forfeitable bonds. We document extremely high attrition and modest weight loss associated with the financial incentives in this program, which contrasts with the better outcomes associated with pilot programs. We conclude by offering suggestions, motivated by behavioral economics, for increasing the effectiveness of financial incentives for weight loss.

Patient-centered financial incentives for health: Can employers get change for their dollars?

While employer-sponsored financial incentives for healthy behaviors have demonstrated the potential to promote short-term employee behavior change, the effectiveness of such incentives in promoting long-term health behavior change has often been disappointing. This paucity of sustained change could be explained by the many factors that shape employees' health behaviors, only some of which may be influenced by incentives. We discuss how employer-sponsored incentives for healthy behaviors could become more patient-centered, and thus perhaps more effective, by integrating insights from self-determination theory and health behavior theories, targeting employees' capacity for change, and using tailoring.