Overweight and obesity are contributing factors

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1 CONTINUING EDUCATION Review of Worksite Weight Management Programs Tanya F. Ausburn, DNP, ANP-BC; Sheryl LaCoursiere, PhD, FNP-BC, PMHNP-BC, APRN; Scott E. Crouter, PhD, FACSM; Tucker McKay, FNP-BC ABSTRACT This article explores worksite weight management programs by reviewing the literature and providing recommendations to address obesity, a major public health challenge. Ten full-text articles published between 2005 and 2013 were reviewed. The literature supports a combination of physical activity, education, and diet to either maintain weight or result in modest weight loss. [Workplace Health Saf 2014;62(3): ] Overweight and obesity are contributing factors to chronic health conditions such as diabetes mellitus, hypertension, coronary artery disease, and hypercholesterolemia, which are primary underlying causes of poor health and premature death in the United States (U.S. Department of Health and Human Services, 2012). Body mass index (BMI) is the method commonly used to determine overweight and obesity. The Centers for Disease Control and Prevention (CDC) (2012) defines healthy weight as a BMI of 18.5 to 24.9 kg/m 2, overweight as a BMI of 25 to 29.9 kg/m 2, and obese as a BMI of 30 kg/m 2 or greater. Despite current efforts through Healthy People 2020 and multimedia campaigns, obesity prevalence in the United States actually increased between 2010 and 2012 from 72.5 to 78 million adults or 35.7% of adults (CDC, 2010; Ogden, Carroll, Kit, & Flegal, 2012). It is estimated that by 2015, 75% of adults in the United States will be classified as overweight (34%) or obese (41%) (Flegal, Carroll, Ogden, & Curtin, 2010). ABOUT THE AUTHORS Dr. Ausburn is Lecturer, Department of Nursing, University of Massachusetts Boston, Boston, Massachusetts, and Clinical Adult Nurse Practioner, HealthStat, Inc., Charlotte, North Carolina. Dr. LaCoursiere is Clinical Assistant Professor, Department of Nursing, University of Massachusetts Boston, Boston, Massachusetts. Dr. Crouter is Assistant Professor, Department of Kinesiology, Recreation, and Sports Studies, University of Tennessee, Knoxville, Tennessee. Mr. McKay is Vice President of Clinical Innovation, HealthStat, Inc., Charlotte, North Carolina. Submitted: May 30, 2013; Accepted: February 3, 2014; Posted online: March 6, 2014 The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support. Correspondence: Tanya F. Ausburn, DNP, ANP-BC, 9 Splitrail Circle, Thomasville, NC tusburn@triad.rr.com For employers, obesity is associated with decreased productivity and increased insurance premiums and absenteeism (Finkelstein, DiBonaventura, Burgess, & Hale, 2010; Loeppke et al., 2009; Rothstein & Harrell, 2009). Worksites often promote a sedentary environment due to heavy workloads that limit exercise by requiring long hours of sitting and limited breaks that would allow physical activity and movement. Employees also experience barriers to healthy food choices because they are too busy to prepare healthy food, worksite location limits access to healthy food, or the company does not provide a worksite cafeteria (Rothstein & Harrell, 2009). Thus, the purpose of this literature review was to examine literature that addresses worksite weight management programs, with a focus on interventions that included diet, physical activity, and education. METHODS A computerized literature review was conducted using Academic Search Premier, MEDLINE, CINAHL, Academic OneFile, and PubMed for articles published between January 1, 2005, and March 1, The lists of relevant studies and articles were subsequently hand searched for additional data to determine whether to include these articles in the review based on the inclusion criteria. Search terms were obesity, health promotion, weight management, worksite, BMI, worksite programs, and work initiatives. The inclusion criteria for this review included primary studies from peer-reviewed English print journals, with a focus on worksite interventions that examined changes in BMI, body composition, or body mass. Articles were 122 Copyright American Association of Occupational Health Nurses, Inc.

2 excluded if they were a systematic literature review or were not focused on BMI, body composition, or body mass. The literature search produced a total of 144 records (Figure 1), 138 from searched databases and six articles retrieved through references in the original results. Sixty-eight records were eliminated due to duplication. Of the 76 remaining records, 41 were excluded because they did not meet the inclusion criteria. The remaining 35 full-text articles were hand searched and assessed for eligibility. Twenty-five additional articles were excluded for the following reasons: did not provide information on weight/body composition change (19) or were systematic reviews (6). Thus, 10 full-text articles met the criteria for inclusion and were used in this integrated review. RESULTS Table 1 includes details of the 10 studies that met the inclusion criteria. Physical Activity Lara et al. (2008) authored the only study that focused solely on physical activity. Using a one-group pretest-posttest design, the authors incorporated 10-minute activity breaks during the workday over a 1-year time frame to examine changes in BMI. In general, participants averaged a weight decrease of 1.0 kg (p =.038) and a BMI decrease of 0.32 kg/m 2 (p =.047). Physical Activity and Education Gemson, Commisso, Fuente, Newman, and Benson (2008) examined physical activity and education in a 1-year quasi-experimental study. The study used pedometers and challenged participants to take 10,000 steps per day. In addition, educational brochures and posters promoted physical activity and blood pressure awareness and the availability of registered nurses to provide additional information. Overall, significant differences in BMI were measured for the intervention group (-1.0 ± 1.6 kg/m 2 ) versus the control group (+0.2 ± 1.2 kg/m 2 ) (p <.01). Additionally, 91.4% of employees in the intervention group reported that the educational brochures motivated them to become more physically active compared with 44.7% of the control group. Physical Activity and Diet Three studies (French et al., 2010; Rigsby, Gropper, & Gropper, 2009; Thorndike, Healey, Sonnenberg, & Regan, 2011) included a combination of physical activity and diet. French et al. (2010) used a combination of walking clubs and fitness rooms with treadmills, stationary bicycles, and free weights. Diet interventions included providing healthier food choices in vending machines, changing cafeteria menus, fruit and vegetable competitions, farmers markets, and lowering prices for healthier food choices. The study showed that after the program, fruit and vegetable consumption was significantly higher in the intervention group (2.2 servings/day) versus the control group (1.9 servings/day) (p <.05). With the combined intervention of physical activity and diet, French et Figure 1. Literature review chart. al. (2010) showed an average BMI change difference of kg/m 2 between groups (p <.05). Thorndike et al. (2011) used a pretest-posttest comparison of all participants to determine whether a program combining physical activity and diet could produce improvements in weight and cardiovascular risk factors. The program used pedometer steps, offered access to an onsite health club, and provided free access to weekly personal training to increase physical activity. The principle diet intervention was a food intake log. On average, participants weight loss was -1.9 kg at 10 weeks (p <.001) and -0.4 kg at 1 year (p =.002). Rigsby et al. (2009) used an 8-week weight loss program competition for women. The women chose whether to compete in a group or as an individual. Participants who chose to be part of a group joined groups that developed their own weight management programs using diet, exercise, or a combination of both. In general, participation in a group had a significantly greater change in BMI (1.3 ± 1.1 kg/m 2 ) compared to participants who received individual counseling (0.7 ± 1.1 kg/m 2 ) (p =.025). Although this suggests group participation was more effective, it also demonstrated that those participating as individuals experienced significant (modest or minor) BMI change through physical activity and diet. Physical Activity, Diet, and Education The last grouping identified studies that used a combination of physical activity, diet, and education to manage weight. Barham et al. (2011) conducted a randomized control study that focused on improving nutrition and physical activity and promoting weight loss. The physical activity component included the use of pedometers and exercise diaries to motivate and promote awareness about physical activity. The diet component focused on portion control using measuring cups and spoons and books to monitor food intake. The education component used 12 weekly 1-hour group sessions during the intervention and then monthly sessions for 12 months to educate the participants about diet and physical activity. During the first 3 months, between-group mean changes showed an average weight loss of 2.3 kg in the intervention group compared to a 0.73 kg weight gain in the control group (p <.001). WORKPLACE HEALTH & SAFETY VOL. 62, NO. 3,

3 Study Type of Intervention Table 1 Selected Results of Studies Examining Worksite Initiative Programs Level of Evidence/Grade of Research Evidence a Sample and Study Design BMI Changes Lara et al., 2008 Physical Activity Level I/Grade B Mexican Ministry of Health office workers (N = 271); uncontrolled pretest-posttest study Gemson et al., 2008 Physical Activity, Education Level II/Grade A Merrill Lynch sites (5 control sites, 2 experimental; experimental group (n = 47), control group (n = 94); quasi-experimental design with no randomization French et al., 2010 Physical Activity, Diet Level I/Grade A Four garages (2 urban; 2 rural) of Metropolitan Transit Council in Minneapolis, (N = 1,070); randomized control study Rigsby et al., 2009 Physical Activity, Diet Level III/Grade B Employees of hospital and nursing home in rural Alabama; control group = 42, individual group = 30); non-experimental Thorndike et al., 2011 Physical Activity, Diet Level III/Grade B Massachusetts General Hospital (N = 757); non-experimental Barham et al., 2011 Physical Activity, Morgan et al., 2011 Physical Activity, Racette et al., 2009 Physical Activity, Siegel et al., 2010 Physical Activity, Dejoy et al., 2011 Physical Activity, Level I/Grade A 45 employees (21 intervention and 24 weight control; Onondaga County, NY; randomized control study Level I/Grade A 110 overweight/obese male employees at Tomago Aluminium (I = 65, C = 45); randomized control study Level I/Grade A 123 employees (68 = worksite A; 55 = worksite B) from large medical center in St. Louis, MO; cohort-randomized trial comparing worksite A assessment and intervention with worksite B assessment only Level I/Grade A 16 school worksites (8 intervention, 8 control) in Los Angeles, CA (N = 340); randomized control study Level II/Grade A 12 Dow sites: (3 control sites, 9 intervention sites with moderate or intense environmental intervention conditions), total employees = 1,859 (1,111 participated in either moderate or intense intervention); quasi-experimental design, no randomization BMI change: kg/m 2 (p =.05), men only: kg/m 2 (p =.03) BMI change: experimental: -1.0 ± 1.6 kg/ m 2 ; control: +0.2 ± 1.2 kg/m 2 (p <.01) BMI change = kg/m 2 (p >.05) BMI change: group = 1.3 ± 1.1 kg/m 2 ; individual = 0.7 ± 1.1 kg/m 2 (p =.025) BMI change: -2.4% (p <.001) BMI change: 3 months: associated decrease; over the next 9 months gradually increased toward baseline (p <.001) BMI change: 1.4 kg/m 2 (p <.001) BMI change: worksite A = -0.4 kg/m 2 ; worksite B = +0.1 kg/m 2 (p =.02) BMI change: intervention = kg/m 2 ; control = kg/m 2 (p <.05) BMI change: no intervention = kg/ m 2 ; intervention = kg/m 2 (p =.9400); moderate environmental intervention = kg/m 2 (p =.6634); intense environmental intervention = kg/m 2 (p =.900) BMI = body mass index a The level of evidence is based on the research evidence appraisal structure by John Hopkins Nursing Evidence Based Practice rating scheme in both strength and quality of the research. Type of evidence was ranked with the following levels: level I = randomized controlled trials, level II = quasi-experimental studies, and Ilevel III = non-experimental study or qualitative study. Quality rating scheme for research evidence rated the quality rating with the following grades: A = high quality, B = good quality, and C = low quality (Newhouse, Dearholt, & Poe, 2007). 124 Copyright American Association of Occupational Health Nurses, Inc.

4 Morgan et al. (2011) examined the feasibility and efficacy of a worksite weight loss program by conducting a randomized control study of male workers using a combination of physical activity, diet, and education interventions over a 3-month period. Physical activity was encouraged by the use of pedometers and exercise diaries. The intervention group was additionally offered education through a combination of one face-to-face session (75 minutes), which included 60 minutes of education on diet, physical activity, weight loss tips, goal setting, and social support, and 15 minutes of technical orientation on a free weight loss website, combined with resources such as a weight loss handbook. Diet was addressed mainly through education; participants completed self-report questionnaires about their consumption of fruits and vegetables and submitted daily eating diaries for feedback by the research team. At 14 weeks, on average, significant differences for physical activity between groups were found (mean = 0.6; p <.001). However, on average, the mean difference between groups for consumption of fruits (0.4) or vegetables (0.2) per day was not significantly different (p =.06 and.39, respectively). Finally, a significant but modest mean change in BMI between the control (0.1 kg/m 2 ) and intervention (-1.3 kg/m 2 ) groups was found (p <.001). Racette et al. (2009) used a cohort randomized trial comparing two worksites in which physical activity, education, and diet interventions were implemented over 1 year. The physical activity component included the use of pedometers and group exercise classes. The diet component included a healthy snack cart at the worksite and WeightWatchers meetings to assist employees with diet modification. Education included monthly lunchtime seminars, monthly newsletters, and the availability of registered dietitians and exercise specialists during the program. In general, weight loss was greater for the intervention group than the control group, with significant decreases in body weight (0.9 kg; p =.02), BMI (0.4 kg/ m 2 ; p =.02), and fat mass (0.7 kg; p =.04). Siegel, Prelip, Erausquin, and Kim (2010) examined 16 school worksites (8 intervention, 8 control) to develop and implement health promotion activities for employees. Physical activity included a combination of walking clubs and fitness rooms with treadmills, stationary bicycles, and free weights. In addition, participants were offered physical exercise programs to keep workers healthy and reduce overall health care costs. Diet was improved by offering healthy snacks at meetings and providing healthy cooking classes. Education was provided through quarterly newsletters that discussed physical activity and diet. On average, no significant changes in fruit and vegetable consumption were observed between groups. However, significant differences for mean change in BMI between the intervention group (-0.14 kg/m 2 ) and the control group (+0.42 kg/m 2 ) were found (p <.05). Dejoy et al. (2011) used a non-randomized quasiexperimental design to focus on environmental issues that affect weight loss by incorporating a combination of physical activity, diet, and education interventions over 2 years. Walking trails were marked and signs were posted in stairwells to encourage physical activity. Awareness of the need for physical activity and healthy eating occurred through the use of targeted messages. Wellness ambassadors provided management support and training on health-related topics. Healthy food choices were encouraged by modifying vending machine choices and cafeteria menus coupled with food journals. The food journal tracked food choices to promote healthier smaller portions and improve overall BMI. During the 2 years of the study, mean BMI change between groups remained unchanged with no statistical significance (mean range = to kg/m 2 ; p =.6634 to.9400). LIMITATIONS Limitations of this review center on the literature search. Like most reviews, literature searches can lead to selection bias; criteria set for exclusion and inclusion of articles in the current review may have biased findings. Thus, it is possible that the search did not identify all published research articles. In an effort to minimize selection bias, selected study references were evaluated for additional previously published reviews and articles. A related limitation of this study was the small number of articles included in this review. This small sample size increased the authors difficulty in summarizing the overall effects of worksite weight management programs. IMPLICATIONS FOR PRACTICE Although somewhat uncertain, the literature suggests that worksite weight management programs have been growing throughout the United States (Dejoy et al., 2011; Rigsby et al., 2009). The findings of this literature review suggest that worksite weight management programs often include physical activity, diet, and education components. Physical activity was a key component in these weight management programs, as evidenced by its inclusion in all studies reviewed. The literature supported that recording pedometer steps and providing facilities and programs for employees to participate in physical activity motivated participants and provided awareness and a more structured approach for employees to address weight management. The literature also supported that education is the cornerstone of any successful weight management program. Diet and healthy eating was a main theme in most weight management programs. The literature suggested that environmental modifications such as modifying vending machine choices, healthy snack carts, healthier cafeteria menus, food logs or journals, and weight loss program competitions resulted in weight maintenance and in some cases mean weight loss and lower BMI. In general, education centered on weight management and ways to improve overall health was provided via classes, seminars, newsletters, and brochures. Despite the fact that each study s criteria varied, the literature supported that intervention groups either maintained or experienced modest decreases in BMI and/or body weight compared to control groups. Of the 10 studies included in the literature review, only two (Dejoy et al., 2011; French et al., 2010) did not find statistically significant changes in BMI for the intervention group. WORKPLACE HEALTH & SAFETY VOL. 62, NO. 3,

5 IN SUMMARY Review of Worksite Weight Management Programs Ausburn, T. F., LaCoursiere, S., Crouter, S. E., McKay, T. Workplace Health & Safety 2013;62(3): Worksite weight management programs with a combination of interventions that address physical activity, diet, and education are effective in lowering body mass index and weight loss. 2Physical activity in these studies included increasing awareness, motivation, and structure to help employees become more active. 3Education included ways to improve overall health, the cornerstone of any successful weight management program. Employee benefits of worksite weight management programs include improved well-being, less sick leave, and lower health care and worker compensation costs. Although there is a lack of clinical significance related to very small changes in weight, these programs support behavior change over time by establishing worksite policies and programs, fostering peer support, and sustaining environmental initiatives, such as healthier food choices. These interventions promote employee awareness and well-being. The limitations of worksite weight management programs include recruiting adequate numbers of employees to participate and properly tailoring programs to provide education, motivation, and support (Finkelstein et al., 2010; Loeppke et al., 2009; Rothstein & Harrell, 2009). CONCLUSION Overweight and obesity are major health challenges in the United States and call for effective intervention strategies. Although mixed results were found in regard to changes in BMI and weight loss, worksite intervention studies that include a combination of physical activity, diet, and education are promising. Based on the literature, the best worksite weight management programs focus on multiple ways to include and motivate employees while addressing physical activity, diet, and educational interventions. REFERENCES Barham, K., West, S., Trief, P., Morrow, C., Wade, M., & Weinstock, R. S. (2011). Diabetes prevention and control in the workplace: A pilot project for county employees. Journal of Public Health Management Practice, 17, Centers for Disease Control and Prevention. (2010). Vital signs: Statespecific obesity prevalence among adults United States, Atlanta: Author. Retrieved from mmwrhtml/mm59e0803a1.htm Centers for Disease Control and Prevention. (2012) Healthy weight: Assessing your weight. Atlanta: Author. Retrieved from healthyweight/assessing Dejoy, D. M., Parker, K. M., Padilla, H. M., Wilson, M. G., Roemer, E. C., & Goetzel, R. Z. (2011). Combining environmental and individual weight management interventions in a work setting: Results from the Dow chemical study. Journal of Occupational and Environmental Medicine, 53, Finkelstein, E. A., DiBonaventura, M. D., Burgess, S. M., & Hale, B. C., (2010). The costs of obesity in the workplace. Journal of Occupational & Environmental Medicine, 52, Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence and trends in obesity among United States adults, Journal of the American Medical Association, 303, French, S. A., Harnack, L. J., Hannan, P. J., Mitchell, N. R., Gerlach, A. F., & Toomey, T. L. (2010). Worksite environment intervention to prevent obesity among metropolitan transit workers. Preventive Medicine, 50, Gemson, D. H., Commisso, R., Fuente, J., Newman, J., & Benson, S. (2008). Promoting weight loss and blood pressure control at work: Impact of an education and intervention program. Journal of Occupational & Environmental Medicine, 50, Lara, A., Yancey, A. K., Tapia-Conye, R., Flores, Y., Kuri-Morales, P., Mistry, R.,... McCarthy, W. J. (2008). Pausa para tu salud: Reduction of weight and waistlines by integrating exercise breaks into workplace organizational routine. Preventing Chronic Disease, 5, A12-A12. Loeppke, R., Taitel, M., Haufle, V., Parry, T., Kessler, R. C., & Jinnett, K. (2009). Health and productivity as a business strategy: A multiemployer study. Journal of Occupational & Environmental Medicine, 51, Morgan, P. J., Collins, C. E., Plotnikoff, R. C., Cook, A. T., Berthon, B., Mitchell, S., & Callister, R. (2011). Efficacy of a workplace-based weight loss program for overweight male shift workers: The Workplace POWER (Preventing Obesity Without Eating like a Rabbit) randomized controlled trial. Preventive Medicine, 52, Newhouse, R. P., Dearholt, S. L., & Poe, S. S. (2007). Johns Hopkins nursing evidence-based practice model and guidelines. Indianapolis: Sigma Theta Tau International. Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2012). Prevalence of obesity in the United States, NCHS Data Brief, 82, 1-8. Retrieved from db82.pdf Racette, S. B., Deusinger, S. S., Inman, C. L., Burlis, T. L., Highstein, G. R., Buskirk, T. D.,... Peterson, L. R. (2009). Worksite opportunities for wellness (WOW): Effects on cardiovascular disease risk factors after 1 year. Preventive Medicine, 49, Rigsby, A., Gropper, D. M., & Gropper, S. S. (2009). Success of women in a worksite weight loss program: Does being part of a group help? Eating Behaviors, 10, Rothstein, M. A., & Harrell, H. L. (2009). Health risk reduction programs in employer-sponsored health plans: Part I. Efficacy. Journal of Occupational and Environmental Medicine, 51, Siegel, J. M., Prelip, M. L., Erausquin, J. T., & Kim, S. A. (2010). A worksite obesity intervention: Results from a group-randomized trial. American Journal of Public Health, 100, Thorndike, A. N., Healey, E., Sonnenberg, L., & Regan, S. (2011). Participation and cardiovascular risk reduction in a voluntary worksite nutrition and physical activity program. Preventive Medicine, 52, U.S. Department of Health and Human Services. (2012). Healthy People 2020: Nutrition and weight. Retrieved from Copyright American Association of Occupational Health Nurses, Inc.