Dr. Mark Wilson Associate Dean, Academic Affairs University of Georgia
Workplace Strategies for Obesity Prevention Second Annual SEC Symposium September 21-23, 2014 Atlanta, GA Mark Wilson University of Georgia Melinda Valliant University of Mississippi Rebecca Kelly University of Alabama Danielle Wadsworth Auburn University Moderator: Joe Sharkey Texas A & M
Prevalence of WHPP National Worksite Health Surveys Health Promotion Programs or Activities* < 100 Employees 1985 < 100 Employees 2004 > 750 Employees 1985 > 750 Employees 2004 Health Risk Assessment 18.5 NR 66.1 NR Smoking Cessation 30.1 8.8 57.6 68.1 Blood Pressure Control 8.8 27.1 48.8 84.9 Exercise/Fitness 14.7 9.0 53.4 66.1 Weight Control 8.6 11.3 47.9 56.1 Nutrition Education 9.3 11.0 47.7 43.0 Stress Management 15.1 17.6 59.6 54.3 Back Injury Prevention 19.2 37.2 46.4 81.5 Off the-job Accidents 12.8 NR 36.8 NR * Nine core activities from 1985 survey
How much does obesity cost employers? Medical, Absenteeism, Presenteeism Expenditures Associated with Overweight and Obesity Overweight BMI 25 29.9 Obese BMI 30 34.9 Obese BMI 35 39.9 Obese BMI 40+ Men Medical $148 $475 $824 $1269 Absenteeism $85 $277 $657 $1026 Presenteeism -$555 $391 $1010 $3792 TOTAL -$322 $1143 $2491 $6087 Women Medical $529 $1274 $2532 $2395 Absenteeism $147 $407 $67 $1262 Presenteeism $121 $843 $1513 $3037 TOTAL $797 $2524 $4112 $6694 Source: Finkelstein EA, Dibonaventura MD, Burgess SM, Hale BC. The costs of obesity in the workplace. J Occup Environ Med 2010;52:971-6.
Occupational Injury Increased levels of: Muscloskeletal injuries Repetitive motion injuries Hand-arm vibration syndrome Carpal tunnel syndrome Motor vehicle crashes Use of PPE
Occupational Impact of Obesity The effect of obesity on work limitations has about the same magnitude as 20 years of aging. Obese younger workers (20-39 years) have the same prevalence of injury as normal-weight middle aged workers (40-59 years) Hertz, et al. (2004). Journal of Occupational and Environmental Medicine, 46(12), 1196-1203.
Cost of Injury Related to Overweight/Obesity Injury Cost per 200,000 Man Hours Risk Injuries per year Mean Cost of Employee FELA Personal Injury 2001 Personal Injury Costs per year Injury Rate Per Year for at-risk employees Injuries per Year for 200,000 man hours* Cost per 200,000 man hours* Smoking 667 $72,763 $48,532,921 5% 5 $363,815 Stress 146 $72,763 $10,623,398 6% 6 $436,578 Depression 229 $72,763 $16,662,727 7% 7 $509,341 Physical Inactivity 657 $72,763 $47,805,291 5% 5 $363,815 Overweight 1161 $72,763 $84,477,843 5% 5 $363,815 *200,000 Man Hours: 100 employees, full-time, for 1 year
New Trends / Future Directions Translation of efficacious programs Communication / Engagement Technology Evidenced-based programs Environment / Culture
Translating obesity programs to worksites: The Fuel Your Life program Mark G. Wilson Workplace Health Group College of Public Health University of Georgia
RESEARCH PHASE NCCDPHP Knowledge To Action Framework May 2010 TRANSLATION PHASE INSTITUTIONALIZATION PHASE DISCOVERY STUDIES EFFICACY STUDIES Practice-based Discovery Practice-based Evidence EFFECTIVENESS AND IMPLEMENTATION STUDIES DECISION to TRANSLATE KNOWLEDGE INTO PRODUCTS DISSEMINATION ENGAGEMENT DECISION to ADOPT PRACTICE INSTITUTION- ALIZATION DIFFUSION Research Supporting Structures Translation Supporting Structures Insitutionalization Supporting Structures EVALUATION Wilson K.M., Brady T.J., Lesesne, C. (in press.) An Organizing Framework for Translation in Public Health: CDC s National Center for Chronic Disease Prevention and Health Promotion s Knowledge to Action Framework. Preventing Chronic Disease.
Translation Three Phases: Disseminate - to public health organizations with the intent to encourage them to adopt the intervention within their organization Implement - throughout the organization with fidelity to the core components with which it was tested to be efficacious or effective (with some adaptation) Institutionalize - the intervention and/or eventually abandon it as newer, effective interventions are introduced
Diabetes Prevention Program Initially developed to test the efficacy of using a lifestyle intervention to reduce the risk of developing diabetes through increased physical activity and decreased body weight Proven to be effective for managing weight By decreasing caloric intake and increasing energy expenditure in clinical studies Demonstrates reductions in weight of 4.9% (clinical study) of initial body weight The program has not been adapted to be implemented on a large scale within the work setting
DPP Core Components weight loss and physical activity goal-based behavioral intervention lifestyle coach delivery frequent contact individual tailoring of the intervention materials and strategies for an ethnically diverse population network support for the interventionists
Translating a Weight Management Program to Worksites Mark G. Wilson, PI Marsha Davis, Co-PI David M. DeJoy, Co-PI Robert J. Vandenberg, Co-PI CDC - 1R18OH009396-01
Fast Facts in The USA Miles of Track 32,300 Employees 50,000 Locomotives 8,500 Freight Cars 104,700 The largest railroad in North America Operating in the western two-thirds of the United States The system serves 23 states
DPP Translation 1. adaptation of the delivery 2. support in the workplace environment 3. support in the home environment
Project Design R Pretest Fuel Your Life Posttest Follow-up 6 Sites goal tracking, process evaluation R Pretest Posttest Follow-up
Demographic Data: Final Gender Male Female Ethnicity White Black / African American Hispanic / Latino Other Marital Status Married/Living with Partner Single Divorced/Separated/Widowed Shift 1st 2nd 3rd 94.0% 6.0% 76.9% 13.1% 7.9% 2.1% 72.3% 14.9% 12.8% 55.0% 28.5% 16.5%
Results Primary Outcomes Pretest Posttest Follow-up Change Body Mass Index Control 29.9 30.2 30.2 0.3 FYL 31.9 31.8 31.8-0.1 Body Weight (pounds) Control 201.4 203.8 204.8 3.1 FYL 220.1 217.4 218.5-1.6 * p >.05
Results Percentage Weight Loss No loss/ weight gain 0.01 4.9 % loss 5 9.9% loss 10 % loss Control 64.8% 26.8% 5.6% 3.0% FYL 44.8% 44.0% 10.3% 0.9%
Conclusions Practical difference between FYL and control group FYL effective for weight maintenance 55% of participants lost weight What is that intensity sweet spot?
Effect of Intensity and Health Coaches on the Translation of DPP to Worksites Mark G. Wilson, PI David M. DeJoy, Co-PI Phaedra S. Corso, Co-PI Robert J. Vandenberg, Co-PI NIH 1R18DK090672-01A1
Athens-Clarke County Consolidated Government Bibb County Government Columbus Consolidated Government Digital Library of Georgia,ß University of Georgia
Project Design R Pretest Fuel Your Life Posttest Follow-up 3 Sites goal tracking, process evaluation R Pretest Posttest Follow-up
Health-coach delivered FYL FUEL Your Life FUEL Your Life 2 Weight loss and physical activity goal-based behavioral intervention PHCs provide social support OCN(s) provide programmatic support PHCs selected to represent all shifts and employees OHNs available at each worksite provide 6 presentations on FYL topics during the intervention phase and 3 presentations during the maintenance phase Weekly announcements in safety meetings Posters displayed at the worksite Project website Tailoring of program materials to the study population based on employee input obtained in focus groups and interviews as part of the formative research process Resources available on the FYL website for an ethnically diverse population Training for PHC and OHN on their role and functions of the program Ongoing communications between the OHN and the research project director Same Master-trained health coach Core: 8 group sessions OR 8 phone sessions Maintenance: 3 group sessions OR 3 phone sessions Individual tailoring of the intervention Same MPH or equivalent training for health coaches Program specific training Motivational interviewing training Weekly meetings with research team and ongoing training
Preliminary Findings Mean, SD, and Sample Size for Weight (Lbs) by Site Group Phone Control Time 1 Mean 204.84 207.89 221.41 SD 54.36 47.99 55.97 N 120 77 101 Time 2 Mean 201.29 202.24 217.10 SD 53.18 48.88 53.59 N 120 77 101 Mean, SD, and Sample Size for BMI by Site Group Phone Control Time 1 Mean 32.70 33.90 34.34 SD 7.15 8.00 7.07 N 168 144 194 Time 2 Mean 31.33 32.40 34.30 SD 6.95 7.24 7.40 N 120 77 101
Weight Change (Time 2 LBS - Time 1 LBS) Scatterplot of participant weight at baseline and participant weight change 30 20 10 0-10 -20-30 ACC Bibb CCG -40-50 -60-70 0 100 200 300 400 500 600 Participant Weight at Timepoint 1
Preliminary Findings (cont.) Mean weights adjusted for baseline weight using latent change regression Pretest Posttest Change Group 204.8 208.8 +4.0 Phone 207.9 201.8-6.1 Control 221.4 230.0 +8.6
Putting CDSMP to Work: Implementation of the Live Healthy, Work Healthy Program Mark G. Wilson, PI Matt L. Smith, PI David M. DeJoy, Co-PI Robert J. Vandenberg, Co-PI Phaedra S. Corso, Co-PI NIH 1R01HL122330-01
Lessons Learned in Translating Program to Worksites Adaptation of program a key there is a fine line between translation and adaptation Recruitment and follow up of participants varies significantly taking all participants regardless of need Local capacity to implement change varies complexity of intervention influences implementation Organizational factors greatly influence programmatic implementation and outcomes Lower your expectations for success
Final Thought We know how to achieve weight loss. Our challenge is to overcome the challenges surrounding that change.
Mark Wilson mwilson@uga.edu Workplace Health Group: http://www.publichealth.uga.edu/hpb/research/workplace