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Capstone Experience Master of Public Health

8-2021

RE-AIM Evaluation of Workplace Weight Management RE-AIM Evaluation of Workplace Weight Management

Interventions: A Systematic Review Interventions: A Systematic Review

Adrienne Gothard University of Nebraska Medical Center

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RE-AIM Evaluation of Workplace Weight Management Interventions: a Systematic

Review

Adrienne Gothard

Concentration: Health Promotion

Capstone Committee:

Paul Estabrooks, PhD (Chair)

Melissa Tibbits, PhD

Fabio Almeida, PhD, MSW

Abstract

Overweight/Obesity is a major public health concern that affects nearly a third of the world’s population. In addition to personal health effects such as cardiovascular disease, cancer, and diabetes, obesity can take a toll on an employer’s bottom line, specifically healthcare costs and absenteeism. Many employers promote intervention programs targeted at lifestyle and behavioral factors to improve workforce health. A 2016 systematic review by Weerasekara et al. compared several of these intervention programs based on the effectiveness of the program, measured in participant’s weight changes from baseline to post-intervention. While this information can be valuable to employers who are interested in implementing their own program, more information is needed on the cost, including implementation and continuing costs, the representativeness of the sample included in the program, and the ability to maintain effectiveness over time. Using the reach, effectiveness, adoption, implementation, and maintenance framework (RE-AIM), this project will expand on previous findings and provide much needed data to assist employers and identify best practices for workplace weight management intervention programs. This systematic literature review evaluates interventions published between August 2015 and June 2021. While most studies address several aspects of the reach dimension, very few effectively outline measures of adoption or the cost aspects of the effectiveness dimension.

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CHAPTER 1- INTRODUCTION

Research Question & Objectives

The aim of this project, RE-AIM Evaluation of Workplace Weight Management

Interventions: a Systematic Review, is to evaluate existing workplace weight

management interventions through the lens of the RE-AIM framework. This project

expands on the findings of a 2016 systematic review titled “Effectiveness of Workplace

Weight Management Interventions: a Systematic Review” by Weerasekara et al. In

addition to the evaluation of intervention effectiveness, this project also evaluates

interventions based on their reach, adoption, implementation, and maintenance. The

original review included a search of literature from inception to August 2015. This

project uses the same search criteria used in the original systematic review to evaluate

recent literature based on studies published after August 2015.

The purpose of this review is to identify long-term (³6 month) workplace weight

management interventions and review the data across the measures of the reach,

effectiveness, adoption, implementation, and maintenance framework (RE-AIM). The

specific question to be answered by the review is: How many of the RE-AIM dimensions

are addressed by the current literature addressing workplace wellness interventions for

obesity? The primary aim of this project is to identify effective and long-lasting

interventions that may be implemented at workplace settings to give employers a place

to start when looking to invest in the health and well-being of their most valuable

resource, the workforce. Building off of the base information included in the

Weerasekara et al. review, the additional information included in this review, can help to

translate this important setting-based research into practice.

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Rationale for Review

In recent decades, the workplace, where employed individuals spend a large

proportion of their waking hours, has become a setting of interest for health promotion

interventions. Interest in workplace wellness intervention programs from the perspective

of an employer often stems from the assumption that these programs will result in

increased employee health status, thus reducing health care costs and increasing

productivity in the workplace. In 2012, an estimated $8.65 billion dollars in lost

productive time was attributed to absenteeism related to obesity in the United States.

Additionally, annual health care spending per capita for obesity related expenses are

estimated at $1600 for men and $1525 for women (Yarborough et al., 2018).

Employer based programs generally target lifestyle and behavioral factors, such

as weight management, physical activity, stress reduction, and tobacco cessation

(Abraham, 2019). These programs are especially important in occupations that are

inherently sedentary, such as “desk jobs”. Excessive sitting and physical inactivity at

work have been associated with increased risk of obesity (Shrestha et al., 2018).

Over the years, studies have shown variable results for the desired outcomes,

and thus evaluation of programs based on gold standard randomized control trials

(RCTs) are needed. This systematic literature review will include only RCT studies and

will add a thorough review of workplace weight management interventions to the current

literature available to researchers and employers.

The RE-AIM framework was developed to help invested parties evaluate a

program through multiple lenses, thus broadening the scope of the evaluation (RE-AIM,

n.d.). The RE-AIM framework takes into account many of the factors that may affect

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program success in a “real-world” situation. The RE-AIM acronym stands for reach,

effectiveness, adoption, implementation, and maintenance (RE-AIM, n.d.). “Reach”

shows the representativeness of individuals of a given program, while “adoption” shows

the representativeness of the setting. “Effectiveness” refers to the outcomes of the

intervention, both positive and negative. The “implementation” element of RE-AIM

evaluates the level of fidelity and consistency with which the intervention program

adheres to the outlined description or program plan. “Maintenance” refers to how the

intervention becomes engrained in the setting culture and the long-term effects in the

individual (RE-AIM, n.d.). Since this framework doesn’t focus only on the outcome of

an intervention (i.e. overall weight loss), this review will help to determine the overall

success of workplace weight management intervention programs.

CHAPTER 2- BACKGROUND

Description of the Health Problem

Overweight and obesity are described by the World Health Organization (WHO)

as “abnormal or excessive fat accumulation that may impair health” (World Health

Organization, 2020). Overweight range is defined by the Centers for Disease Control

and Prevention (CDC) as a body mass index (BMI) of 25 to <30 kg/m2, while obesity is

defined as a BMI of 30 kg/m2or higher (CDC, 2021). Obesity increases an individual’s

risk for a myriad of health conditions, such as diabetes mellitus, cardiovascular disease,

and certain types of cancers (Sandercock & Andrade, 2018).

Overweight/obesity is a global health problem, affecting nearly one-third of the

population worldwide. The number of individuals who fall into an overweight or obese

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category has doubled since 1980 (Chooi et al, 2019). These staggering statistics speak

to the need for interventions, including setting-based approaches, to address weight

management.

The definition of clinically significant weight loss is a measure of weight reduction

of at least 5% of baseline weight (Swift et al., 2016). This is the level of weight loss that

has been shown to improve cardiometabolic risk factors, and as such the threshold of

>5% weight loss is an attractive goal for public health researchers when designing

weight loss interventions.

CHAPTER 3 - METHODS

Search Strategy

In June 2021, a systematic literature search was conducted using the following

literature databases: Medline, CINAHL, Scopus, and Cochrane Central Register of

Controlled Trials. The search strategy of the original review by Weerasekara et al. was

mimicked for the search (Appendix A). Due to limitations in the availability of databases

through University of Nebraska Medical Center library, not all of the databases used in

the original review were used for this search (e.g. Scopus, SportDiscus and LILACS

were not included in the search). An additional search criterion for publication date

(August 2015-current) was added to ensure no overlap in articles from the original

study.

Inclusion and Exclusion Criteria

As per the Weerasekara et al. protocol, study eligibility included the

following:

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1. Intervention(s) was conducted in a workplace with a primary aim to promote

weight loss, prevent weight gain, or maintain weight status;

2. Study design included randomization of samples, such as randomized control

trials, cluster randomized trials, and crossover designs (pre-post and quasi

experimental designs were not included);

3. Study population of adults of both sexes, age greater than or equal to 18

years, and who were employed at the workplace with no exclusions based on

weight status, co-existing risk factors, or comorbidities;

4. Primary outcomes of intervention studies were change in weight, BMI (body

mass index), and/or body fat;

5. Intervention duration of ³ 6 months;

6. Intervention type including dietary, physical activity, financial incentives,

behavior change and goal setting, environmental workplace modification, and

health risk appraisal with feedback. Intervention types excluded were those

where food or meal replacements (³1 meal/day) were provided.

Data extraction & Quality Assessment

Once eligible studies were identified, data extraction for the dimensions of the

RE-AIM framework was completed using the coding methods described in the 2018

review titled “Understanding the impact of rural weight loss interventions: A systematic

review and meta-analysis” by Porter et al. The data abstraction tool used by the Porter

et al. study team was utilized to code the RE-AIM data and ensure a thorough review of

all dimensions (Porter et al., 2018). Prior to coding the eligible articles for this review,

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the coder (AG) selected a sample study to review and code information for each of the

five dimensions of the RE-AIM framework: reach, effectiveness, adoption,

implementation, and maintenance. This sample coding was reviewed by a senior

scientist to ensure competence in data extraction. The list of RE-AIM indicators and

their corresponding definitions is presented in Appendix B. This assessment was

completed in lieu of a formal quality assessment tool, as relevant data was extracted

from all studies included for review.

CHAPTER 4 – RESULTS

Search Results & Selection Process

The literature database searches in Medline, CINAHL, Scopus, and Cochrane

Central Register of Controlled Trials originally yielded 625 potentially relevant articles.

Once duplicates were removed, remaining articles titles and abstracts were screened

for eligibility criteria. Final review of the full text of potentially eligible articles was then

performed to identify articles for inclusion. Ultimately, 21 articles from 13 unique

intervention studies were included for review and data abstraction. Figure 1 outlines the

study selection process in the Preferred Reporting Items for Systematic Reviews

(PRISMA) flow diagram (Page et al., 2021).

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Figure 1. Preferred Reporting Items for Systematic Reviews (PRISMA) flow diagram.

Description of Studies

Interventions included in this review varied by geographic location, including the

United States (n=9), Denmark (n=1), Iran (n=1), Ireland (n=1), and Malaysia (n=1). By

design, all study settings were workplaces with a focus on employee study participants.

Intervention settings included government agencies, nursing home/health care facilities,

social service organizations and health centers, manufacturing workplaces,

transportation companies, and academic institutions. Study duration varied from 6-24

months. Table 1 summarizes the characteristics of each study, including the study goal,

design, and evaluation period.

Potentially relevant records identified from electronic databases search

(N=625)

Records screened (N=382)

Duplicates excluded (N=243)

Records excluded by title/abstract (N=346)

Full text articles assessed for eligibility

(N=36)

Records identified by secondary reference

(N=2)

Full text articles eligible and included in analysis (N=21 articles from 13 unique intervention studies)

Records excluded (N=17)

Does not apply to key question (n=8) Study design did not meet criteria (n=5) Study duration did not meet criteria (n=3) Not in a worksite (n=1) Article not in English (n=1)

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Table 2. RE-AIM Indicators with the number of studies (N=13) reporting each RE-AIM indicator. Table measures and characteristics from Porter et al.

Indicator Number (%) reporting

REACH Number of eligible participants exposed to recruitment 11 (85%) Sample Size 13 (100%) Participation rate (as reported by the authors) 1 (8%) Participation rate (number of articles with sufficient data to calculate standardized participation rate [sample size/ number of eligible participants contacted for participation]) 10 (77%)

Individual-level representativeness (comparisons between target population and study sample) 5 (38%) Demographic and behavioral information about study population 10 (77%) Method to identify target audience 7 (54%) Inclusion/exclusion criteria 13 (100%) Description of recruitment methods used 13 (100%)

EFFICACY/EFFECTIVENESS Weight change (weight loss in kg or percent of body weight loss, change in BMI) 13 (100%) Proportion of the sample that achieved ³ 5% weight loss 3 (23%) Quality of life measure 5 (38%) Unintentional negative consequences and results 1 (8%) Imputation of missing data 8 (62%)

ADOPTION Number of eligible and invited sites 1 (8%) Number of participating sites 8 (62%) Site participation rate 1 (8%) Description of intervention setting 2 (15%) Setting representativeness (comparisons of target location and study sites) 0 (0%) Method to identify and engage intervention setting 1 (8%) Number of staff eligible and invited to participate in intervention delivery 0 (0%) Number of staff participating in intervention delivery 3 (23%) Level of expertise of delivery agent(s) 10 (77%)

IMPLEMENTATION Statement of theories or principles used to develop intervention 8 (62%) Intervention duration 13 (100%) Description of encounters with participants during intervention (intervention number, timing, and/or duration of contacts) 13 (100%)

Participant attendance/completion rates 6 (46%) Extent intervention protocol was delivered as intended 3 (23%) Consistency of implementation across study sites 2 (15%) Cost 2 (15%) Cost of recruitment 0 (0%) Start-up costs 0 (0%)_ Ongoing cost of intervention delivery 0 (0%) Cost benefit or cost-effectiveness 2 (15%)

MAINTENANCE Weight outcome assessed at one or more points post-intervention 6 (46%) Participant attrition during follow-up period 8 (62%) Description of program continuation/institutionalization 2 (15%) Abbreviations: RE-AIM reach, effectiveness, adoption, implementation, maintenance; BMI body mass index

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Summary of Findings

Table 2 summarizes the results of the coding and RE-AIM indicators

assessment.

REACH All studies included a description of the target population, and a majority of the

studies included the demographic and behavioral information about the study population

(e.g. participants’ sex, age range, education level, marital status, etc.). All studies also

included at least a brief description of the recruitment strategies used for participation in

the intervention program. Inclusion criteria was included for all studies, while 4 studies

listed exclusion criteria as “none”, as all employees were encouraged to participate in

the intervention. According to one study “…all employees at the sites were eligible to

participate. This is typical of worksite programs, which tend to be all-inclusive to avoid

issues related to fairness and access.” (Wilson et al., 2016b). Authors of another study

stated, “There were no exclusions by BMI category or other chronic conditions because

the interventions addressed small lifestyle changes that could be adopted regardless of

any underlying conditions.” (Fernandez et al., 2015).

All studies reported the sample size of the study population, with a majority in the

range from 42 to 850 participants with an outlier of 3799 participants. After removing the

outlier, the median sample size was 290 (± 560). Only one study explicitly stated the

participation rate (Ing et al., 2018), although 10 of the studies (77%) provided sufficient

data to calculate a standardized participation rate.

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Five of the studies (38%) provided comparisons between the study sample and

the broader target population. One study noted that the financial component of the study

led to “higher income and more educated participants than the overall hospital

workforce” (Cleveland et al., 2020). Of note, one limitation noted by many of the studies

in this review is the potential for selection bias. Although these studies are randomized,

they rely on voluntary participation, which may lead to study samples having more

motivated participants compared to general workplace population.

EFFECTIVENESS

All 13 studies included a measure of weight change as an outcome of the

intervention. These measures included change in weight, BMI, or body weight (percent)

in comparison to an untreated control group, a comparison group, or other treatment

groups. All studies reported mean loss in weight, BMI, or % body weight compared to

baseline measures. Table 3 outlines the outcomes of the studies with an outcome of

weight change (studies with a goal of weight gain prevention and/or weight maintenance

excluded).

Interventions that focused on weight loss maintenance or weight gain prevention

reported mixed success. One study showed that a deposit contract led to more

participants meeting their weight loss maintenance goals than the control (Cleveland et

al., 2020), and another study with the goal of weight loss maintenance showed that a

larger proportion of participants in a DVD intervention were able to maintain weight loss

compared to a face-to-face intervention (Ing et al., 20148). One study showed that

minimizing environmental exposure to calorically dense foods may have an impact on

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preventing weight gain (Fernandez et al., 2015), while another study showed no

difference in intervention and control groups for preventing weight gain (Thorndike et a.,

2021).

Only three studies (23%) reported the proportion of the sample that achieved

³5% weight loss (Jamal et al., 2016; Patel et al., 2016; Wilson et al., 2016). One

additional study gave participants a goal to lose 5-7% of their body weight but did not

report outcomes in terms of body weight percent loss (Ferrera et a., 2020).

Table 3. Impact of interventions on weight for those studies with a goal of weight loss

Study Weight Change from Baseline, Mean (kg) Evaluation

Period (month)

Abdi et al. -1.9 kg (telephone group) -1.08 kg (web group) 6

Balk-Møller et al. -1.04 kg (intervention group) 9.5

Geaney et al. -0.7 kg (education group) -0.04 kg (environmental group) -0.4 kg (combined intervention group)

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Jamal et al. -2.24 kg (intervention) -0.69 kg (comparison) 6

Kullgren et al. -2.3 kg* (no match group) -1.6 kg* (1:1 match group) -1.3 kg* (2:1 match group)

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Patel et al. -0.55 kg* (delayed premium adjustment group) -0.64 kg* (immediate premium adjustment group) -0.45 kg* (daily lottery group)

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Wilson et al. -2.2 kg* (phone group) -1.5 kg* (small group) -1.2 kg* (self-study)

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Study Weight Change from Baseline, Mean (BMI, kg/m2)

Evaluation Period

(month) Fernandez et al. -0.54 kg/m2 (intervention group) 24

Study Weight Change from Baseline, Mean (% body weight)

Evaluation Period

(month) Ferrera et al. -2.7% body weight (YMCA DPP group)

-2.41% body weight (VLM-DPP group) 6

*original measure of weight change listed in pounds, converted to kg [number in pounds/2.2]

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ADOPTION

Of the five dimensions of RE-AIM, adoption was the dimension with the least

amount of reporting across the board for all studies. The number of participating sites

was described in eight (62%) of the studies, while the number of individuals participating

in the delivery of the intervention was only stated in three (23%) of the studies.

The level of expertise of the intervention delivery agent was described in a

majority of the studies (10 studies, 77%), although the detail provided varied greatly. For

instance, one study simply stated, “trained staff from the research group” (Balk-Møller et

al., 2017), while another study went into much more detail, describing the ideal peer

health coach as “outgoing, respected and a good communicator” and specifying that an

occupational health nurse would be on site at the workplace (Wilson et al., 2016b).

IMPLEMENTATION All 13 studies described intervention details (number of contacts, timing and/or

duration of contacts) to some extent. For several of the interventions, outlines of class

schedules and teaching points were provided in table form. Three studies (Jamal et al.,

2016; Wilson et al., 2016; Wilson et al., 2016b) were adaptations of previous protocols,

and as such described the extent to which the protocol was modified and the reasons

why the protocol was modified to fit the target worksite populations. Eight studies (62%)

described the public health theories or principles used to develop the intervention.

An important feature of the “Implementation” dimension of RE-AIM is cost. Very

few studies reported details on the costs of the interventions, specifically cost of

recruitment, start-up costs, ongoing costs, and cost-effectiveness. Only two studies

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provided a description of intervention costs and cost effectiveness, and these numbers

were published in supplemental articles dedicated to the cost aspect of the studies

(Fitzgerald et al., 2018 & Corso et al., 2018). One of these studies (Corso et al., 2018)

described the cost of the intervention for each of the three treatment arms (ranging from

$143/employee for the self-study group to $601/employee for the phone treatment

group).

MAINTENANCE For the maintenance dimension, eight (62%) of the studies described the attrition

of the participants, including the reasons for loss to follow-up. Additionally, six (46%) of

the studies assessed a weight outcome at some point post intervention during the

study. Many of the reasons listed for loss to follow-up were financial, job change,

personal reasons, and workplace restructuring.

Quality Assessment

As outlined in the inclusion criteria for eligible studies, intervention types

including dietary, physical activity, financial incentives, behavior change and goal

setting, and environmental workplace modification were considered. Table 4 outlines

the intervention characteristics of each of the 13 intervention studies. An inclusion

criterion was a measure of weight to evaluate effectiveness of the intervention. Table 4

also shows the studies that had an additional dietary and or physical activity measure

included in their evaluation.

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DISCUSSION

Summary

The RE-AIM framework is an effective assessment for identifying the necessary

program components that should be included not only in the report of an intervention

program, but also the planning and design of the program. By addressing the

dimensions of RE-AIM, program planners can help to ensure generalizability of studies,

therefore making them more available to be reproduced or adapted to other settings

(RE-AIM, n.d.).

The concept of reach (representativeness of individuals) is especially important

in workplace settings, as there can be many differences in population characteristics

and setting (RE-AIM, n.d.). In the same workplace, the population could have a large

difference in age, baseline health status, education level, etc., all of which could play a

role in how they respond to an intervention. Understanding the reach of an intervention

program will help employers to understand how the intervention may work with their

specific workplace population.

Effectiveness, of course, is important in the evaluation of any intervention

program, especially when able to be compared to cost. If a study is able to show

positive outcomes for employee health, employers may be more likely to employ a

program if they can justify the cost. In contrast, if a study does not show positive

impacts (e.g. clinically significant weight loss, weight gain prevention, or weight loss

maintenance), there is likely little incentive to invest resources into a program.

The findings of this study, specifically the categorical lack of information

regarding intervention program costs, show a need for transparency in this area,

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especially if the program is to be replicated and translated to other settings. Additionally,

information on the adoption, both at the individual and setting levels, may be beneficial

for public health practitioners and researchers when creating similar programs.

Public Health Implications

Worksite weight management intervention programs have the potential to have

major public health implications on adults in the workforce. Interventions targeted at

weight management have the potential to not only increase the health of the individual,

through weight reduction, but also mental health. Improvements in workplace

environment and lifestyle interventions also have the potential to improve the health and

well-being of all employees, not just those who are overweight or obese.

Strengths and Limitations

One strength of this review is that techniques from other successful reviews were

able to be utilized. This created a strong foundation to build upon for this review of more

recent studies. The assessment tool used by Porter et al. provided and thorough review

of the dimensions of the RE-AIM framework.

One potential limitation of this review is the relatively small sample size. Since

the window for study publication was a little under seven years and many studies did

not meet the eligibility criteria, this systematic review only represented 13 studies from

21 published articles. Additionally, the effects of the COVID-19 pandemic over the past

year and a half have likely affected many studies that were in progress during the onset

of the pandemic, and delayed others that may have been planned.

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In addition to the small sample size of studies, another limitation to this review is

the evaluation of study effectiveness. Since the studies did not all have the same

primary outcome measure, very few comparisons in terms of effectiveness could be

made in contrast to a review where all of the studies had the same measure (e.g. weight

loss measured in kg or pounds lost from baseline to post-intervention). Additionally,

there was a large range for intervention duration (ranging from 6 to 24 months), which

also makes comparisons in weight changes difficult. Future studies in this area could

potentially expand some of the other eligibility criteria, while honing in on only studies

with similar intervention durations and units of measure.

Gaps in Evidence

Many workplace weight management studies are currently evaluating the

potential of deposit contracts for weight loss, weight loss maintenance, or weight gain

prevention. Starting in 2014, the limit of the amount that employers may use to provide

wellness-inceptives increased from 20% to 30% of the total amount of an employee’s

health insurance premiums (Volpp et al., 2011). More studies evaluating the optimal

incentive type (e.g. deposit contracts vs. cost-sharing mechanisms) as well as the

optimal financial investment for the employer are needed to evaluate the prospective

success of financial incentives for weight management.

Another possible future area of study is the adaptation of successful health

promotion interventions to be specific to weight management in the workplace. Three of

the studies included in this review (Ferrara et al., 2020; Wilson et al., 2016; Wilson et

al., 2016b) derived interventions from the National Diabetes Prevention Program,

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including the lifestyle change programs that are recognized by the CDC (Ferrara et al.,

2020). Employers may be able to utilize programs and resources that are already in

existence to implement successful and cost-effective weight management interventions.

Conclusions

The potential of workplace interventions for overweight/obesity has been seen as

an area of great potential over the past few decades. The importance of reaching

individuals where they spend a large proportion of their waking hours is essential to

promoting a healthy lifestyle. These of interventions can provide a mix of dietary and

physical activity instruction, behavioral modification, environmental changes, and

financial incentives. In program planning and evaluation, it is crucial to take into account

the dimensions of the RE-AIM framework to increase the validity and generalizability of

public health interventions.

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Appendix A: Literature Database Search Strategies

Database Search Strategy- OVID Medline

August 2015-Present Workplace ((work* or job* or employment*) adj2 (place* or site* or location* or setting*)).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier] OR (workplace* or workplace* or work setting* or work-place* or work-site* or work-setting*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier] OR exp Workplace/ OR (employer* adj2 (sponsor* or support* or based)).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept] AND Weight loss/ Primary outcome body constitution/ or exp "body weights and measures"/ or anthropometry/ OR (body adj2 (fat or composition or weight or measure* or constitution)).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier] OR (bmi or "body mass index").mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier] OR (skinfold* adj2 thick*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier] OR (waist adj2 (hip or circumference)).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier] OR exp Body Composition/ OR (body adj2 (fat or composition or weight or measure* or constitution)).mp. [mp=title, abstract, original title,name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier] OR exp Adipose Tissue/ OR (adipos* or anthro*).mp. OR body weight/ or weight gain/ or weight loss/ or exp overweight/ OR (weight adj2 (loss* or reduc* or lower* or control* or prevent* or gain* or over)).mp.

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AND Randomized Controlled Trial (randomized controlled trial or controlled clinical trial).pt. or randomized.ab.or placebo.ab. or clinical trials as topic.sh. or randomly.ab. or trial.ti OR (random* or RCT*).mp. or exp Randomized Controlled Trials/ or exp Clinical Trials as Topic/ Limit to: Clinical trial, all or comparative study or controlled clinical trial or evaluation studies or meta-analysis or multicenter study or systematic reviews)

Database Search Strategy - CINAHL Workplace ( (work* OR job* OR employment*) N2 (place* OR site* OR location* OR setting*) ) OR ( (workplace* OR workplace* OR worksetting* OR workplace* OR workplace* OR worksetting*)) OR (MH "Work Environment") OR ( employer* N2 (sponsor* OR support* OR based) ) AND Weight loss/ Primary outcome ( body mass index or bmi ) OR (MH "Body Weights and Measures" OR MH "Body Weight Changes" OR MH "Body Mass Index" OR MH "Waist Circumference" OR MH "WaistHip Ratio" OR MH "Anthropometry" ) OR (weightloss or overweight or obes*) OR ( MH "Body Weight" OR MH "Obesity+" OR MH "Weight Loss" OR MH "Body Constitution" ) OR ( weight N2 (change* OR loss* or reduc* or lower* or control* or prevent* or gain* or over) ) OR ((MH "Adipose Tissue Distribution") OR (MH "Adipose Tissue+") OR adipos* OR anthropomet* ) OR ( waist N2 (hip or circumference) ) OR skinfold* N2 thick* OR body N2 (fat or composition or weight or measure* or constitution) AND Randomized Controlled Trial ( (MH "Clinical Trials") OR (MH "Randomized Controlled Trials") ) OR TI trial* Limiters – Publication Type: Randomized Controlled Trial; Published Date: August 2015- June 2021

Database Search Strategy – Cochrane Clinical Trial Registry (Title Abstract Keyword search) Workplace ((work* or job* or employment* or occupation*) adj2 (place* or site* or location* or setting*)).mp. (mp=title, original title, abstract, mesh headings, heading words, keyword) OR (workplace* or workplace* or worksetting* or work-place* or work-site* or worksetting*). mp. (mp=title, original title, abstract, mesh headings, heading words,

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keyword) OR Workplace OR (employer* adj2 (sponsor* or support* or based)).mp. (mp=title, original title, abstract, mesh headings, heading words, and keyword) AND Weight loss/ Primary outcome body constitution or "body weights and measures" or anthropometry OR (body adj2 (fat or composition or weight or measure* or constitution)).mp. (mp=title, original title, abstract, mesh headings, heading words, keyword) OR (bmi or "body mass index").mp. (mp=title, original title, abstract, mesh headings, heading words, keyword) OR (skinfold* adj2 thick*).mp. (mp=title, original title, abstract, mesh headings, heading words, keyword) OR (waist adj2 (hip or circumference)).mp. (mp=title, original title, abstract, mesh headings, heading words, keyword) OR Body Composition OR (body adj2 (fat or composition or weight or measure* or constitution)).mp. (mp=title, original title, abstract, mesh headings, heading words, keyword) OR Adipose Tissue OR (adipos* or anthro*).mp. (mp=title, original title, abstract, mesh headings, heading words, keyword) OR “body weight” or “weight gain” or “weight loss” or “overweight” OR (weight adj2 (loss* or reduc* or lower* or control* or prevent* or gain* or over or change*)).mp. AND Randomized Controlled Trial (randomized control trial or controlled clinical trial) or clinical trials Limit to Content Type: Trials, Original Publication Year: Between 2015-2021

Database Search Strategy – Scopus Workplace ( TITLEABSKEY ( ( work* OR job* OR employment* ) W/2 ( place* OR site* OR location* OR setting* ) ) OR ( TITLEABSKEY ( workplace* OR workplace* OR worksetting* OR workplace* OR workplace* OR worksetting* ) ) OR TITLEABSKEY ( employer* W/2 ( sponsor* OR support* OR based ) ) ) This was combined with the following search strategy using AND: Weight loss/ Primary outcome ( ( TITLEABSKEY ( body W/2 ( fat OR composition OR weight OR measure* OR constitution ) ) ) OR ( TITLEABSKEY( bmi OR "body mass index" ) ) OR ( TITLEABSKEY ( skinfold* W/2 thick* ) ) OR ( TITLEABSKEY ( waist W/2 ( hip OR circumference ) ) ) OR ( TITLEABSKEY ( adipos* OR anthropomet* ) ) OR ( TITLEABSKEY ( weight W/2 ( loss* OR reduc* OR lower* OR control* ORchange* OR prevent* OR gain* OR over ) ) ) OR ( TITLEABSKEY ( "body weight" OR obes* OR "weightloss" OR "weight gain" OR "weight loss" OR overweight ) ) OR ( TITLEABSKEY ( "body composition" OR "body constitution" OR "body fat" ) ) ) )

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This was combined with the following search strategy using AND: Randomized Controlled Trial ( ( TITLEABSKEY ( random* OR trial* ) ) ) A date range was added: Published from 2015 to Present

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Appendix B- RE-AIM Indicators and Corresponding Definitions

REACH Number of Eligible and

invited (exposed) to recruitment

The total number of eligible participants contacted for participation.

Sample size The number of people who agree to participate (e.g. n= ).

Participation rate Sample size divided by the target population denominator.

Participation rate (calculated)

Sufficient data to calculate standardized participation rate [sample size/ number of eligible participants contacted for participation].

Individual-level representativeness

Comparisons made between target population and study sample with a description of what those comparisons were.

Description target audience A brief description of the broader target population (i.e., not simply of the study sample).

Method to identify target population

Describe the process by which the target population was identified for participation in the study.

Inclusion criteria/ Exclusion criteria

Explicit statement of characteristics of the target population that were used to determine if a potential participant is eligible to participate. Explicit statement of characteristics that would prevent a potential participant from being eligible to participate.

Description of recruitment strategies used Describe the methods used to recruit participants into the study.

EFFICACY/EFFECTIVENESS Weight change Weight loss in kg or percent of body weight loss, change in BMI

Proportion of the sample that achieved ³ 5% weight

loss

Proportion of the sample that achieved ³ 5% weight loss

Quality of life measure Includes a measure of quality of life with some latitude for coding articles that refer to well-being or satisfaction with life.

Unintentional negative consequences and results

To evaluate unanticipated consequences and results that may be a product of the intervention and may have caused unintended harm.

Imputation of missing data Substitution of some value for missing data. Specify imputation procedure.

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ADOPTION

Number of eligible and invited sites

Total sites that met eligibility criteria and were approached for intervention delivery.

# Participating (sites) The total number of sites that agreed to participate. Participation rate (sites) The proportion of sites eligible and contacted that participated. Description of targeted

location Characteristics that would be considered an ideal location for the intervention.

Description of intervention location

The explicit statement of characteristics of the location of the intervention.

Method to identify setting Describe the process by which the location was identified for participation in the study.

Setting Representativeness (# of Comparisons)

Total number and type of comparisons of targeted intervention sites and those that participated, including a list: size, location, etc.

# eligible and invited(exposed)

Total staff that met eligibility criteria and were approached for intervention delivery.

# Participating in delivery The total staff members that agreed to participate.

Level of expertise of delivery agent

Training or educational background in relevant area; Degrees, certifications of delivery agents (such as PhD, Masters, Registered Dietitian, etc.)

IMPLEMENTATION

Theories Explicit statement of theories or principles used to develop the intervention

Intervention number of contacts

Total number of encounters with participants. Could include face-to-face meetings, telephone calls, newsletters etc.

Timing of contacts Describe when the intervention contacts occur over the course of the intervention.

Duration of contacts Length of each intervention contact.

Extent protocol delivered as intended (%) Description of fidelity to the intervention protocol.

Consistency of implementation across

setting and delivery agents

Description of the degree of similarities between multiple settings sites & delivery agents

Participant attendance/completion

rates

The proportion of the intervention that the participants received, on average.

Measure of cost The ongoing cost of delivery across all levels of the intervention

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Cost of recruitment The cost of recruitment can reflect monetary and/or time units.

Cost effectiveness Code as reported if specific mention and amounts are provided for the cost of the intervention.

MAINTENANCE

Was individual behavior assessed at some duration following the completion of

the intervention? (give duration of follow-up)

Description of follow-up outcome measures of individuals available at some duration after intervention termination

Participant Attrition Describe the degree to which participants were lost to follow-up (and the reasons) during the period in time from the interventions completion to the follow-up.

Was the program institutionalized?

Description of the how the intervention was integrated into the delivery system through methods such as policy changes, job description changes.

Biography & CV

Adrienne Gothard is a Master of Public Health student at the University of Nebraska

Medical Center, with a concentration in health promotion. Ms. Gothard holds a

Bachelor’s degree in Nutrition and Dietetics from the University of Northern Colorado

and has been a Registered Dietitian since 2012. Her current professional public health

interests center around corporate wellness and improving the health of the workforce.

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AdrienneGothard,RDN

RegisteredDietitianNutritionist

EDUCATIONMasterofPublicHealth:HealthPromotionconcentrationExpectedAugust2021UniversityofNebraskaMedicalCenterDieteticInternship July2011-March2012UniversityofNorthernColorado(UNC),Greeley,COBachelorofScience:Dietetics,Minor:PsychologyMay2010UniversityofNorthernColorado(UNC),Greeley,CO

RELEVANTWORKEXPERIENCE

FOOD SAFETY CONSULTANT National Environmental Health Association, Denver CO May 2021- Present

§ Execute tasks for project deliverables as directed within the food safety team § Develop thoroughly researched reports and content for the organization’s website § Communicate effectively and professionally with stakeholders, subject matter experts,

partner organizations, and other project participants

CLINICAL NUTRITION MANAGER Sodexo Inc., Good Samaritan Medical Center, Lafayette CO November 2019– April 2021

§ Directed daily operations of hospital clinical nutrition program § Managed team of 6 Registered Dietitian Nutritionists § Responsible for the training of new clinical dietitians and interns § Monitored staffing productivity and managed the clinical nutrition program budget § Completed audits of malnutrition program data to create action plans and report

financial outcomes to the client § Created and presented educational in-services for nutrition department staff, hospital

wide employee health classes, and client-facing presentations § Promoted health and wellness as a 6-year member of the hospital’s Employee Wellness

Committee § Implemented health and wellness initiatives in the hospital café

PATIENT FOOD SERVICES MANAGER Sodexo Inc., Good Samaritan Medical Center, Lafayette CO March 2019 – November 2019

§ Directed daily operations of patient meal services to ensure timely and accurate delivery of meals and nourishments to patients

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§ Managed a team of twenty-five+ employees § Collaborated with clinical departments and hospital leaders to ensure exceptional

patient experience § Ensured that employees had appropriate equipment, inventory, and resources to

perform their jobs § Ensured compliance with all state, federal, and local regulations for quality assurance,

food safety, and workplace safety CLINICAL DIEITITAN Sodexo Inc., Good Samaritan Medical Center, Lafayette CO September 2012 – March 2019