Worksite Obesity Research and

Recommendations

Charlotte A. Pratt, PhD

Program Director

National Heart, Lung, and Blood Institute,

National Institutes of Health

January 21, 2015

George Washington University

#GWICF2015

Financial or material support: None

The views expressed are my own and do not

necessarily represent the views of the National

Institutes of Health or the United States

Government.

Disclosures#GWICF2015

Overview of NIH funding for Worksite Obesity Research: 2007-2014

Important Research Questions in Worksite Obesity Control

Examples of Promising Active NIH-funded grants: Investigator-Initiated

Recommendations for Future Research

NIH Workshop Recommendations

Pathways to Prevention Workshop-NIOSH-CDC/NIH: upcoming late fall/early winter

Outline#GWICF2015

16%

15%

14%

12%

11%

11%

11%

10%

Number of grants

NHLBI NINR NIDA NIDDK NIAAA NCI NICHD NIEHS

Worksite obesity-related grants: 2007-2014

Total= 119, 2007-14

8 Institutes-- 61% of NIH worksite obesity -related grants;

16 Other Institutes: N= 46 or 39%

Search term: Worksite or workplace and obesity

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Altering the worksite physical activity and nutrition environments, social, economic or organizational systems

Addresses obesity control from multiple fronts

Larger reach; may be more generalizable

Opportunity to enhance weight loss maintenance

Social support

Reduction of health care cost for the employer and employee--cost benefit; cost effective

Socially responsible employer

Worksite Overweight and Obesity Control #GWICF2015

Do interventions that modify the worksite food and physical activity environments (or combined with individual approaches) control body weight in adults?

Will participation in a worksite obesity intervention sustain and maintain weight loss, and reduce cardiovascular disease risk factors in adults?

Key Research Questions for Worksite

Obesity Research

#GWICF2015

Coordinating

Functions

Vic Stevens

Kaiser

Permanente

20 School

personnel

(ACTION!)

N=600 school

staff

6 Hospitals

(Step Ahead)

N= 806

30 Hotels

(3W: Work,

Weight and

Wellness

N=~12,000

30 Small-

mediums size

Businesses

(PACE)

N=3,000

4 Bus

Garages-transit

workers

Route H)

N=1,200

12 Dow

Chemical Co.

(Lighten Up)

N=6,000

12 Kodak Co

(Images of a

Healthy

Workplace)

N=4,000

To test environmental or combinations of environmental and individual interventions

Emory

Univ.

Univ. Mass

Tulane

Univ.

Univ. of

Rochester

Univ. of

MN

Univ. of

Washington

Univ. of Hawaii

Total N= 23,000 selected for measures

Worksite Obesity Trials– R01s (Research Projects Grants)

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Citation Lemon et al. Am J Prev Med. 38(1):27-38; 2010

Research

question

Would a worksite environmental intervention prevent weight

gain among hospital employees?

Conceptual

Framework

Socio-ecological model of health behavior, social marketing

campaign, leadership support

Design 6 hospitals; 3 matched pairs; random assignment

Intervention Cafeteria menu and vending machine changes, portion

control, web-based counseling, walking groups, stairwell

changes, group-level behavioral programs

Outcomes PO: change in BMI at 12 and 24 months; SO: change in

organizational commitment

Overall take

home

message

Intervention had a dose-response relationship with

participation but overall, no BMI effect.

Overweight & Obesity Control at Worksites-

Hospitals#GWICF2015

Lemon et al. Am J Prev Med. 38(1):27-38; 2010

BMI effect related positively to participation.

Improved perceptions of organizational commitment to worker health

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ROUTE H! Mean change in selected foods, physical activity

& perceptions of metro employees

Intervention Effect 95% CI

BMI effect -0.14 -0.84, 0.57

Fast foods (times/wk) -0.31** (-0.66, 0.04)

Kcal/day -407** (-778, -36)

Fruits and Vegetables

svg/day)

0.25* (0.01, 0.49)

MVPA (min/day) 2.7 (-5.2, 10.6)

TV viewing (h/day) -0.09 (-0.35, 0.18)

Information on health eating 18.6* (3, 34.2)

Easy to eat healthfully at

work

12.2* (0.2, 24.2)

French et al., Preventive Medicine, 50, 180-185, 2010

Adjusted for age, education, income, marital status, race, gender, smoking

Status; * p<.05, ** p<.10, 2 df

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Citation Thorndike et al. Am J. Prev Med 2012; 43 (1) 27-33

Research

question

Will participation in a worksite obesity intervention sustain

and maintain weight loss, and reduce cardiovascular

disease risk factors in adults?

Design Be fit weight loss program; RCT; Teams Rdz into

maintenance intervention (Internet and personal contact);

and control arm

Intervention Goal setting, self monitoring via internet logging and

weekly counseling; personal contact and counseling with

nutritionist every 3 months

Outcomes Weight loss at 10 weeks ~4.2 lb in both groups;

maintenance- 3.4 lb vs. 2.5 lb (I vs.C). Improvement in BP,

TC, LDL-C, TG, Fasting blood glucose

Take home

message

Weight loss maintained in both groups; prevention of

usual increase in weight post intervention.

Overweight & Obesity Control at Worksites- Hospital

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Weight maintenance after weight loss

Thorndike et al. Am J. Prev Med 2012; 43 (1) 27-33

Absolute weight loss % weight loss

Improvements in all CV risk factors at 10 weeks; TC & LDL-C effects maintained at 1 yr

-4.2 lb

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Examples of Promising Active NIH-

Funded Grants

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Research

Question

Can a multi-level worksite-based physical activity (PA)

intervention in child care for low wage workers enhance their PA?

Grant Title Care2bWell: A Worksite Physical Activity & Wellness Program for

Child Care Staff

Grant #/duration 1R01HL119568-01; Fiscal Year 2014-2018

Setting Small Worksites/Child Care Setting

Design Two-arm, cluster-randomized controlled trial (RCT) with a sample

of 104 child care centers and 416 workers.

Intervention 6 month PA intervention compared to a financial empowerment

(FE) control arm followed by 18 month maintenance (minimal

intervention).

Outcome

Measures

PO: accelerometer-measured minutes of MVPA

SO: diet, psychosocial & center wellness environments, cost

effectiveness

Conceptual

framework

Social ecological framework, Perceptual

Control, Social Support, and Diffusion of Innovation

Promising Worksite Interventions#GWICF2015

Research

Question

Will adaptations of a Chronic Disease Self-Management (CDSM)

Intervention Program improve chronic disease risk in adults?

Grant Title Putting CDSM Program to Work: Implementation of the Live Healthy,

Work Healthy Program

Grant # 5 R01 HL122330; Fiscal Year 2014-2018

Setting 7 organizations from a rural county in partnership with YMCA trained

staff

Design Two arm: adapted CDSM versus usual CDSM programs

Intervention 6 month followed by 12 month follow up.

Outcome

Measures

PO: Composite of BMI, diastolic and systolic blood pressure, blood

glucose, HDL, LDL, and Total cholesterol

SO: Diet, physical activity, patient-provider communication, quality of

life, medication adherence, work performance and productivity and

cost-effectiveness.

Conceptual

framework

Social Learning Theory

Promising Worksite Interventions#GWICF2015

Desk-Compatible Elliptical Device

R21 HL118453

Fits under desk for simultaneous physical activity and desk work; low cost $100,

space efficient. Participants expended 179.1 kcal/hr (range = 108.2–269.0)

Rovniak et al. J Sci Med Sport. 2014,17(4):376-80

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Modest-to-minimal or no BMI effects:

demonstrated feasibility, low-cost interventions

could complement individual approaches for

weight management and potentially translate to

long-term gains if sustained.

Lessons: better job of addressing participation in

environmental interventions, consider lifestyle

beyond the worksite, influence of family, peer,

and upper-level administrative/leadership

support.

Summary#GWICF2015

Recommendations for Future

Research

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NIH, CDC-NIOSH Workshop Report and Recommendations on Preventing Chronic

Disease At the Workplace. Sorensen et al. AJPH. 2011;101(S1):196-207

• Study the adoption of integrated

interventions: individual, work-

family- community factors ,and

work environment.

• Attend to population, job, and

worksite characteristics.

• Use appropriate study designs

and methods.

• Apply appropriate and expanded

measures and metrics.

• Study sustainability and

knowledge transfer from research

to practice.

• Address global concerns. Workshop conceptual model

http://www.nhlbi.nih.gov/resources/docs/index.htm. Workshop: May 21-22, 2009

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Research that emphasizes combinations of

environmental and individual interventions,

(e.g., adaptation of the DASH diet) plus

outside of the work environment diet and

physical activity are needed.

Research targeting small businesses, minority

owned businesses and businesses in rural

communities by adapting proven modalities

from large businesses are needed.

Future Research Recommendations#GWICF2015

P2P Workshop focusing on worker health planned for late fall/winter 2015

Co-Sponsors NIH (NHLBI) and CDC (NIOSH) serve as content-area leads ODP serves as the programmatic and logistical lead

Goal Understand scientific evidence Develop recommendations for future research

Outcomes Panel report Systematic evidence report Post-workshop dissemination

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Beresford SAA et al. Worksite study to promote activity and changes in

eating for obesity prevention: The PACE Project. Obesity, Supplement 1, 15,

4S-15S, 2007.

French SA, Harnack LJ, Hannan PJ, Mitchell NR, Gerlach AF, Toomey TL.

Worksite environment intervention to prevent obesity among metropolitan

transit workers. Preventive Medicine. 50: 180-185, 2010.

Pratt, CA, Lemon, SC, Fernandez, ID, Goetzel, RZ, Beresford, SA, French,

SA, Stevens, VJ, Vogt, TM & Webber, LS. Design Characteristics of

Worksite Environmental Interventions for Obesity Prevention, Obesity, 15

(9), 1-10, 2007.

Additional References#GWICF2015

To watch Dr. Charlotte Pratt’s presentation online, visit:

www.icfi.com/ObesityPreventionCharlottePratt

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