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Obesity Prevention and Control
Once a company has conducted assessment and planning of obesity prevention and control programs, and developed the specific tasks of implementation for these programs, it is time to develop the evaluation plan. This evaluation plan should be in place before any program implementation has begun.
Metrics for worker productivity, health care costs, heath outcomes, and organizational change allow measurement of the beginning (baseline), middle (process), and end or outcome (outcome) of workplace health programs. It is not necessary to use all these metrics for evaluating programs. Some information may be difficult or costly to collect, or may not fit the operational structure of a company. These lists are only suggested approaches that may be useful in designing an evaluation plan.
These measures are designed for employee group assessment. They are not intended for examining an individual’s progress over time, which would raise concerns of employee confidentiality. For employer purposes, individual-level measures should be collected anonymously and only reported (typically by a third party administrator) in the aggregate, because the company’s major concerns are overall changes in productivity, health care costs, and employee satisfaction.
In general, data from the previous 12 months will provide sufficient baseline information and can be used in establishing the program goals and objectives in the planning phase, and in assessing progress toward goals in the evaluation phase. Ongoing measurements every 6 to 12 months after programs begin are usually appropriate measurement intervals, but measurement timing should be adapted to the expectations of the specific program.
The use of body mass index (BMI) is an approach to assessing whether a person is overweight or obese. While the use of BMI has some drawbacks, it is useful for identifying people whose weight may place them at risk for chronic diseases. The measurement of BMI is described in obesity prevention and control implementation.
Worker productivity measures for obesity prevention and control1-8
Healthier employees are less likely to call in sick. Companies can sometimes assess sick day use as the most direct measure to determine whether health programs are increasing worker productivity.
- Determine the average number of sick days per employee over the previous 12 months for health conditions related to obesity
- This measure may be less useful if there has been a large increase or decrease in numbers of employees over the past 12 months
- Determine the costs for worker absenteeism including costs of replacement workers, costs in training replacement workers, and loss and delay in productivity
- Obesity related absenteeism may occur due to injury, type 2 diabetes, high blood pressure, heart disease, or stroke
- Determine time employees spend during working hours participating in obesity related worksite programs
- Additional validated surveys have been developed to provide employers with information about the indirect costs of untreated or undertreated employee health issues such as obesity. Employers who use these health and productivity surveys on an ongoing basis can begin to evaluate the return on investment (ROI) of offering obesity prevention and control programs on employee absence or productivity. These surveys may be proprietary and may require a modest fee to use. Two examples are provided below:
- Health and Work Performance Questionnaire (HPQ) is a short, easy to administer self-report survey designed to estimate workplace indirect costs (absenteeism, reduced productivity, and injury due to accidents) of employee health problems developed by the World Health Organization (WHO) and the Harvard Medical School
- The Work Limitations Questionnaire (WLQ) developed by the Health Institute at Tufts Medical Center is an easy to use questionnaire that addresses general work limitations which can be built into other health assessment tools such as a health risk appraisalAn assessment tool used to evaluate an individual’s health. An HRA could include a health survey or questionnaire (see Employee Health Survey); physical examination, or laboratory tests resulting in a profile of individual health risks often with accompanying advice or strategies to reduce the risks. or employee health survey
- Re-assess the average number of sick days per employee at the first follow-up evaluation
- Periodic repeats of other baseline measures.
- Assess changes in the average number of sick days per employee in repeated follow-up evaluations
- Assess changes in the time employees spend during working hours participating in obesity related worksite programs
- Assess changes in costs from baseline
Health care cost measures for obesity prevention and control1-4
In contrast with the worker productivity costs described above, health care costs are measures of the direct medical expenses of providing employee health care and preventive health programs.
- Determine current health care use and costs of health care, including pharmaceuticals, counseling, inpatient and outpatient care, for obesity and diseases and health conditions where obesity increases risk such as type 2 diabetes, high blood pressure, and high cholesterol
- Determine costs for work related disability claims and worker’s compensation for disorders related to obesity (see first bullet)
- Determine the current health care use and costs of services for obesity counseling, medication, or bariatric surgery (if covered)
- Determine the health care use and costs of program participants before education and other programs are initiated and after operation of these programs
- Periodic repeats of baseline measures
- Assess changes in health care use and costs from baseline
- Assess changes in the type, use, and costs of employee health benefits related to clinical obesity services (if covered)
- Compare health care use and costs of program participants before education and other programs are initiated and after operation of these programs
The effectiveness of obesity prevention and control programs depends on the intensity of program effort and the use of multiple interventions. A rule of thumb is that the more programs implemented together as a package or campaign, the more successful the interventions will be.
- Determine levels of employee overweight/obesity from employee health survey or health risk appraisalAn assessment tool used to evaluate an individual’s health. An HRA could include a health survey or questionnaire (see Employee Health Survey); physical examination, or laboratory tests resulting in a profile of individual health risks often with accompanying advice or strategies to reduce the risks. . Examples include:
- Determine percent of employees who are overweight or obese using the body mass index (BMI)
- If feasible, conduct biometric screeningThe measurement of physical characteristics such as height, weight, body mass index, blood pressure, blood cholesterol, blood glucose, and aerobic fitness tests that can be taken at the worksite and used as part of a workplace health assessment to benchmark and evaluate changes in employee health status over time. of overweight/obesity for employees. Test examples include bioelectrical impedance testing or anthropometric measurement with calipers
- Physical activity and nutrition workplace programs play a key part in addressing obesity. For in-depth discussion of the evaluation of employee physical activity and nutrition levels, see their evaluation descriptions
- Determine baseline percentage of employees with health conditions affected by overweight/obesity including type 2 diabetes, high blood pressure, and high cholesterol
- The key health concern of obesity is that overweight and obesity increase the risk of type 2 diabetes, high blood pressure, and high cholesterol which in turn increase the rates of heart attack and stroke. For in-depth discussion of the evaluation of interventions for these risk factors and diseases, see their evaluation descriptions
- Determine employee knowledge, attitudes, and beliefs about overweight/obesity
- Evaluate employee’s current knowledge of the health benefits of physical activity, good nutrition, and maintaining a healthy weight
- Measure employee’s knowledge of current physical activity and nutrition guidelines
- Measure employee’s knowledge of current overweight/obesity guidelines
- Determine the number of employees who report they want to lose weight
- Assess employee awareness of existing workplace overweight/obesity programs, policies and benefits
- Number of employees currently screened and referred for and receiving clinical obesity evaluation and treatment including counseling, weight loss medications and bariatric surgery (if covered)
- Periodic repeat of baseline measures
- Assess changes in employee overweight/obesity such as:
- Changes in the percentage of employees who are overweight/obese
- Changes in the percentage of employees reaching physical activity and dietary guidelines
- Assess changes in health conditions affected by overweight/obesity including type 2 diabetes, high blood pressure, and high cholesterol
- Compare changes of program participants before education and other programs are initiated and after operation of these programs
- Assess changes in employee knowledge, attitudes, and beliefs about overweight/obesity
- Evaluate changes in employee's knowledge of the health benefits of physical activity, good nutrition, and maintaining a healthy weight
- Measure changes in employee's knowledge of current physical activity and nutrition guidelines
- Measure changes in employee's knowledge of current overweight/obesity guidelines
- Determine changes in the number of employees who report they want to lose weight
- Assess changes in employee awareness of workplace overweight/obesity programs, policies, and benefits
- Assess changes in the number of employees receiving clinical obesity services (if covered)
Organizational change measures for obesity prevention and control1-4
Physical activity and healthy eating, along with other health habits, require ongoing support from employers. New programs can be added over time and evaluated periodically for their effectiveness in establishing, maintaining, and increasing employee health behaviors. For best results, recognition of the benefits of healthy eating should become an inherent part of organizational change and corporate culture.
Measuring organization change is an assessment of company-initiated programs and policies that affect most employees regardless of their health status (e.g., changes of food options in the cafeteria, establishing walking trails on the company campus). These efforts need to be integrated for greatest effectiveness and will require time for full implementation. Regular measures of employee attitudes and program success are key in determining whether new programs are effective or require further adaptation to prevent continuing investment in ineffective efforts.
- Determine barriers to good employee weight management at the workplace
- Assess current workplace obesity prevention and control programs
- List current obesity related program options for employees through worksite and identify number of employees (i.e., participation in classes) using each option. Examples:
- Number of weight management classes and participation in these programs
- Availability of educational materials on obesity prevention and control
- Number of physical activity and nutrition related policies
- Number of environmental strategies such as healthy foods in the vending machines, cafeterias, or garden markets for healthy eating or walking trails and exercise rooms for physical activity
- Number of partnerships with community resources for weight management programs such as YMCAs, local hospital or health department
- Determine costs of current worksite obesity programs such as:
- Capital investment in building or facilities for physical activity or nutrition
- Staffing, equipment, and space
- Gym memberships
- Cafeteria and vending machine contracts
- Incentives tied to obesity programs
- Conduct survey of employee satisfaction with current workplace supported obesity programs
- Reassess barriers to good employee weight management at the workplace
- Document steps taken and progress toward implementing each intervention selected
- List numeric goals in each form of intervention within a designated time period (e.g., 12 months from startup):
- Employee reach (e.g. number of educational pamphlets distributed)
- Employee participation (e.g., number of desired participants in physical activity or weight management classes)
- Describe timeline for implementation of each planned intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
- Create a baseline budget for new interventions including classes, instructors, classroom space, cafeteria and vending machine contracts, gym fees, printed and online educational material, etc.
- Identify opportunities for new partnerships with community groups who provide weight management programs (e.g., YMCA, local health department, local hospital, etc.)
- Reassess employee satisfaction regarding workplace supported obesity prevention and control programs
- Measure reductions in the number and type of employee barriers to weight management in the workplace
- Assess changes in workplace obesity prevention and control programs
- Measure changes in the number of obesity related program options for employees through the worksite and changes in employee participation using each option before and after the obesity prevention and control program or campaign. Examples:
- Number of new programs developed and offered to employees and participation in these programs
- Number of new educational materials developed and made available to employees
- Number of physical activity and nutrition related polices developed and implemented compared to baseline
- Number and type of new environmental support changes made (e.g., healthy foods in vending machines, cafeterias, building of a walking trail etc.)
- Number of new partnerships with community groups created to enhance access and opportunity for employees to manage weight
- Assess changes in program costs from baseline
- New capital investments made (e.g., cafeteria)
- Increases in staffing or materials needs due to new program offerings
- New incentives or changes in existing incentives based on employee participation
- Changes in costs for vending or cafeteria contracts
- Assess changes in survey responses for employee satisfaction following implementation of a workplace supported obesity prevention and control program and compare with baseline
Depending on goal success, assess need to adjust workplace programs.
The assessment tools described in the assessment module include specific questions related to obesity prevention and control.
- Q11; Q12; Q13; Q20b,c,h; Q21d,e,f,g; Q24a,b,c,d,e,i,j,k,l; Q25; Q26; Q27; Optional questions A, B, C, I, J, K, M, N, OO
- Q29; Q30; Q31; Q32; Q36; Q37; Optional Question T, V, W, Z, AA
- Q24g; Q39; Q40; Q41; Q43; Q45; Q46; Q47; Optional question CC, DD, EE, FF, GG, HH, JJ
- CDC Health Scorecard [PDF – 3.5MB] developed by the Centers for Disease Control and Prevention (CDC), the Health Scorecard is a tool designed to help employers assess the extent to which they have implemented evidence-based health promotion interventions or strategies in their worksites to prevent heart disease, stroke, and related conditions such as hypertension, diabetes, and obesity.
- Health Risk Appraisals at the Worksite: Basics for HRA Decision Making [PDF - 2.3MB] is a guide developed by the National Business Coalition on Health in collaboration with the Centers for Disease Control and Prevention (CDC) in the selection and use of health risk appraisals in the workplace available for employers
- The CDC Healthy Communities Program developed the Community Health Assessment and Group Evaluation (CHANGE) assessment tool to provide communities with a picture of the policy, systems, and environmental change strategies currently in place throughout the community, where gaps exists and facilitate action planning for making improvements. The CHANGE tool address five community sectors including worksites and health indicators related to physical activity, nutrition, tobacco use, chronic disease management, and leadership
- CDC has developed LEANWorks!, a toolkit to guide small-and-medium-sized companies through designing and customizing employee obesity prevention and control programs