Multi-Component Worksite Obesity Prevention

Interventions Changing the Context

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What is multi-component worksite obesity prevention?

Worksite nutrition and physical activity programs are designed to improve health-related behaviors and outcomes among employees.[1] Employers may offer worksite weight management interventions separately or as part of a comprehensive wellness package that addresses multiple health issues (e.g., smoking cessation, stress management, cholesterol reduction).[2] Worksite strategies can include one or more approaches to support behavioral change including:

  • Informational and educational strategies to increase knowledge about a healthy diet, such as lectures, written materials (electronic or print), or educational software.[2]
  • Behavioral and social strategies to support positive beliefs and social factors, such as counseling, skill-building, rewards or reinforcement, building support systems,[2,3] or health risk assessments followed by counseling.[4]
  • Environmental approaches that make healthy choices easier and target the entire workforce by changing the physical built environment or organizational structures. They may include improving access to healthy foods and providing opportunities to be more physically active at work.[2,5]
  • Policy strategies could help support behavior change.  Some examples are: providing health insurance benefits, or providing cash incentives for health club membership.[2,4] Additionally, allowing flexible work schedule policies might help remove the barrier of time constraints to participating in physical activity, for employees.[4,6]

Worksite obesity prevention may be implemented by employers in both the public and private sectors. Moving toward this goal, the state of Ohio has included strategies such as education and environmental approaches to improve physical activity, nutrition, and overall health, to promote health and wellness among all of its state employees in its state obesity prevention plan.[7]

What is the public health issue?

Obesity is common, serious, and costly. Obesity is related to several leading causes of death, including heart disease, stroke, type 2 diabetes, and certain types of cancer.[8,9]  Data from the National Center for Health Statistics (NCHS) show that 42.4 percent of U.S. adults have obesity.[10] Obesity affects some groups more than others. Non-Hispanic Blacks have the highest age-adjusted rates of obesity (49.6 percent) followed by Hispanics (44.8 percent), non-Hispanic whites (42.2 percent), and non-Hispanic Asians (17.4 percent).[10]  Obesity is also more common among middle-aged adults 40 to 59 years old (44.8 percent) than adults 60 years or older (42.2 percent) or younger adults aged 20 to 39 years (40.0 percent).[10]

Map: Prevalence of Self-Reported Obesity among U.S. Adults by State and Territory

The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 dollars.[11] Obesity-related medical expenditures, absenteeism, and reduced productivity while at work among full-time U.S. employees is estimated to cost over $73 billion annually in 2006 dollars.[12]

What is the evidence of health impact and cost effectiveness?

Studies examining the effectiveness of multi-component worksite obesity prevention and control programs, including systematic reviews,[1,5] a meta-analysis,[13] and a randomized control trial,[14] found that programs were consistently associated with:

  • Increased physical activity.[4,5,13,14]
  • Reductions in weight.[1,5,13]
  • Reductions in percentage of body fat.[5,13]
  • Reductions in BMI.[1,5]

A study examining a workplace behavioral weight management program with monetary incentives compared to a non-incentivized program found, among both groups, weight loss among obese and overweight employees and also net savings for employers primarily due to increased productivity, with significantly larger effects among the incentivized participants.[15] Another study that assessed the return on investment to employers for workplace obesity interventions found that a 5 percent weight loss among employees who have overweight or obesity would result in an average per person reduction of $90 due to reductions in medical costs and absenteeism costs.[16]

A systematic review on the financial return of worksite health promotion programs aimed at generally improving nutrition or increasing physical activity found positive impacts among the 13 non-randomized studies (NRS) included in the review, and negative impacts among the 4 randomized control trials (RCT). However, 3 of the RCTs and 1 NRS were conducted outside the U.S. and no adjustments were made to account for the differences in medical costs between countries.[17]

  1. Anderson LM, Quinn TA, Glanz K, et al. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review. American journal of preventive medicine. 2009;37(4):340-357.
  2. The Guide to Community Preventive Services. Obesity Prevention and Control: Worksite Programs. Accessed January 31, 2022.
  3. Thorndike AN, McCurley JL, Gelsomin ED, et al. Automated Behavioral Workplace Intervention to Prevent Weight Gain and Improve Diet: The ChooseWell 365 Randomized Clinical Trial. JAMA network open. 2021;4(6):e2112528-e2112528.
  4. Gutermuth LK, Hager ER, Porter KP. Using the CDC’s Worksite Health ScoreCard as a Framework to Examine Worksite Health Promotion and Physical Activity. Preventing chronic disease. 2018;15
  5. Upadhyaya M, Sharma S, Pompeii LA, Sianez M, Morgan RO. Obesity prevention worksite wellness interventions for health care workers: A narrative review. Workplace health & safety. 2020;68(1):32-49.
  6. Fletcher GM, Behrens TK, Domina L. Barriers and Enabling Factors for Work-Site Physical Activity Programs: A Qualitative Examination. Journal of Physical Activity and Health. 2008;5(3):418-429. doi:10.1123/jpah.5.3.418
  7. Ohio Department of Health. The Ohio Obesity Prevention Plan. 2009. Accessed January 31, 2022.
  8. CDC Division of Nutrition, Physical Activity, and Obesity. Adult Obesity Facts. Centers for Disease Control and Prevention. Updated September 21, 2021. Accessed January 31, 2022.
  9. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report (1998).
  10. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief. 2020(360)
  11. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health affairs. 2009;28(5):w822-w831.
  12. Finkelstein EA, daCosta DiBonaventura M, Burgess SM, Hale BC. The costs of obesity in the workplace. Journal of Occupational and Environmental Medicine. 2010;52(10):971-976.
  13. Verweij L, Coffeng J, van Mechelen W, Proper K. Meta‐analyses of workplace physical activity and dietary behaviour interventions on weight outcomes. Obesity Reviews. 2011;12(6):406-429.
  14. Dishman RK, DeJoy DM, Wilson MG, Vandenberg RJ. Move to improve: a randomized workplace trial to increase physical activity. American journal of preventive medicine. 2009;36(2):133-141.
  15. Lahiri S, Faghri PD. Cost-effectiveness of a workplace-based incentivized weight loss program. Journal of Occupational and Environmental Medicine. 2012;54(3):371-377.
  16. Trogdon J, Finkelstein EA, Reyes M, Dietz WH. A return-on-investment simulation model of workplace obesity interventions. Journal of Occupational and Environmental Medicine. 2009;51(7):751-758.
  17. Van Dongen J, Proper K, Van Wier M, et al. Systematic review on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity. Obesity reviews. 2011;12(12):1031-1049.