Settings-based approaches: workplaces

The World Health Organization recommends strategies in community settings to tackle modifiable risk factors for chronic disease including poor diet and physical inactivity.¹ Strategies may draw on existing infrastructure in settings such as workplaces, healthcare settings, sports clubs and grocery stores to reach large numbers of people.

For adults, the workplace is an important setting because it is where most adults spend a substantial amount of time.² In addition, workplaces can contribute to obesity through prolonged sitting³ and provision of unhealthy food in vending machines, cafeterias and at catered events.⁴ Workplace interventions that promote physical activity and healthy diets have been shown to help employees achieve and maintain a healthy weight.⁵

A review of workplace dietary interventions found they could positively influence dietary outcomes, particularly by increasing fruit and vegetable consumption, and reducing fat consumption and total energy intake.⁶ There was also evidence that such interventions could aid weight loss and reduce cholesterol; and may help reduce employee costs by reducing absenteeism and lost productivity. The diverse nature of interventions, which mostly included various components, made it difficult to identify their most successful elements. Based on the evidence, however, authors of the review recommended that future interventions:

• Obtain management support and commitment (because this was key to success of the intervention)
• Involve employees in planning, implementation and management
• Maximise participation rates and intervention adherence and plan for a study duration of at least 6–12 months
• Intervene at multiple levels (e.g. environmental and individual)
• Increase the availability of healthy options in the workplace
• Tailor the intervention to the workplace context and population
• Include multiple, face-to-face contacts.

A snapshot of two large trials run across multiple workplace sites and comprising various intervention components is provided below.

The Working Well trial

A large cancer prevention trial involving 28,000 workers across 111 worksites in the US (the Working Well trial) compared outcomes of a sustained, two-year workplace intervention targeting unhealthy diet and smoking to control sites.⁷ The intervention included measures directed towards individuals (launch event, interactive activities, posters and brochures, self-help material and classes) and measures aimed at environmental change (changes to food offerings in cafeterias and vending machines, and to catering policy). The intervention resulted in small but significant decreases in fat consumption and increases in fruit and vegetable intake. Researchers said that given the large number of workers in the trial, results could indicate a potentially important public health impact if interventions were maintained and had a cumulative effect.

The Dow study

Also in the US, researchers studied the effects of an obesity prevention program at the Dow Chemical Company covering more than 10,000 employees across 12 sites.⁸ There was a control group and two levels of intervention intensity, as follows:

• All sites received the company’s standard programs including health education materials, physical activity and weight management counselling, health assessments and online behaviour change programs.
• At moderate-intensity sites, environmental prompts were also used to encourage employees to make healthy food choices and be physically active, including by modifying vending machine items and cafeteria menus, creating walking paths, offering an online weight tracking program and appointing wellness ambassadors.
• High-intensity sites received the above interventions along with additional measures to influence organisational culture and leadership, including management training on employee health, making health objectives part of management goals and setting targets for program participation.

Over the two years of the Dow study, intervention site employees maintained their baseline weight while control site employees gained weight of an average 1.3 pounds (more than half a kilogram). Employees at intervention sites also had improved blood pressure and cholesterol scores, compared to those at control groups, and improvements were greater at high-intensity sites compared to moderate-intensity sites. Researchers said that while the study effects were modest, they had the potential to translate to long-term clinical gains if sustained. They said helping employees prevent age-related weight gain may be as important as supporting weight loss efforts since weight gain in midlife can negatively impact health in older age.

In a single-component intervention in the US state of California, banning sales of sugary drinks on a university campus and its associated hospital led to reduced consumption, reduced waist circumference, better insulin resistance and lower cholesterol in a group of regular consumers.⁹ The health benefits were greatest in half of the group randomly assigned to also receive a motivational intervention, which included showing people how much sugar they were consuming daily using sugar cubes in a cup and setting goals associated with sugary drink intake. Authors of the study said it showed meaningful effects on employees’ health could result from a simple sales ban easily enacted by any workplace.¹⁰