Automated Behavioral Workplace Intervention to Prevent Weight Gain and Improve Diet

Anne N Thorndike,Eric B Rimm,Charles Johnson,Emily D Gelsomin,Jessica L Mccurley,Emma Anderson,Bianca Porneala,Douglas E Levy,Yuchiao Chang

doi:10.1001/jamanetworkopen.2021.12528

Anne N Thorndike, Eric B Rimm + Show 7 more

Open Access

https://doi.org/10.1001/jamanetworkopen.2021.12528

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Abstract

Personalized interventions that leverage workplace data and environments could improve effectiveness, sustainability, and scalability of employee wellness programs. To test an automated behavioral intervention to prevent weight gain and improve diet using employee cafeteria purchasing data. This individual-level randomized clinical trial of a 12-month intervention with 12 months of follow-up was conducted among employees of a hospital in Boston, Massachusetts, who purchased food at on-site cafeterias that used traffic-light labels (ie, green indicates healthy; yellow, less healthy; red, unhealthy). Participants were enrolled September 2016 to February 2018. Data were analyzed from May to September 2020. For 12 months, participants in the intervention group received 2 emails per week with feedback on previous cafeteria purchases and personalized health and lifestyle tips and 1 letter per month with peer comparisons and financial incentives for healthier purchases. Emails and letters were automatically generated using survey, health, and cafeteria data. Control group participants received 1 letter per month with general healthy lifestyle information. The main outcome was change in weight from baseline to 12 months and 24 months of follow-up. Secondary outcomes included changes in cafeteria purchases, including proportion of green- and red-labeled purchases and calories purchased per day, from baseline (12 months preintervention) to the intervention (months 1-12) and follow-up (months 13-24) periods. Baseline Healthy Eating Index-15 (HEI-15) scores were compared to HEI-15 scores at 6, 12, and 24 months. Among 602 employees enrolled (mean [SD] age, 43.6 [12.2] years; 478 [79.4%] women), 299 were randomized to the intervention group and 303 were randomized to the control group. Baseline mean (SD) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) was 28.3 (6.6) and HEI-15 score was 60.4 (12.4). There were no between-group differences in weight change at 12 (0.2 [95% CI, -0.6 to 1.0] kg) or 24 (0.6 [95% CI, -0.3 to 1.4] kg) months. Compared with baseline, the intervention group increased green-labeled purchases by 7.3% (95% CI, 5.4% to 9.3%) and decreased red-labeled purchases by 3.9% (95% CI, -5.0% to -2.7%) and calories purchased per day by 49.5 (95% CI, -75.2 to -23.9) kcal more than the control group during the intervention period. In the intervention group, differences in changes in green (4.8% [95% CI, 2.9% to 6.8%]) and red purchases (-3.1% [95% CI, -4.3% to -2.0%]) were sustained at the 24-month follow-up. Differences in changes in HEI-15 scores were not significantly different in the intervention compared with the control group at 6 (2.2 [95% CI, 0 to 4.4]), 12 (1.8 [95% CI, -0.6 to 4.1]), and 24 (1.6, 95% CI, -0.7 to 3.8]) months. The findings of this randomized clinical trial suggest that an automated behavioral intervention using workplace cafeteria data improved employees' food choices but did not prevent weight gain over 2 years. ClinicalTrials.gov Identifier: NCT02660086.

Highlights

Obesity and unhealthy diet are leading risk factors for chronic disease and mortality.[1,2,3] US adults gain a mean of 0.7 to 0.9 kg per year.[4,5] With approximately 150 million US adults employed and spending half their waking hours working,[6] the workplace provides an opportunity to promote health
Baseline mean (SD) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) was 28.3 (6.6) and Healthy Eating Index-15 (HEI-15) score was 60.4 (12.4)
The intervention group significantly increased healthy cafeteria purchases during the 1-year intervention, and this was sustained during 1-year of additional follow-up. Meaning These findings suggest that an automated intervention using food purchasing data improved workplace food choices over 2 years, but dietary changes did not prevent weight gain

Summary

Introduction

Obesity and unhealthy diet are leading risk factors for chronic disease and mortality.[1,2,3] US adults gain a mean of 0.7 to 0.9 kg per year.[4,5] With approximately 150 million US adults employed and spending half their waking hours working,[6] the workplace provides an opportunity to promote health. Multiple workplace factors may contribute to unhealthy behaviors and weight gain, including psychosocial stressors, shift work, and sedentary jobs.[7] Over the past 3 decades, most workplace wellness programs have used short-term education-based interventions that require employees to take time away from work and other responsibilities.[8,9,10] Few provide long-term behavioral and environmental supports to sustain employees’ healthy choices. Personalized approaches that use insights from behavioral economics and leverage workplace data and environments could improve the effectiveness, sustainability, and scalability of workplace health promotion

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