Worksite-based Intervention On Prevention And Control Of Overweight And Obesity

BackgroundObesity prevention and control are major public health priorities due to its increasing prevalence,impact on downstream health outcomes,and associated health care system costs.Weight gain,overweight,and obesity have been associated with various behaviors related to diet and physical activity.Well established lifestyle behaviors that could decrease risk of obesity suggest that environmental and behavioral factors play a critical role.Worksites offer an appropriate setting where targeted obesity prevention efforts could be taken because most employees spend about half of their waking hours at work,and worksites have several characteristics that could support multi-components,ecological interventions.In recent years,preventing weight gain at worksites has been an important form of community intervention project in America.However,as far as we are aware,most of the workplace health promotion projects in China lacked mature intervention methods,operation guide and evaluation tools,where cross-sectional survey or self-controlled quasi-experimental research were common adopted.AimThis pilot study was to develop a worksite-based health behavior intervention project for prevention and management of overweight and obesity and assess the effectiveness using pilot cluster randomize controlled trial.MethodsTwo phase mixed methods design is proposed.Qualitative research: Four focus groups were organized in the recruited worksites,each including 8-10 participants,with consideration of equivalence in gender,age,weight and work.An intervention project based on Grounded Theory and Social Cognitive Theory was then developed including increasing motivation(individual domain),goal setting(individual domain),self-monitoring(individual domain),workplace activities(environmental domain),organizational change(human-environment interactions).We identified the themes by thematic analysis and classified them using NVivo 12.Quantitative research: A pilot cluster randomized controlled trial was conducted to evaluate the intervention effect.Four worksites with 50-150 employees,more than 50% of employees having sedentary work,in Yangtze River Delta,China,were paired according to the demographic and working characteristics and randomly assigned into an intervention group(n=2)and a control(n=2)group.Employees were considered eligible if they were full-time,had signed informed consent,were not on sick leave for more than 4 weeks,and were not pregnant at the time of recruitment.The primary outcome was the change in clinical indicators including measured weight,BMI,waist circumference,hip circumference,blood pressure,blood glucose and blood lipid.The secondary outcomes included changes in weight related life behaviors including self-reported servings of fruits and vegetables,dietary behaviors such as fast food consumption,physical activities such as daily walking steps and Godin free-time physical activity scores.The tertiary outcomes included Obesity and Weight-Loss QOL(OWLQOL)scores and Weight-Related Symptom Measure(WRSM).Data were collected before and after a 1-year intervention and analyzed using descriptive statistics,t-test,chi-square test,binary logistic regressionand linear mixed regression.Intervention PlanThis study developed a worksite-based intervention plan mainly from the individual level(strategies to improve compliance and health behavior skills),environment(environmental improvement to increase access to healthy diet and exercise)and organization(Employee Advice Committee and supportive workplace policy)based on the qualitative data analysis.The whole intervention plan was designed by the guidance of the Social Cognitive Theory,the path of the Grounded Theory and the strategies of lifestyle intervention in Diabetes Prevention Project.Multi-level comprehensive interventions were used in this study to improve the employees' lifestyle and the quality of life,as well as to prevent and control weight gain.ResultsQualitative results632 codes were generated from the first focus groups,including 55 codes for the opinions on overweight and obesity,260 codes for cognition of healthy behavior,and317 codes for the factors associated with healthy behaviors.115 codes were generated from the second focus groups,including 79 codes for the access to information,and 36 codes for the feedback of the initial intervention plan.The intervention plan mainly from individual,environmental and organizational levels was developed based on these codes and the research path of the Grounded Theory.Quantitative results1.The intervention group had a remarkable reduction in body mass index(P<0.01),hip circumference(P=0.03),waist-to-height ratio(P=0.01),diastolic pressure(P=0.02)and fasting blood glucose(P<0.01).When the effect of group was adjusted for the demographic characteristics and the values at baseline using repeated-measures analysisXII of variance(ANOVA),significant between-group intervention effect was observed in Total cholesterol(P=0.047)and Low density lipoprotein(P<0.01).When the effect of group was further adjusted for the demographic characteristics and the worksites using linear mixed model,significant between-group intervention effect was observed in Low density lipoprotein(P<0.01).2.The intervention group had an increase in fast food frequency(P<0.01).There was no statistical difference in other indicators.When the effect of group was adjusted for the demographic characteristics and the values at baseline using repeated-measures analysis of variance(ANOVA),significant between-group intervention effect was observed infrequency of vegetables intake(P=0.04),daily servings of vegetables(P<0.01),frequency of fruits intake(P=0.01),daily servings of fruits(P=0.01),and the daily servings of vegetables and fruits(P<0.01).When the effect of group was further adjusted for the demographic characteristics and the worksites using linear mixed model,significant between-group intervention effect was observed in frequency of sweet drink(-1.81,95%CI:-0.52,-3.11),frequency of vegetables intake(5.66,95%CI:1.59,9.74),daily servings of vegetables(0.53,95%CI: 0.24,0.82),frequency of fruits intake(3.68,95%CI: 1.25,6.12),daily servings of fruits(0.26,95%CI: 0.44,0.92),and the daily servings of vegetables and fruits(0.79,95%CI: 0.43,1.16).Logistic regression analysis shows that the employees in the intervention group were more likely to meet the vegetables intake standard(OR=2.10,95%CI: 1.01,4.39)and the fruits intake standard(OR=3.31,95%CI: 1.20,49.14).Generalized linear mixed models further shows that the employees in the intervention group were more likely to meet the fruits intake standard(OR =2.71,95%CI: 1.05,7.00).3.There was no statistical difference in the indicators of physical activities in the intervention group compared with those at the baseline.When the effect of group was adjusted for the demographic characteristics and the values at baseline using repeated-measures analysis of variance(ANOVA),significant between-groupintervention effect was observed in daily walk steps(P<0.01).When the effect of group was further adjusted for the demographic characteristics and the worksites using linear mixed model,significant between-group intervention effect was observed in daily walk steps(P=0.02).Logistic regression analysis shows that the employees in the intervention group were more likely to have high exercise self-efficacy(OR=1.91,95%CI: 1.05,3.48).Generalized linear mixed models further shows that the employees in the intervention group were more likely to have high exercise self-efficacy(OR=1.91,95%CI: 1.02,3.60).4.The control group had a remarkable reduction in Obesity and Weight-Loss QOL scores and an increase in Weight-Related Symptom Measure scores compared with those at the baseline.When the effect of group was adjusted for the demographic characteristics and the values at baseline using repeated-measures analysis of variance(ANOVA),no statistical difference was observed between the two groups.When the effect of group was further adjusted for the demographic characteristics and the worksites using linear mixed regression,no statistical difference was observed between the two groups.Conclusion:Our health behavior intervention project for prevention and control of overweight and obesity helped improve several employees' dietary behaviors and physical activities at worksites.A decrease of the body mass index was observed in the intervention group.Weight loss and improvement of obesity related quality of life remain to be tested for a longer period of intervention.