Promoting Employee Health Through The Worksite Food Environment



Status:Active, not recruiting
Healthy:No
Age Range:21 - 75
Updated:6/23/2018
Start Date:September 2016
End Date:February 2020

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This project tests a scalable and sustainable approach to weight gain prevention in a
population of employees by using the worksite environment to deliver personalized feedback
about worksite food purchases, daily calorie goals, social norms for healthy eating, and
financial incentives for healthy food purchases. In the future, similar strategies could be
adopted by other worksites, institutions, and food retailers and could contribute to the
long-term environmental and social changes needed to reverse the obesity epidemic in the
United States and worldwide.

The overall objective of ancillary studies added on to this project is to examine the
psychological traits, cognitive skills, and genes that may influence the impact of the
behavioral intervention to promote healthy diet and weight among employees at a large
hospital worksite.

Adults in the United States gain an average of 1-2 pounds a year. Interventions to prevent
weight gain at the population level are needed to reverse the rising prevalence of obesity.
Although individual-level interventions can result in large weight changes among small groups
of individuals, achieving changes in the population will require long-term strategies that
create healthier food environments, establish new social norms, and improve motivation and
skills for healthy lifestyle behaviors. The worksite is ideal for interventions to address
weight and lifestyle behaviors because a majority of adults are employed, and provisions in
the Affordable Care Act encourage worksite wellness. Our research team at Massachusetts
General Hospital (MGH) has demonstrated that behavioral economics strategies, including
traffic-light labels, choice architecture, social norms, and financial incentives, improve
employees' healthy food choices. The proposed project will address the critical next phase of
this research to determine if a worksite intervention delivered through the food environment
can prevent weight gain and reduce cardiovascular risk of employees. This project builds on
the established traffic-light labeling system at MGH and tests an intervention that aims to
increase nutrition knowledge, motivate change in lifestyle behaviors, and promote socially
normative behavior for healthier lifestyles among employees. The intervention will be
integrated into the flow of the work day, thus lowering burden to employees and the employer.
Study Design: In a randomized controlled trial, 600 MGH employees will be assigned to: 1) an
intervention arm with automated, personalized feedback about (a) worksite food purchases and
calorie and physical activity goals (weekly emails) and (b) social norm feedback plus small
financial incentives for healthy food purchases (monthly letters) or 2) a control arm
(standardized monthly letters). Study outcomes will be assessed at 1 year (end of
intervention) and 2 year follow-up. The primary outcome is change in weight at 1 year.
Secondary outcomes are cardiovascular risk factors, worksite food purchases, and dietary
intake (as measured by the Healthy Eating Index). A novel exploratory outcome will be healthy
food purchases of co-workers who are socially connected to study subjects. Aim 1 is to
determine if employees assigned to the intervention have less weight gain and lower
cardiovascular risk factors than the control group at 1 year and 2-year follow-up. Aim 2 is
to determine if employees assigned to the intervention group make healthier food choices than
the control group at 1 year and 2-year follow-up. Exploratory Aim 3 is to determine if
employees socially connected to the intervention group make healthier worksite food choices
over 1 year than employees connected to the control group. Implications: This innovative
strategy utilizing personalized feedback, social norms, and financial incentives will provide
a scalable and sustainable model that could be adopted in other worksite, institutional, and
retail settings to prevent obesity at the population level.

The overall objective of the ancillary studies added on to this project is to examine the
psychological traits, cognitive skills, and genes that may influence the impact of a
behaviorally-informed intervention on dietary choices, weight, and other objective health
indicators. This research will expand on the randomized trial by examining psychological
traits (impulsivity, self-control, social acceptance), cognitive skills (numeracy, health
literacy), and genes (97 known BMI loci) that are associated with obesity and poor health and
are specifically targeted by the intervention. We will use validated measures to assess
traits and skills and well-established methods for genotyping and calculating genetic risk
scores. Aim 1 will determine if psychological traits moderate the behavioral intervention
effects on diet and weight. Aim 2 will determine if cognitive skills moderate the behavioral
intervention effects on diet and weight. Aim 3 will determine if genetic risk for obesity
moderates the intervention effect on weight. In secondary analyses, potential mediators of
diet and weight outcomes, including dietary intent, self-efficacy, reward sensitivity,
perceived norms, and perceived stress, will be assessed. Implications: Results of this
research will l will inform the future design and implementation of more effective, tailored,
and sustainable population approaches for obesity prevention.

Inclusion Criteria:

- Employee at Massachusetts General Hospital; uses hospital cafeterias at least 4 times
a week and willing to pay for purchases with employee debit card.

Exclusion Criteria:

- Planning to leave employment at MGH in the next year; currently pregnant; currently
participating in the MGH employee wellness program Be Fit
We found this trial at
1
site
185 Cambridge Street
Boston, Massachusetts 02114
617-724-5200
Principal Investigator: Anne Thorndike, MD, MPH
?
mi
from
Boston, MA
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