| Abstract |
The workplace can be an important setting for addressing obesity. As increasing numbers of employers offer weight management programs, there is a need for evaluation. The Steps to Health study (STH) was a randomized trial to evaluate the effectiveness of two preexisting employee weight management programs offered at Duke University and Medical Center. A total of 550 obese (body mass index [BMI], >30 kg/m2) employees were randomized 1:1 to either Steps to Health (STH) or STH+. We also compared the study participants with an observational group of obese employees not taking part in the study. Baseline data included height/weight, accelerometry, and questionnaires querying physical activity, and dietary intake. Employees were contacted to complete a follow-up visit approximately 14 months after baseline. Health risk appraisal data, human resource data, health insurance claims data, and data on the observational group were available through the Duke Occupational Health Surveillance System. We recontacted the participants to investigate the barriers to participation and behavior change they experienced. In secondary analyses of health care utilization and health care costs, participants in the two programs were compared using propensity score adjustment. We also compared the two intervention groups with the observational group and compared those who lost weight with those who did not. In separate analyses of all Duke Employees from the last decade, we set out to evaluate the relationship between BMI and health claims costs over the last decade, assess the strength and nature of the relationship between BMI and costs, and identify comorbidities that may drive increased costs. At baseline, the mean age was 45 years, 83% were female, 41% white, and 53% black. Mean BMI was 37.2. Participants consumed a mean of 2.37 servings of fruits and vegetables per day (in the past week), participated in 11.5 min of moderate-to-vigorous physical activity, and spent 620 min being sedentary. At follow-up, there were no clinically, or statistically, meaningful differences in outcomes between the two arms, but there were modest reductions in BMI. In terms of health care utilization and health care costs, there were no significant differences between the two intervention groups, or between these intervention groups and the observational group. However, those who lost weight reduced their overall health care costs. The main barriers to healthy eating were Lack of self-control and convenience and Lack of access to healthy foods. The main barriers to physical activity were Time constraints and Lack of interest and motivation. In the related analysis of BMI and morbidity, we found that there was a gradual increase in health claims costs with increasing BMI starting at the low end of the recommended BMI range. The findings of the STH study suggest that to achieve weight loss, behavioral change, and associated morbidity reductions through the workplace, more extensive and intensive interventions, with more attention to motivation and compliance, are required. Common barriers must also be considered when designing workplace management programs to improve their uptake and effectiveness. |
