Promoting Employee Health Through The Worksite Food Environment
Condition: Weight; Food Choice; Nutrition Intake
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Personalized nutrition feedback
Intervention type(s): Behavioral
Intervention description(s): Automated personalized nutrition feedback about cafeteria food purchases (weekly); social norms and small financial incentives to promote healthy purchases (monthly)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Weight; Prevention; Food choice; Nutrition; Behavior change; Behavioral economics; Feedback; Incentives