Settings-based approaches: workplaces

The World Health Organization recommends strategies in community settings to tackle modifiable risk factors for chronic disease including poor diet and physical inactivity.¹ Strategies may draw on existing infrastructure in settings such as workplaces, healthcare settings, sports clubs and grocery stores to reach large numbers of people.²

For adults, the workplace is a particularly important setting, as it is where many adults spend a substantial amount of their time. However, workplaces can also contribute to obesity through prolonged sitting³ and by providing access to unhealthy food in vending machines, cafeterias and at catered events.⁴ A recent umbrella review examined workplace interventions that aimed to promote healthy weight among adults by targeting healthy diets and physical activity.⁵ Overall, dietary programs and physical activity programs delivered in workplaces were both found to improve weight-related outcomes. On the other hand, workplace-based programs targeting sedentary behaviour were less effective in improving weight-related outcomes. Web-based interventions (e.g. email, website, apps) also showed positive effects on weight and BMI. Multicomponent interventions (e.g. targeting a combination of education, food access, physical activity or environmental prompts) related to workplace wellness were also found to effectively reduce BMI.

Workplace interventions have also led to improvements in diet-related outcomes when they are web-based, focus on providing healthy food, offer informational support, include individual counselling, or involve multiple components.⁶

In relation to physical activity, the workplace Diabetes Prevention Program, which includes health coaching, and a focus on diet and physical activity, was found to be effective in improving physical activity. Other workplace programs found to improve physical activity included self-monitoring and goal setting, general physical activity interventions and treadmill desks. Interventions that used sit-stand desks and provided information and counselling were also likely effective in reducing sitting time.⁶

A snapshot of two large trials run across multiple workplace sites and comprising various intervention components is provided below.

The Working Well trial

A large cancer prevention trial involving 28,000 workers across 111 worksites in the US (the Working Well trial) compared the outcomes of a sustained, two-year workplace intervention targeting unhealthy diet and smoking to control sites.⁷ The intervention included measures directed towards individuals (launch event, interactive activities, posters and brochures, self-help material and classes) and measures aimed at environmental change (changes to food offerings in cafeterias and vending machines, and to catering policy). The intervention resulted in small but significant decreases in fat consumption and increases in fruit and vegetable intake. Researchers said that given the large number of workers in the trial, results could indicate a potentially important public health impact if interventions were maintained and had a cumulative effect.

The Dow study

Also in the US, researchers studied the effects of an obesity prevention program at the Dow Chemical Company covering more than 10,000 employees across 12 sites.⁸ There was a control group and two levels of intervention intensity, as follows:

• All sites received the company’s standard programs including health education materials, physical activity and weight management counselling, health assessments and online behaviour change programs.
• At moderate-intensity sites, environmental prompts were also used to encourage employees to make healthy food choices and be physically active, including by modifying vending machine items and cafeteria menus, creating walking paths, offering an online weight tracking program and appointing wellness ambassadors.
• High-intensity sites received the above interventions along with additional measures to influence organisational culture and leadership, including management training on employee health, making health objectives part of management goals and setting targets for program participation.

Over the two years of the Dow study, intervention site employees maintained their baseline weight while control site employees gained weight of an average 1.3 pounds (more than half a kilogram). Employees at intervention sites also had improved blood pressure and cholesterol scores, compared to those at control groups, and improvements were greater at high-intensity sites compared to moderate-intensity sites. Researchers said that while the study effects were modest, they had the potential to translate to long-term clinical gains if sustained. They said helping employees prevent age-related weight gain may be as important as supporting weight loss efforts since weight gain in midlife can negatively impact health in older age.⁸

Content for this page was updated by Melanie Lum, Research Fellow and Serene Yoong, Associate Professor at the Global Centre for Preventive Health and Nutrition at Deakin University. For more information about the approach to content on the site please see About | Obesity Evidence Hub.