The impact of a workplace catering initiative on dietary intakes of salt and other nutrients: a pilot study. Worksite Opportunities for Wellness (WOW): effects on cardiovascular disease risk factors after 1 year. Influence of placement of a nutrition logo on cafeteria menu items on lunchtime food Choices at Dutch work sites. Process Tracking Results from the Treatwell 5-a-Day Worksite Study Small portion sizes in worksite cafeterias: do they help consumers to reduce their food intake? Worksite and family education for dietary change: the Treatwell 5-a-Day program. Pre-ordering lunch at work. Results of the what to eat for lunch study Seattle 5 a Day worksite program to increase fruit and vegetable consumption. Traffic-light labels and choice architecture: promoting healthy food choices. Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. [Assessment of the impact over one year of a workplace health promotion programme in the province of Bergamo]. An intervention study targeting energy and nutrient intake in worksite cafeterias. Work-site nutrition intervention and employees' dietary habits: the Treatwell program. Increasing fruit and vegetable consumption through worksites and families in the treatwell 5-a-day study. Take heart: results from the initial phase of a work-site wellness program. The application of an occupational health guideline reduces sedentary behaviour and increases fruit intake at work: results from an RCT Behavioral and Cognitive Effects of a Worksite-Based Weight Gain Prevention Program: The NHF-NRG In Balance-Project
OBJECTIVE Owing to modern lifestyles , individuals are dependent on out-of-home eating . The catering sector can have a pivotal role in influencing our food choices . The objective of the present study was to examine the impact of a structured catering initiative on food choices in a public sector workplace setting . DESIGN A cross-sectional comparison study in two hospitals , one of which had implemented a catering initiative design ed to provide nutritious food while reducing sugar , fat and salt intakes . SETTING Two public sector hospitals in Cork , Irel and . SUBJECTS A total of 100 r and om participants aged 18 - 64 years ( fifty intervention , fifty non-intervention ) who consumed at least one main meal in the hospital staff canteen daily .  Each respondent was asked to complete one anonymous 24 h dietary recall and question naire . Food and nutrient analysis was conducted using WISP ( Weighed Intake Software Program ) . RESULTS Reported mean intakes of total sugars ( P < 0·001 ) , total fat ( P < 0·000 ) , saturated fat ( P < 0·000 ) and salt ( P < 0·046 ) were significantly lower in the intervention hospital when adjusted for age and gender . In the intervention hospital , 72 % of respondents , compared with 42 % in the non-intervention hospital , complied with the recommended under-3 daily servings of food high in fat and sugar ( P < 0·005 ) . In the intervention hospital , 43 % of respondents exceeded the recommended salt intake of 4 - 6 g/d , compared with 57 % in the non-intervention hospital . CONCLUSIONS Structured catering initiatives in the workplace are a potentially important option in the promotion of healthy food choices . Targeted public health programmes and health policy changes are needed to motivate caterers in the public sector and other industries to develop interventions that promote a healthy diet OBJECTIVE To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors . METHODS In St Louis , Missouri from 2005 to 2006 , 151 employees ( 134 F , 17 M , 81 % overweight/obese ) participated in a cohort-r and omized trial comparing assessment s + intervention ( worksite A ) with assessment s only ( worksite B ) for 1 year . All participants received personal health reports containing their assessment results . The intervention was design ed to promote physical activity and favorable dietary patterns using pedometers , healthy snack cart , WeightWatchers(R ) meetings , group exercise classes , seminars , team competitions , and participation rewards . Outcomes included BMI , body composition , blood pressure , fitness , lipids , and Framingham 10-year coronary heart disease risk . RESULTS 123 participants , aged 45+/-9 yr , with BMI 32.9+/-8.8 kg/m(2 ) completed 1 year . Improvements ( P < or = 0.05 ) were observed at both worksites for fitness , blood pressure , and total- , HDL- , and LDL-cholesterol . Additional improvements occurred at worksite A in BMI , fat mass , Framingham risk score , and prevalence of the metabolic syndrome ; only the changes in BMI and fat mass were different between worksites . CONCLUSION A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors , but many of the improvements were achieved with worksite health assessment s and personalized health reports in the absence of an intervention This study investigated the effectiveness of labeling foods with the Choices nutrition logo on influencing cafeteria menu selection and the behavioral determinants of menu choices in work site cafeterias in the Netherl and s. A cluster r and omized controlled trial was conducted .  Intervention cafeterias ( n=13 ) , where the Choices logo was used to promote healthier eating for a 3-week period , were compared with control cafeterias ( n=12 ) , which offered the same menu without the logo .  Sales data were collected daily for 9 weeks , from March to May 2009 . In addition , employees from one intervention and one control company completed an online question naire at baseline and after the intervention ( n=368 ) in which the behavioral determinants of food choice ( ie , attitude , self-efficacy , and intention ) and logo use were measured . Generalized estimating equation analyses , χ² tests , t tests and linear regression analyses were performed . No nutritionally meaningful intervention effects were found in the sales of s and wiches , soups , snacks , fruit , and salads . Also , no significant differences in behavioral determinants were found . " Intention to eat healthier " and " paying attention to product information " were positively associated with self-reported consumption of foods with the Choices logo at lunch . The intervention did not have a significant effect on employees ' lunchtime food choices . Labeling healthy choices might be useful for health-conscious employees in the volitional phase of behavior change . Further research should focus on the possible health benefits of menu reformulation in the catering sector Purpose . To report findings from Treatwell 5-a-Day process tracking . Design . Worksites were r and omly assigned to a minimal intervention control , worksite-only condition , or worksite-plus-family condition . Setting . Twenty-two small community health centers in Massachusetts . Subjects . Employees of the community health centers . Intervention . Both intervention conditions included the formation of employee advisory boards ; activities such as nutrition discussion s and taste tests targeting individual behavior change ; and point-of-purchase labeling as an environmental strategy . Worksite-plus-family sites incorporated activities such as family contests , campaigns , and picnics . Measures . Documentation of the number and type of activities for extent of implementation ; number of participants in activities for reach ; program awareness and participation from the follow-up employee survey ( n = 1306 , representing 76 % [ range , 56%–100 % ] of the sample ) ; change in fruit and vegetable consumption from a comparison between the follow-up and baseline surveys ( n = 1359 , representing 87 % [ range , 75%–100 % ] of the sample ) . Results . A higher number of activities per employee was significantly correlated with greater program awareness ( . 68 ; p = . 006 ) and greater change in fruit and vegetable consumption ( .55 ; p = .04 ) . Greater participation in activities was significantly correlated with greater awareness ( .67 ; p = .007 ) , higher participation ( .61 ; p = .02 ) , and increase in fruit and vegetable consumption . ( .55 ; p = .04 ) . Conclusions . These results provide quantitative indicators of a dose-response relationship between the number of intervention activities per employee and higher percentage of employee participation and observed increases in fruit and vegetable consumption Background : Environmental interventions directed at portion size might help consumers to reduce their food intake . Objective : To assess whether offering a smaller hot meal , in addition to the existing size , stimulates people to replace their large meal with a smaller meal . Design : Longitudinal r and omized controlled trial assessing the impact of introducing small portion sizes and pricing strategies on consumer choices . Setting / participants : In all , 25 worksite cafeterias and a panel consisting of 308 consumers ( mean age=39.18 years , 50 % women).Intervention : A small portion size of hot meals was offered in addition to the existing size . The meals were either proportionally priced ( that is , the price per gram was comparable regardless of the size ) or value size pricing was employed . Main outcome measures : Daily sales of small and the total number of meals , consumers ’ self-reported compensation behavior and frequency of purchasing small meals . Results : The ratio of small meals sales in relation to large meals sales was 10.2 % . No effect of proportional pricing was found B=−0.11 ( 0.33 ) , P=0.74 , confidence interval ( CI ) : −0.76 to 0.54 ) . The consumer data indicated that 19.5 % of the participants who had selected a small meal often-to-always purchased more products than usual in the worksite cafeteria . Small meal purchases were negatively related to being male ( B=−0.85 ( 0.20 ) , P=0.00 , CI : −1.24 to −0.46 , n=178 ) . Conclusion : When offering a small meal in addition to the existing size , a percentage of consumers that is considered reasonable were inclined to replace the large meal with the small meal . Proportional prices did not have an additional effect . The possible occurrence of compensation behavior is an issue that merits further attention The National Cancer Institute 's ' 5-a-Day for Better Health Campaign is examining the efficacy of interventions in increasing the consumption of fruits and vegetables to five or more servings a day . This paper presents the study design , intervention and baseline survey results of the Treatwell 5-a-Day project , a r and omized , controlled worksite-based intervention study . Twenty-two community health centers were r and omly assigned to either a Minimal Intervention , Worksite Intervention or Worksite Plus Family Intervention . The Worksite Intervention included participation of employee advisory boards , programs aim ed at individual behavior change and programs aim ed at changes in the worksite environment . The Worksite Plus Family Intervention incorporated family-focused interventions into the worksite program , including a learn-at-home program , family newsletter , family festival and material s mailings . A self-administered survey was conducted prior to r and omization ( mean response rate : 87 % , n = 1359 ) . Twenty-three percent reported consuming five or more servings of fruits and vegetables a day . Consumption of fruits and vegetables was directly associated with level of household support for healthy eating . The Treatwell 5-a-Day intervention model has the potential to enhance existing worksite-based intervention through incorporation of its family focus , especially given the association of household support with individual eating habits The objective of this study was to evaluate an intervention that combined mindful eating and online pre-ordering to promote healthier lunch purchases at work . The study took place at an urban hospital with 26 employees who were overweight or obese . The design included a contemporaneous comparison with delayed-treatment control and a three-phase prospect i ve study . A minimum 4-week baseline period preceded a 4-week full-intervention , in which participants received mindful eating training , pre-ordered their lunches , and received price discounts toward lunch purchases . In a 4-week reduced intervention phase , participants pre-ordered lunches without price discounts . Participant lunch purchases were tracked electronically at the point of purchase . The primary outcome measures were the amounts of kilocalories and fat grams in purchased lunches . In contemporaneous comparisons , the treatment group purchased lunches with an average of 144.6 fewer kilocalories ( p = 0.01 ) and 8.9 fewer grams of fat ( p = 0.005 ) compared to controls . In multivariable longitudinal analyses , participants decreased the average number of calories in their meals by 114.6 kcal per lunch and the average grams of fat by 5.4 per lunch during the partial-intervention compared to the baseline ( p < 0.001 ) . At the end of the study , a moderate increase was observed in participants ' overall mindful eating behaviors as compared to the beginning of the study ( p < 0.001 ) . The majority of participants ( 92 % ) said they would use the pre-ordering system if offered in the future . Combined mindful eating training and online pre-ordering appears a feasible and useful worksite intervention to improve food choices by employees BACKGROUND 5 a Day for Better Health is a simple message encouraging people to eat more fruits and vegetables . The Seattle 5 a Day worksite investigators design ed and evaluated an intervention , organized on stages of behavioral change , to increase worksitewide fruit and vegetable consumption . METHODS We recruited 28 worksites with cafeterias and r and omized 14 to intervention and 14 to control . The intervention addressed both changes in the work environment and individual level behavior change . In each worksite , an employee advisory board , with study interventionist assistance , implemented the program . By surveying cross-sectional sample s of 125 employees per worksite , we compared worksite mean fruit and vegetable consumption at 2-year follow-up with that at baseline .  Unobtrusive site-level indicators including plate observation and cafeteria checklist  were also used . RESULTS The difference at 2 years was 0.5 for the intervention worksites and 0.2 for the control worksites , with an intervention effect of 0.3 daily serving ( P < 0.05 ) . Other measures of fruit and vegetable consumption , including unobtrusive indicators , supported the effectiveness of the intervention . CONCLUSIONS This simple 5 a Day intervention is feasible and acceptable for use in worksites with cafeterias . There was a significant differential increase in fruit and vegetable consumption in the intervention worksites . This kind of worksite intervention can achieve important health benefits on a population basis , because of its potential to reach large numbers of people BACKGROUND Preventing obesity requires maintenance of healthy eating behaviors over time . Food labels and strategies that increase visibility and convenience of healthy foods ( choice architecture ) promote healthier choices , but long-term effectiveness is unknown . PURPOSE Assess effectiveness of traffic-light labeling and choice architecture cafeteria intervention over 24 months . DESIGN Longitudinal pre-post cohort follow-up study between December 2009 and February 2012 . Data were analyzed in 2012 . SETTING / PARTICIPANTS Large hospital cafeteria with a mean of 6511 transactions daily . Cafeteria sales were analyzed for ( 1 ) all cafeteria customers and ( 2 ) a longitudinal cohort of 2285 hospital employees who used the cafeteria regularly . INTERVENTION After a 3-month baseline period , cafeteria items were labeled green ( healthy ) ; yellow ( less healthy ) ; or red ( unhealthy ) and rearranged to make healthy items more accessible . MAIN OUTCOME MEASURES Proportion of cafeteria sales that were green or red during each 3-month period from baseline to 24 months . Changes in 12- and 24-month sales were compared to baseline for all transactions and transactions by the employee cohort . RESULTS The proportion of sales of red items decreased from 24 % at baseline to 20 % at 24 months ( p<0.001 ) , and green sales increased from 41 % to 46 % ( p<0.001 ) . Red beverages decreased from 26 % of beverage sales at baseline to 17 % at 24 months ( p<0.001 ) ; green beverages increased from 52 % to 60 % ( p<0.001 ) . Similar patterns were observed for the cohort of employees , with the largest change for red beverages ( 23%-14 % , p<0.001 ) . CONCLUSIONS A traffic-light and choice architecture cafeteria intervention result ed in sustained healthier choices over 2 years , suggesting that food environment interventions can promote long-term changes in population eating behaviors OBJECTIVES To develop and vali date a new risk-of-bias tool for nonr and omized studies ( NRSs ) . STUDY DESIGN AND SETTING We developed the Risk of Bias Assessment Tool for Nonr and omized Studies ( RoBANS ) . A validation process with 39 NRSs examined the reliability ( interrater agreement ) , validity ( the degree of correlation between the overall assessment s of RoBANS and Method ological Index for Nonr and omized Studies [ MINORS ] , obtained by plotting the overall risk of bias relative to effect size and funding source ) , face validity with eight experts , and completion time for the RoBANS approach . RESULTS RoBANS contains six domains : the selection of participants , confounding variables , the measurement of exposure , the blinding of the outcome assessment s , incomplete outcome data , and selective outcome reporting . The interrater agreement of the RoBANS tool except the measurement of exposure and selective outcome reporting domains ranged from fair to substantial . There was a moderate correlation between the overall risks of bias determined using RoBANS and MINORS . The observed differences in effect sizes and funding sources among the assessed studies were not correlated with the overall risk of bias in these studies . The mean time required to complete RoBANS was approximately 10 min . The external experts who were interviewed evaluated RoBANS as a " fair " assessment tool . CONCLUSIONS RoBANS shows moderate reliability , promising feasibility , and validity . The further refinement of this tool and larger validation studies are required OBJECTIVES To estimate short-term effects of integrated health promotion in the workplace within the framework of the Bergamo WHP ( Workplace Health Promotion ) network , which involves 94 companies and about 21,000 workers . METHODS A controlled non-r and omized , before-after evaluation was carried out . Data were collected through anonymous question naires before ( t0 ) and after participation in a 12-month health promotion programme ( t1 ) . The " control " group consisted of workers of companies participating in the programme who had not yet undertaken any interventions in the theme areas covered by the assessment . RESULTS In the workers participating in the programme , positive early effects ( after 12 months ) were related to intake of food providing protection ( fruit and vegetables ) and increased rates of smoking cessation . The effects were more evident in males and in white collars . The physical activity and alcohol consumption trends went in the desired direction and with more effects than in the non-participating group , but without statistical significance . In the short term , no evident changes in events of road injury risk or in the quality of personal relationships were seen , probably due to the small size of the sample involved in these study areas . CONCLUSIONS The results , although within the method ological limitations of the study , showed that after 12 months there was a reduction in some important risk factors for chronic diseases in workers participating in the programme , particularly for fruit and vegetable intake and smoking cessation . It will be important to monitor the effects of the programme on other risk factors in the medium and long term , and also the impact of employment status and gender so as to adjust the programme interventions accordingly . Cooperation with occupational/authorized physicians with use of their data collected from health surveillance , together with a limited set of general risk factor indicators , would be a desirable development for further studies Modifying the food environment is a promising strategy for promoting healthier eating behavior . This study aim ed to evaluate nutritional and weight changes in a program that used worksite cafeterias to reduce employees ' calorie content of purchased foods and improve their macronutrient intake . Participants were r and omly assigned to one of two conditions : 1 ) only environmental change ( i.e. , the introduction of 10 new low-energy-density ( ED ) foods and provision of labels for all foods sold at lunch , which listed ED , calories , and macronutrient content ) or 2 ) the environmental change plus pricing incentives for purchasing low-ED foods and education about low-ED eating delivered in four , 1-hour group sessions . Participant lunch choices were monitored electronically at the point of purchase for 3 months before the intervention was instituted ( i.e. , the baseline period ) and for 3 months afterward ( i.e. , intervention period ) . Participants were adults ( n=96 , BMI = 29.7+/-6.0 kg/m(2 ) ) who regularly ate lunch at their workplace cafeteria . There was no difference between groups in total energy intake over the study period . Across groups , energy and percent of energy from fat decreased and percent of energy from carbohydrate increased from baseline to the intervention period ( all p<.01 ) . Follow-up analyses , conducted by averaging Baseline Months 1 and 2 and comparing them to Intervention Month 3 as a conservative estimate of overall impact of the intervention , indicated that change in energy , carbohydrate , and fat intake remained significant ( p<.001 ) . Providing nutrition labels and reducing the ED of selected foods was associated with improved dietary intake In a r and omized , controlled study of the Treatwell work-site nutrition intervention program , which focused on promoting eating patterns low in fat and high in fiber , 16 work sites from Massachusetts and Rhode Isl and were recruited to participate and r and omly assigned to either an intervention or a control condition . The intervention included direct education and environmental programming tailored to each work site ; control work sites received no intervention .  A cohort of workers r and omly sample d from each site was surveyed both prior to and following the intervention . Dietary patterns were assessed using a semiquantitative food frequency question naire . Adjusting for work site , the decrease in mean dietary fat intake was 1.1 % of total calories more in intervention sites than in control sites ( P less than .005 ) . Mean changes in dietary fiber intake between intervention and control sites did not differ . This study provides evidence that a work-site nutrition intervention program can effectively influence the dietary habits of workers OBJECTIVES We report on the results of the Treatwell 5-a-Day study , a worksite intervention aim ed at increasing consumption of fruits and vegetables . METHODS Twenty-two worksites were r and omly assigned to 3 groups : ( 1 ) a minimal intervention control group , ( 2 ) a worksite intervention , and ( 3 ) a worksite-plus-family intervention . The interventions used community-organizing strategies and were structured to target multiple levels of influence , following a socioecological model . Data were collected by self-administered employee surveys before and after the intervention ; the response rate was 87 % ( n = 1359 ) at baseline and 76 % ( n = 1306 ) at follow-up . A process tracking system was used to document intervention delivery . RESULTS After control for worksite , gender , education , occupation , race/ethnicity , and living situation , total fruit and vegetable intake increased by 19 % in the worksite-plus-family group , 7 % in the worksite intervention group and 0 % in the control group ( P = .05 ) . These changes reflect a one half serving increase among workers in the worksite-plus-family group compared with the control group ( P = .018 ) . CONCLUSIONS The worksite-plus-family intervention was more successful in increasing fruit and vegetable consumption than was the worksite intervention . Worksite interventions involving family members appear to be a promising strategy for influencing workers ' dietary habits OBJECTIVES The purpose of this study was to evaluate the short-term effects of a low-intensity work-site heart disease risk reduction program using a matched pair design with work site as the unit of analysis . METHODS Twenty-six heterogeneous work sites with between 125 and 750 employees were matched on key organization characteristics and then r and omly assigned to early or delayed intervention conditions . Early intervention consisted of an 18-month multifaceted program that featured an employee steering committee and a menu approach to conducting key intervention activities tailored to each site . RESULTS Cross-sectional and cohort analyses produced consistent results . At the conclusion of the intervention , early and delayed intervention conditions did not differ on changes in smoking rates , dietary intake , or cholesterol levels . There was considerable variability in outcomes among work sites within each condition . CONCLUSIONS Despite documented implementation of key intervention activities and organization-level changes in terms of perceived support for health promotion , this intervention did not produce short-term improvements beyond secular trends observed in control work sites . Research is needed to underst and determinants of variability between work sites Objective To evaluate the effectiveness of a draft occupational health practice guideline aim ed at preventing weight gain on employees ' physical activity , sedentary behaviour and dietary behaviour and on body weight-related outcomes . Methods A r and omised controlled trial was performed comparing guideline -based care to usual care among 16 occupational physicians and 523 employees in the Netherl and s between 2009 and 2011 . Occupational physicians in the intervention group followed the draft guideline by providing advice to employers on how to assess and intervene on the obesogenic work environment and conducted five face-to-face behavioural change counselling sessions with employees to improve their lifestyle . Data of employees were collected by question naire and physical measurements at baseline and 6-months follow-up . Linear and logistic regression analyses were performed to determine effects . Results The intervention showed significant effects on sedentary behaviour at work ( β −28 min/day , 95 % CI −2 to −54 ) and on fruit intake ( β 2.1 pieces/week ; 95 % CI 0.6 to 3.6 ) . No significant intervention effects were found for physical activity , sedentary behaviour in leisure time or during weekend days , snack intake and body weight-related outcomes . Conclusion Guideline -based care result ed in a more favourable sedentary behaviour at work and increased fruit intake but did not improve employees '  physical activity , snack intake or body weight-related outcomes . Trial registration number IS RCT N/73545254 and NTR/1190 Objective : Examine the effectiveness of the  worksite-based weight gain prevention program  Netherl and s Heart Foundation-Netherl and s Research program weight Gain prevention In Balance , with regard to behavioral changes and corresponding cognitive determinants . Methods : A nonr and omized pretest-repeated posttest control group design was applied in 12 worksites . Intervention groups received individual and environmental interventions , directed at physical activity and food intake . Measurements were executed at baseline and after 12 and 24 months . Results : Nearly all behaviors in the intervention group improved more than in the control group , even though improvements in behaviors were often too small to reach statistical significance . No positive intervention effects were observed for the cognitive factors . Conclusion : Differential changes between the intervention and control group were observed for several important dietary and physical activity behaviors . Valuable information is gained regarding the implementation of weight gain prevention programs in worksites
OBJECTIVES We were commissioned by the behavioural insights team at Public Health Engl and to synthesis e the evidence on choice architecture interventions to increase healthy purchasing and /or consumption of food and drink by National Health Service ( NHS ) staff .