Multi-Level Trial of a Workplace Sales Ban of Sugary Beverages and Brief Motivational Counseling Intervention on Adiposity

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ABSTRACT Sugar-sweetened beverages (SSBs, e.g., sodas, sports drinks, “fruit” drinks, bottled teas, coffees) have emerged as a key dietary risk factor for obesity and type 2 diabetes. We propose a double-randomized controlled trial of a multilevel workplace intervention that combines an employer-sponsored sales ban on SSBs with brief motivational counseling to support reduced consumption. Health systems and schools are increasingly adopting sales bans of SSBs and replacing them with healthier options. Employer-based brief counseling interventions, despite being low-cost and highly efficacious for alcohol and tobacco reduction, have received limited attention as a strategy to reduce SSB consumption. A multilevel intervention combining both strategies may be the most effective: the brief counseling intervention can increase motivation to reduce SSBs despite cravings while the sales ban removes SSB-related availability and cues from the workplace. Our pilot data strongly support the rationale for combining these interventions and for the mediating role of SSB cravings. The proposed trial tests this multilevel intervention, called the workplace Metabolic Health Improvement Program (MHIP), in partnership with a Northern California-based academic healthcare system, Sutter Health (enrolling N=700 employees on N=16 hospital campuses). The first randomization will assign hospital campuses to the employer-sponsored sales ban on SSBs (8 sites) versus control (8 sites). The second randomization will assign employees to the brief counseling intervention versus control, split equally across sales ban and control sites. We assess anthropometrics and blood at baseline and 12 months. The primary outcome is change in central obesity (e.g., waist circumference). Secondary outcomes include changes in SSB consumption, Body Mass Index (BMI), serum insulin sensitivity (homeostatic model assessment [HOMA]), and lipids. Dietary and beverage composition is assessed remotely using the Automated Self-Administered 24- Hour recall (ASA-24) at baseline, 6 and 12 months. The first aim of this research is to assess the independent effects of the brief counseling intervention and workplace SSB sales ban on changes in primary and secondary outcomes. The second aim is to test the multilevel effects of combining the brief intervention and SSB sales ban on outcomes. A third, exploratory aim examines whether reductions in SSB cravings mediate the effects of the multilevel intervention on outcomes. If effective, the employer-sponsored multilevel intervention will offer an efficient, scalable strategy for preventing obesity and metabolic disease in millions of American working adults.