Steps to Health: Targeting Obesity in the Health Care Workplace

描述（由申请人提供）：超重和肥胖会增加糖尿病、心脏病和癌症的风险。近三分之二的美国人口超重或肥胖，占医疗保健支出的9-10%。迄今为止，工作场所肥胖干预措施通常没有强有力的方法设计或评估干预策略的长期影响-无论是对参与者的益处，即，满足体重和健康目标，也不是对雇主的好处，包括提高生产力和降低医疗保健成本。NIOSH工作生活倡议鼓励在这一领域进行进一步研究。本提案的主要目的是比较两个单独定制的综合工作场所体重管理计划的有效性-健康步骤（STH：“通常的护理标准”）和健康步骤加！(STH+）采用随机对照试验设计（n=500），并在12、24和36个月进行随访。主要终点将是36个月时的体重减轻，并进行额外分析，以确定社会认知和行为（饮食和体力活动）因素在干预成功中的作用。进一步的分析将比较干预后两年内两个试验组的工作场所伤害、医疗保健利用和索赔成本以及缺勤/出勤率的减少情况。对于这些结果，还将以前瞻性（非随机化）方式将参与者与观察性对照组中符合资格标准但未参加两种干预措施中任何一种的个体进行比较。最后，我们将估计干预措施相对于其有效性和节省的成本，包括缺勤和出勤率的变化，工人的赔偿要求和健康索赔报销。该提案利用了现有的综合职业监测系统，该系统将允许评估干预措施对医疗保健报销的影响。该研究将建立在一个完善的机构员工健康计划的基础上，并加强该计划，大部分干预费用将由该机构以实物形式提供，多学科研究团队在行为干预，肥胖和工作场所以及成本效益分析方面拥有广泛的经验。将在一个有混合族裔和社会经济地位人口的保健工作场所对干预措施进行评价，以提高普遍性。这项研究的结果应该是非常有价值的工作场所考虑干预措施，鼓励健康的体重。干预现场特别相关，因为卫生保健机构可以成为其他工作场所的榜样，卫生保健工作者可以成为其家人和患者的榜样。 工作场所可能是一个理想的设置，以达到大量的超重和肥胖的成年人与体重控制计划;几个联邦机构呼吁进一步追求这一机会，以改善公众健康。Steps To Health的目标是：1）通过健康饮食和增加体力活动帮助员工达到并保持健康的体重目标; 2）降低工伤率; 3）减少与肥胖相关的医疗保健支出。

DESCRIPTION (provided by applicant): Overweight and obesity increase the risk of diabetes, heart disease, and cancer. Nearly two thirds of the US population is overweight or obese, accounting for 9-10% of health care expenditures. Worksite obesity interventions to date have not typically been characterized by strong methodological designs or assessed the long-term impact of intervention strategies - neither in terms of the benefits to the participants, i.e., meeting weight and health goals, nor in terms of benefits to employers, including increased productivity and decreased health care costs. The NIOSH WorkLife Initiative encourages further research in this area. The primary objective of this proposal is to compare the effectiveness of two individually tailored, integrated worksite weight management programs - Steps to Health (STH: "usual standard of care") and Steps to Health Plus! (STH+) using a randomized controlled trial design (n=500) and follow-up at 12, 24, and 36 months. The primary endpoint will be weight loss at 36 months, with additional analysis to determine role of social-cognitive and behavioral (diet and physical activity) factors in intervention success. Further analysis will compare reductions in workplace injuries, health care utilization and claims costs, and absenteeism/presenteeism in the two trial arms during the two years following the intervention. For these outcomes, participants will also be compared, in a prospective (non-randomized) fashion, with individuals in an observational comparison group, who meet eligibility criteria but do not take part in either of the two interventions. Finally, we will estimate the costs of the interventions relative to their effectiveness and savings, including changes in absenteeism and presenteeism, workers' compensation claims, and health claim reimbursements. The proposal takes advantage of an existing comprehensive occupational surveillance system which will permit evaluating the impact of the intervention on health care reimbursements. The study will build upon and enhance a well-established institutional employee wellness program, most of the intervention costs will be provided in kind by the institution, and the multidisciplinary research team has broad experience with behavioral interventions, obesity and the workplace, and cost effectiveness analysis. The interventions will be evaluated in a health-care worksite with a population of mixed ethnicity and socioeconomic status, allowing greater generalizability. The results of this study should be of great value to worksites considering interventions encouraging healthy weight. The intervention site is especially pertinent in that health care institutions can be models for other workplaces, and health care workers can be models for their families and patients. The workplace may be an ideal setting for reaching large populations of overweight and obese adults with weight control programs; several federal agencies have called for further pursuit of this opportunity to improve public health. Steps To Health aims to 1) help workers meet and maintain healthy weight goals through healthy eating and increased physical activity, 2) reduce the rate of work-related injuries, and 3) decrease health care expenditures associated with obesity.