Steps to Health: Targeting Obesity in the Health Care Workplace

描述(申请人提供)：超重和肥胖会增加患糖尿病、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%。到目前为止，工作场所肥胖干预的特点通常不是强有力的方法设计或评估干预战略的长期影响--既不是从对参与者的好处，即实现体重和健康目标，也不是从对雇主的好处，包括提高生产率和降低医疗费用。NIOSH职业生活倡议鼓励这一领域的进一步研究。这项建议的主要目标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-Steps to Health(STH：“通常的护理标准”)和Steps to Health Plus！(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个月后的体重减轻，并进行额外的分析，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期间两个试验单位的工伤、医疗保健利用和索赔费用以及旷工/出勤的减少情况。对于这些结果，参与者还将以前瞻性(非随机)方式与观察性对照组中符合资格标准但未参与两项干预中的任何一项的个人进行比较。最后，我们将估计干预措施相对于其有效性和节余的成本，包括缺勤和出勤的变化、工人赔偿索赔和健康索赔报销。该提案利用了现有的全面职业监测系统，该系统将能够评估干预措施对保健报销的影响。这项研究将建立并加强完善的机构员工健康计划，大部分干预成本将由机构以实物形式提供，多学科研究团队在行为干预、肥胖与工作场所以及成本效益分析方面拥有丰富的经验。这些干预措施将在卫生保健工作场所进行评估，该工作场所的人口具有混合种族和社会经济地位，从而允许更大的普及性。这项研究的结果对于考虑鼓励健康体重的干预措施的工作场所应该有很大的价值。干预地点特别相关，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家人和患者的榜样。对于通过体重控制计划接触到大量超重和肥胖成年人来说，工作场所可能是一个理想的环境；几个联邦机构呼吁进一步追求这个机会，以改善公共健康。Steps to Health旨在1)通过健康饮食和增加体力活动帮助员工实现和保持健康的体重目标，2)降低工伤发生率，3)减少与肥胖相关的医疗支出。

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.