Promoting Employee Health Through The Worksite Food Environment

 描述(申请人提供)：美国成年人平均每年增重1-2磅。需要在人口层面采取干预措施，防止体重增加，以扭转肥胖率上升的趋势。尽管个人层面的干预措施可以导致一小群人的体重大幅变化，但要实现人口的变化，将需要制定长期战略，创造更健康的食物环境，建立新的社会规范，并提高健康生活方式行为的动机和技能。该工作场所非常适合 针对体重和生活方式行为的干预措施，因为大多数成年人都有工作，而且《平价医疗法案》中的条款鼓励工作场所的健康。我们在马萨诸塞州总医院(MGH)的研究团队已经证明，行为经济学策略，包括红绿灯标签、选择架构、社会规范和财务激励，可以改善员工的健康食品选择。拟议的项目将解决这项研究的关键下一阶段，以确定通过食物环境提供的工作场所干预是否可以防止体重增加和降低员工的心血管风险。该项目建立在麻省理工学院已建立的红绿灯标签系统的基础上，并测试了一种干预措施，旨在增加营养知识，推动生活方式行为的改变，并促进员工更健康的生活方式的社会规范行为。这种干预将融入工作日的流程中，从而减轻员工和雇主的负担。研究设计：在一项随机对照试验中，600名MGH员工将被分配到：1)干预组，提供关于(A)现场食物购买、卡路里和体力活动目标(每周电子邮件)的自动化、个性化反馈，以及(B)社会规范反馈加上购买健康食品的小额经济激励(每月信函)或2)对照组(标准化每月信函)。研究结果将在1年(干预结束)和2年随访时进行评估。主要结果是一年后体重发生变化。次要结果是心血管风险因素、工作场所食物购买和饮食摄入量(由健康饮食指数衡量)。一项新的探索性成果将是为与研究对象有社会联系的同事购买健康食品。目标1是确定在1年和2年的随访中，分配到干预组的员工是否比对照组体重增加更少，心血管风险因素更低。目标2是确定在1年和2年的随访中，被分配到干预组的员工是否比控制组做出了更健康的食物选择。探索性目标3是确定与干预组有社会联系的员工是否比与控制组有联系的员工在一年内做出了更健康的工作场所食物选择。影响：这一利用个性化反馈、社会规范和财务激励的创新战略将提供一个可扩展和可持续的模式，可以在其他工作场所、机构和零售环境中采用，以防止人口水平的肥胖。

 DESCRIPTION (provided by applicant): Adults in the United States gain an average of 1-2 pounds a year. Interventions to prevent weight gain at the population level are needed to reverse the rising prevalence of obesity. Although individual-level interventions can result in large weight changes among small groups of individuals, achieving changes in the population will require long-term strategies that create healthier food environments, establish new social norms, and improve motivation and skills for healthy lifestyle behaviors. The worksite is ideal for interventions to address weight and lifestyle behaviors because a majority of adults are employed, and provisions in the Affordable Care Act encourage worksite wellness. Our research team at Massachusetts General Hospital (MGH) has demonstrated that behavioral economics strategies, including traffic-light labels, choice architecture, social norms, and financial incentives, improve employees' healthy food choices. The proposed project will address the critical next phase of this research to determine if a worksite intervention delivered through the food environment can prevent weight gain and reduce cardiovascular risk of employees. This project builds on the established traffic- light labeling system at MGH and tests an intervention that aims to increase nutrition knowledge, motivate change in lifestyle behaviors, and promote socially normative behavior for healthier lifestyles among employees. The intervention will be integrated into the flow of the work day, thus lowering burden to employees and the employer. Study Design: In a randomized controlled trial, 600 MGH employees will be assigned to: 1) an intervention arm with automated, personalized feedback about (a) worksite food purchases and calorie and physical activity goals (weekly emails) and (b) social norm feedback plus small financial incentives for healthy food purchases (monthly letters) or 2) a control arm (standardized monthly letters). Study outcomes will be assessed at 1 year (end of intervention) and 2 year follow-up. The primary outcome is change in weight at 1 year. Secondary outcomes are cardiovascular risk factors, worksite food purchases, and dietary intake (as measured by the Healthy Eating Index). A novel exploratory outcome will be healthy food purchases of co- workers who are socially connected to study subjects. Aim 1 is to determine if employees assigned to the intervention have less weight gain and lower cardiovascular risk factors than the control group at 1 year and 2- year follow-up. Aim 2 is to determine if employees assigned to the intervention group make healthier food choices than the control group at 1 year and 2-year follow-up. Exploratory Aim 3 is to determine if employees socially connected to the intervention group make healthier worksite food choices over 1 year than employees connected to the control group. Implications: This innovative strategy utilizing personalized feedback, social norms, and financial incentives will provide a scalable and sustainable model that could be adopted in other worksite, institutional, and retail settings to prevent obesity at the population level.