ROCKVILLE, Md.— Despite lifestyle interventions for weight-loss having limited effectiveness in workplaces when evaluated in randomized trials, a new program named Healthy Weight for Living (HWL) implemented with and without meal replacements and delivered in person or by videoconference reveals a significant weight loss in employees after six months, according to a new study in Obesity, The Obesity Society’s (TOS) flagship journal.
“We know that one-size-fits-all type solutions do not work for everyone, and as nutrition scientists, it is our responsibility to provide options for weight management that are both effective and easy to follow,” said Sai Krupa Das, PhD, Senior Scientist, Jean Mayer USDA Human Nutrition Research Center on Aging and Professor, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Mass. Das is the lead and corresponding author of the study.
The Centers for Disease Control and Prevention recommend offering lifestyle interventions for healthy weight management in workplaces since the majority of adults are employed and rising health care costs incentivize employers to support employee health. However, systematic reviews have indicated that most lifestyle interventions tested in employees, as well as commercial lifestyle interventions suited for scaled use in workplaces, have not achieved significant weight loss. Researchers observe that one potential explanation is that burdensome core features such as daily food logging limit participant adherence. Another factor is the widespread availability of unhealthy food at workplaces.
The HWL approach addresses biological antecedents of food intake (hunger, food cravings, and food preferences), and develops intrinsic motivation for behavior changes leading to weight loss, topics that receive limited emphasis in traditional lifestyle interventions.
Twelve workplaces in the Boston area were randomized to an 18-month intervention with or without meal replacements by a commercial provider. Workplaces were cluster randomized in a 2:1 ratio with eight intervention sites and four control sites stratified by workplace type (e.g., commercial organizations, nonprofits). Participants within intervention sites were individually randomized to HWL or HWL and meal replacements, with the group weight loss program delivered in person or by videoconference.
Participants were employees with overweight or obesity. More than 80% of participants were female, an average age of 48, with a body mass index of 33 kg/m2. To recruit employees, emails were sent out by the organizations informing them of the study. Researchers conducted onsite information sessions with prospective participant screenings. Approximately 260 individuals enrolled in the HWL and HWL meal replacements groups, while 76 participants were in the control group. Recruitment took place between September 2015 and February 2016 with the trial completed in February 2018.
Results were measured at the workplaces by a research team that had no role in intervention delivery. Assessments were conducted at baseline and 6 months in all participants and at 12 and 18 months in intervention participants. Results showed that at the 6-month mark, weight loss among participants was 8.8% in the HWL group and 8.0% in the HWL with meal replacements group with improvements in general health, vitality and sleep in both groups. Weight loss greater than 5% was maintained at the 18-month mark for both groups.
“The study results show how significant and scalable weight reduction is achievable in the workforce community. Rather than focusing on food logging and exercise, the use of a revised health behavior change model makes impactful changes. Clinically meaningful weight loss was shown among participants, along with lower dropout rates and sustained weight reduction at 18 months. Additionally, the results demonstrate the effectiveness and flexibility of delivering a low-cost intervention by videoconference,“ said Florencia Ziemke, MD, dABOM; Founder and CEO, Evexia Medical. Ziemke was not associated with the study.
Ziemke added that promoting health in the workforce can improve physical, mental, emotional health; boost productivity, increase engagement, decrease health care costs and improve staff retention. “These results are a first step and very promising for future studies,” she said.
The study, titled “Randomized Controlled Trial of a Novel Lifestyle Intervention Used with or without Meal Replacements in Worksites" will be published in the February 2023 print edition of Obesity.
Other study authors include Rachel Silver, Taylor Vail, Susan Roberts, and Edward Saltzman, Jean Mayer USDA Human Nutrition Research Center on Aging and Friedman School of Nutrition Science and Policy, Tufts University, Boston, Mass.; Meghan Chin and Caroline Blanchard, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University; David Allison, Xiwei Chen and Stephanie Dickinson, Department of Epidemiology, School of Public Health, Indiana University, Bloomington; and Lisa Ceglia, Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, Mass.
This study was supported by Nutrient Foods LLC, and in part by the National Institutes of Health’s (NIH) National Heart, Lung and Blood Institute under award number R25HL124208. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or any other organization.
Roberts has a financial interest in the iDiet (www.theidiet.com). Her interests are managed by Tufts University in accordance with its conflict-of-interest policy, and she had no role in recruitment, randomization, collection or analysis of outcome data, intervention delivery or in the final interpretation of results. In the last 12 months, Allison has received personal payments or promises for same from the following: Alkermes, Inc.; American Society for Nutrition; Amin, Talati, Wasserman for KFS Acquisition Corporation (Glanbia); Big Sky Health; Kaleido Biosciences; Law Offices of Ronald Marron; Novo Nordisk Foundation; The Obesity Society; and Tomasik, Kostin, & Kasserman. Donations to a foundation have been made on his behalf by the Northarvest Bean Growers Association/Communique. Indiana University, which employees Allison, Dickinson and Chen, and the Indiana University Foundation have received funds to support their research or educational activities from the following: Alliance for Potato Research and Education; American Egg Board; American Federation for Aging Research; Arnold Ventures; Eli Lilly and Company; Mars, Incorporated; and the National Cattlemen’s Beef Association. Das, Silver, Dickinson and Chen had full access to the data and take responsibility for the integrity of the data and accuracy of the analysis. The other authors declared no conflicts of interest.
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The Obesity Society (TOS) is the leading organization of scientists and health professionals devoted to understanding and reversing the epidemic of obesity and its adverse health, economic and societal effects. Combining the perspective of researchers, clinicians, policymakers and patients, TOS promotes innovative research, education and evidence-based clinical care to improve the health and well-being of all people with obesity. For more information, visit www.obesity.org.
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Obesity