Eating healthily at work matters

A new study in the American Journal of Preventive Medicine finds unhealthy worksite food purchases associated with unhealthy diet outside of work and more risk factors for diabetes and cardiovascular disease


Ann Arbor, May 22, 2019

A new study in the American Journal of Preventive Medicine, published by Elsevier, demonstrated that employees at a large urban hospital who purchased the least healthy food in its cafeteria were more likely to have an unhealthy diet outside of work, be overweight and/or obese, and have risk factors for diabetes and cardiovascular disease, compared to employees who made healthier purchases. These findings contribute to a better understanding of the relationship of eating behaviors at work with overall diet and health and can help to shape worksite wellness programs that both improve long-term health outcomes and reduce costs.

“Employer-sponsored programs to promote healthy eating could reach millions of Americans and help to curb obesity, a worsening epidemic that too often leads to diabetes, cardiovascular disease, and cancer,” said lead investigator Anne N. Thorndike, MD, MPH, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.

Most Americans spend about half their waking hours at work and consume food acquired at work. Nearly a third of all US workers are obese, which has an impact beyond the individual’s health risks. Previous research has shown that obesity contributes to higher absenteeism, lower productivity, and higher healthcare expenses for employers. This study’s findings can lead to more effective strategies to encourage employees to choose healthier foods and reduce their risks for chronic conditions.

“Workplace wellness programs have the potential to promote lifestyle changes among large populations of employees, yet to date there have been challenges to developing effective programs. We hope our findings will help to inform the development of accessible, scalable, and affordable interventions,” noted Jessica L. McCurley, PhD, MPH, one of the study’s investigators and Postdoctoral Fellow at the Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.

Participants were 602 Massachusetts General Hospital employees who regularly used the hospital’s cafeterias and were enrolled in a health promotion study in 2016−2018. As part of the hospital’s “Choose Well, Eat Well” program, foods and beverages in the hospital cafeterias have “traffic light” labels to indicate their healthfulness: green is healthy, yellow is less healthy, and red is unhealthy. Food displays have also been modified to put healthier choices in the direct line of sight, while unhealthy foods were made less accessible to reduce impulse purchases. “Simplified labeling strategies provide an opportunity to educate employees without restricting their freedom of choice. In the future, using purchase data to provide personalized nutritional feedback via email or text messaging is another option to explore to encourage healthy eating,” added Dr. Thorndike.

Image of hospital canteen with a “traffic light” display to highlight nutritional labeling system so employees could make healthy food selections.
A “traffic light” approach to nutritional labeling directed employees to healthy food selections. Check-out scans were linked with employee IDs, providing an efficient and accurate approach for capturing data.

The study is a cross-sectional analysis of worksite food purchases from cash register data; food consumption reports from surveys; and cardio-metabolic test results, diagnoses, and medication information. Using cafeteria purchasing data, the investigators developed a Healthy Purchasing Score (HPS) to rate the dietary quality of employees’ overall purchases. The investigators compared participants’ HPS to the quality of their overall diet (using an online survey and tool developed by the National Cancer Institute), as well as to measures of obesity, diabetes, high blood pressure, and high cholesterol (data acquired through test results and self-reporting). The analysis showed that employees with the lowest HPS (least healthy purchases) had the lowest overall dietary quality and the highest risk for obesity, diabetes, and high blood pressure. Healthier purchases were associated with higher dietary quality and lower prevalence of obesity, hypertension, and prediabetes/diabetes.

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Notes for editors
The article is “Association of Worksite Food Purchases and Employees’ Overall Dietary Quality and Health,” Jessica L. McCurley, PhD, MPH, Douglas E. Levy, PhD, MPH, Eric B. Rimm, ScD, Emily D. Gelsomin, MLA, RD, LDN, Emma M. Anderson, BA, Jenny M. Sanford, BA, and Anne N. Thorndike, MD, MPH (https://doi.org/10.1016/j.amepre.2019.02.020). It appears in advance of the American Journal of Preventive Medicine, volume 57, issue 1 (July 2019) published by Elsevier.

ChooseWell 365 was funded by the NIH R01 grants HL125486 and DK114735. The project was also supported by NIH Grant Number 1UL1TR001102.

Full text of this article is available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or ajpmmedia@elsevier.com. Journalists who wish to interview the authors should contact Anne N. Thorndike, MD, MPH, at athorndike@mgh.harvard.edu.

About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com

Media contact
Jillian B. Morgan, MPH, Managing Editor
AJPM
+1 734 936 1590
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