Introduction
Most Americans spend half their waking hours at work and consume food acquired there.
The hypothesis was that the healthfulness of worksite food purchases was associated
with employees’ overall diet and health.
Methods
Participants were 602 hospital employees who regularly used worksite cafeterias and
enrolled in a health promotion study in 2016–2018. All cafeterias used traffic-light
labels (green=healthy, yellow=less healthy, red=unhealthy). A Healthy Purchasing Score
was calculated for each participant by summing weighted proportions of cafeteria items
purchased over a 3-month observation period (red=0, yellow=0.5, green=1; range, 0–1).
Healthy Eating Index scores (range, 0–100) were calculated based on two 24-hour dietary
recalls. BMI, blood pressure, and HbA1c were measured. Hypertension and prediabetes/diabetes
diagnoses were determined by self-reported and clinical data. Regression analyses
examined dietary quality and diagnoses by tertile of Healthy Purchasing Score (T1=least
healthy purchases, T3=most healthy), adjusting for demographics. All data were collected
before the start of the intervention and were analyzed in 2018.
Results
Mean age was 43.6 years (SD=12.2), 79% were female, and 81% were white. Mean BMI was
28.3 kg/m2 (SD=6.5); 21% had hypertension, and 27% had prediabetes/diabetes. Mean Healthy Eating
Index was 60.4 (SD=12.5); mean Healthy Purchasing Score was 0.66 (SD=0.15). Healthier
purchases were associated with healthier Healthy Eating Index scores (T1=55.6, T2=61.0,
T3=64.5, p<0.001) and lower obesity prevalence (T1=38%, T2=29%, T3=24%, p<0.001); similar patterns were observed for hypertension and prediabetes/diabetes.
Conclusions
Worksite food purchases were associated with overall dietary quality and cardiometabolic
risk. Interventions to increase healthfulness of food choices at work may improve
employees’ health.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Economic News Release: American Time Use Survey −2016 Results.2016 (Published 2016)
Onufrak SJ, Zaganjor H, Pan L, et al. Foods and beverages obtained at worksites in the United States. J Acad Nutr Diet. In press. Online January 22, 2019. https://doi.org/10.1016/j.jand.2018.11.011.
- Obesity trends by industry of employment in the United States, 2004 to 2011.BMC Obes. 2016; 3: 20
- Worker Health Charts: Health Behavior Charts, Behavioral Risk Factor Surveillance System (BRFSS), 2013–2015.2018wwwn.cdc.gov/Niosh-whc/chart/brfss-behavior/behavior?OU=BMI5_30&T=I&V=R2(Published)Date accessed: December 19, 2018
- The association between employee obesity and employer costs: evidence from a panel of U.S. employers.Am J Health Promot. 2014; 28: 277-285
- Productivity loss due to overweight and obesity: a systematic review of indirect costs.BMJ Open. 2017; 7e014632
- Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States.JAMA. 2017; 317: 912-924
- Association of changes in diet quality with total and cause-specific mortality.N Engl J Med. 2017; 377: 143-153
- A 2-phase labeling and choice architecture intervention to improve healthy food and beverage choices.Am J Public Health. 2012; 102: 527-533
- Traffic-light labels and choice architecture: promoting healthy food choices.Am J Prev Med. 2014; 46: 143-149
- Choice architecture to promote fruit and vegetable purchases by families participating in the Special Supplemental Program for Women, Infants, and Children (WIC): randomized corner store pilot study.Public Health Nutr. 2017; 20: 1297-1305
- Worksite food and physical activity environments and wellness supports reported by employed adults in the United States, 2013.Am J Health Promot. 2018; 32: 96-105
- The medical care costs of obesity: an instrumental variables approach.J Health Econ. 2012; 31: 219-230
- Design of ChooseWell 365: randomized controlled trial of an automated, personalized worksite intervention to promote healthy food choices and prevent weight gain.Contemp Clin Trials. 2018; 75: 78-86
- Dietary Guidelines for Americans 2010.7th Edition. U.S. Government Printing Office, Washington, DC2010
- 2015-2020 Dietary Guidelines for Americans.8th Edition. U.S. Government Printing Office, Washington, DC2015 (2015)
- International Physical Activity Questionnaire: 12-country reliability and validity.Med Sci Sports Exerc. 2003; 35: 1381-1395
- The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity.Public Health Nutr. 2007; 9: 755-762
- ASA24 automated self-administered 24 hour dietary assessment tool.2018https://epi.grants.cancer.gov/asa24/(Published)Date accessed: November 30, 2018
- Dietary intake measured from a self-administered, online 24-hour recall system compared with 4-day diet records in an adult U.S. population.J Acad Nutr Diet. 2012; 112: 1642-1647
- The Automated Self-Administered 24-hour dietary recall (ASA24): a resource for researchers, clinicians, and educators from the National Cancer Institute.J Acad Nutr Diet. 2012; 112: 1134-1137
- Update of the Healthy Eating Index: HEI-2015.J Acad Nutr Diet. 2018; 118: 1591-1602
- A population's distribution of Healthy Eating Index-2005 component scores can be estimated when more than one 24-hour recall is available.J Nutr. 2010; 140: 1529-1534
- Evaluation of the Healthy Eating Index-2015.J Acad Nutr Diet. 2018; 118: 1622-1633
U.S. National Center for Health Statistics. What we eat in America/National Health and Nutrition Examination Survey, 2013-2014: Healthy Eating Index-2015. www.cnpp.usda.gov/healthyeatingindex. Published 2018.
- Alternative dietary indices both strongly predict risk of chronic disease.J Nutr. 2012; 142: 1009-1018
Economic News Release: American Time Use Survey 2016 Results. [press release]. U.S. Bureau of Labor Statistics. www.bls.gov/news.release/archives/atus_06272017.pdf. Published June 27, 2017. Accessed March 5, 2019.
- Food choices of minority and low-income employees: a cafeteria intervention.Am J Prev Med. 2012; 43: 240-248
- Workplace wellness programs can generate savings.Health Aff (Millwood). 2010; 29: 304-311
- Beyond ROI: using value of investment to measure employee health and wellness.Popul Health Manag. 2016; 19: 227-229
- Placing workplace wellness in proper context: value beyond money.Prev Chronic Dis. 2014; 11: 140128
- Employers See Wellness Link to Productivity, Performance.Society for Human Resource Management, 2015www.shrm.org/resourcesandtools/hr-topics/benefits/pages/wellness-productivity-link-.aspx(Published)Date accessed: February 5, 2019
- Employee benefits: the evolution of benefits.2018www.shrm.org/hr-today/trends-and-forecasting/research-and-surveys/pages/2018-employee-benefits.aspx(Published)Date accessed: February 6, 2019
Article Info
Publication History
Published online: May 22, 2019
Identification
Copyright
© 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
