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Automated Behavioral Workplace Intervention to Prevent Weight Gain and Improve Diet: The ChooseWell 365 Randomized Clinical Trial.
JAMA Netw Open. 2021 Jun 01; 4(6):e2112528.JN

Abstract

Importance

Personalized interventions that leverage workplace data and environments could improve effectiveness, sustainability, and scalability of employee wellness programs.

Objective

To test an automated behavioral intervention to prevent weight gain and improve diet using employee cafeteria purchasing data.

Design, Setting, and Participants

This individual-level randomized clinical trial of a 12-month intervention with 12 months of follow-up was conducted among employees of a hospital in Boston, Massachusetts, who purchased food at on-site cafeterias that used traffic-light labels (ie, green indicates healthy; yellow, less healthy; red, unhealthy). Participants were enrolled September 2016 to February 2018. Data were analyzed from May to September 2020.

Interventions

For 12 months, participants in the intervention group received 2 emails per week with feedback on previous cafeteria purchases and personalized health and lifestyle tips and 1 letter per month with peer comparisons and financial incentives for healthier purchases. Emails and letters were automatically generated using survey, health, and cafeteria data. Control group participants received 1 letter per month with general healthy lifestyle information.

Main Outcomes and Measures

The main outcome was change in weight from baseline to 12 months and 24 months of follow-up. Secondary outcomes included changes in cafeteria purchases, including proportion of green- and red-labeled purchases and calories purchased per day, from baseline (12 months preintervention) to the intervention (months 1-12) and follow-up (months 13-24) periods. Baseline Healthy Eating Index-15 (HEI-15) scores were compared to HEI-15 scores at 6, 12, and 24 months.

Results

Among 602 employees enrolled (mean [SD] age, 43.6 [12.2] years; 478 [79.4%] women), 299 were randomized to the intervention group and 303 were randomized to the control group. Baseline mean (SD) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) was 28.3 (6.6) and HEI-15 score was 60.4 (12.4). There were no between-group differences in weight change at 12 (0.2 [95% CI, -0.6 to 1.0] kg) or 24 (0.6 [95% CI, -0.3 to 1.4] kg) months. Compared with baseline, the intervention group increased green-labeled purchases by 7.3% (95% CI, 5.4% to 9.3%) and decreased red-labeled purchases by 3.9% (95% CI, -5.0% to -2.7%) and calories purchased per day by 49.5 (95% CI, -75.2 to -23.9) kcal more than the control group during the intervention period. In the intervention group, differences in changes in green (4.8% [95% CI, 2.9% to 6.8%]) and red purchases (-3.1% [95% CI, -4.3% to -2.0%]) were sustained at the 24-month follow-up. Differences in changes in HEI-15 scores were not significantly different in the intervention compared with the control group at 6 (2.2 [95% CI, 0 to 4.4]), 12 (1.8 [95% CI, -0.6 to 4.1]), and 24 (1.6, 95% CI, -0.7 to 3.8]) months.

Conclusions and Relevance

The findings of this randomized clinical trial suggest that an automated behavioral intervention using workplace cafeteria data improved employees' food choices but did not prevent weight gain over 2 years.

Trial Registration

ClinicalTrials.gov Identifier: NCT02660086.

Authors+Show Affiliations

Division of General Internal Medicine, Massachusetts General Hospital, Boston. Harvard Medical School, Boston, Massachusetts.Division of General Internal Medicine, Massachusetts General Hospital, Boston.Department of Nutrition and Food Services, Massachusetts General Hospital, Boston.Division of General Internal Medicine, Massachusetts General Hospital, Boston.Division of General Internal Medicine, Massachusetts General Hospital, Boston.Division of General Internal Medicine, Massachusetts General Hospital, Boston.StudyMaker, Boston, Massachusetts.Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts.Harvard Medical School, Boston, Massachusetts. Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34097048

Citation

Thorndike, Anne N., et al. "Automated Behavioral Workplace Intervention to Prevent Weight Gain and Improve Diet: the ChooseWell 365 Randomized Clinical Trial." JAMA Network Open, vol. 4, no. 6, 2021, pp. e2112528.
Thorndike AN, McCurley JL, Gelsomin ED, et al. Automated Behavioral Workplace Intervention to Prevent Weight Gain and Improve Diet: The ChooseWell 365 Randomized Clinical Trial. JAMA Netw Open. 2021;4(6):e2112528.
Thorndike, A. N., McCurley, J. L., Gelsomin, E. D., Anderson, E., Chang, Y., Porneala, B., Johnson, C., Rimm, E. B., & Levy, D. E. (2021). Automated Behavioral Workplace Intervention to Prevent Weight Gain and Improve Diet: The ChooseWell 365 Randomized Clinical Trial. JAMA Network Open, 4(6), e2112528. https://doi.org/10.1001/jamanetworkopen.2021.12528
Thorndike AN, et al. Automated Behavioral Workplace Intervention to Prevent Weight Gain and Improve Diet: the ChooseWell 365 Randomized Clinical Trial. JAMA Netw Open. 2021 Jun 1;4(6):e2112528. PubMed PMID: 34097048.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Automated Behavioral Workplace Intervention to Prevent Weight Gain and Improve Diet: The ChooseWell 365 Randomized Clinical Trial. AU - Thorndike,Anne N, AU - McCurley,Jessica L, AU - Gelsomin,Emily D, AU - Anderson,Emma, AU - Chang,Yuchiao, AU - Porneala,Bianca, AU - Johnson,Charles, AU - Rimm,Eric B, AU - Levy,Douglas E, Y1 - 2021/06/01/ PY - 2021/6/7/entrez PY - 2021/6/8/pubmed PY - 2021/6/8/medline SP - e2112528 EP - e2112528 JF - JAMA network open JO - JAMA Netw Open VL - 4 IS - 6 N2 - Importance: Personalized interventions that leverage workplace data and environments could improve effectiveness, sustainability, and scalability of employee wellness programs. Objective: To test an automated behavioral intervention to prevent weight gain and improve diet using employee cafeteria purchasing data. Design, Setting, and Participants: This individual-level randomized clinical trial of a 12-month intervention with 12 months of follow-up was conducted among employees of a hospital in Boston, Massachusetts, who purchased food at on-site cafeterias that used traffic-light labels (ie, green indicates healthy; yellow, less healthy; red, unhealthy). Participants were enrolled September 2016 to February 2018. Data were analyzed from May to September 2020. Interventions: For 12 months, participants in the intervention group received 2 emails per week with feedback on previous cafeteria purchases and personalized health and lifestyle tips and 1 letter per month with peer comparisons and financial incentives for healthier purchases. Emails and letters were automatically generated using survey, health, and cafeteria data. Control group participants received 1 letter per month with general healthy lifestyle information. Main Outcomes and Measures: The main outcome was change in weight from baseline to 12 months and 24 months of follow-up. Secondary outcomes included changes in cafeteria purchases, including proportion of green- and red-labeled purchases and calories purchased per day, from baseline (12 months preintervention) to the intervention (months 1-12) and follow-up (months 13-24) periods. Baseline Healthy Eating Index-15 (HEI-15) scores were compared to HEI-15 scores at 6, 12, and 24 months. Results: Among 602 employees enrolled (mean [SD] age, 43.6 [12.2] years; 478 [79.4%] women), 299 were randomized to the intervention group and 303 were randomized to the control group. Baseline mean (SD) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) was 28.3 (6.6) and HEI-15 score was 60.4 (12.4). There were no between-group differences in weight change at 12 (0.2 [95% CI, -0.6 to 1.0] kg) or 24 (0.6 [95% CI, -0.3 to 1.4] kg) months. Compared with baseline, the intervention group increased green-labeled purchases by 7.3% (95% CI, 5.4% to 9.3%) and decreased red-labeled purchases by 3.9% (95% CI, -5.0% to -2.7%) and calories purchased per day by 49.5 (95% CI, -75.2 to -23.9) kcal more than the control group during the intervention period. In the intervention group, differences in changes in green (4.8% [95% CI, 2.9% to 6.8%]) and red purchases (-3.1% [95% CI, -4.3% to -2.0%]) were sustained at the 24-month follow-up. Differences in changes in HEI-15 scores were not significantly different in the intervention compared with the control group at 6 (2.2 [95% CI, 0 to 4.4]), 12 (1.8 [95% CI, -0.6 to 4.1]), and 24 (1.6, 95% CI, -0.7 to 3.8]) months. Conclusions and Relevance: The findings of this randomized clinical trial suggest that an automated behavioral intervention using workplace cafeteria data improved employees' food choices but did not prevent weight gain over 2 years. Trial Registration: ClinicalTrials.gov Identifier: NCT02660086. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/34097048/Automated_Behavioral_Workplace_Intervention_to_Prevent_Weight_Gain_and_Improve_Diet:_The_ChooseWell_365_Randomized_Clinical_Trial_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2021.12528 DB - PRIME DP - Unbound Medicine ER -
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