RUNNING HEAD: Reducing Adult Obesity by Workplace Health Intervention

Adult Obesity

Healthy People 2020 Objective NWS-9 “Reduce the proportion

of adults who are obese”

Cassandra Babington
Jaclyn Land
Morgan James
Ciera Williams
Sean Schoeneman

Adult Obesity has become a global crisis and an American epidemic. Globally, more than

39% of Adults were overweight in 2016 and 13% were obese (WHO, 2018). Nationally, more
Reducing Adult Obesity by Workplace Health Intervention

than one-third of U.S. adults were obese in 2015 (CDC, 2015). Overweight and obesity are

defined by the World Health Organization as “abnormal or excessive fat accumulation that

presents a risk to health.” Obesity can also be referred to as having a body mass index (BMI)

greater than 30. Being overweight is classified as having a BMI equal to or greater than 25. BMI

is used as a tool to categorize individuals into groups based upon the relationship between height

and weight.

People who are overweight or obese are at an increased risk for more serious health

conditions, compared to those who maintain a normal weight (CDC, 2017). Being overweight is

a precursor to chronic conditions such as heart disease, type 2 diabetes, high cholesterol,

osteoarthritis, as well as some cancers. Mental disorders such as depression, anxiety, and other

related disorders are also associated with obesity (CDC, 2017). Obesity is one of the leading risk

factors to incurring more serious chronic diseases. It also happens to be one of the most

preventable. Obesity is a complex issue. It progresses from a combination of different factors

such as an individual's behavior, lifestyle choices, and physical activity or inactivity. Other

contributing factors are the individual's physical environment, access to healthy food, level of

education, safety of the environment, and access to medical care (CDC, 2017). Simply put,

weight gain is a result of consuming more calories than are expended over time.

Statewide, the obesity rate is approximately 26% in Florida. Locally, the obesity rate is

22% in St. Johns county; which is lower than the state average (County Health Rankings, 2017).

Despite this, a very high percentage of overweight males, aged 45- 64, reside within St Johns

county (FDH, 2018). In order to reduce the prevalence of obese and overweight adults, our

prevention efforts will focus on targeting middle-aged men in St. Johns County; particularly

through worksite wellness programs. Traditionally, this population has been largely neglected.

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Once laws mandated that employers were required to offer health insurance to their employees,

they began to see the potential benefits of workplace wellness programs in reducing medical

costs. Since then, many workplace wellness programs have been created and implemented, but

very few target middle-aged men.

Obesity raises the risk for an individual to develop serious health complications such as

cardiovascular disease (CVD). Ebbert, Elrashidi and Jensen (2014) concluded that there is a

positive association between BMI and CVD risk. Weight loss can be beneficial in reducing the

risk of developing CVD. The implications of developing CVD may not only affect the person

with the disease, but could also impact the individual’s employer. Each employee with CVD is

indirectly responsible for productivity-loss costs of approximately $2700 per year (Kempf et al.,

2016). This encourages employers to implement and promote wellness programs at their

facilities to keep their employees healthy and reduce annual employee medical expenses. Within

the next ten years, research predicts that there will be an increase in CVD in the working

population if worksite wellness programs are not more commonly implemented in the

workplace.

Obesity presents an array of physical impairments to normal, everyday activities.

Research by Schultz, Byrne and Hills (2014) points out that obese individuals often get caught in

a feedback loop of weight gain, pain, injury, and decreased physical activity. As a person

becomes increasingly overweight, his or her relative strength decreases, and it becomes more

difficult to move their own body mass. Altered kinematic strategies are often required in order to

improve their sense of balance while moving. Decreased strength and balance results in a higher

rate of injurious falls. Injuries can further reduce the ability or willingness of an individual to

participate in physical activities to regain requisite strength and balance (Shultz et al., 2014).

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There is a need for the awareness and availability of weight loss programs in the workplace.

Katowski and Davis (2010) highlight that even a small amount of weight loss can reduce pain,

especially in the upper and lower back, hips, and elbows; which are weight-bearing regions of

the body. In turn, as pain is reduced, physical activity becomes an increasingly attractive method

of weight loss, which cascades into a mutually beneficial relationship for both the employee and

the employer.

Middle-aged men is St. Johns County report not perceiving the risks of being overweight.

Their weight and shape are seen as socially acceptable for their age. In a previous study

conducted by Andrea M. Brace et al. (2015) the participants even came up with a term for their

shape known as the “railroad physique”. This is much like what popular culture would refer to as

the “dad-bod.” Middle-aged men are unaware of the risks associated with being overweight. Our

program will address this issue by providing statistical information relevant to the target

population at risk. Currently in St. Johns County, Flagler Hospital offers free classes to the

community on heart failure education and diabetes education. These are two chronic disorders

that being overweight or obese is linked to (Flagler Hospital Patient and Community Education,

2018).

To successfully find a program that will target this population it is imperative to evaluate

previously implemented programs. One program that saw success was Fuel Your Life. This

program took place in a predominantly male population and was successful in reaching

overweight and obese employees as well as preventing weight gain. Incentives were offered to

the employees at the start of the program. The incentive was $10 for initial data collection and an

additional $10 for participating in data collection at six months and twelve months. Employees

who had the highest level of participation lost the most weight. The largest limitation of the

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study was the level of participation. Andrea M. Brace et al. (2015) reported that the lack of

participation was largely linked to the self-perception of health and physique. They did not see

themselves as being overweight therefore they didn't believe they needed a wellness program.

Another study conducted by Morgan et al. (2011) had successful results as well. Their program,

Workplace Power targeted middle-aged men who were at risk for cardiovascular disease within

the workplace. The results of their study showed statistically significant weight loss in the

population as a whole. This program also had a high percent of participation due to incentives

from their employers. The employers offered group based incentives for the crew with the most

weight loss after one month and the crew with the most weight loss at the end of the program.

The financial incentives were $50 gift cards for each member of the crew to be used at a local

sporting equipment store.

When designing our specific workplace wellness program our target population will be

overweight middle-aged men in St. Johns county. We are modeling our program after the Brooks

Wellness Program which is an evidence program that has seen success in both middle aged men

and women. Brooks Wellness Program includes physical activity, nutrition, financial wellness,

stress, and prevention activities that target their employees. The program rewards employees

who practice healthy behaviors through a point system (Brooks Wellness, 2018). We plan to

implement parts of their program and also incorporate a few ideas of our own.

Our wellness program is designed to focus on physical activity and nutrition. Within our

physical activity component will be a partnership with a local fitness facility. Also under

physical activity will be fitness programs and quarterly challenges. Within our nutrition

component we will have recipe books, cooking classes, grocery shopping guides, and quarterly

challenges. Within the quarterly challenges will be surveys that record the employee's knowledge

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about related health risks as well as data on the employees behaviors related to said risks. The

winners of each challenge will receive points and company wide recognition. Along with these

components we will also conduct annual health screenings and quarterly biometric screenings.

Those who participate in the quarterly screenings will be given pre and post tests. Each week we

will have on-site Wellness Wednesdays in the cafeteria where we offer healthy food choices and

recipes to take home. Participation in these events and challenges will be recorded by a wellness

certificate and certificates with a thousand plus points will be entered into a drawing for

incentives.

Due to the high prevalence of overweight middle-aged men St. Johns county is in need of

an evidence-based wellness program. Since the majority of middle-aged men in this county are

working a full-time job, we decided to target them through a worksite wellness program. In past

programs we saw that men of this age primarily do not perceive the risks of being overweight.

With this information in mind, our obesity prevention program will strive to change the target

populations perceived susceptibility and ultimately help them achieve a healthy lifestyle.

In selecting which population would benefit the greatest from the implementation of our

worksite wellness program, we first examined statistical data from state and local health

departments. Overall, St. Johns county has had the highest health ranking in Florida since 2014.

However, when we separated the county by demographics, we noticed an abnormally high

percentage of overweight middle-aged men (40-64 yrs.) in St. Johns county (County Health

Rankings, 2017). Even though St. Johns county has a very low rate of obese adults, it’s high rate

of overweight males could become obese if not introduced to effective weight control methods.

St. Johns county ranks in the least favorable county quartile for overweight population, sufficient

physical activity, and people that meet the minimum recommended aerobic activity levels

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(County Health Rankings, 2017). A lack of knowledge and time to devote to healthy lifestyle

choices is the root cause of the health disparity in St. Johns county.

Due to the high number of overweight males in St. Johns county, our target population

will be sampled from the top five manufacturing facilities located within the county (Northrop

Grumman, Carlisle Interconnect Technologies, Sapa Extrusion Americas, Rulon International,

and Ideal Deals) (St. Johns County Office of Economic Development, 2018). Traditionally, a

majority of the employees at manufacturing facilities are male. All of the selected facilities have

at least 100 employees, and of those, at least 70% are males- potentially within our target

demographic. The needs assessment survey will consist of a compilation of questions derived

from the Global Physical Activity Questionnaire developed by the World Health Organization.

The survey will be administered by our program plan health educators, and will be given to

employees during their morning meetings. We will supply incentives to ensure the highest level

of integrity and accuracy in survey responses. The two companies demonstrating the highest

level of need or desire, based on survey responses, will be chosen for our program.