Long-Term Effects of an Occupational Health Guideline on Employees' Body Weight-Related Outcomes, Cardiovascular Disease Risk Factors, and Quality of Life: Results from a Randomized Controlled Trial

Article excerpt

Verweij LM, Proper Kl, Weel ANH, Hulshof CTJ, van Mechelen W. Long-term effects of an occupational health guideline on employees' body weight-related outcomes, cardiovascular disease risk factors and quality of life: results from a randomized controlled trial. Scand J Work Environ Health. 2013;39(3):284-294. doi:10.5271/sjweh.3341

Objective This study aims to evaluate the effectiveness of a draft occupational health guideline, aimed at preventing weight gain, on employees' body weight-related outcomes, cardiovascular disease (CVD) risk factors, and quality of life.

Methods In a cluster randomized controlled trial including 16 occupational physicians (OP) and 523 employees, guideline-based care was compared to usual care by OP between 2009-201 1 in the Netherlands. Guideline-based care consisted of (i) providing advice to employers on how to assess and intervene on the obesogenic work environment, (ii) conducting five face-to-face behavioral change counseling sessions with employees to improve their lifestyles, and (iii) evaluating the outcome and maintaining sections i and ii. Data were collected at baseline and 6, 12, and 18-months follow-up. To evaluate the effects of the intervention, multilevel analyses were performed.

Results No significant differences were found between the intervention and control group on waist circumference [ß 1 .2 cm, 95% confidence interval (95% CI) -0.6-2.9], body weight (ß 0.3 kg, 95% CI -1 .0-1 .6), body mass index (ß 0.1 kg/m2, 95% CI -0.3-0.5), systolic blood pressure (ß 1.7 mmHG, 95% CI -2.4-5.8), diastolic blood pressure (ß 0.3 mmHG, 95% CI -1 .0-0.6), cholesterol (ß 0 mmol/1, 95% CI -0.2-0.2), or quality of life indicators after 1 8-months follow-up. Stratified analyses showed an increase in waist circumference among men (ß 2.5 cm, 95% CI 0.5-4.5) and obese intervention participants (ß 2.7 cm, 95% CI 0.6-4.7) compared to control participants.

Conclusion The draft occupational health guideline was not more effective than usual care. Therefore, the guideline in its current form cannot be recommended for implementation.

Key terms BMl; body mass index; CVD; obesity; practice guideline.

Overweight and obesity are leading preventable causes of death worldwide (1). In 2008, over 2.8 million deaths were due to overweight or obesity (2, 3). Both conditions are associated with an increased risk of morbidity, and reduced life expectancy (4) and have been linked with increased healthcare use and medical costs over the past years (5). As prevalence and costs are expected to continue to rise, efforts to prevent overweight and obesity are warranted (6, 7).

Lifestyle interventions addressing modifiable risk factors such as physical activity and nutrition have shown to be promising methods for preventing overweight and its related morbidity (8, 9). For example, regular physical activity may reduce the risk of cardiovascular disease (CVD), including high blood pressure and diabetes (10, 11), as well as prevent weight gain (12, 13). A diet low in satured fat may reduce total cholesterol (14), while a diet high in fruits and vegetables may reduce the risk of CVD (15) and decrease body weight (16). However, a recent Cochrane review of interventions using counseling and education aimed at behavioral change showed no reduction in total or CVD mortality or clinical events in general populations (17).

Improving physical activity and dietary behavior through lifestyle interventions may not only be beneficial for health, but may also enhance quality of life, decrease healthcare costs, and increase productivity by decreasing illness and absenteeism (3). Occupational physicians (OP) have not conducted many lifestyle interventions although the occupational healthcare setting provides good opportunities to reach employees ( 1 8, 19). The Balance@Work project aims to evaluate the effectiveness of an occupational health practice guideline aimed at preventing weight gain among employees in the Netherlands compared to usual care. …