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. 2024 Apr 20:42:102736.
doi: 10.1016/j.pmedr.2024.102736. eCollection 2024 Jun.

Differential effect by chronic disease risk: A secondary analysis of the ChooseWell 365 randomized controlled trial

J Cheng  1   2 , D E Levy  3   4 , J L McCurley  5 , E B Rimm  1   3 , E D Gelsomin  2 , A N Thorndike  2   3
Affiliations

Differential effect by chronic disease risk: A secondary analysis of the ChooseWell 365 randomized controlled trial

J Cheng et al. Prev Med Rep. .

Abstract

Objective: Whether employees' health status is associated with the effectiveness of workplace health promotion programs is unknown. The objective of this study was to determine if the effect of a workplace healthy eating intervention differed by baseline chronic disease status.

Methods: This was a secondary analysis of a randomized controlled trial conducted September 2016 to February 2018 among US hospital employees to test the effect of a 12-month behavioral intervention (personalized feedback, peer comparisons, and financial incentives) on diet and weight. Participants were classified as having chronic disease (yes/no) based on self-reported hypertension, hyperlipidemia, heart disease, stroke, pre-diabetes, diabetes, cancer or another serious illness. BMI was measured at study visits and calories purchased were measured from cafeteria sales data over 24 months. Mixed models with random effects assessed heterogeneity of treatment effects by chronic disease.

Results: Participants (N = 548) were mostly female (79.7 %) and white (81.2 %); 224 (40.9 %) had chronic disease. Among those with chronic disease, intervention participants reduced caloric intake by 74.4 [22.3] kcal more than control, with a smaller difference between intervention and control (-1.9 [18.7] kcal) (three-way p-interaction = 0.02). The effect on BMI for those with chronic disease (0.47 [0.21] kg/m2) indicated weight stability among intervention participants and weight gain among controls while the effect (-0.56 [0.18] kg/m2) for those without chronic disease was the opposite (three-way p-interaction < 0.01).

Conclusions: Those with chronic diseases had greater reductions in calories purchased and gained less weight. Employers with limited resources for health promotion might consider tailoring programs to employees at highest risk.

Keywords: Behavioral economics; Diet quality; Lifestyle; Nutrition; Weight maintenance; Workplace wellness program.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This study was funded by grant No. R01HL125486 (Thorndike) from the NIH. The project was also supported in part by NIH grants R01DK114735 (Thorndike), 1UL1TR001102 (Nadler), K24 HL163073 (Thorndike), and T32HL098048 (Cheng). The sponsor had no role in the conduct or reporting of this research. No authors have financial disclosures to report.

Figures

Fig. 1
Fig. 1
Adjusted Mean HEI and HPS Scores by Study Arm and Chronic Disease over 24 Months among US-based Hospital Employees, September 2016 to February 2018 Abbreviations: HEI, Healthy Eating Index-2020; HPS, Healthy Purchasing Score; kcal, kilocalories. Three-way interaction p-value > 0.5.
Fig. 2
Fig. 2
Adjusted Mean Calories Purchased by Study Arm and Chronic Disease over 24 Months among US-based Hospital Employees, September 2016 to February 2018 Abbreviations: kcal, kilocalories. Three-way interaction p = 0.02.
Fig. 3
Fig. 3
Adjusted Mean BMI by Study Arm and Chronic Disease over 24 Months among US-based Hospital Employees, September 2016 to February 2018 Abbreviations: BMI, body mass index (kg/m2). Three-way interaction p < 0.01.
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