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Implementing a Lifestyle Behavioral Intervention for Workplace Wellness

Research sponsored by the eat+LIVE Meal Solution brand

Abstract

Background

According to the CDC, sixty nine percent of the U.S. population 20 years of age or older is overweight, obese or extremely obese. And obesity is a major cause of many chronic health conditions including heart related illnesses and Type 2 diabetes.

Lifestyle interventions provided by professionals to highly motivated participants does lead to positive health outcomes (eg weight loss).  However, all individuals who are obese and/or at high risk for type 2 diabetes and/or hypertension are not highly motivated to participate in intervention programs.  We wanted to determine if a lifestyle behavioral intervention that focused on making it easier to consume healthier meals could lead to positive health outcomes (eg weight loss).

Methods

We recruited 20 participants (10 sample and 10 control) for a research survey to test our hypothesis that a healthier meal focused behavioral lifestyle intervention can result in a modest (4%-5%) weight loss.  Our research survey plan proposed the delivery of lifestyle intervention through the use of home or office-delivered meals and healthy lifestyle education provided by the Wellness experts from the Cleveland Clinic.

For a period of twenty five days 10 sample participants received and ate fully prepared lunches and dinners as well received healthy breakfast and snack recommendations and healthy living educational materials provided by the Wellness experts at the Cleveland Clinic.

At the start and the end of the survey each participant’s (control and sample group) weight, body mass index and lab work was collected by the staff of a physician run medical weight loss practice in Alpharetta, Georgia.

Results

Over the twenty five day period, on average the sample participants lost 4.0% of their body weight, with absolute weight loss ranging from 4.0 to 14.4 pounds.  In addition, based on a paired t test, the two tailed P value = 0.0001, allowed us to reject the null hypothesis that the lifestyle behavioral intervention of delivered meals and educational materials had no effect on weight loss.  As well, at a 95% CI we would expect the weight loss range for similar participants, for a similar duration receiving the lifestyle intervention to be from 5.143 to 10.537 pounds.

More Detailed Report

The Problem

According to the CDC, sixty nine percent of the U.S. population 20 years of age or older is overweight, obese or extremely obese. (1)  And for African American women, 4 out of 5 are overweight or obese. (2)  Obesity is a major cause of many chronic health conditions including heart related illnesses and Type 2 diabetes. (3)

The World Health Organization (WHO) cites that 1.5 million deaths were directly caused by diabetes and that by 2030 diabetes will be the seventh leading cause of death in the world.  And type 2 diabetes, largely the result of excess weight and physical inactivity, comprises 90% of people with diabetes around the world. (4)  According to the Center for Disease Control (CDC), 86 million Americans have pre diabetes (blood sugar levels higher than normal) and 15-30% of them will develop type 2 diabetes within five years without lifestyle intervention. (5)

In 2012, the total estimated cost of diabetes and its related complications was $245 billion which includes $176 billion in direct medical cost and $69 billion in reduced productivity. On average individuals with diabetes incur medical costs of approximately $13,700 per year with almost 58% of that cost being attributed to diabetes.  (6)

In 2010, in the United States, diabetes was cited as the seventh leading cause of death with over 230,000 death certificates noting diabetes as a cause of death.  And unfortunately, this number is likely understated as studies have shown that about 35%-40% of those who had diabetes did not have diabetes listed anywhere on their death certificates. (7)

Type 2 diabetes is a costly disease that can be managed with the monitoring of blood glucose, appropriate use of medications and the incorporation of lifestyle modifications including physical activity and diet modifications into one’s daily routine.

Lifestyle interventions provided by professionals to highly motivated participants does lead to positive health outcomes (eg weight loss).  However, all individuals at high risk for type 2 diabetes and/or hypertension are not highly motivated to participate in intervention programs.  Thus, there is a need to implement an intervention strategy which will generate participation from a greater percentage of those at risk.

Further, behavioral lifestyle intervention compliments voluntary wellness incentives being offered by employers (EAP) and healthcare insurance providers.  These programs and incentives are designed to help employees and those insured develop healthier lifestyles and encourage them to maintain the lifestyle.  Therefore, funding for the proposed lifestyle intervention for some participants could be accommodated by a healthcare incentive delivered via healthcare insurers or employers (EAP).

Hypothesis

Our hypothesis is that behavioral lifestyle interventions can result in a modest (4-5%) weight loss.

Our research survey plan proposes the delivery of lifestyle intervention through the use of home-delivered nutrition education and meals.

We do believe that food can be a major impediment to lifestyle intervention success.  To successfully change eating habits one often must change engrained food selection and cooking preferences and behaviors, which takes time.  For many the intervention involves the altering of cultural and familial meal planning, grocery shopping and meal preparation habits.  In June 2014, Life Logistics, LLC conducted consumer focus groups in suburban Atlanta with a participant group of diabetic or pre diabetic 50-75 year olds. The focus group findings uncovered the following apprehensions with changing to healthier eating habits –

  • Healthier meal options will not be as flavorful or fulfilling as their higher calorie, sugar and fat alternatives.
  • It is hard to not cook with salt, I have always used ‘Lawry’s’ seasoning
  • Will have to give up favorite dishes like red beans and rice, pizza, etc.
  • It takes too long and cost too much to shop and prepare healthier meals
  • A hassle to prepare healthier meals when you live alone
  • Like the convenience of eating out and having restaurant quality meals

Our strategy asserts that supporting the learning and behavior modification process with home-delivered, fully prepared, portion controlled, flavorful and fulfilling meals; the participants will experience – convenience, appropriate meal portions and fresh meals prepared with flavorful herbs and spices in place of high sodium seasoning and excessive added sugar.

Survey Approach

Participants

  • Total of 20 employees of a women’s health care medical practice in Alpharetta, GA
    • 10 sample participants to receive lifestyle intervention – fully prepared lunches and dinners, healthy breakfast/snack recommendations and lifestyle educational materials
    • 10 control participants that receive no intervention
  • Women, 21 years of age or older (not pregnant)
  • Physical activity/exercise level: none to light
  • Body mass index (BMI) of > 25.

Data Collection

At the start of the survey baseline information was collected for each participant (control and sample group) including:

  • Medical history
  • Nutrimed patient questionnaire
  • Food and hunger diary
  • Weekly questionnaire on symptoms and level of adherence to the meal plan
  • Isis Weight Management Solution intake form
  • Pre and post lab work including CBC with differential platelet, composite metabolic panel, lipid panel, A1C, T4, TSH, Triiodothyronine and free serum
  • Weekly Tanita Body Composition Analyzer weigh-ins

The baseline data was collected by the staff of a physician run medical weight loss practice – Isis Weight Management Solutions in Alpharetta, Georgia.

At the end of the survey (day twenty six) each participants’ (control and sample group) weight, body mass index and lab work was collected by the same staff of a physician run medical weight loss practice – Isis Weight Management Solutions in Alpharetta, Georgia.

Lifestyle Intervention – Fully Prepared Delivered Meals

For a period twenty five days, the survey participants received fully prepared and home/office delivered meals and printed healthy living educational materials.  Participants used the delivered meals as a convenient bridge as they learned how to plan different meal options; grocery shop for higher nutrient and lower calorie and fat food options; and learned new cooking techniques.

Each delivery of meals included five fully prepared lunches and five fully prepared dinners – a total of ten meals per week.

  • A lunch comprised of a total of approximately 11 oz of food and will includes a protein/meat (approximately 4 oz), complex carbohydrate and vegetable and/or legume.
  • A dinner comprised of a total of approximately 15 oz of food and includes a protein/meat (approximately 4 oz), complex carbohydrate and vegetable and/or legume.

Each meal meets the Cleveland Clinic’s Go! Healthy Food criteria and contains:

  • Only 100% Whole Grains
  • No more than 6 grams of added sugar
  • No more than 700 mg of sodium
  • No more than 6 grams of saturated fat
  • No trans fat

In addition all meals contain:

  • No high fructose corn syrup
  • No artificial sweeteners
  • Under 500 calories
  • 45-65 grams of carbohydrates

Each meal delivery included printed educational materials provided by Wellness experts from the Cleveland Clinic covering topics such as

  • What is Pre-Diabetes/Type 2 Diabetes/Hypertension?
  • How Can I Reverse Type 2 Diabetes?
  • How Do I Plan Healthier Meals?
  • How Do I Grocery Shop Differently?
  • How Do I Prepare Meals Differently?
  • Recipes

Finally, each participant received a list of healthy breakfast and snack recommendations by brand and serving size to complete their meals for each day.

The meals and nutrition education introduces the participants to appropriate meal portion sizes, allows them to experience new seasoning options and provides them with easy healthy meal recipes and cooking tips.

The Results

Over the twenty five day period, on average the sample participants lost 4.1% of their body weight, with absolute weight loss ranging from 4.0 to 14.4 pounds.  In addition, over the twenty five day period, each sample participants A1C (indicator of risk or presence of Type 2 diabetes) lowered.  And further, two participants’ A1C levels moved from the pre-diabetic range (5.7 to 6.4) to the normal range (4.8 to 5.6).  Whereas the control saw no change in weight or negligible weight gain.

In addition, based on a paired t test, the two tailed P value = 0.0001, allowed us to reject the null hypothesis that the lifestyle behavioral intervention of delivered meals and educational materials had no effect on weight loss.  As well at a 95% CI we would expect the weight loss range for similar participants, for a similar duration receiving the lifestyle intervention to be from 5.143 to 10.537 pounds.

Future Research

We would like to further our initial findings and conduct research with a larger sample size over a longer time period.  Our hypothesis for this future research would be that behavioral lifestyle interventions paired with healthy lifestyle coaching can result in a modest (5-10%) weight loss and prevent or delay the development of several weight related chronic conditions – specifically Type 2 diabetes.

 

References

  1. Obesity and Overweight. Centers for Disease Control and Prevention. Updated June 2, 2015.

http://www.cdc.gov/nchs/fastats/obesity-overweight.htm

  1. The State of Obesity Report. Special Report – Racial and Ethnic Disparities “Obesity Prevention in Black Communities”. September 2014

http://stateofobesity.org/disparities/blacks/

  1. Adult Obesity Facts. Centers for Disease Control and Prevention. Updated June 16, 2015.

http://www.cdc.gov/obesity/data/adult.html

  1. Diabetes Fact Sheet #312. World Health Organization. Updated January 2015.

http://www.who.int/mediacentre/factsheets/fs312/en/

  1. National Diabetes Statistics Report, 2014. Centers for Disease Control and Prevention.
  2. The Cost of Diabetes. American Diabetes Association. Last Edited June 22, 2015.

http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html

  1. National Diabetes Statistics Report, 2014. Centers for Disease Control and Prevention.

http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf