Worksite intervention to prevent obesity among hospital employees

Mudita Upadhyaya, The University of Texas School of Public Health


Obesity is common, serious and costly. Substantial evidence has linked diet, physical activity, and sedentary behaviors to obesity, and these factors are significantly influenced by the environment. Certain worksites like healthcare settings are linked to higher obesity rates in their employees. Despite the obesity risk that hospital employees face, little is known of the current impact of worksite wellness programs targeting nutrition, physical activity and sedentary behaviors in a healthcare set up. The overall aim of this dissertation was to assess worksite wellness strategies focused on diet and physical activity on the prevention of obesity in hospital employees. The first paper of this dissertation presented the results of a systematic review of the literature between 2000–2016, and identified 30 worksite wellness programs (eight randomized control trials, six cluster randomized control trials, and sixteen quasi-experimental studies) focused on nutrition and physical activity for obesity prevention in health care settings (hospitals, clinics, nursing homes). The findings indicated that a majority of the studies focused on changing diet and physical activity behaviors using behavioral and educational intervention strategies. Multicomponent intervention including behavioral and environmental component fared better than only environmental approaches. Cognitive/behavioral and educational strategies fared better than only educational strategies. While studies included in this review showed evidence that worksite wellness programs have the potential to improve weight outcomes in healthcare employees, there is still a need for well-designed studies with large sample size to demonstrate effectiveness of worksite strategies in preventing obesity in healthcare employees. The second paper of this dissertation evaluated pre-to-post changes of an environmental and social marketing obesity prevention intervention, on the hospital’s nutrition, physical activity environment, and organizational policies and practices using a validated Environment Assessment Tool (EAT) in six hospitals (five intervention, one control) in Houston, Texas. This study also assessed, using key informant interviews, management support, organizational engagement, alignment of the intervention with the organizational objectives and its impact on implementation and sustainability of the intervention in the participating hospitals. A mixed method, sequential explanatory analysis approach was used to analyze secondary data from the Shape Up Houston (SUH) study (EAT survey), and primary data from key informant interviews. Results indicated that only one out of five hospitals demonstrated significant post intervention changes (P=.004) when all subscales were included in the analysis (organizational characteristics, physical activity support, food and nutrition support). Lessons learned included the importance of continued organizational engagement and leadership support, resource allocation (space, budgetary, staff), frequent monitoring and regular follow up of the program components by the program staff, and partnership between wellness staff and departments like vending/cafeteria contractors for the implementation and sustainability of environmental changes for obesity prevention in healthcare settings.

Subject Area

Public health

Recommended Citation

Upadhyaya, Mudita, "Worksite intervention to prevent obesity among hospital employees" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10131759.