Design of a randomized trial testing a multi-level weight-control intervention to reduce obesity and related health conditions in low-income workers

Abstract

Weight-control is a major public health focus for preventing multiple obesity-related health conditions. While clinic-based intensive lifestyle interventions are successful, low-socioeconomicstatus (SES) populations, which have a higher burden of obesity, are difficult to reach; thus, the workplace offers a useful setting to target low-SES workers. The current paper presents the design of a study testing a workplace intervention aimed at low-SES employees. Partnering with a large healthcare system and affiliated university, this project will test an innovative multi-level intervention ("Working for You") adapted from existing group-and individual-level intervention models to promote healthy weight among low-wage workers. The individual-level component is an interactive obesity treatment approach (iOTA) program that involves assessment of behavior risks, collaborative goal-setting with a health coach, and interactive SMS text-messages for ongoing support and self-monitoring. This mHealth intervention is embedded in the group-level component, a workplace participatory program that involves worker teams engaged in the design and implementation of interventions to change their workplace environments. These nested interventions are being tested in a group-randomized trial among 22 work groups (~1000 total workers, ~300 workers with obesity). The primary outcome will be program effects on weight at 2-year follow-up, compared to control, and the secondary outcomes will be effects on diet and physical activity; iOTA adherence, process measures, and work environment/support will also be examined. This pragmatic clinical trial will test scalable interventions that can be translated to other work settings to reduce obesity and related health risks among low-SES workers.

Pilot test of an interactive obesity treatment approach among employed adults in a university medical billing office

“…The pilot was originally intended to last 3 months, but nearly all participants requested that the pilot study continue after that time; we thus continued for 21 more months (24 months total, the duration of the full clinical trial testing the iOTA intervention, which incorporated the feedback from the current pilot) [41]. Participants were predominantly female (85%).…”

“…Given the focus of the intervention on low-wage employees, this workgroup was selected to mirror the inclusion criteria employed in the larger trial to evaluate iOTA, including a high proportion of lower wage workers. Recruitment criteria for the larger trial are described fully elsewhere [41]. From this group, employees self-reporting a body mass index (BMI) greater than 30 kg/m 2 were invited to participate and were screened for exclusion criteria: currently pregnant or nursing, bariatric surgery in the last 12 months, current cancer diagnosis, or planning to leave the work unit within the next month.…”

“…Each participant then receives interactive, automatic text messages which include weekly weight and goal achievement check-ins as well as one behavioral tip per week for each goal and periodic motivational messages. iOTA goals are fully described elsewhere [41]; sample behavioral tip messages include: "Don't tempt yourself -Empty the fridge of sugary drinks. And keep low-calorie choices handy, like water and unsweetened coffee or tea."…”

Test@Work Texts: Mobile Phone Messaging to Increase Awareness of HIV and HIV Testing in UK Construction Employees During the COVID-19 Pandemic

“…UK mobile phone ownership is high with 96% of the population having access to a mobile phone [12]. Mobile phone based text messaging is acceptable to younger [13,14] and older populations [15,16]. Text-based health promotion has been shown to be effective in improving a range of health behaviours in various settings and contexts [11,17] and text messaging interventions can have 'read rates' as high as 98% compared with other forms such as email alone [18] and are widely accessible since they do not require a data plan or Wi-Fi signal to work [19].…”

“…safety queries [39]; reporting accidents [40]) and to promote a range of health behaviours to employees (e.g. weight control [15]: smoking cessation [16]: physical activity [41][42][43]). Workplace text messaging interventions have included those targeted specifically at low -income workers (obesity and weight loss [20,21]) as well as workers with known health risks (e.g.…”