University of Connecticut
OpenCommons@UConn
UCHC Articles - Research University of Connecticut Health Center Research
3-26-2012
Worksite Weight Loss Intervention for Employees
in Stressful Workplaces: A Pilot Study and Baseline
Survey Indicators of Success
Pouran D. Faghri
University of Connecticut School of Medicine and Dentistry
Valerie B. Du(y
University of Connecticut - Storrs
Nicole R. Benson
University of Connecticut - Storrs
Martin G. Cherniack
University of Connecticut School of Medicine and Dentistry
Follow this and additional works at: h9ps://opencommons.uconn.edu/uchcres_articles
Part of the Medicine and Health Sciences Commons
Recommended Citation
Faghri, Pouran D.; Du8y, Valerie B.; Benson, Nicole R.; and Cherniack, Martin G., "Worksite Weight Loss Intervention for Employees
in Stressful Workplaces: A Pilot Study and Baseline Survey Indicators of Success" (2012). UCHC Articles - Research. 101.
h9ps://opencommons.uconn.edu/uchcres_articles/101
Obesity & Weight loss Therapy
Faghri et al., J Obes Weig los Ther 2012, 2:2
http://dx.doi.org/10.4172/2165-7904.1000121
Volume 2 • Issue 2 • 1000121
J Obes Weig los Ther
ISSN: 2165-7904 JOWT, an open access journal
Open Access
Research Article
Worksite Weight Loss Intervention for Employees in Stressful
Workplaces: A Pilot Study and Baseline Survey Indicators of Success
Pouran D. Faghri
1
*, Valerie B. Duffy
2
, Nicole R. Benson
3
and Martin G. Cherniack
4
1
Department of Allied Health Sciences, University of Connecticut, USA
2
Department of Allied Health Sciences, University of Connecticut, USA
3
Department of Allied Health Sciences, University of Connecticut, USA
4
Occupational & Environmental Medicine, University of Connecticut Health Center, USA
Abstract
Statement of problem: Correctional facilities are stressful, unhealthy and dangerous working environments,
which increase the risk of chronic diseases and a shortened lifespan for employees, particularly corrections ofcers.
The need exists for effective worksite interventions to lower chronic disease risk and improve health of correctional
employees.
Objective: The primary aim was to pilot test eight-week worksite nutrition and physical activity educational
intervention for correctional employees and to determine baseline indicators of weight loss success.
Methods: Twenty overweight/obese volunteer employees were recruited by convenience sampling. Educational
material was tailored to baseline responses on diet and physical activity knowledge, preferences, and behaviors.
Adiposity status was both self-rated by the study participants and measured by researchers. The primary indicator was
change in adiposity with a goal of 3% loss in weight across the intervention.
Results: The group averaged one-pound loss per week; eleven of 20 employees lost ≥3% of body weight. The
number of overweight/obese employees with healthy waist circumferences increased from 3 to 8 post-intervention. At
baseline, employees who reached the weight loss goal were most likely to: accurately assess their level of adiposity;
have lower knowledge about nutrition and healthy eating; report greater preference for discretionary-energy foods but
less preference for vegetables; and less condence in changing their physical activity behaviors.
Conclusions: The intervention resulted in clinically meaningful, short-term weight loss among employees in
stressful workplaces. Simple baseline survey-assessment dened employees who reported room to change their
dietary and physical activity patterns as well as an accurate realization of their level of excessive adiposity.
*Corresponding author: Pouran D. Faghri, MD, MS, FACSM, Department of Allied
Health Sciences, University of Connecticut, 358 Manseld Road, U-2101, Storrs, CT
06269, USA, Tel: 860.486.0018; Fax: 860.486.5375; E-mail: pouran.faghri@uconn.edu
Received January 23, 2012; Accepted March 23, 2012; Published March 26,
2012
Citation: Faghri PD, Duffy VB, Benson NR, Cherniack MG (2012) Worksite Weight
Loss Intervention for Employees in Stressful Workplaces: A Pilot Study and Baseline
Survey Indicators of Success. J Obes Weig los Ther 2:121. doi:10.4172/2165-
904.1000121
Copyright: © 2012 Faghri PD, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Keywords: Obesity; Worksite; Correctional ocers; Tailored
intervention
Introduction
Correctional ocers must cope with a variety of stressors within
and outside of their institutional roles [1]. Correctional institutions are
high-stress workplaces due to hierarchal organization, rotating work
shis, irregular meal schedules, and risks to personal safety during
violent emergencies [2-4]. Much of the research on the health of
workers in hazardous duty services (e.g., police ocers, civil servants,
and correctional ocers) has identied a relationship between the
work environment and stress [5-12]. For example, Chandola et al. [5]
reported an association between chronic work stress, elevated cortisol
level, and coronary heart disease among a large cohort of civil servants.
Increased stress and depression also can lead to dis inhibited and binge
eating [13], which increases risk of excessive adiposity.
Smoking, poor eating habits and inactivity also challenge the health
of correctional ocers. From our experience in northeastern United
States, correctional ocers exit the training academy physically t,
having passed the Cooper Institute Fitness Standards [14]. Yet, most
exceed recommended weight norms within 5 years on the job due to
lack of regular physical conditioning and unhealthy food environments
in correctional facilities [15]. Increased stress and related behavioral
risks have been attributed to the overwhelming number of overweight
and obese correctional ocers [4], increasing risks for coronary heart
disease, hypertension, and diabetes [4,16-18].
Health promotion and public health advocates have identied
the workplace as a promising setting for addressing excessive
adiposity and chronic disease risk [17]. Evidence from best practices
recommends that weight management interventions should include
health professional-facilitated education and tailored feedback, a
work environment that supports behavior changes, and employee
involvement in the intervention [19,20]. Success in weight loss
programs has been attributed to improvements in the participant’s
level of self-ecacy and condence in changing dietary and physical
activity behaviors [21] across relatively short 8-week [22] and longer
18-month [23] interventions. Traditional workplace health promotion
programs typically use “one size ts all” approaches, which may be
incongruent with the job conditions (demanding work schedule,
inexibility, and lack of control) and organizational hierarchy of
correctional institutions. Tailoring a weight loss intervention to
participant’s level of knowledge, self-ecacy and extant workplace
barriers, may empower correctional ocers toward achieving and
maintaining a healthy weight by counteracting the potential negative
inuences of work environment, job characteristics, and lifestyle [24].
Citation: Faghri PD, Duffy VB, Benson NR, Cherniack MG (2012) Worksite Weight Loss Intervention for Employees in Stressful Workplaces: A Pilot
Study and Baseline Survey Indicators of Success. J Obes Weig los Ther 2:121. doi:10.4172/2165-904.1000121
Page 2 of 7
Volume 2 • Issue 2 • 1000121
J Obes Weig los Ther
ISSN: 2165-7904 JOWT, an open access journal
e purpose of this pilot study was to evaluate the eectiveness
of a worksite nutrition education program in achieving weight loss
through healthy behaviors for overweight/obese employees in stressful
workplaces (i.e., correctional employees). e intervention was tailored
to the employee’s baseline survey responses on nutrition knowledge,
exercise behaviors, condence in changing behaviors, and preference
for foods and exercise. e ability for these baseline responses to
explain dierences in those who were successful in weight loss (goal of
≥3% of baseline body weight) across the intervention was tested.
Materials and Methods
Study design and recruitment
e study used an 8-week pre-post test design. A convenience
sample was recruited via yers and registration forms distributed to
all employees and posted for two-weeks in the ocer’s mess. Due to
an established partnership with the State Department of Correction,
and, as a stipulation of our partnership, the study enrollment was
open to all employees at the selected correctional facility. Four weeks
prior to program initiation, the Program Facilitator (PF) coordinated
a best approach to register participants with the warden at the
correctional facility. e cooperation of the warden and correctional
facility administrators was critical for successful completion of the
program including recruitment and implementation via the provision
of: semi-private space to complete study forms and surveys and to
conduct weekly educational sessions; private space for weigh-ins; and
employee’s time and coverage for participation without compromise to
job and facility security.
Participants and procedure
Convenience sampling was used to recruit volunteer participants
who met the inclusion and exclusion criteria. Inclusion criteria were:
being an employee of the correctional facility, a body mass index (BMI)
of ≥25, no restriction in physical activity as indicated by the Physical
Activity Readiness Questionnaire [25] and a commitment to the 8-week
intervention and evaluation. Twenty-seven employees volunteered
for the program, and aer baseline measurements, 20 participants
continued for the entirety of the intervention. Attrition was attributed
to employee transfer of work location.All of the participants signed
an informed consent approved by the University Institutional Review
Board prior to participation. At baseline and aer obtaining informed
consent, participants were asked to complete the surveys. Adiposity
measures were completed at pre and post-intervention.
e PF measured the participant’s body weight using the same
digital weight scale, which was calibrated regularly. BMI was calculated
from the baseline weight and self-reported height (wt/ht
2
). Using a
non-stretchable tape measure, waist circumference was measured
around the smallest area below the rib cage and at the level of the top
of the hip. Hip circumference was measured around the widest area of
the hips. Perceived body size was estimated from the Stunkard Figure
Rating Scale [26]. Participants identied their body size using the
scale’s body type pictograms to assess self-awareness of adiposity and
discrepancy between measured and self-reported adiposity. Previous
work in a worksite wellness program suggeststhat individuals are more
willing to list a weight category than to report their actual weight [27].
Table 1 shows the characteristics of the participants. e study
sample was slightly older than the overall facility employees (average
age 42.5 years) and the average age for females (51.6 years) exceeded
that for males (43.3 years, p<0.05). According to the pre-intervention
BMI, 7 participants (35%) were overweight (25-29), 6 (30%) had class
I obesity (30-34.9), 5 (25%) had class II obesity (35-39.9) and 2 (10%)
had class III or extreme obesity (≥40) [28]. e males at baseline had
signicantly higher BMIs than did the females (p=0.01), and were
skewed toward being obese. Higher risk waist circumferences were
seen for all of the males (>40 inches) and for 6 of the 9 women (<35
inches).
Surveys on nutrition knowledge, attitudes and behaviors
toward food and physical activity
Following previously validated protocols [29-31], participants
completed 3-section nutrition and physical activity questionnaire to
assess knowledge, usual dietary and exercise habits, as well as levels
of condence and barriers to changing eating and exercise behaviors.
e rst section contained ten multiple-choice or multiple component
questions, adopted from the Hawkes and Nowak nutrition knowledge
questionnaire [25], which asked whether foods were low in cholesterol,
fat, or ber. One point was given for correct answers and zero points
for incorrect or “not sure” answers, for a total maximal score of 38
points. e second section contained 26 multiple choice and open-
ended questions to identify participant’s eating and exercise habits
at the workplace [29,30]. e third section assessed the participant’s
motivation and self-ecacy regarding a regular exercise program
[32,33].
Participants completed a separate survey asking their level of liking/
disliking for foods and physical activity. Previous research has shown
that reported preference for foods serves as a proxy of habitual dietary
intake [27,34]. e survey contained 62 foods/beverages, 7 physical
activity items, and 7 pleasurable (e.g., jumping into a pool on a hot
day) and unpleasurable (e.g., glare of headlights) items on the hedonic
general Labeled Magnitude Scale. e bidirectional scale has labels
spaced to give the scale ratio properties: strongest liking/disliking is
located at the ends (±100), neutral in the middle (0), and intermediate
labels of weakly (±6), moderately (±17), strongly (±35), and very
strongly (±54) like/dislike. e non-food items generalize the hedonic
scale, increasing the ability to compare ratings across individuals [35]
and providing insight to motivation for eating (e.g., food hedonism)
[27,34]. Individual items were conceptually grouped by foods, physical
activities, and non-foods.
Intervention period
e study group participated in eight, 1-hour weekly educational
sessions lead by the PF who had formal training in health promotion
and health education, was certied by a major insurance corporation
Baseline Characteristics
Gender
Male 11
Female 9
Age Years ± St. Dev. (Range: 19-72 yrs) 47.1 ± 8.8
Anthropometrics
Male
Weight: Pounds ± St. Dev.
BMI: Kg/cm
2
± St. Dev.
Waist: Inch ± St. Dev.
262±6.2
36.6±6.7
46.6±6.9
Anthropometrics
Female
Weight: Pounds ± St. Dev.
BMI: Kg/cm
2
± St. Dev.
Waist: Inch ± St. Dev.
170±21.1
29.6±4.4
35.8±2.6
Race
Hispanic (Answered Yes) 2
White 15
African American / Black 3
Table 1: Baseline Characteristics of Worksite Employees.
Citation: Faghri PD, Duffy VB, Benson NR, Cherniack MG (2012) Worksite Weight Loss Intervention for Employees in Stressful Workplaces: A Pilot
Study and Baseline Survey Indicators of Success. J Obes Weig los Ther 2:121. doi:10.4172/2165-904.1000121
Page 3 of 7
Volume 2 • Issue 2 • 1000121
J Obes Weig los Ther
ISSN: 2165-7904 JOWT, an open access journal
on their workplace weight loss programs, and had previous experience
implementing health program interventions at correctional facilities.
Four weekly education sessions (two per week, one in the morning, and
one in the aernoon to reach all shis) were held to provide employees
with maximum opportunity to attend sessions convenient to their
work and shi schedules. ey were discouraged from attending more
than 1 session per week. During the rst week, the PF met with the 20
participants, who then created seven teams of 2-5 members each. e
team model was consistent with the small group nature of corrections
work. Weekly meetings were scheduled between the PF and each team
to discuss and provide nutrition and weight loss information. e
participants were required to attend at least in 6 of the 8 weekly sessions
and monitored their progress through food and activity logs.
Tailored weight loss intervention
e focus of the intervention was to promote knowledge and
attitudes conducive to improving or maintaining positive dietary
and physical activity practices for healthy behaviors and weight loss,
following the US Department of Agriculture’s Food Guide Pyramid
and the US Department of Health and Human Services’ National
Cholesterol Program Guidelines. e general topic areas are shown in
Table 2.
Although the session topics were the same for all teams, the PF
utilized the baseline survey responses to tailor the educational sessions
and handouts for nutrition messages, emphasizing portion control,
exible restraint, planned indulgences and a positive relationship with
food. is approach is consistent with most of the research identifying
barriers to weight loss including perceived taste, lack of convenience/
time, high cost, confusing advertising, and lack of knowledge of actual
food intake and dietary recommendations [36-39]. During educational
sessions, the PF discussed issues regarding energy balance, portion size
and calorie counting. In terms of nutrition knowledge for example, the
instruction addressed that 15 of 20 participants incorrectly answered
questions pertaining to fat and cholesterol contents of foods as well
as fruit and vegetable intake recommendations. Further educational
tailoring was specic to environmental constrains of the correctional
facility (e.g., planning healthy meal options for extended shi hours
and avoiding overeating energy dense, low-nutrient quality foods
during double shis). For each session, a detailed outline of the didactic
materials was presented to the participants.
Data analysis
Changes in adiposity across the intervention were tested with
paired t-tests. Dierences in baseline survey responses and associations
with change in adiposity were tested for central tendency (independent
t-test) and distribution with Chi Square Test of Association or the
Fisher Exact Probability Test (two-tailed). e criterion for signicance
was p≤0.05.
Results
Change in adiposity across the intervention and associations
with perceived adiposity
From pre to post intervention, there were signicant losses in
weight, BMI and waist circumference in both males and females
(p<0.01). e average weight loss at week 8 was 8.3 lbs, ranging from
26.2 lbs lost to 1.8 pounds gained, which corresponds to an average of
3.6% weight lost across all participants (Figure 1). e average BMI
decreased from 33.5 at baseline to 32.3 at the nal week. In comparison
with females, males achieved signicantly greater loss of weight and
BMI (p<0.05), but not greater percentage of weight loss.e average
reduction in waist circumference was 1.4 inches, ranging from 6.6
inches lost to 1.2 inches gained.e number of participants with normal
waist circumference (lower disease risk, according to the CDC BMI/
Waist circumference classication) increased by two and half fold,
from 3 or 15% at baseline to 8 or 40% at post intervention (Table 3).
Although there was no gender dierence in loss of waist circumference,
females showed signicantly greater variance in circumference lost
(+1.2 to -6.6 inches) than did males (+0.5 to -4 inches, p<0.05).
Comparing measured to perceived adiposity status, 14 individuals
(70%) showed concordance between perceived and measured BMI
categories (Table 4). None of the individuals perceived that they
Figure 1: Individual participant’s percentage weight loss following 8-weeks
intervention.
0
1
2
3
1 % 0 -1 % -2 % -3 % -4 % -5 % -6 % -7 % -8 % >-9 %
Number of Parcipants
Distribuon of weight change across the 8-week
intervenon
Categories*
Baseline Post Intervention
Total
Waist
Normal
Waist
Elevated
Total
Waist
Normal
Waist
Elevated
Normal (18.5<BMI<25) 0 1 1
Overweight (25<BMI<30) 7 3 4 8 7 1
Obese I (30<BMI<35) 6 6 6 1 5
Obese II (35<BMI<40) 5 5 3 3
Obese III (40≤BMI) 2 2 2 2
Table 3: Participants BMI/Waist-circumference classication.
*CDC classications including waist circumference normal as <35 in. for females
and <40 in. for males; waist elevated above these cutoffs (www.nhlbi.nih.gov/
guidelines/obesity/prctgd_c.pdf)
Session Lessons
1
Introduction to My Pyramid, Caloric Balance, Your Healthy Weight,
and Portion Sizes
2
Benets to Exercise, Create an Exercise Plan, Learn How to Move
Everyday
3
Sample Meal Plans, Learn How to Read Nutrition Labels, Healthy
Snacks, Plan-Ahead Meals
4
Create a Healthy Environment at Home and Work, Hunger Scale,
Identifying Triggers
5
Prioritize a Healthy Lifestyle, Finding Your Support System, Making
Time to Exercise, On-the-go Activities
6
Strategies to Healthy Eating While Dining Out, Ingredient
substitutions, Key Components to a Healthy Diet
7 Identify Signs and Sources of Stress, Problem Solving
8 Keys to Success, Positive Self-Talk
Table 2: Lessons for intervention sessions.
Citation: Faghri PD, Duffy VB, Benson NR, Cherniack MG (2012) Worksite Weight Loss Intervention for Employees in Stressful Workplaces: A Pilot
Study and Baseline Survey Indicators of Success. J Obes Weig los Ther 2:121. doi:10.4172/2165-904.1000121
Page 4 of 7
Volume 2 • Issue 2 • 1000121
J Obes Weig los Ther
ISSN: 2165-7904 JOWT, an open access journal
were a normal weight. e 6 individuals (30%) who were discordant
in perceived vs. measured adiposity (Table 4) achieved less than 3%
weight loss from pre to post intervention (Fisher Exact Probability
Test, p <0.05).
Baseline nutrition survey responses and associations with
intervention weight loss
e nutrition knowledge score at baseline ranged from 11 to 29, with
an average score (20.3±4.5) equal to half of the items being answered
incorrectly, and did not dier signicantly between males and females.
ere was no signicant relationship between nutrition knowledge and
either baseline adiposity or waist circumference. However, employees
with below average knowledge scores showed more success in the
weight loss intervention they tended to be distributed in the greater
than 3% weight loss category than those with above average baseline
knowledge scores (Fisher Exact Probability Test, p=0.07).
Fruits, vegetables, whole grain, and milk products were ranked
as less preferred at baseline than were high-fat food groups (Table 5).
Participants who lost 3% of their baseline weight or more across the
intervention (versus those who lost <3%) reported less healthy dietary
preferences at baseline. According to Fisher’s Exact Probability Testing,
the more successful weight loss group fell into higher liking categories
at baseline for sweets and alcoholic beverages (p<0.05) but tended to
fall into lower liking group at baseline for vegetables (p=0.06). Eleven
participants (55%) were classied as having high food interest (food
groups were ranked as more liked than pleasurable non-food items),
while eight participants (45%) were classied as having lower food
interest (food groups were ranked as less liked than pleasurable non-
food items). High food interest individuals had signicantly higher
baseline BMIs (p<0.05), yet did not dier signicantly in the amount of
weight/adiposity lost from pre to post intervention.
Baseline physical activity survey responses and associations
with intervention weight loss
From the survey reports at baseline, 15 participants (75%) reported
no activity or less than three times of recommended physical activity
per week [40]. Males and females did not dier in level of physical
inactivity and higher age was not associated with greater inactivity
(none or less than once/week). Participants who reported inactivity did
not dier signicantly in baseline BMI or waist circumference, central
tendency or distribution, from those who reported physical activity.
Across all participants, the average hedonic rating for physical
activity was just above moderately liked (average=22.1±27.5 St. Dev.),
with large variation (< moderately disliked to > strongly liked) that did
not dier signicantly between males or females or by age. Reported
liking for physical activity did not dier signicantly between those
who were inactive versus active, suggesting other barriers to physical
activity than level of liking (see below). e relationship between liking
for physical activity and adiposity measures was not linear. ose who
were heaviest (BMI≥35) reported greatest level of liking for physical
activity.
From the survey responses, 85% of participants (17 of 20) reported
no time, not enough energy, or laziness as barriers to physical activity,
with none reporting health or injury worry as a barrier. Reported
condence in physical activity across the 11 items was varied, ranging
from low (score<2) to high (score=5) condence.e relationship
between reported physical activity and physical activity condence
was j-shaped: those with highest condence either reported being
inactive or being highly activity. Individuals who lost >1 inch in waist
circumference across the intervention had lower baseline condence
scores than did individuals who lost ≤1 inch (p<0.05). Change in BMI
was not related signicantly to baseline condence scores.
Discussion
e present pilot study evaluated 8-week worksite weight loss
intervention for correctional employees, supplemented with nutrition
and physical activity survey assessments that were used to tailor the
messages and educational intervention as well as characteristics of
employees who were most successful in losing weight. e average
pre-post intervention loss of weight and adiposity was signicant and
reached clinical signicance (>3% weight loss).Participants who had less
healthy dietary behaviors at baseline, measured by less healthy dietary
preferences and lower nutrition knowledge, were most responsive to
the intervention as measured by percentage weight loss. e reported
level of physical activity at baseline was unrelated to the level of weight
loss, however, those who were less condent about their physical
Perceived Body Size
BMI Normal Overweight Obese
Normal 0 0 0
Overweight 0 6 1
Obese I 0 3 3
Obese II 0 2 3
Obese III 0 0 2
Table 4: The joint distribution between measured CDC BMI categories and perceived body size based on the Stunkard gures (1=very thin, 2-3 normal, 4-6 overweight,
7-9 obese) showing concordance (shaded) and discordance (un-shaded) at baseline.
